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An estimated 5.6 million people are living with diabetes in the UK. Diabetes is a condition that causes our blood sugar levels to become too high. There are two main types of diabetes, type 1 and type 2. Both are characterised by a problem with the hormone insulin, which is there to control the amount of sugar we have in our blood. Insulin is produced by cells in the pancreas and is responsible for turning glucose into energy.
Type 1 diabetes is a lifelong condition that affects less than 1 in 10 people with diabetes. It is an autoimmune condition that results in a person not having enough insulin in their body. This happens because the body’s immune system attacks and destroys the beta cells in the pancreas that produce insulin. Type 1 diabetes is managed with regular insulin injections.
Type 2 diabetes accounts for around 90% of all diabetes cases in the UK. Type 2 diabetes leads to high blood sugar levels because we fail to make enough insulin or the insulin we make isn’t working properly. Type 2 diabetes can be controlled with medication; however, sometimes you can put your type 2 diabetes into remission by losing weight and becoming healthier.
During pregnancy, some women develop a condition called gestational diabetes. It happens when we are not producing enough insulin to meet the extra needs of our bodies during pregnancy. Gestational diabetes usually goes away once the baby is born.
Symptoms of diabetes include constant thirst, increased urination (especially at night), tiredness, weight loss, blurred vision and itching of the genitals.
In this article we will look at some lifestyle changes for effective diabetes management that can be used in conjunction with medication and your doctor’s advice.
The Importance of Lifestyle in Diabetes Management
Lifestyle factors such as diet, exercise and stress levels can have an effect on both our physical and mental health. Being diagnosed with diabetes can be overwhelming; however, it is critical that you make an effort to look after your health and wellbeing.
Type 1 diabetes is not preventable; however, making simple lifestyle changes can reduce the risk of developing type 2 diabetes. Lifestyle changes can also help with managing the impact of all types of diabetes on our health and wellbeing. Over time, having high levels of glucose in our blood can lead to complications including damage to organs and blood vessels. Diabetes can put us at a higher risk of developing serious health problems including kidney failure, heart problems and strokes.
Lifestyle changes play an important role in all types of diabetes management and they can also reduce the chances of developing type 2 diabetes.
By eating more healthily, staying active and reducing stress, you may enjoy some of the following benefits:
- Better control of your blood sugar
- Prevention of complications
- Less reliance on medication
- Better mental and physical health
- Improved wellbeing
Healthy Eating Habits
Eating well can help us to feel better, stay at a healthy weight, have more energy and get all of our essential nutrients. A balanced diet can also support our immune system. There is no one size fits all diet for people with diabetes, though it is recommended that people with all types of diabetes limit sugar and don’t overdo it on the carbs, as carbohydrates break down into glucose which can affect blood sugar levels.
A diabetes friendly diet is one that:
- Is balanced
- Is healthy
- Is low in fat
- Is low in sugar
- Contains plenty of fresh vegetables
- Contains some fruit
- Encompasses all of the main food groups (fruit and veg, starchy food, protein, dairy, oils and spreads)
A healthy diet should be low in pre-packaged and ready meals; however, if you occasionally need to buy these items, you should know how to read and understand the food labels and warning labels. Pre-packaged food has to be labelled with certain information including the ingredients, allergens, nutritional value (sugars, fats, calories etc) and what percentage of a person’s daily intake it contains.
Some manufacturers also choose to use a traffic light system (red, amber, green) to indicate whether products are low, medium or high in sugar, fat, saturated fat or salt. Try to choose foods that are mostly green, with a few ambers and very few red labels. Always opt for foods that are lower in saturated fat, sugar and salt, as this can help to:
- Control blood fats
- Control blood pressure
- Maintain a healthy weight
You may find meal planning useful if you have diabetes, especially in the early days or if you are short on time. Meal planning can also save money, reduce food waste and take some of the stress out of shopping and cooking.
Diabetes UK has 12 different meal plans for you to choose from. Their plans are nutritionally balanced, as well as calorie and carb counted. You will need to select a meal plan in line with your specific goals and needs, keeping in mind any allergies or dietary requirements. Some of their meal plans include:
- Budget meal planner
- Vegan meal planner
- Cooking for one meal planner
- 1500 calories per day for men and women
- Low-carb meal planner
Generally, regardless of which type of diabetes you have, the advice is to eat a healthy, balanced diet; however, some specific advice to keep in mind includes:
- If you have type 1 diabetes, carb counting is important. This means estimating the amount of carbohydrates you are eating and matching this with how much insulin you take.
- If you have type 2 diabetes and are overweight, your doctor will advise you to lose weight. Losing weight is one of the most effective lifestyle changes for effective diabetes management. Consider trying a Mediterranean diet, low-calorie diet or low-carb diet.
You can continue to eat some of the food you enjoy by making some sensible swaps, for example:
- Swap out white bread for wholegrain or seeded batch
- Try a sliced or mashed banana on your toast instead of sugary jam
- Choose a diet option if you are craving a fizzy drink
- Swap white rice for brown rice
- Instead of crisps, snack on some sunflower seeds or unsalted nuts
- Steam or roast your veg, rather than cooking it in oil
Key tips to eat well with diabetes and keep your blood sugar consistent:
- Don’t skip meals
- Avoid sugary drinks and alcohol
- Think about portion control
- Choose products that have more fibre
- Remember all carbohydrates will raise blood sugar levels
- Make sure you stay hydrated but avoid sugary, fizzy drinks or juice (although these can be effective to treat hypos)
- Avoid processed food and ready meals
- Make sensible snack swaps and try to tackle sugar cravings
Regular Physical Activity
Physical activity can help to lower our blood sugar levels as it can increase how well our bodies use insulin which in turn brings your blood sugar down. Exercising and staying active can support both our mental and physical wellbeing. Other benefits of staying active when you have diabetes are:
- Lowers blood pressure
- Improves cholesterol levels
- Helps with weight loss and weight management
- Helps to regulate energy levels and improves sleep
- Improves flexibility
- Releases endorphins (feel good hormones) that make you feel happier
It is important to measure your blood sugar before, during and after physical exercise to avoid hypoglycaemia or hyperglycaemia. You can do the same exercise and eat the same foods on different days but find that you have completely different blood sugar levels. This is why it is important to monitor your blood sugar closely each time you exercise and not get complacent.
If you struggle to exercise, or have additional complications such as a heart condition, high impact exercise such as cardio will not be suitable for you. However, you can still consider other ways to stay active such as:
- Walking
- Swimming
- Stretching
- Yoga
- Pilates
- Tai chi
Some people with diabetes find it helps them to set small goals to ensure they stay active, such as:
- Completing an exercise video once per week
- Walking to work or the shops instead of going in the car on certain days of the week
- Getting off the bus a couple of stops earlier
- Doing a short, gentle yoga or stretching routine each morning
- Taking a weekly or biweekly walk in nature, e.g. in a local park
Weight Management
Maintaining a healthy weight is a key part of diabetes management. If you are overweight you are at an increased risk of developing type 2 diabetes and of having complications if you already have any type of diabetes.
- Around 60% of people with type 1 diabetes are overweight or obese
- Around 85% of people with type 2 diabetes are overweight or obese
- Losing weight can help to prevent type 2 diabetes if you are in an at-risk group
- Learning how to calculate your BMI can help you to work out what a healthy weight is for you
- If your waist measurement is equal to more than half your height, you are carrying too much weight around your middle
Being overweight can make fat build up in the organs, including the liver and pancreas which can result in insulin resistance.
After losing excess weight and becoming a healthy weight, many people report:
- Having more energy
- Feeling in a better mood
- Improved sleep
- Better immune system
If you have diabetes or are at risk of diabetes, it is important that you try to lose weight safely and gradually. Crash dieting or skipping meals will affect your blood sugar and can be dangerous for you. To maintain a healthy weight, a multifaceted approach is best that includes staying active, making healthy choices and portion control.
Stress Management
Having diabetes can lead to increased stress levels due to worry about the condition. You may feel worried about your symptoms, stressed about adapting your lifestyle and annoyed about having to check what you eat and drink every day. Some people with diabetes will need to keep an eye on blood sugar levels using regular testing and may require regular insulin injections. If you have diabetes, it is important to learn some stress management techniques.
Stress can affect us physically, emotionally and psychologically. When we are stressed, it affects our health and can lower our immune system. Stress is especially bad for diabetes because when we are stressed our bodies release hormones, including cortisol and adrenaline, which can interfere with insulin and make it more difficult for insulin to work properly.
High levels of stress in people with diabetes can:
- Keep blood sugar levels high
- Increase the risk of diabetes complications
- Affect mood and mental/emotional health
- Interfere with sleep
- Increase blood pressure
Although stress does not cause diabetes, there is some evidence that suggests a correlation between stress and type 2 diabetes.
Tips and techniques to cope with stress include:
- Meditation and mindfulness
- Gentle exercise such as yoga or tai chi
- Getting out in nature
- Deep breathing techniques
- Grounding techniques
- Creative activities such as colouring or painting
- Taking a hot bath or warm shower
It is important to practise self-care and to speak to yourself with kindness and compassion in times of stress and difficulty. Try to remain positive and calm and don’t be afraid to reach out for help when needed. It is important not to resort to bad coping mechanisms, such as smoking, drinking alcohol or comfort eating, when you have diabetes as it may affect your health or blood sugar levels and may lead to a hypo.
Many people experience work-related stress. Stressful situations at work can lead to raised blood sugar levels and make it more difficult for someone to manage their diabetes. This can lead to feelings of negativity and overwhelm that leave workers stuck in a vicious cycle. As diabetes is a long-term condition that can significantly interfere with a person’s daily life, it is usually covered under the Equality Act 2010. This means that employers have a duty by law to provide reasonable adjustments:
- If you are struggling with your diabetes at work don’t be afraid to ask your employer or colleagues for support
- You are entitled to reasonable adjustments to your workload, e.g. regular breaks at set times
- You may need to take time off work for healthcare appointments and annual check-ups; you should communicate this in advance with your line manager and they should allow you to attend
- Education courses are available (e.g. DAFNE for type 1 diabetes and DESMOND for type 2 diabetes); if you manage someone with diabetes, encourage them to take a course and share what they have learned with the team!
Although type 1 diabetes cannot be prevented, we know that a healthy, balanced diet and regular exercise can help to manage the condition and help prevent type 2 diabetes. Workplaces should find ways to model healthy behaviour, for example offering healthy options in the canteen or starting the day with a (optional) short stretching session.
Sleep and Diabetes Management
Getting enough good quality sleep is essential for our mental and physical health. Some research has shown there is a link between sleep, blood sugar and type 2 diabetes, although more investigation is needed to fully unpack the complex relationship between these factors.
Low blood sugar (hypoglycaemia or hypos) during the night can affect people who have type 1 diabetes; likewise, those with other types of diabetes who take insulin can also experience high and low blood sugar during the night.
Low blood sugar at night can lead to tiredness the next day and irregular sleep patterns. High blood sugar (hyperglycaemia) can also affect sleep quality and interrupt sleep at night due to:
- Increased trips to the bathroom at night to urinate
- Increased thirst
- Headaches
The consequences of poor sleep if you have diabetes may include:
- Increased insulin resistance
- Weight gain
- Low energy levels
If you have diabetes, it is important to try to maintain good sleep hygiene:
- Stay active during the day
- Sleep in a calm, quiet, comfortable environment without bright light
- Avoid blue light just before bed (emitted from smartphones, laptops, tablets etc)
- Relax and unwind for an hour or so before bedtime. You could try taking a bath, reading a book or meditating
- Ensure your sleep space is at a comfortable temperature (e.g. setting your central heating on a timer or using a fan in summer)
Building a Support System
If you have diabetes, it can be stressful, especially at first, as there is a lot to remember and you may need to make significant changes to your lifestyle. Some people with diabetes have to check their blood sugar using finger pricks and inject insulin to regulate their blood sugar levels. It is perfectly normal to find this scary and uncomfortable at first, although most people with diabetes find it is something they get used to. You may need help with this from a trusted person, especially if you are very young, elderly or have other conditions.
Having a good support system around you can help you to manage having a long-term condition and to stay positive. A support system can include friends and family, colleagues, employers, teachers and healthcare professionals, who can all offer different types of support including physical, emotional and mental.
Building a strong support system can also help with goal setting, accountability and staying motivated.
Many people with diabetes learn to manage it by themselves, although some may need extra support for various reasons. If you are supporting someone with diabetes, you can help them by:
- Getting involved with shopping and cooking, encouraging healthy eating and modelling healthy behaviour
- Helping them to do a foot check to prevent foot problems related to diabetes
- Assisting them with booking and getting to appointments (including doctors, dieticians and opticians)
- Learning how to spot hypos and hypers
- Looking out for signs that they are seriously struggling (e.g. developing diabetes burnout, depression or an eating disorder)
Conclusion
Diabetes is a chronic condition that can cause significant disruption to a person’s day-to-day life. In addition to following doctor’s advice regarding medication administration, for example insulin injections, people with diabetes can make simple lifestyle changes to help manage their condition. To reduce the likelihood of developing type 2 diabetes and to lessen the impact diabetes may have on you, it is important to maintain a healthy weight, eat a balanced diet and stay active.
Always consult your GP or specialist before making any major changes to your diet or lifestyle.
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