Diabetes and Lifestyle Changes

In this discussion, diabetes refers to diabetes mellitus. Other forms of diabetes (such as diabetes insipidus) are not included.

People with diabetes cannot properly process glucose, a sugar the body uses for energy. As a result, glucose stays in the blood, causing blood glucose to rise. At the same time, however, the cells of the body can be starved for glucose. Diabetes can lead to poor wound healing, higher risk of infections, and many other problems involving the eyes, kidneys, nerves, and heart.

There are two types of diabetes mellitus. Childhood-onset diabetes is also called type 1, or insulin-dependent, diabetes. In type 1 diabetes, the pancreas cannot make the insulin needed to process glucose. Natural therapies cannot cure type 1 diabetes, but they may help by making the body more receptive to insulin supplied by injection. It is particularly critical for people with type 1 diabetes to work carefully with the doctor prescribing insulin before contemplating the use of any herbs, supplements, or dietary changes mentioned in this article. Any change that makes the body more receptive to insulin could require critical changes in insulin dosage that must be determined by the treating physician.

Adult-onset diabetes is also called type 2, or non-insulin-dependent, diabetes. With type 2 diabetes, the pancreas often makes enough insulin, but the body has trouble using the insulin. Type 2 diabetes responds well to natural therapies.

Lifestyle changes that may be helpful: Most people with type 2 diabetes are overweight.¹ Excess abdominal weight does not stop insulin formation,² but it does make the body less sensitive to insulin.³ Excess weight can even make healthy people pre-diabetic.⁴ Weight loss reverses this problem.⁵ In most studies, type 2 diabetes has improved with weight loss.⁶ ⁷ ⁸

Increased weight gain in infancy has been associated with a one-and-a half-fold increase in the risk of developing type 1 diabetes in childhood.⁹ Being overweight also increases the need for insulin. Therefore, people with type 1 diabetes should achieve and maintain appropriate body weight.

Exercise helps decrease body fat¹⁰ and improve insulin sensitivity.¹¹ People who exercise are less likely to develop type 2 diabetes than those who do not.¹² People with type 1 diabetes who exercise require less insulin.¹³ However, exercise can induce low blood sugar or even occasionally increased blood sugar.¹⁴ Moreover, a preliminary study has shown that long-term physical activity was not associated with control of blood glucose in people with type 1 diabetes.¹⁵ Therefore, people with diabetes should never begin an intensive exercise program without consulting a healthcare professional.

Moderate drinking in healthy people improves glucose tolerance.¹⁶ ¹⁷ ¹⁸ ¹⁹ However, alcohol has been reported to worsen glucose tolerance in the elderly²⁰ and in people with diabetes²¹ in some studies. People with diabetes who drink have also been reported to have a high risk for eye²² and nerve damage.²³

Questions remain about where the line should be drawn regarding alcohol intake. For healthy people, light drinking will not increase the risk of diabetes, and may even reduce the risk of developing type 2 diabetes;²⁴ however, heavy drinking does increase the risk of developing diabetes and should be avoided.²⁵ People with diabetes should limit alcohol intake to two drinks per day. Total avoidance of alcohol in people with diabetes who are not suffering from alcoholism, liver disease (e.g., cirrhosis), gastritis, ulcers, and other conditions made worse by alcohol might actually be counterproductive. In one report, older people with type 2 diabetes who drank daily, but moderately, had a dramatically lower incidence of deaths from heart disease compared with nondrinkers.²⁶ This outcome is not surprising since moderate alcohol intake is associated with protection from heart disease in most other reports. This finding may be of particular importance because heart disease is the leading killer of people with diabetes. In another study, nondrinkers had a higher incidence of type 2 diabetes than did moderate drinkers.²⁷

People with diabetes who smoke are at higher risk for kidney damage,²⁸ heart disease,²⁹ and other diabetes-linked problems. Smokers are also more likely to develop diabetes;³⁰ therefore, it is important to quit smoking.

Although most healthcare providers agree on the necessity of self-monitoring of blood glucose (SMBG) by people with type 1 diabetes, disagreement exists within the medical community regarding the efficacy and necessity of SMBG by people with type 2 diabetes. A controlled clinical trial found that home glucose monitoring strips did not affect the management of type 2 diabetes.³¹ Moreover, a review of available literature concluded that the efficacy of SMBG in people with type 2 diabetes is questionable and should be tested in a rigorous high-quality trial.³² Advocates of SMBG, such as the ADA, have observed that SMBG by people with diabetes has revolutionized management of the disease, enabling them to achieve and maintain specific goals.³³ These observations are well-supported in the medical literature.³⁴ Detractors point out that indiscriminate use of self-monitoring is of questionable value and adds enormously to healthcare costs.³⁵ The ADA acknowledges that accuracy of SMBG is instrument- and technique-dependent. Errors in technique and inadequate use of control procedures have been shown to lead to inaccurate test results.³⁶ Nevertheless, it is likely that self-monitoring of blood glucose, if used properly, can have a positive effect by increasing patient involvement in overall diabetes care.³⁷ Pharmacists and healthcare practitioners can teach people with diabetes certain skills that will enhance their ability to properly self-manage blood glucose.

References:

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