Educating Your Patients On Nutrition And Exercise

Author(s): 
By Pamela M. Jensen, DPM

Diet and exercise are essential for blood sugar management and are subject of much frustration for the diabetic patient and the physician. With each visit to the physician’s office, the patient has to anticipate the stern lecture about exercising, controlling his or her diet, abstaining from sweets, and testing his or her sugars regularly or face the multitude of complications from diabetes. In addition, physicians may also give a patient a handout with the recommendations from the American Diabetes Association.
But does this method work? King and Armstrong studied the effectiveness of this type of program and followed a cohort of chronic dieters who see a doctor and are told to lose weight. They found that half of all these patients actually gained weight. The conclusion of this study and years of experience was twofold: deprivation invites bingeing and diets don’t work.

So what is the solution? Lifestyle modification. This includes a balanced diet with moderate physical activity. The Diabetes Prevention Program is a 27-center randomized clinical trail that studied more than 3,200 adults who were 25 years or older and who were at increased risk of developing type 2 diabetes. This was the first major clinical trial to show that lifestyle changes in diet, exercise and loss of a little weight can prevent or delay the progression of the disease. This study evaluated the effectiveness of intensive lifestyle modification, including healthy diet, moderate physical activity of 30 minutes a day five days a week, standard care plus the use of metformin and standard care plus placebo.
Participants who made lifestyle changes reduced their risk of getting type 2 diabetes by 58 percent. A healthy diet and moderate exercise lower blood sugars and improve the body’s use of insulin, and slow progression of the disease and its complications.

Redefining The 'Well-Balanced’ Diet
Most mistakenly believe that a “diabetic diet” means restriction on sugar intake and the need to avoid sugar-containing items such as cakes, cookies and candies. The key words here are “well-balanced” diet. In reality, diabetics can eat anything a non-diabetic can eat as long as it is a well-balanced diet and the carbohydrate intake is spread out through the day. In addition, if the diabetic is taking insulin or oral medication, he or she will want to eat carbohydrates in such a way that the sugar from the meal peaks when the medication is working at its peak.
The Food Pyramid is the best example of a well-balanced diet for the average person as well as the diabetic. On average, Americans eat 40 to 45 percent of the recommended caloric intake of carbohydrates. Grains, beans and starchy vegetables have very little fat, saturated fat or cholesterol. They are also filled with vitamins, minerals and fiber. Vegetables are low calorie and full of vitamins and fiber. A minimum of three servings a day is required.
Fruits should be eaten at least twice a day when blood sugars are low. In addition, eating a whole orange with the pulp and fiber does not increase blood sugars as quickly as concentrated orange juice, enabling the diabetic to have more control over the glycemic response. Low fat options from the milk group will provide calcium to prevent osteoporosis without the saturated fat and cholesterol.
Patients with diabetes need as much protein as anyone else although cutting down on saturated fats and using leaner options will help decrease the diabetic’s already high risk of heart disease. Moderate protein restriction has shown that diabetic patients have increased adiposity and decreased muscle strength.
Sweets should be taken in moderation. Although studies have shown that sugars do not raise blood glucose any higher than carbohydrates upon ingestion, sweets contain little nutritional value.

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