Lifestyle adjustment is the most important measure in the treatment of diabetes. This includes reducing excess weight and stabilizing blood glucose levels, especially by eating healthy foods and getting enough exercise. At the beginning of type 2 diabetes, no further measures are often necessary. But over time, a change in diet and exercise alone are often not enough to keep diabetes in check. Therapy with tablets or insulin is then sometimes necessary. What do treatment and everyday life look like with diabetes?
Diabetes: lifestyle change as basic therapy.
To treat diabetes, the first step is to try to get the metabolism under control by changing the lifestyle. In type 2 diabetes, obesity is often among the causes, so weight reduction is needed. Often, other factors that can negatively influence the course of the disease, such as smoking, must also be eliminated. Appropriate training courses help type 2 diabetics to acquire knowledge about the disease and how to manage it, as well as to learn about possible secondary diseases and the necessary lifestyle changes. There, those affected also receive tips on the necessary self-monitoring with diabetes, for example on blood glucose measurement.
Dietary changes for diabetes
The right diet is particularly important in diabetes, because it directly affects blood glucose and – if insulin is injected – also the amount of insulin needed. A special diabetes diet is usually not necessary in this case; instead, a balanced, wholesome mixed diet with lots of fiber is recommended. Long-chain carbohydrates from fruit and vegetables are preferable, because unlike carbohydrates from white flour and sugar, they cause blood glucose levels to rise more slowly. Alcohol should only be enjoyed in moderation and with caution, as hypoglycemia can be threatened, diabetic nerve damage can be increased, high blood fat levels are promoted, and alcohol is very high in calories. Here we provide detailed information on proper nutrition for diabetes.
Increase physical activity
Physical activity is especially important for diabetes patients because exercise lowers blood glucose levels, improves insulin sensitivity of cells, lowers blood pressure, and aids in weight loss. A first step in this process is to reduce sedentary activities as much as possible or to interrupt them regularly. It is also advisable to integrate small units of exercise into everyday life, for example by taking the stairs more often, walking short distances or doing gardening.
What types of sports are suitable for diabetes?
In addition to exercise in everyday life, a sport should be found that is, of course, primarily fun, but at the same time increases endurance if possible. Combining it with strength training is also a good idea. At least 150 minutes of moderate-intensity exercise per week is recommended. Moderate intensity means that breathing is accelerated but you can still talk. An alternative is 75 minutes of higher intensity exercise weekly. This involves breathing so fast that only short exchanges of words are possible. Suitable sports for diabetics are:
- Swimming or aqua fitness
- Cycling or spinning
- Jogging
- Walking or Nordic walking
- Hiking
- Dancing
Sports such as yoga or tai chi can also train flexibility and coordination, which is considered advisable, especially at an older age, to prevent falls. In particular, in the case of pre-existing conditions, if you are very overweight or if you have not done any sports for a long time, the selection of a suitable sport should be made in consultation with the attending physician.
Hypoglycemia possible due to sports
Diabetics should note that exercise affects insulin requirements. Therefore, there is a risk of hypoglycemia from exercise, especially during therapy with insulin or sulfonylureas. It is therefore important to monitor blood glucose closely and make appropriate adjustments to the insulin dose or the intake of carbohydrates. Metabolic derailments can occur even hours after exercise. Reducing high blood pressure and elevated blood lipid levels
Many people with diabetes have other risk factors for developing secondary diseases. These include elevated blood lipid levels and high blood pressure.Additional therapy may be required here, which should be individually tailored to the affected person.
Drug treatment of diabetes
Once a diagnosis has been made, the physician consults with the affected person to determine which medications are best for him or her. For type 2 diabetics, there is often the option of using medications to increase the body’s production of insulin or to influence insulin resistance. These blood sugar-lowering tablets are called oral antidiabetics. However, as soon as insulin production is too poor or – as is typical for type 1 diabetes – stops working altogether, foreign insulin must be added.
Therapy with oral antidiabetic agents
The aim of taking antidiabetic drugs in type 2 diabetes is to lower the HbA1c level and bring it into an individually agreed target range. Various types of agents are available for this purpose. For example, the drugs may:
- Stimulate the production of insulin (glinides such as repaglinide as well as sulfonylureas such as glibenclamide, glimepiride or gliclazide).
- Enhance the effectiveness of existing insulin (biguanides such as metformin and glitazones such as pioglitazone).
- Stimulate the formation of insulin only when blood glucose is elevated (glutides and gliptins).
- Improve the excretion of sugar by the kidneys (gliflozines such as dapagliflozin and empagliflozin).
- Delay the absorption of carbohydrates from the digestive tract (alpha-glucosidase inhibitors).
All tablets should be used with caution and taken as prescribed by your doctor, because they can also have side effects. For example, too much stimulation of insulin production can cause hypoglycemia. Interactions with other medicines or contraindications in the case of any other pre-existing conditions are also possible. The therapy is therefore precisely tailored to the patient by the physician. Since type 2 diabetes is a progressive disease, it may be necessary to adjust the treatment occasionally. Over time, there is often an increase to two different agents. A combination of oral antidiabetics and insulin (BOT) is also possible. The steps in this graduated regimen should usually be maintained for three to six months at a time.
Diabetes: treatment with insulin
If blood glucose-lowering tablets are no longer sufficient or if insulin is no longer produced by the body at all, therapy with insulin is required – in type 1 diabetes this is always the case, in type 2 diabetes it often takes several years. The doctor will go through the various options for insulin therapy – conventional regimen, intensified therapy or basal-assisted oral therapy, insulin pump or pen – with the person affected and select the most suitable method in each case. Injecting insulin is not that complicated anymore thanks to today’s tools like the insulin pen. Self-monitoring of blood glucose levels can also be mastered with a little practice. Detailed information on insulin therapy can be found here. Alternatives to lifelong insulin therapy are being researched – in individual cases, juvenile diabetes can be treated with islet cell transplantation (transplantation of insulin-producing cells from a foreign pancreas), and in the field of stem cell research, therapy approaches are being sought. The dosage form of insulin is also being discussed, but insulin tablets are not currently available.
Living with diabetes: tips for everyday life
Every newly diagnosed diabetic naturally wonders to what extent diabetes will change his or her life in the long run. What are the consequences of being diagnosed with diabetes? What affects the blood sugar? In order to answer these questions and to strengthen the self-confidence of those affected in dealing with the disease, there are a wide variety of training courses on living with diabetes. With well-controlled blood sugar, people can lead an almost normal life despite diabetes. The following tips can help you manage your daily life better:
- Regular checks: Integrate regular self-monitoring, such as measuring blood glucose, into your daily routine as part of set routines. In a diabetes diary, the measurement results are recorded.
- Doctor visits: also plan the recommended checks at the family doctor, ophthalmologist and dentist. The control examinations are regulated in the framework of so-called disease management programs of health insurance companies.
- Partying: when going out, it should be noted that dancing and alcohol can lower blood glucose. Diabetes therapy may therefore need to be adjusted.
- Travel: As an insulin-dependent diabetic, but also if you are dependent on tablets or diet, you should set off on vacation well prepared. Inform yourself in advance about how to deal with time differences, climate changes or unfamiliar foods and make sure that you carry your medication in sufficient quantity and proper storage. A consultation with your doctor is recommended in preparation for a vacation.
- On the road: even if you are on the road in everyday life, you should have any meters and medications with you and also be prepared for the emergency of hypoglycemia.
- Profession: whether you have to inform employers and colleagues of your illness depends on the job you do – for example, there are professions that could involve a possible risk to others in the event of hypoglycemia. Regardless of the profession, at least in the case of forms of therapy in which hypoglycemia may occur, it makes sense to inform colleagues so that they can help in an emergency.
