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Abstract

Diabetes Mellitus is a chronic metabolic disorder characterized by hyperglycemia due to absolute (Type 1 Diabetes Mellitus) or relative (Type 2 Diabetes Mellitus) deficiency of insulin hormone. Diabetes Mellitus virtually affects every system of the body as a result of the metabolic disturbances caused by hyperglycemia, and if improperly managed can cause medical complications such as cardiovascular diseases, neuropathy, retinopathy and peripheral vascular diseases which can result in chronic morbidities and premature death. Genetic susceptibility and environmental factors seem to be the most crucial factors responsible for the progression of this condition. Simple changes in your lifestyle can greatly reduce the risk and chances of becoming a diabetic patient. Therefore, to prevent this condition, actions should be taken regarding the modifiable environmental factors that influence its development, lifestyle and dietary habits. This includes maintaining a healthy diet, promoting walking, exercise, and other physical activities which have beneficial effects on human health and prevention or treatment of diabetes.

Introduction

Diabetes Mellitus (DM) is a chronic progressive metabolic disorder manifested by hyperglycemia and resulting from absolute (Type 1 Diabetes Mellitus) or relative (Type 2 Diabetes Mellitus) deficiency of insulin hormone. Diabetes mellitus or type-2 diabetes, is one of the major non-communicable and rapidly growing public health problems in the world, a condition difficult to be treated and expensive to be managed (Asif M. et.,al 2014). It has been founded that the number of diabetic patients will double from the current value of about 190 million to 325 million during the next 25 years (Asif M. et.,al 2014).

Diabetes Mellitus is associated with some medical complications such as cardiovascular diseases, nephropathy, retinopathy (changes to the retina and blindness), and neuropathy that can lead to disability and premature death. Genetic susceptibility and environmental factors seem to be the most important factors which are responsible for the development of this condition (Zucchi P et al., 2005). Lifestyle management is a substantial aspect of diabetes care and includes diabetes self-management education (DSME), diabetes self-management support (DSMS), nutrition therapy, physical activity, smoking stoppage counseling, and psychosocial care (Powers MA et al., 2015).

Patients and care providers should focus together on how to optimize and enhance lifestyle from the time of the initial comprehensive medical evaluation, throughout all following evaluations and check-ups, to promote overall nutritional well-being, glycogenic control, and prevent diabetes-related complications. Fortunately, since environmental factors are modifiable, diet is one of the major factors now linked to a wide range of diseases including diabetes. The amount and type of food consumed is a fundamental aspect of human health and plays a crucial role in diabetes management. Diet is dependent on age, weight, gender, health condition, and occupation (Asif M. et al., 2014).

Carbohydrates

Individuals with diabetes should be encouraged to replace refined carbohydrates and added sugars present in their diet with whole grains, legumes, vegetables, and fruits. The consumption of non-sugar-sweetened beverages and processed low-fat or nonfat food products with high amounts of refined grains. Most of the carbohydrate consumed should be in the form of starch (polysaccharides) such as maize, rice, beans, bread, potatoes. All refined sugars such as glucose, sucrose, and their products (soft drinks, sweets, toffees) and honey should be avoided, except during extreme illness or episodes of hypoglycemia. These foods contain simple sugar, which is easily absorbed causing rapid rise in blood sugar. Non-nutritive sweeteners, e.g., Canderel, saccharine, and NutraSweet are suitable sugar substitutes for diabetic subjects (Bouchard C et al., 2010).

Fats

Diabetics should be advised and encouraged to follow the guidelines for the general population for the recommended intakes of saturated fat, dietary cholesterol, and trans fat. Generally, trans fats should be avoided. Animal fat such as butter, lard, egg yolk, and other foods high in saturated fatty acids and cholesterol should be reduced to a minimum and be changed with vegetable oils, particularly polyunsaturated fats. Many trials including patients with type 2 diabetes have reported that a Mediterranean-style eating pattern, rich in monounsaturated fats, can improve both glycemic control and blood lipids (Estruch R et al.,2013).

Protein

There is no evidence that regulating the daily level of protein ingestion (typically 11.5 g/kg body weight/day or 1520% total calories) will enhance and improve health in individuals without diabetic kidney disease. Protein intake goals should be individualized based on current eating patterns. Some research has found successful management of type 2 diabetes with meal plans including slightly increased levels of protein (2030%) (Ley SH et al., 2014). For diabetic kidney disease patients (with albuminuria and/or reduced estimated glomerular filtration rate), dietary protein should be regulated at the recommended daily allowance of 0.8 g/kg body weight/day. Reducing the amount of dietary protein below the recommended daily allowance is discouraged because it does not alter glycemic measures, cardiovascular risk measures, or the rate at which glomerular filtration rate declines (Pan Y et al., 2008). Proteins (fish, meat, beans, soyabean, and chicken) are restricted for those with diabetic nephropathy (Sinitskaya N et al., 2007). In individuals with type 2 diabetes, ingested protein may enhance the insulin response to dietary carbohydrates (Layman DK et al., 2008). Therefore, carbohydrate sources high in protein should be avoided in treatment and prevention of hypoglycemia.

Sodium

Diabetics should limit their sodium intake to 30 min) by briefly standing, walking, or performing any other light physical activities (Katzmarzyk, P. T. et al., 2009). This may help prevent type 2 diabetes for those at risk and may also aid in glycemic control for diabetics.

Physical Activity and Glycemic Control

Regular physical activity helps the body cells absorb glucose and thus lower blood glucose levels and blood pressure. Crucial advantages of a regular aerobic exercise program in diabetes management include decreased need for insulin, decreased risk of obesity, and decreased risk for heart disease. Exercise reduces total cholesterol, improves the ratio of low-density lipoprotein (LDL) to high-density lipoprotein cholesterol (HDL), decreases blood triglycerides and reduces stress levels. Walking, easiest and fastest exercise, is one activity that can be done for a lifetime without special equipment and with no or little risk of injury. Supervised activity is recommended due to the risk of an insulin imbalance, for any fluctuations to be under control (Qi L et al., 2008).

Smoking, Alcohol, and Caffeine

Smoking: may have a role in the arise of type 2 diabetes (Jankowich M et al., 2011). One study in smokers with newly diagnosed type 2 diabetes showed that smoking cut off was associated with improvement of metabolic parameters and decreased blood pressure and albuminuria at 1 year (Voulgari C et al., 2011). Nonsmokers should be recommended not to use e-cigarettes as there are no studies that showed that e-cigarettes are a healthier alternative to smoking or that e-cigarettes can facilitate smoking cessation. (Schraufnagel DE et al., 2014).

Alcohol: limit to less than 2 drinks per day (1 drink = 12 oz beer = 1.5 oz liquor = 4 oz wine). Alcohol intake is not advised if you have high triglycerides (blood fats), increased blood pressure, liver problems, are pregnant or breastfeeding. If you decide to drink alcohol, drink with your meal or snack (not on an empty stomach), to drink slowly or dilute with water or diet soda.

Caffeine: drink no more than four (4) cups of coffee or caffeine containing beverages per day.

Conclusion

In conclusion, effective lifestyle modifications including weight loss, maintenance of a healthy dietary pattern like the Mediterranean diet, together with physical activity are the cornerstone in the prevention and control of type-2 diabetes. Emphasis must be given to promoting a healthier lifestyle and finding solutions in order to increase adherence and compliance to the lifestyle modifications, especially for high-risk individuals. Your diabetic meal plan, physical activity, and medication are all balanced to help regulate your blood glucose levels and prevent the risk of getting diabetes. Over the short run, people with uncontrolled diabetes may experience fatigue, thirst, frequent urination, and blurred vision. In the long run, they are at risk for heart diseases, kidney problems, disorders of vision, nerve damage, and plenty of other difficulties which in severe cases may lead to premature death. There is no cure for diabetes. However, you can manage or delay diabetes through diet, exercise, weight control and, if necessary, medication.Figure 4. (Melanie J. Davies et al., 2018)

References

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Layman, D. K., Clifton, P., Gannon, M. C., Krauss, R. M., & Nuttall, F. Q. (2008). Protein in optimal health: heart disease and type 2 diabetes. The American journal of clinical nutrition, 87(5), 1571S-1575S.
Ley, S. H., Hamdy, O., Mohan, V., & Hu, F. B. (2014). Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet, 383(9933), 1999-2007.
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