Diet and Exercise in Diabetes Mellitus

Diet and exercise are the key elements in managing diabetes successfully in the long term. 

It is important to understand the key elements of a successful strategy. 

Some of these are:

1. Set reasonable goals and review these goals regularly.
2. Start eating more nutritious meals with a lot of variety. 
3. Read food labels. When you shop, shop with a plan. 
4. Learn serving sizes and measure servings in the food. 
5. Learn to count carbohydrates. 
6. Start exercising and try to incorporate it into your daily routine. 
7. Monitor your success (keep a diary of your eating and activity, and track your weight and waist circumference). 
8. Be patient and do not give up.

1. SET REASONABLE GOALS:  

To keep yourself motivated and avoid frustration, set reasonable goals. Studies show that people who lose weight gradually and steadily have a better chance of keeping the weight off in the long run. Health experts suggest losing 1-2 pounds a week as a good goal.  This is better than suddenly losing a lot of weight with crash dieting. 

Almost all long-term surveys identify ‘weight watchers’ as one of the best programs. Although it may appear boring and produce slow results, the results are sustained over the long run.  

2. EATING NUTRITIOUS MEALS:  

Nutritious meals should have vitamins and minerals. Eat vegetables, whole fruits, and some whole grains/nuts instead of high-calorie processed food such as French fries, potato chips, ice cream, doughnuts, and other desserts. Limit the use of creamy sauces, dressings, and dips with fruits and vegetables. 

FIBER: Food items with high fiber such as beans, whole grains, fruit with peel, and green leafy vegetables (broccoli, spinach, or carrots) are recommended. Look for food with 2.5 or more grams of fiber per serving (usually among fruits, vegetables, and whole grains). Fiber slows down digestion and absorption of food and therefore helps stabilize blood glucose. 

PROTEIN: Protein should be lean and unprocessed such as chicken without skin, fish, eggs, and tofu. Avoid processed meat, such as sausage, hot dogs, pepperoni, beef jerky, deli meats, cured bacon, and canned meat). 

SUGARY BEVERAGES: Limit sugar-sweetened beverages you drink such as soft drinks, sports drinks, and fruit drinks.

CARBOHYDRATES: Carbohydrates are the main source of energy for our body. There are three main types of carbohydrates in our food. They include starches, sugars, and fiber. Starches (bread, pasta, potatoes, brown rice, and corn) do not raise blood glucose levels as fast as sugary food (desserts, juices, cereal, and soda pop). Limit sugary foods and choose whole grain, fiber-rich items and avoid processed white flour. 

FAT: Avoid saturated fat (Beef, poultry with skin, cheese, butter, ice cream) and trans-fat (Fried foods, baked goods – chips, doughnuts, crackers, and stick margarine). Instead, you should consume heart-healthy unsaturated fat – olive oil, fish oil, canola oil, nuts, avocado, and peanut butter) 

3. READ FOOD LABELS:  

Learn to read food labels with particular emphasis on serving size, number of servings per container, and the amount of carbohydrates, fiber, and fat. Learn to measure serving size. This will help you estimate the right amount of food you need to achieve your goals. Remember low fat or nonfat does not always mean low calorie. Similarly, low carb is not always healthy. Reduce calories for weight reduction (do not supersize your plate and eat smaller portions). 

Cut back on eating out. 

4. COUNTING CARBOHYDRATES:  

Carbohydrates are converted in your body to sugar molecules absorbed by the intestines and raise your blood sugar levels. Therefore, it is important to be aware of carbohydrates in your food, particularly if you are taking insulin or diabetes medications (see our video on ‘Introduction to Carbohydrates’). By estimating servings or grams of carbohydrates and using a CGM (continuous glucose monitoring system), you can start to predict what your BG will do when you have a meal or a snack. This will help you and your doctor adjust your medicines or insulin better.

5. START EXERCISING:  

Being active is good for blood glucose control, weight control, and overall health. It also helps reduce stress. The American Diabetes Association (ADA) recommends being active for at least 150 minutes (2.5 hours) spread over 3-5 days a week. Spending 30 minutes doing exercises daily would be the best way to accomplish this goal. An example would be 10-minute yoga in the morning, 10-minute recumbent bike at lunchtime, and a 10-minute walk after dinner. 

Always check with your physician before starting exercise and start slowly. Balance and flexibility exercises (Tai Chi, Yoga, Stretches) or water exercises are generally suitable for older adults. 

In addition, incorporate activity into your daily living, such as climbing stairs, parking a bit farther from your place of work, vacuuming, raking leaves, carrying groceries, yard work, going to the park instead of sitting in front of the TV, etc. 

6. TRACKING PROGRESS:  

You can improve your chances of success when you (or a dietitian/physician etc.) are monitoring your food intake and activity level. The success rate in achieving goals is increased by keeping a food diary, weighing yourself regularly (or measuring waist circumference), counting your steps, and monitoring your blood glucose levels. Glucometer has been traditionally used to check BG but requires carrying your glucometer and its supplies. CGMS (Continuous Glucose Monitoring System) a small wearable device, which continuously measures glucose levels in real-time. It is an excellent tool to assess the effectiveness of diet, exercise, and stress on diabetes control. Many apps such as “MyFitnessPal” make it easier to keep a track of your food intake and exercise. Such digital tools help millions around the world reach their nutrition and fitness goals every year.

7. BE PATIENT: 

Sometimes it may take a while before you start seeing results. There will be good and bad patches, ups and downs, successes and failures. It is essential to stay positive and think of it as a long-term project. Pessimism and stress may derail your progress. 

The best strategy in dealing with weight issues and diabetes is to work with your physician, a dietitian, or a diabetes educator. They can help you develop a management plan that best suits your situation. A positive approach, supportive family, and cooperative friends make this journey easier and increase the likelihood of success. Think of it as a path toward a healthier and productive – more meaningful life. 

Good luck!