Life style management in diabetes mellitus.pptx

Life style management in diabetes mellitus

1. Life style management in diabetes mellitus

2. outline Diabetes Self-Management Education and Support Nutrition Therapy Physical Activity Smoking Cessation: Tobacco and e-Cigarettes Psychosocial Issues IMMUNISATION

3. Diabetes Self-Management Education and Support (DSMES) DSMES services facilitate the knowledge, skills, and abilities necessary for optimal diabetes self-care and incorporate the needs, goals, and life experiences of the person with diabetes.

4. Diabetes Self-Management Education and Support (DSMES) DSMES focuses on supporting patient empowerment by providing people with diabetes the tools to make informed self-management decisions

5. Diabetes Self-Management Education and Support (DSMES) four critical times of DSMES evaluation should be done, At diagnosis Annually When new complicating factors arise that influence self-management When transitions in care occur

6. Diabetes Self-Management Education and Support (DSMES) The common issues addressed are, diet life style modifications e.g. exercise, stopping alcohol and smoking Monitoring blood glucose and other parameters and interpreting and using the results for self-management decision making. Drug education Detection and prevention of acute and chronic complication of diabetes

7. Diabetes Self-Management Education and Support (DSMES) Commonly involved health care providers are, Doctors – physician/ endocrinologist,psychiatrist , other specialities (e.g . cardiologist, nephrologist, surgeon) Specialized nurse Health educators physiotherapist, occupational therapist, Optometrist dietician

8. Diabetes Self-Management Education and Support (DSMES) OUTCOMES improved diabetes knowledge and self-care behaviors lower HbA1c lower self-reported weight improved quality of life Reduced all-cause mortality risk healthy coping and reduced health care costs

9. Nutrition Therapy Goals of Nutrition Therapy for Adults With Diabetes T o promote and support healthful eating patterns emphasizing attainment of individualized glycemic, lipid, blood pressure targets and to delay diabetic complications. To address individual nutrition needs based on personal and cultural preferences To maintain the pleasure of eating

10. Nutrition Therapy Macronutrient Distribution there is no single ideal dietary distribution of calories among carbohydrates, fats, and proteins for people with diabetes; therefore, macronutrient distribution should be individualized while keeping total calorie and metabolic goals in mind. variety of eating patterns are acceptable for the management of type 2 diabetes and prediabetes

11. Nutrition Therapy Energy balance negative energy balance will lead to weight loss which in turn improve glycemic control and reduce HbA1c levels by 0.3% to 2%. target weight loss is more than 5% reduction of weight and 7% reduction from baseline and maintenance is optimum. this is achieved by maintaining energy deficit of 500kcal/day by providing low calorie diet ( for men 1500-1800kcal or for women 1200-1500kcal/day) (normal requirement for men 2500kcal/day and for women 2000kcal/day)

12. Nutrition Therapy emphasis should be on nutrient dense foods, such as vegetables, fruits, legumes, low-fat dairy, lean meats, nuts, seeds, and whole grains, as well as on achieving the desired energy deficit e.g. Mediterranean diet

13. The Mediterranean diet emphasizes: Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts Replacing butter with healthy fats such as olive oil and canola oil Using herbs and spices instead of salt to flavor foods Limiting red meat to no more than a few times a month Eating fish and poultry at least twice a week Enjoying meals with family and friends Drinking red wine in moderation (optional) Getting plenty of exercise

14. Nutrition Therapy Carbohydrates glycemic load or glycemic index doesn’t affect the hba1c in the long term. controlling the type of carbohydrate e.g. refined sugars will improve post-prandial blood sugar. people with type-1 diabetes on fixed dose insulin need to couple their injection time with carbohydrate meals as well as consistent intake of carbohydrates to prevent hypoglycemic episodes and better glycemic control.

15. Nutrition Therapy Carbohydrates contd … portion control and healthy food choices are required in all e.g. stop added sugar some studies have shown modest benefits of very low–carbohydrate or ketogenic diets (less than 50-g carbo hydrate per day) for shorter duration. Consumption of whole grains aren’t improve glycemic control but have benefits of reduced mortality and cardiovascular disease.

16. Nutrition Therapy Proteins maintaining specific amount of proteins (1-1.5mg/kg) or specific source of proteins did not alter health in diabetic patients without nephropathy. thus protein intake should be individualized according their eating pattern.

17. Nutrition Therapy Proteins In patients with diabetic nephropathy recommended daily uptake of proteins should be 0.8mg/kg/day and should not be reduced further as it didn’t prevent further the progression of nephropathy. Proteins are known to enhance insulin sensitivity and therefore carbohydrate preparations high in proteins should not be used to treat hypoglycemia

18. Nutrition Therapy FATS the ideal amount of dietary fat for individuals with diabetes is controversial the national academy of medicine has defined an acceptable macronutrient distribution for total fat for all adults to be 20–35% of total calorie intake.

19. Nutrition Therapy FATS the type of fats consumed is more important than total amount of fat when looking at metabolic goals and CVD risk; percentage of total calories from saturated fats should be limited Mediterranean style eating pattern rich in polyunsaturated and monounsaturated fats, can improve both glycemic control and blood lipids. However trials with dietary supplementation with n-3 fatty acids did not improve glycemic control or CVD risk.

20. Nutrition Therapy Fats in general, trans fats should be avoided. Consumption of(fatty) fish at least twice a week and other foods rich in long chain omega-3 fatty acids and omega-3 linoleic acid (ALA) is recommended. e.g.- fish, sunflower oil, Olive oil, soybean oil, walnuts (coconut oil has higher saturated fat of 90%)

21. Nutrition Therapy SODIUM as for the general population, people with diabetes are advised to limit their sodium consumption to,2,300mg/day and to reduce less than 1,500mg/day to control hypertension. Sodium intake recommendations should take into account palatability, availability, affordability, and the difficulty of achieving low-sodium recommendations in a nutritionally adequate diet

22. Nutrition Therapy Micronutrients there is no clear benefit from supplementation of micronutrients of herbal or non-herbal origin in the absence of deficiency. E.g.- chromium, antioxidants, vitamin -D metformin can cause vitamin b-12 deficiency and needs to be monitored periodically (DPPOS study)

23. Nutrition Therapy Alcohol Alcohol intake should be in moderation Allowed amount is one drink/day for women and two drinks/day for men. (one drink is equal to a 12-oz beer, 5-oz glass of wine, or 1.5-oz distilled spirits) Alcohol may lead to delayed hypoglycemia in those who

24. Nutrition Therapy Non-nutritive Sweeteners use of nonnutritive sweeteners does not appear to have a significant effect on glycemic control, they can reduce overall calorie and carbohydrate intake FDA approved non-nutritive sweeteners are- Aspartame, saccharin, sucralose, Acesulfame potassium etc.

25. Nutrition Therapy Prevention of diabetes overall low calory diet will be beneficial for prevention diabetes. higher intakes of nuts, berries, yogurt, coffee, and tea are associated with reduced diabetes risk.

26. PHYSICAL ACTIVITY Evidence of health benefits structured exercise interventions of at least 8 weeks’ duration have been shown to lower a1c by an average of 0.66% in people with type 2 diabetes, even without a significant change in BMI. exercise has been shown to improve blood glucose control, reduce cardiovascular risk factors, contribute to weight loss, and improve well-being.

27. PHYSICAL ACTIVITY Recommendation - 1 All children and adolescents including type 1 or type 2 diabetes or prediabetes should engage in 60 min/day or more of moderate- or vigorous intensity aerobic activity , with vigorous muscle-strengthening and bone-strengthening activities at least 3 days/week.

28. PHYSICAL ACTIVITY Recommendation -2 most adults with type 1 and type 2 b diabetes should engage in 150 min or more of moderate-to vigorous intensity aerobic activity per week , spread over at least 3 days/week, with no more than 2 consecutive days without activity. shorter durations (minimum 75 min/week) of vigorous-intensity or interval training may be sufficient for younger and more physically fit individuals. (for adults able to run at 6 miles/h (9.7 km/h) for at least 25 min)

29. PHYSICAL ACTIVITY High intensity interval training high-intensity interval training (HIIT) is characterized by brief, intermittent bursts of near- or maximal-intensity exercise, interspersed by periods of active or passive recovery.  evidance suggests benefits in fasting insulin, lipoproteins, systolic blood pressure, and endothelial function Effects of long term benefits needs further evidence.

30. PHYSICAL ACTIVITY Recommendation -3 adults with type 1 and type 2 diabetes should engage in 2–3 sessions/week of resistance exercise on nonconsecutive days.

31. PHYSICAL ACTIVITY Recommendation -4 all adults, and particularly those with type 2 diabetes, should decrease the amount of time spent in daily sedentary behavior. prolonged sitting should be interrupted every 30min for blood glucose benefits, particularly in adults with type 2 diabetes.

32. PHYSICAL ACTIVITY Recommendation -5 flexibility training and balance training are recommended 2–3 times/week for older adults with diabetes. yoga and tai chi may be included based on individual preferences to increase flexibility, muscular strength, and balance.

33. PHYSICAL ACTIVITY Conditions that might be contraindicated for certain types of exercise uncontrolled hypertension severe autonomic neuropathy – needs cardiovascular assessment before exercise severe peripheral neuropathy- better foot wear history of foot lesion unstable proliferative retinopathy- needs ophthalmological assessment before engaging vigorous- intensity exercise

34. Smoking Cessation: Tobacco and e-Cigarettes smokers with diabetes (and people with diabetes exposed to second hand smoke) have a heightened risk of CVD, premature death, and microvascular complications. smoking may have a role in the development of type 2 diabetes

35. Smoking Cessation: Tobacco and e-Cigarettes Advice and motivate patients not to smoke or use tobacco use. Nonsmokers should be advised not to use e-cigarettes. There are no rigorous studies that have demonstrated that e-cigarettes are a healthier alternative to smoking or that e-cigarettes can facilitate smoking cessation For those who are willing to quit smoking should be provided with support Nicotine gums, bupropion

36. Psychosocial Issues assessing psychological and social situation is part of ongoing medical management of diabetes mellitus screen for attitudes about illness, expectation for medical management and outcomes, general and diabetes related quality of life, past history of psychiatric illnesses. routine screening for psychological stressors- diabetic distress, anxiety, eating disorders, cognitive impairment once identified any particular problem a referral to a psychiatrist is appropriate

37. immunization annual influenza hepatitis –B vaccine pneumococcal vaccine- ppsv-23 for patients more than 2 years of age more than 65yrs- pcv-13 and ppsv-23 6months after.

38. references ADA standards of care 2018 Companion to clinical diabetology( by Dr. Noel Somasundaram and Dr. Gnani Somasundaram)