5 Easy Steps: How Lifestyle & Daily Routine Affect Blood Sugar

Holistic care beyond just glycemic control is crucial in diabetes management. Lifestyle modifications for diabetes should focus on the following

• Diet and medication
• Physical activity and mental health
• Sleep routine
• Avoid or cut down on alcohol and quit smoking
• Regular check-up

• Diet is one of the most important aspects of diabetes management. Based on factors like age, sex, physical activity, height, weight, body mass index (BMI) and cultural factors, the diabetic diet chart should be individualized, close to the family pattern, should have variety and meal timing should be according to the patient’s daily schedule.
• Six small meals a day is advisable with 55-60 % of energy from carbohydrates. The quality and quantity of carbohydrates impact the blood sugar levels differently.
• Right choice of foods helps to control diabetes naturally. Carbohydrates should be complex in nature with high fiber e.g. whole grains (unpolished cereals and millets), legumes, peas, beans, oats, barley and fruits, and salads with low glycemic index and glycemic load are recommended. Consuming soluble fiber in certain fruits, vegetables, and grains are one of the naturalways to control diabetes.
• It is better to avoid non-nutritive sweeteners; nutritive sweeteners like stevia can be used in moderation. Proteins should provide 12-15 % of the total energy.
• Proteins from vegetable sources like pulses, soy, grams, peas as well as low fat milk, low fat curds, fish and lean meats are recommended.
• Supplementation of foods like cereal and pulse (4:1 ratio) can improve the protein quality and also gives satiety. For e.g; Idli, dosa, Missi roti, Khichdi, Dhokla, Khandvi etc. Certain foods are specifically good for diabetics like bitter gourd, fenugreek, drumstick, amla, moringa, curry leaves, raw banana etc.
• Fats should provide 20-30 % of total energy intake for people with diabetes. Fat quality is as important as quantity.  Saturated fats ≤10% energy and less than 7% in those with raised blood lipid levels. Polyunsaturated fats (PUFA) 10 % energy, Monounsaturated Fatty Acids (MUFA) 10-15% energy + any calories left from the carbohydrate portion. Trans fats < 1% energy – preferably totally avoided. MUFA-rich cooking oil and nuts in moderation may benefit glycemic control and CVD risk factors. Use of MUFA-rich oils like mustard, rice bran, peanut (groundnut) and gingelly are good options. Oils rich in n6 PUFA like safflower, sunflower, and cotton seed, should be mixed with oils rich in n3 like soy and mustard to maintain N6:N3 the ratio between 5-10. Use of mixed oils or alternating oils is recommended. 
• Salt or Sodium intake recommendations for people with diabetes are the same as that for the general population. Added (iodized) salt should be less than 5 g/day. For persons with hypertension and diabetes, the intake should be reduced to less than 3 g/ day. In hypertensive patients or edematous patients with nephropathy, sodium restriction is required.
• All preserved and processed foods such as pickles, chutneys, packaged namkeens/savouries, and sauces should be restricted. Watch out for deceiving labels like high fiber, low fat, low sugar, and read between the lines before consuming.
• Avoid sugar-sweetened beverages. The exception is if you are experiencing low blood sugar levels, beverages such as soda, juice and sports drinks can be used as an effective treatment for quickly raising blood sugar that is too low.
• Medication should be taken as advised on time and regular check-up is crucial to regulate the dosage.

• Healthy lifestyle choices for diabetics are very crucial in order to control diabetes naturally. Lack of physical activity and stress leads to weight gain and a rise in blood sugar levels. Regular physical activity is an essential component of the management of type 2 diabetes.
• The daily routine for diabetic person should include an individualized exercise programme according to one’s capacity. Patients beginning an exercise program should check blood glucose levels before, during, and after exercise to assess their individual responses to exercise. If the pre-exercise blood glucose level is <100 mg/dL the individual may need to consume carbohydrates before exercise.  Carbohydrates may be needed during exercise depending on the intensity and duration. 
• Recommendation is about 150 minutes of aerobic activity or its equivalent /week along with some resistance training at least twice a week and flexibility exercises.
• Yoga is considered a part of holistic diabetes management. Some of the aspects used in yoga are asanas (involving postures), pranayama (involving breath) and dhyana (involving meditation). Sedentary time should be limited to no longer than 30 minutes.
• Benefits of exercise improves insulin sensitivity, reduces the risk of heart disease, high blood pressure, bone diseases, and unhealthy weight gain, keeps one flexible and agile, helps relieve stress, and anxiety and prevents depression, increases strength and stamina, promotes sound sleep, increases metabolic rate and digestion, lowers lipids, improves the quality of life and delays the process of ageing, reduces the dosage of anti-diabetic medication.

• Sleep routine is an important aspect diabetes management, which is usually ignored.  It was reported that short and long sleep duration, as well as poor sleep quality, was related to increased blood glucose levels, in turn, blood glucose could affect sleep quality.
• Persons with diabetes report higher rates of insomnia, poor sleep quality, excessive daytime sleepiness, and higher use of sleeping medications.
• Sleep apnea is significantly more in persons with diabetes and is related to obesity.
• In fact, a strong association exists between obesity, impaired glucose tolerance, insulin resistance, and sleep-disordered breathing.
• Establish a regular bedtime and rise time, a comfortable sleep environment, and a regular relaxing pre-sleep routine such as listening to soft music, reading a book, a few minutes of meditation and putting cell phones in silent/off mode.
• Avoid taking daytime naps, too much caffeine and smoking especially in late evening and night, avoid drinking alcohol before bedtime, sleeping too hungry or after a too heavy meal at night, avoid too spicy foods at night and also late-night television watching or phone calls.

• Lifestyle modification for diabetes includes determined efforts to change certain habits. It is best to avoid alcohol, however, if used, should be taken in moderation. If alcohol is consumed, it should not be counted as part of the meal plan.
• However, it should be borne in mind that alcohol does provide calories (7 kcal/g), which are considered 'empty calories'. In the fasting state, alcohol may produce hypoglycemia.
• Alcohol can further exacerbate fatty liver, neuropathy, dyslipidemia, obesity and also worsen blood glucose levels. Nicotine increases your blood sugar levels and makes them harder to handle.
• People with diabetes who smoke often need larger doses of insulin to keep their blood sugar close to their target levels. Smokers are more likely to have complications than people who have diabetes and don’t smoke.
• Heart disease deserves special attention. Over time smoking along with diabetes causes high blood sugar from diabetes and can damage blood vessels as well as nerves in and around your heart, increasing plaque (a fatty, waxy substance that builds up on your artery walls).
• Talk to smokers who have quit smoking, no matter how long you’ve smoked—or how much—quitting will help you get healthier.
• As soon as you stop smoking, your body starts healing itself. In 12 hours, carbon monoxide (a toxic gas from cigarette smoke) in your blood drops to normal. In 2 weeks to 3 months, your circulation and lung function improve. In a year, your risk for heart disease is half that of someone who still smokes.
• Quitting smoking also helps your body use insulin better, which can make your blood sugar levels easier to manage.

• Key to diabetes management involves regular check-up which includes the following.
• Blood sugar checks- Check blood sugar several times a day as directed by your doctor, keep a record of your numbers and share it with your doctor during your next visit.
• Foot check-up - If you have any cuts, redness, swelling, sores, blisters, corns, calluses, or other changes to the skin or nails report it to your doctor immediately.
• Every 3 Months- Hba1c test is required if you’re having trouble meeting your blood sugar goals, have this test every 3 months. Your blood pressure and weight will be checked, and your self-care plan and medicines will be reviewed. Ask your doctor to check your feet if you’ve ever had diabetes-related foot problems.
• Every 6 Months- Dental exam, Hba1c tests if your treatment and blood sugar goals are met.
• Every Year - Flu shot, kidney tests, cholesterol test, dilated eye exam, hearing check, complete foot check
• Just Once - Pneumonia shot (you’ll need two more doses when you’re 65 or older), get a hepatitis B shot if you’re 60 or younger and haven’t had the shot before. Talk to your doctor about getting the shot if you’re over 60.
• Follow covid guidelines at all times to avoid serious complications.
• Mental health check - As needed, let your doctor know right away if you are feeling sad or hopeless so you can get help.

SUMMARY

Therapeutic lifestyle changes are fundamental to achieving treatment targets, minimising the use of diabetes medications, and reducing the risk of comorbid conditions and psychological distress. Prevention of microvascular complications like retinopathy, neuropathy and nephropathy and prevention of macrovascular complications like cardiovascular, cerebrovascular and peripheral vascular disease is of prime importance in diabetes management. Diabetes education and support, provided by diabetes specialists, are vital to the successful self-management of diabetes.

Sources

o    ICMR Guidelines for Management of Type 2 Diabetes 2018-20 https://main.icmr.nic.in/sites/default/files/guidelines/ICMR_GuidelinesType2diabetes2018_0.pdf

o    https://www.cdc.gov/diabetes/library/features/smoking-and-diabetes.html

o    https://www.cdc.gov/diabetes/managing/care-schedule.html

o    Zhu, B., Hershberger, P. E., Kapella, M. C., & Fritschi, C. (2017). The relationship between sleep disturbance and glycaemic control in adults with type 2 diabetes: An integrative review. Journal of Clinical Nursing, 26(23-24), 4053–4064. doi:10.1111/jocn.13899.