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Living with Diabetes

Jessica Evert, MD, edited by Benjamin McDonald, MD

woman runningPeople with diabetes of any type face numerous debilitating consequences if they fail to take care of themselves adequately. The following lifestyle choices can help individuals with diabetes preserve and enhance their health and avoid some of the negative outcomes that can easily result from diabetes.

Blood Sugar Management. With regard to Type 1 diabetes the single most important factor for preserving health is proper glucose and insulin management. This is accomplished by way of diligent periodic direct measurement of blood sugar levels, ketones, etc. and periodic injections of insulin. Persons with Type 2 diabetes also need to pay attention to blood sugar management issues, but often can accomplish that management through careful attention to diet and exercise. Insulin injection and blood sugar measurement topics were addressed in the previous "Treatment" section of this document.

Sustained Weight Reduction (via Diet and Exercise). Research has linked recent rising rates of Type 2 diabetes with the similarly rising rates of obesity. Obesity, which itself is related to physical inactivity and poor dietary choices, is arguably the most important risk factor for Type 2 diabetes. People can eliminate this risk factor if they set their minds to the task

The best way to combat obesity, and some of the other risk factors for Type 2 Diabetes as well, is to eat a healthy and balanced diet and to commit to a program of regular physical exercise.

A healthy and balanced diet is one, which suggests that meals be balanced combinations of different food groups. Cereals, grains, fruits and vegetables represent the bulk of meals, with meats, fish, and dairy as a smaller component and fats/sweets consumed in very limited quantities. A healthy diet is also one that contains fresh and relatively unprocessed foods. Meals made from scratch from fresh ingredients are far more likely to be good for you than are convenience foods. In contrast to this healthy approach, the average Western diet favors food items high in fat or sugar such as cheeseburgers and ice cream. Not surprisingly, fast food meals are highly popular even though they typically offer generally unhealthy meal choices. Switching to a healthier way of eating means deciding to limit portion sizes and meals eaten in restaurants, spreading small meals out through the day (rather than eating infrequent large meals) and choosing more fresh fruits and vegetables. For example, eating a baked potato (without a lot of sour cream or butter added!) is a far healthier choice than is eating pasta, because the potato (a complex unprocessed carbohydrate) will take far longer to digest into glucose than the pasta (which is in comparison, a highly refined carbohydrate). If you are going to eat the pasta, it is better to eat pasta made of whole wheat (a complex carbohydrate) than white flour (a highly refined carbohydrate).

Regular exercise (a raised heart rate for at minimum 30 minutes a day, three days each week) is a critical part of effective weight loss. Though many different kinds of exercise will be helpful, exercise that raises your heart rate for an extended period, is most helpful for weight loss and health promotion. Examples of useful exercises include running, jogging, fast walking, swimming, cycling, stair-climbing, Pilates, and some types of yoga. Many team sports are also helpful, including tennis, soccer and basketball. Activities such as weightlifting and playing golf will provide some benefit but are less likely to raise your heart rate enough to burn significant calories or fat. Exercise strengthens your cardiovascular system (your heart and blood vessels) and helps maximize burning of calories and fat thus helping you lose weight. Because exercise increases the body's metabolic demand for glucose fuel, it can also help to lower mild hyperglycemia states for some Type 2 diabetics.

Sustained weight loss is a difficult thing to achieve, as there are many food and recreational temptations that can undercut your resolve. It is highly useful to seek out social support for your weight loss project. Organized programs such as Weight Watchers can be very helpful in keeping motivation high. Dieting with a partner can also help to sustain motivation.



1. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.

2. American Diabetes Association. 2010 Clinical Practice Recommendations. Diabetes Care January 2010 33:S1-S2; doi:10.2337/dc10-S001.

3. Ligaray, Kenneth and Isley, William. Diabetes Mellitus, Type 2. Emedicine.com