Diabetes Management: Diet, Exercise, and Insulin

Posted on Feb 24, 2025 in Medicine & Health

Characteristics of a Good Diet

A balanced diet, adjusted for height, weight, and activity level, is crucial. It should include five or six meals a day, avoiding soluble sugars and artificial sweeteners. It should also be alcohol-free.

Factors Hindering Dietary Compliance

  • Use of rigid and monotonous diets, unadjusted to each patient’s characteristics.
  • Insufficient instruction on diet management and understanding its usefulness.
  • Failure to involve the patient in managing their diet.
  • Lack of support from family and friends.
  • Temptations at social events or family gatherings.
  • Feeling of not being able to eat like everyone else and the temptation to deviate temporarily.

Physical Exercise

Physical exercise is extremely important in diabetes treatment due to its effects on reducing blood glucose levels and cardiovascular risk factors. Exercise lowers blood glucose by increasing glucose uptake in muscle and improving insulin utilization. It also promotes blood circulation and muscle tone.

Important: Patients with blood glucose above 250 mg/dL and ketonuria should not start exercising until ketonuria is negative and blood glucose is close to normal.

Exercise in Type 1 Diabetes

Before Exercise

  • Plan the exercise, estimating intensity, duration, and caloric expenditure. Always warm up.
  • Adjust insulin dose based on the interval between insulin injection and the onset of exercise.
  • Consider food intake: type of previous meal, interval before exercise, and the need for supplementation during exercise.
  • Check glycemia after:
    • Less than 100 mg/dL: Take a carbohydrate supplement.
    • 100-150 mg/dL: Begin exercise and take a supplement during the activity.
    • More than 250 mg/dL: Check for ketonuria.
      • If ketonuria is negative: With blood glucose higher than 250 mg/dL, delay exercise or start with gentle warm-up.
      • If ketonuria is positive: With blood glucose of 250 mg/dL, do not exercise and administer rapid-acting insulin.

During Exercise

  • Take supplements of 10-12g of carbohydrates every 30 minutes if exercise is vigorous, or every 60 minutes if moderate.
  • Determine insulin behavior with different types of exercises by measuring capillary blood glucose with a reflectometer.

After Exercise

  • Determine blood glucose immediately after finishing exercise and during the late period.
  • If exercise is short but very intense, blood glucose may increase.
  • Adjust food intake according to blood glucose levels in certain self-monitoring situations.

Exercise in Type 2 Diabetes

The type of exercise in these cases should aim to increase patient participation and motivation, avoiding injuries. Recommended activities include walking or increasing activities/exercises that have been done regularly, aiming for a daily duration of one hour.

Risks of Exercise for Diabetics

Despite the great benefits, there are some risks:

  • Hypoglycemia: If the treatment is with insulin or sulfonylureas.
  • Late-onset or post-strenuous exercise hyperglycemia.
  • Hyperglycemia and ketosis: If there is an effective insulin deficit.
  • Exacerbation of cardiovascular diseases: Myocardial infarction, angina, arrhythmias, or sudden death.
  • Worsening of chronic diabetes complications: Peripheral neuropathy, retinopathy, nephropathy, autonomic neuropathy.

Indications for Insulin Therapy

  • Type 1 Diabetes Mellitus.
  • Patients with underweight or ideal weight with a basal blood glucose level greater than 140 mg/dL, equivalent to glycosylated hemoglobin (HbA1c) greater than 8%, despite appropriate treatment and maximal doses of oral antidiabetic drugs (ADO).
  • Pregnancy.
  • Hyperglycemic conditions in Type 2 Diabetes Mellitus: Severe infection, trauma, stress.
  • Type 1 Diabetic Ketoacidosis, Hyperosmolar Hyperglycemic Nonketotic State Type 2.