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Lifestyle measures which combine increased physical activity and dietary modifications are an important component in the management of diabetes mellitus.
The goal of dietary therapy is to provide a nutritionally balanced diet to maintain the ideal body weight (IBW) of the patient to achieve good glycaemic control along with correction of the dyslipidaemia.
The dietary planning is based on the type of diabetes, weight of the patient, activity profile and presence of co-morbid conditions.
The calorie requirements are calculated for each individual based on his weight and physical activity. These are distributed into three principal meals and two snacks.
The calories are derived mainly from carbohydrates 50-60 %, 20 % from proteins and 20% from fats.
The carbohydrates should be of low glycaemic index and should be rich in fibre, the source of fat should be 7% each of saturated mono- and poly-unsaturated fats. Three percent of total energy should be derived from essential fatty acids.
Cholesterol intake should be less than 300 mg per day.
As per the choice of oils in the diet, none of the available oils are ideal, however the choice of cooking oil should be as follows :
(1) Use an oil, which has moderate quantity of linoleic acid like groundnut oil, rice bran or sesame, (2) use an oil which has high amounts of linoleic acid like sanflower oil, cotton seed or corn oil along with an oil which has relatively low levels of linoleic acid like palm oil, (3) use any of above oils with alpha linoleic acid containing oil like mustard oil or soyabean oil.
Roughly the oil intake should be half a litre per person per month.
Fresh fruits up to 400 grams per day advisable. Ideal fruits are citrus fruits, orange sweat lime, guava, apple, papaya and pomegranate.
The salt intake should be between 5 to 6 g per day.
Adequate physical activity helps in correcting obesity which is a major modifiable risk factor in type 2 DM. in addition, physical activity may independently enhance insulin sensitivity and glucose tolerance. Exercise increases the skeletal glucose transporter protein GLUT 4 which is responsible for insulin independent glucose transport into the skeletal muscle.
Regular physical exercise is associated with changes in body composition with a reduction in body fat and increase in muscle mass, reduction in triglycerides, reduction in blood pressure, corrects the endothelial dysfunction and brings about improvement in the fibrinolytic activity.
To be effective, exercise should be performed regularly. Daily exercise of 30 -45 minutes is preferable. An exercise session should have a warming up and cooling down session. Apart from the aerobic exercises, resistance training exercises are also useful since they increase the muscle mass.
Before an exercise program is initiated a thorough clinical evaluation of the patient should be made and accordingly precautions and modification should be made in the exercise schedule.
Several recent studies have documented the beneficial effect of yogic practices in DM. Also improve glycaemic control, reduce blood pressure, correct dyslipidaemia, reduce insulin resistance and eliminate stress leading to effective control of diabetes and prevention of its long term complications.
EXERCISE AND YOGA SHOULD BE DONE ONLY AS ADVICED BY TRAINED AND QUALIFIED PERSON.
BEFORE AN EXERCISE PROGRAMME OR YOGA IS INITIATED A THROUGH CLINICAL EVALUATION OF THE PATIENT SHOULD BE MADE PARTICULARLY IN REGARD TO CARDIOVASCULAR DISEASE, NEUROPATHY, AUTONOMIC NEUROPATHY, NEPHROPATHY AND RETINOPATHY. IF ANY OF THESE IS PRESENT, SUITABLE PRECAUTIONS AND MODIFICATION SHOULD BE MADE.
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