Diabetes

Diabetes mellitus has raced ahead as one of the most prominent contenders for ‘Disease of the 21st century’ and India has the proud privilege of being the diabetic capital of the world. Diabetes Type 2, the more common kind, refers to a disease that usually makes its appearance after the age of 40. What is horrifying now, however, is that even children in their teens are diagnosed with type 2 diabetes so it can hardly be called ‘adult onset’ anymore. 

diabetes

Let’s start by trying to prevent diabetes altogether. If you are a person of Indian origin you are more likely to have an inherent predisposition to the disease. Compound that with our lifestyle like food habits (especially the huge amounts of refined carbs and sugar most people in India consume), sedentary lifestyles, poor sleep, and stress levels, the chances of developing the full-blown disease is higher.

As a result of poor lifestyle habits like sedentary living, obesity and unhealthy food patterns, Diabetes type 2 appears much earlier in life and is rampant in the Indian subcontinent as this article suggests (1). I have patients tell me that they are resigned to the fact that they will develop diabetes since they have a ‘family history’ of the disease. This is not necessarily true. While there is a genetic component to diabetes (as with many other lifestyle diseases), Epigenetics plays a large role in the actual development of the disease. 

Epigenetics

This exciting field of research has revealed to us that our lifestyle, (what we eat, how much we exercise, how we manage stress, how much sleep we get and so on) play a critical role in the ‘expression’ of a gene. What this means is that even when we may have inherited the gene for a particular disease, it does not necessarily imply that the disease is inescapable. We can certainly prevent it with our lifestyle choices. Even stress is implicated in the development of diabetes (2). Consuming sugar, for instance, can be a cause for diabetes, hypertension and heart disease (3) So… lifestyle matters…. a great deal. 

What do we do about it? How do we prevent it? 

This is not an exhaustive review of the prevention and management of diabetes. Instead, it is a quick read to run you through what you can do to both prevent and manage the disease.

Fitness, Food & Lifestyle is the cornerstones of both prevention and management. 

Food

Diabetes

Stay off sugar. Yes literally go on a no-added-sugar diet. That includes refined or unrefined sugar, jaggery, honey, molasses etc. Artificial sweeteners have not been found to be safe. Stevia (which is a natural plant) is your best bet if you must have something sweet.  Remember that most packaged foods (even savories) have added sugar. Consider sugar a treat to be eaten on very rare occasions. You get used to it! Your palate adapts beautifully and if you go off sugar completely and after a while, you really do develop a dislike for the sweet flavor. I can just see some people saying, ‘Now why would I want to do that?’. The answer to that will be, ‘Because you will thank yourself later for making that choice’.

  • Stay completely away from processed or refined food, which tends to rapidly increase blood sugar levels (besides adding calories). This includes white flour, packaged foods and snacks and anything that says ‘refined’ or ‘processed’.
  • Eat more fiber – in the form of vegetables and fruit. Fiber slows the absorption of glucose from the food and keeps the blood sugars stabilized. This would mean eating about three to six cups of vegetables and a couple of fruits a day (depending on your weight, gender, activity level and so on).
  • Ensure you get enough nuts seeds and healthy fats. Fats in your food also slow absorption of sugar and keep you sated longer.

While on your medication, be attentive to the timings and quantity of your meals. Long periods of hunger or binge eating result in wildly fluctuating blood sugars. Every meal needs to be well planned and contain a combination of complex carbs, protein, and good quality fats to slow the absorption of glucose. 

Exercise 

Exercise
Depending totally on medication to control your diabetic condition is, at best, a pretty shortsighted strategy. Including regular exercise for instance not only burns calories to keep your weight, sugar in check and so on but also has been found to
control, modify, slow down the progression or even reverse the disease and its outcome. Besides, the obvious benefits of exercise like weight loss, stronger bones and muscles, more flexibility, better mood, and higher self-confidence apply for a diabetic as much as anybody else to improve the overall quality of life. 

What kind of exercise? 

Include Aerobic activity, Strength training, and Flexibility to your routine. 

Aerobic activities like walking, running, cycling etc. burn calories and utilize blood glucose for energy. Depending on your body weight and weight loss goals, you would need to exercise aerobically for about 30-60 minutes every day. If you are already diabetic you should still be exercising aerobically at least 30-60 minutes/day. Cardio is great for diabetics and to prevent the disease. If you are already diabetic on medication, however, keep in mind that long duration cardio may cause drops in blood sugar levels making you feel faint and so on.

Interestingly HIIT or High-Intensity Interval Training has been found to be very effective in diabetics (as this article (4) shows) for both fat loss and effective sugar control without the drastic and sudden blood sugar decline. HIIT is much shorter in duration but with intervals of high-intensity work.

Strength training on a regular basis (using weight machines, dumbbells, barbells, and own-body-weight) increases muscle mass and eventually decreases fat percentage. So why build muscle? How is that related to diabetes? Can we just not do cardio?

As this article shows (5), Strength training is crucial if you want to build muscle mass and better manage Diabetes. This aspect of fitness is very often neglected. Training with weights encourages the movement of glucose into the muscles and improves sensitivity to insulin. This may mean a decrease in dosage of insulin (if you are taking it) or other diabetic medication over time. Weight training 2-4 times a week is adequate to show improvement in muscle mass and strength.

Stretching is an integral part of any routine. Stretching every day, or incorporating a modality like Yoga to your routine will keep you agile, improve posture (which is often the result of muscle imbalance), prevent injury and muscle soreness.

stretching

Work on your balance. Balance and strength training reduces the likelihood of falls and injury, which could prove dangerous, particularly for a diabetic whose wound healing is impaired. This is especially important for an elderly diabetic.

What special precautions does a diabetic need to take while exercising? 

  • Get a medical clearance from your doctor. Work with someone like a Lifestyle Medical Practitioner who is familiar with exercise for Diabetics.
  • Have regular health checks to monitor the disease and your blood sugar.
  • Confer with a fitness consultant familiar with your disease to plan and supervise your routine for you.
  • Check your blood sugar level before and after exercising initially until you get familiar with your activity and the way your body responds to your workout.
  • Check your feet for blisters or sores before and after exercising. There is no such thing as ‘just a little blister’ for a diabetic. That ‘little’ blister could become a full-blown ulcer or abscess that can tailspin into an unmanageable infection.
  • Wear properly fitted shoes and good quality socks. It is worth investing in superior quality training gear. Not only will this prevent unnecessary injury, it will keep you motivated to continue exercising!
  • Drink plenty of fluids before, during and after exercising. Plain water is fine.
  • Always warm up before exercising and cool down afterward.
  • Have a snack or fruit handy just in case your blood sugar levels drop too low.
  • Familiarize yourself with the symptoms of low blood sugar and recognize them at the earliest.

Don’t let diabetes get in the way of your fitness. Some people, for fear of ‘going hypo’, avoid exercise altogether. However, this happens more often in insulin dependent, Type 1 diabetics. If you are cautious and aware of the precautions while exercising, there is no reason for you not to exercise regularly and lead a great quality life by experiencing all the positive spin-offs of regular exercise. Being fit helps you gain some semblance of control over this disease and your life in general.

Symptoms of low blood sugar – known as ‘going hypo’-

  • Dizziness or a general feeling of lightheadedness
  • Difficulty in focusing even slurring of speech
  • Nervousness and tremors
  • Sweating and weakness
  • Intense hunger
  • Palpitations
  • May lead to loss of consciousness

Diabetes is not fun and the repercussions of uncontrolled blood sugar are quite dreadful, affecting various parts of the body like the kidneys, eyes, and nerves. But what is quite shocking to me is how easily people adapt to living a ‘diabetic life’ with just medication and without really trying to manage it effectively with lifestyle. They blithely pop an extra anti-diabetic tablet and proceed to devour sweets with abandon. They gaily progress from taking anti-diabetic tablets to insulin, gradually evolving to higher and higher doses to control the blood sugar (which by the way is the symptom of the disease and not the disease itself), not recognizing that the medication itself has its own side-effects in the long term.

The disease is actually both preventable and reversible if you do it right. Yes, it takes effort and discipline. I would think however that discipline now is worth a better quality of life for the future.  

Reference:

1) https://www.ncbi.nlm.nih.gov/pubmed/15645957

2) https://www.heart.org/en/news/2018/11/06/stress-may-increase-type-2-diabetes-risk-in-women

3) Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic…

4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334091/

5) https://www.ncbi.nlm.nih.gov/pubmed/21425888

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