Lifestyle Management of Type 2 Diabetes Mellitus
what are the 3 things that impact our health
environment- mutations/ in utero genetics lifestyle
prediabetes
term for impaired fasting glucose (IFG) &/or impaired glucose tolerance (IGT) place individuals at risk of developing diabetes and its complications. anyone with impaired fasting glucose (6.1-6.9 mmol/L) or impaired glucose tolerance (7.8-11 mmol/L). place individuals at risk of developing diabetes and its complications.
obesogens
the chemicals that are disrupting our endocrine system (mimic estrogens)
CPG's address lifestyle modification: 4
a) healthy eating; b) increasing physical activity; c) smoking cessation; & d) stress management. ---not a diabetic diet
Gestational Diabetes
-glucose intolerance with onset or first recognition during pregnancy. pre indicator for diabetes down the road
Nutrition diabetes - 6
1. Nutrition counselling by a Registered Dietitian. 2. Encouraged to follow Eating Well with Canada's Food Guide (aim for balance, timing/spacing of meals). may be TOO simple and out of date 3. Choose low glycemic index carbohydrates. whole grain Vs white; and importance of fiber 4. Sucrose and sucrose-containing foods can be substituted for other carbohydrates (max. of 10% of total daily energy). 5.Consume < 7% of total daily energy from saturated fats and should limit intake of trans fatty acids to a minimum. 6. Other dietary patterns -Mediterranean & Vegan!/ DASH
Alcohol in T2D
<2 drink - distilled
Physical Activity -3 - consideration for CVD
Accumulate 150 minutes of aerobic exercise/week (spread over at least 3 days of the week). Resistance exercise at least 2 times per week (preferred 3 times/week). (Initial instruction /supervision is recommended). People with possible CVD or microvascular complications should be assessed (medical evaluation) if undertaking exercise greater than brisk walking high intense training is good ( 8 minutes)
Metabolic syndrome (CDA) (any 3): 5
FPG > 5.6 (equal) BP > 130/85 mm/Hg TG > 1.7 mmol/L HDL < 1.0 mmol/L (men); 1.3 (women) Abdominal obesity > 102 cm (men); 88 (women)
Non-Communicable Diseases (NCD) includes- 4 -- what are the 4 shared risk factors what do they cause.... to prevent them -4
Cancer, cardiovascular disease, chronic respiratory disease and diabetes Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol (stress) leading cause of chronic disease therefore.. Healthy diet, physical activity, decreased alcohol intake & tobacco use;
diets that are okay...y? -2
Glycemic benefit of non-oil seed pulses (chickpeas, beans, peas, lentils) Fructose...small amounts okay (10g/day), but chose wisely (Ann Intern Med, 2012).
Stress Management - examination? strategies?
Individuals with diabetes should be screened routinely for subclinical psychological distress (depressive and anxious symptoms) and psychiatric disorders. Interview or by standardized questionnaires. Should offer stress management strategies, coping skills training, behavioural therapy, family therapy, case management and/or pharmacotherapy if required.
Pathophysiology of T2DM
Is a heterogeneous disorder. Three basic metabolic defects characterize the disease: insulin resistance; the more you carry the more you are resistence an insulin secretory defect that is not autoimmune-mediated; it is modified an increase in glucose production by the liver.- leaky liver Learning more about the gut (incretins)
diabetes risk factors
Population is aging Obesity rates are increasing Sedentary lifestyles Aboriginal people 3-5 x's more likely to develop T2DM 80% of new Canadians are from high risk population.
Smoking Cessation smoking causes.....4
Smoking in people with diabetes is an independent risk factor for all cause mortality. Increases risk of MI (3-fold), stroke (30%) and progression to end stage renal disease (chronic kidney disease). neuropathy Smoking cessation is recommended and supported.
What about diabetes prevention? - what kind of prevention decreases the risk ? -3
Structured lifestyle modification that includes moderate weight loss (5%), regular physical activity = risk reduction for T2DM was approximately 58% at 4 years. Lifestyle interventions (exercise/diet) for those at risk = 7 studies showed a decreased risk for T2DM up to 10 years after the intervention (Schellenberg, 2013) can prevent and delay it in some!
preventing the disease 3 main things:
healthy eating: dec. sodium, high fibre PA - weight loss , CA training healthy lifestyle: smoking cessation, stress management, alcohol intake
Canada Good Health Eating Guide problems
not good for ethnic people, and may be top simplistic -