PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.

Diabetes Diet And Exercise

Reviewing dietary management

Healthy eating

Advise carbohydrate intake should be higher, and fat intake lower than that of most Europeans, but not different from recommendations for the population in general. The proposed contribution to energy intake should be:

• Saturated fat : <10 % of calories
• Polyunsaturated fat : <10 % of calories
• Carbohydrate: : use foods containing soluble fibre in a carbohydrate rich diet
• Simple sugars : need not be rigorously excluded from the diet, but should be limited
• Protein : <15 % of calories
• Monounsaturated fat : use to maintain palatability and balance calorie intake
• Total calories : as required for normal body mass index
• Fresh fruit/vegetables : encouraged as part of meal-time calorie intake; (insulin dependent patients should try and have a high intake - five items a day).
• Alcohol : if desired, as part of total daily calorie intake

Individualize intake to match needs, preferences and culture

Meal patterns - insulin patients

Multiple injection regimens :

Advise snacks will help to attain better blood glucose control, but use self-monitoring to learn what is necessary and desirable

Advise on flexibility to adjust meal timing and content (together with insulin doses) without affecting blood glucose control. But warn about the temptations of extra total calories

Rapid-acting insulin analogue regimens:

Advise snacks only if self-monitoring suggests a need; check particularly if a high insulin analogue dose is needed to correct hyperglycaemia present pre-prandially

Physical Exercise^1,2

Management - type 1 Diabetes

Advise that physical exercise :

• can benefit insulin sensitivity, hypertension, and blood lipid control
• should be taken at least every 2-3 days for optimum effect
• may increase the risk of acute and delayed hypoglycaemia

Manage physical exercise using :

• self-monitoring to learn about the exercise response, and the effects of insulin and dietary changes on this
• a prospective reduction in insulin dose for regular exercise
• additional carbohydrate as necessary
• warnings:
  • about delayed hypoglycaemia, especially with more prolonged, severe, or unusual exercise, and a possible need for less insulin overnight and the next day
  • that exercise during insulin deficiency will raise blood glucose and ketone levels
  • that alcohol may exacerbate the risk of hypoglycaemia after exercise
  • about risks of foot damage from exercise (advise low impact exercise)²
  • need to consider ischaemic heart disease in those beginning new exercise programmes

Management - Type 2 Diabetes

Assess and review :

• activity at work, and in getting to and from the workplace
• physical activity practice and opportunities in domestic activities and hobbies
• the possibility of formal physical exercise on a regular basis
• Examples :
  • brisk walking 30 min per day
  • active swimming for 1 h three times a week

Advise that physical exercise :

• can benefit insulin sensitivity, blood pressure, and blood lipid control
• should be taken at least every 2-3 days for optimum effect
• may increase the risk of acute and delayed hypoglycaemia

Manage physical exercise using :

• formal recording of levels of physical activity
• identification of new exercise opportunities ( see above ), and encouragement to develop these
• appropriate self-monitoring, additional carbohydrate, and dose adjustment
  of glucose lowering therapy for those using insulin or insulin secretagogues
• warnings :
  • about delayed hypoglycaemia, especially with more prolonged, severe, or unusual exercise for those using insulin therapy
  • that alcohol may exacerbate the risk of hypoglycaemia after exercise
  • about risks of foot damage from exercise (advise low impact exercise)
  • need to consider ischaemic heart disease in those beginning new exercise programmes

References, footnotes and further reading

1. Adapted from the Transnational diabetes guidelines from the International Diabetes Federation (European Region) on behalf of the St Vincent Declaration Initiative of IDF (Europe)/WHO (Regional Office for Europe). ©1999, International Diabetes Federation (European Region), Brussels. Reproduced with permission.
   Published as : A desktop guide to Type 2 diabetes mellitus. European Diabetes Policy Group 1999. Diabet Med. 1999 16(9):716-30. and A desktop guide to Type 1 (insulin-dependent) diabetes mellitus. European Diabetes Policy Group 1998. Diabet Med. 1999 16(3):253-66. (Download Guidelines from internet)
2. ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities; American College of Sports Medicine; Human Kinetics, 1997

Internet

• Newcastle Diabetes Website - with downloadable versions of guidelines
• Diabetes UK(formerly British Diabetic Association)
• International Diabetes Federation
• Children with Diabetes
• American Diabetes Assn

Many thanks to Prof. Philip Home for his help and advice with this article, Professor of Diabetes Medicine, University of Newcastle upon Tyne, UK http://www.staff.ncl.ac.uk/philip.home/

Last issued 30 Aug 2006