Ueda2015 life style2 dr.emad hamed

New Concepts in

Lifestyle Management of Diabetics

DR. EMAD HAMED

EIDC – NAGA-HAMMADY

QENA

Lifestyle Management of Diabetics

Lifestyle = Diet + Exercise

NO

Lifestyle is much broader than that.

I believe we need a different approach to a holistic lifestyle management.

The one I’m going to present is different, but I think it may be more logic from the

practical point of view

Diabetic Patient Care

Non-Pharmacological

Non-Interventional

Exercise

Stress Management

Foot Care Education

SMBG

Smoking Cessation

Diet

Pharmacological

Interventional Care

Oral Hypoglycemic Drugs

Insulins

Insulin Analogs

Interventional Foot Care

Interventional Cardiology

Etc….

Education

Exercise

Increase B-Endorphins

MetforminStress

Management

Improve ……..Mood

Insulin ResistanceGlycemic Control

1

3 2

4

Many Modalities of Diabetes Care are Interconnected(Beta-Endorphins May be one of the Links)

Endorphins

These are often classified to be the happy hormones.

Any form of physical activity leads to the release of these

feel good neurotransmitters. The increase in endorphins

secretion leads to a feeling of euphoria, modulation of

appetite, the release of different sex hormones and an

enhancement of immune response. This helps combat the

negative effects of stress.

Metformin increases insulin sensitivity and plasma beta-endorphin in human subjects.

In conclusion, metformin causes a significant parallel increase in insulin sensitivity and plasma beta-endorphin level in human subjects.

ReferenceOu HY1, Cheng JT, Yu EH, Wu TJ. Metformin increases insulin sensitivity and plasma beta-endorphin in human subjects. Horm Metab Res. 2006 Feb; 38(2):106-11

Exercise

LS11 Encourage increased duration and frequency of physical activity (where needed), up to 30-45 minutes on 3-5 days per week, or an accumulation of 150 minutes per week of moderateintensity aerobic activity

Adults with diabetes should be advised to perform at least 150 min/ week of moderate-intensity aerobic physical activity (50–70% of maximum heart rate), spread over at least 3 days/week with no more than 2 consecutive days without exercise. A

Both aerobic and resistance exercise are beneficial for patients with diabetes, and it is optimal to do both types of exercise. At least 150 minutes per week of aerobic exercise, plus at least two sessions per week of resistance exercise, is recommended.

Adults and older people: 150 minutes (two and half hours) each week of moderate- to vigorous-intensity physical activity. Muscle-strengthening activity should also be included twice a week.

Exercise

Endorphins and exercise

Elevated serum beta-endorphin concentrations induced by exercise have been linked to several psychological and physiological changes, including mood state changes and 'exercise-induced euphoria', altered pain perception, menstrual disturbances in female athletes, and the stress responses of numerous hormones (growth hormone, ACTH, prolactin, catecholamines and cortisol)

Stress Management

Stress in Diabetics

Stress within the Family

Stress in the work

Other stresses

Stress due to Diabetes

PS2 Explore the social situation, attitudes, beliefs andworries related to diabetes and self-care issues. Assess well-being (including mood and diabetes distress), periodically, by questioning or validated measures

Psychosocial screening and follow up may include, but arenot limited to, attitudes about the illness, expectations formedical management and outcomes, affect/ mood, general and diabetes related quality of life, . E

In both type 1 and 2 diabetes, interventions that target families’ ability to cope with stress or diabetes-related conflict should be included in educational interventions when indicated (Grade B, Level 2)

Stress, whether physical stress or mental stress, has been proven to instigate changes in blood sugar levels, which for people with diabetes can be problematic.*

Stress Management

Reference1. Surwit RS, van Tilburg MAL, Zucker N, McCaskill CM, Parekh P, Feinglos MN, Edwards CL, Williams P, and Lane JD. Stress management improves long-term glycemic control in Type 2

diabetes. Diabetes Care, 2002; 25: 30-34.

Stress Management improves long-term glycemic control in Type 2 diabetes

Foot Care Education

Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry, India

We found that even 5-6 min of time devoted to individual patient education improved their foot care practice. When consistently reinforced, this education is likely to result in healthy habit formation, which may prevent disability and reduce medical expenditure in the long run.

ReferenceSuman Saurabh, Sonali Sarkar, Kalaiselvi Selvaraj, Sitanshu Sekhar Kar, S. Ganesh Kumar, andGautamRoy. Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry, India. Indian J Endocrinol Metab. 2014 Jan-Feb; 18(1): 106–110.

Foot care education in patients with diabetes at low risk of complications: a consensus statement

The key educational elements for diabetes patients at low risk of

complications are captured with the mnemonic CARE:

Control: control blood glucose levels (in accordance with recommendations

from your healthcare professional).

Annual: attend your annual foot screening examination with your healthcare

professional.

Report: report any changes in your feet immediately to your healthcare

professional.

Engage: engage in a simple daily foot care routine by washing and drying

between your toes, moisturizing and checking for abnormalities.

Foot care education in patients with diabetes at low risk of complications: a consensus statement “cont”

Educational initiatives, based on the CARE framework

above, should be tailored to the individual and take into account

their health beliefs, motivation to change and personal

circumstances. The importance of reinforcing the principles of

the CARE framework on a regular basis cannot be overstated.

ReferenceA McInnes, W Jeffcoate, L Vileikyte, F Game, K Lucas, N Higson, L Stuart,§ A Church, J Scanlan, and J Anders. Foot care education in patients with diabetes at low risk of complications: a consensus statement. Diabet Med. 2011 Feb; 28(2): 162–167.

Smoking Cessation

Effectiveness of smoking cessation counseling

Smoking cessation is one of the few interventions that

can safely and cost-effectively be recommended for all patients, and it has been identified as a gold standard against which other preventive behaviors should be evaluated. A number of large randomized clinical trials have demonstrated the efficacy and cost-effectiveness of certain forms of provider and behavioral counseling in changing smoking behavior of primary care and

hospitalized patients.

SMBG

Strategies for improving glycemic control: effective use of glucose monitoring “SMBG”

Self-monitoring of blood glucose (SMBG) is one strategy for improving glycemic control; however, patient adherence is suboptimal and proper education and follow-up are crucial.

Patients need to understand:- why they are being asked to self-test

what their glycemic targets are

what they should do based on the results of self-monitoring

Patients also must be taught proper technique and must be given specific recommendations regarding frequency and timing for self-monitoring.

Strategies for improving glycemic control: effective use of glucose monitoring

SMBG should include postprandial monitoring to:- identify glycemic excursions after meals

indicate the need for lifestyle adjustments

provide patient feedback on dietary choices.

Situations in which SMBG is essential or should be more frequent include:-

self-adjustment of insulin doses

changes in medications

lack of awareness of hypoglycemia

gestational diabetes

Illness

when hemoglobin A1c (HbA1c) values are above target

ReferenceDavidson J. Strategies for improving glycemic control: effective use of glucose monitoring. Am J Med. 2005 Sep;118(Suppl 9A):27S-32S.

Education

ED1 Make patient-centered, structured self-managementeducation an integral part of the care of all people with type 2 diabetes.

ED4 Ensure that education is accessible to all people with diabetes, taking account of culture, ethnicity, psychosocial, and disability issues.

People with diabetes should receive diabetes self-management education (DSME) and diabetes self-management support (DSMS)

when their diabetes is diagnosed and as needed thereafter. B

People with diabetes should be offered timely diabetes education that is tailored to enhance self-care practices and behaviors(Grade A, Level 1A).

Managing diabetes can be exceedingly demanding, often requiring you to make lifestyle changes – stopping smoking, changing your diet and physical activity levels, taking medication and monitoring your blood glucose levels.

Education

Development of a Therapy“Drug Mesh”

Effectiveness

Safety

Affordability

Exercise

Stress Management

Foot Care Education

SMBG

Smoking Cessation

Diet

Education

In Conclusion

All mentioned

“Non-Pharmacological/Non-Interventional”

modalities of Diabetes Care are

Effective, Safe and can be affordable.

In Conclusion

It is the right of

every Diabetic

to have

a real comprehensive care

particularly the modalities that are

effective, most safe and can be easily affordable

In Conclusion

If we can offer our Diabetics such care

This is excellent

If we don’t have the time or the “Know How”

We have to develop a system to deliver such care

This is their RIGHT

& Our Mission