If you are interested in losing weight, a dietitian can provide suggestions that will help you do so in a safe, nutritionally sound manner while still focusing on blood glucose control to prevent the complications of diabetes. If you have high blood pressure or abnormal blood lipid levels, which are common among people with diabetes, your meal plan should address those issues as well. If you have any diabetes complications, the dietitian may also recommend some changes in your meal plan that can help slow their progression.
Keep in mind that as you age, your body and your diabetes treatment needs change, so your nutrition status and caloric needs will need to be reevaluated. Periodic follow-up visits with the dietitian are key to maintaining your diabetes health.
Diabetes education. In addition to covering your medical visits, most health plans, including Medicare, provide some coverage for diabetes self-management education and training. All people with diabetes should receive diabetes education from a diabetes educator, preferably at an American Diabetes Association–recognized education service, which must meet a set of national standards. Certified diabetes educators (C.D.E.’s) are health-care professionals, such as doctors, nurses, dietitians, pharmacists, exercise physiologists, and social workers, who specialize in the care and treatment of people with diabetes. They can help you learn how to stay healthy with diabetes.
Diabetes education can take place in group or individual sessions. Initially, the educator should cover topics such as what diabetes is; tools for managing the condition, including meal planning, physical activity, diabetes drugs, blood glucose monitoring, and common lab tests that should be done periodically; potential complications related to diabetes; and coping skills. Special training is also available for women with diabetes who are planning to become pregnant or are currently pregnant.
Individualized training that considers your age, career, and culture as well as your medical status can be essential to your success in managing diabetes. Diabetes education should encourage you to set goals to achieve behavior change as well as address your specific needs. If you feel your individual needs have not been addressed, let your educator know what areas you need help with.
Physical activity. The benefits of physical activity for people with diabetes include improvement in blood glucose levels, weight control, and, when moderate-to-intense aerobic physical activity is done regularly, reduction of cardiovascular disease risk. Research has also shown that resistance training exercises (such as weight lifting) can be helpful in the management of Type 2 diabetes (though lifting heavy weights may not be appropriate for people with certain diabetes complications).
See your doctor for a physical exam before starting an exercise program, especially if you haven’t been active for a while. Your physician may recommend a graded exercise test with electrocardiogram (ECG) monitoring to evaluate the effect of physical activity on your heart.
While physical activity can have a positive effect on blood glucose control, there are times when it should be avoided. If you have Type 1 diabetes and your blood glucose levels are above 250 mg/dl and you detect ketones in your urine, or if your blood glucose levels are above 300 mg/dl (even if there are no ketones in your urine), you should not exercise until your blood glucose levels have been brought into your target range. If your blood glucose level is less than 100 mg/dl and you use insulin or a drug that stimulates the pancreas to release more insulin (such as glyburide, glipizide, or glimepiride), you should have a carbohydrate-containing food or beverage to raise your blood glucose level before you exercise. Your diabetes care team can help you determine a safe way to include physical activity in your diabetes care plan.