National Diabetes Month

National Diabetes Month

I feel pretty safe saying most people have heard of diabetes and may know the fundamentals of diabetic management, such as reducing refined sugar and exercising.

However, reducing sugar and make sure to exercise is quite a broad request and statement, so we are here to dive into Type II Diabetes Mellitus (T2DM) management a little further.

T2DM accounts for 90% of Canadian Diabetes cases and is a largely avoidable condition impacted by lifestyle choices and daily habits relating to activity and diet addressing your lifestyle is imperative to disease management. 

Doctor Leslie Housefather discusses diabetes management daily with his patients, aiming to utilize lifestyle change as an initial tool and only using pharmacological intervention when the condition is not controlled placing the individual at risk of further health complications. Dr. Housefather will insist on a change in lifestyle factors even before seeing changes in A1C creeping up above 5.5%. As this measure elevates further, you are at greater risk for diabetic complications and the need for drug intervention as a management tool. Waiting for A1C markers to get to 6.0% before exercise or dietary intervention sadly puts you years behind the metabolic changes associated with ‘insulin resistance,’ and we must act sooner than this.

When undertaking exercise for diabetes management, we want to focus on a balance of aerobic and resistance training.

Clinical Exercise Physiologist Cassie says, focussing on the individual is so important, cookie-cutter programs just doesn’t cut it. When I’m developing an exercise program for someone, there are so many factors to consider. Not everyone has the same 24-hours. The exercise equipment two people have varies. People often have access to weights, but having access to a pair of 5-kilogram weights compared to a full gym is very different. The experience someone has had using gym equipment or exercising, motivation, any other physical barriers or health conditions that the person is managing, are all essential considerations.

Placing the aforestated and more considerations to the side. In an ideal world, Cassie wants anyone who is insulin resistant to partake in resistance exercise at least twice weekly on non-consecutive days utilizing large muscle groups. A “bro-split” won’t cut it either. A global strength program completing 6-10 exercises, depending on exercise experience and tolerance.

Around this, we need at least three thirty-minute blocks of aerobic exercise, such as walking. However, for those who are obese the thirty-minute recommendation for aerobic exercise should be raised further.

Monitoring glucose readings around exercise is important for those whose glucose levels are uncontrolled (such as hypoglycemic events and readings above 10 mmol/L) to ensure safety during and after movement. Higher-intensity resistance exercise is most effective for diabetic populations (Liu et al., 2019), with resistance exercise resulting in lower fasting blood glucose levels up to 24 hours after exercise, with greater impact correlating with the volume and intensity of the exercise session (Colberg et al., 2010).

Taking an individualized approach and working with a registered dietitian, nutrition can help reduce A1c by 1-2% or more (Diabetes Canada, 2018). When considering food and nutrition, registered dietitian Kaitlin finds clients often come in wanting to eliminate all forms of carbohydrates and sugars. Some even come into the clinic seeking a low or no-carbohydrate diet like the ketogenic diet. The ketogenic diet can potentially lead to a more harmful state of health as cutting out complete food groups, specifically carbs in this case, can lead to poor energy levels, a lack of mental focus and concentration, poor exercise performance, and macro- or micro-nutrient deficiencies such as a lack of fiber, potassium, magnesium, and calcium. Rather, Kaitlin focuses on teaching her clients “what, when, and how much an individual eats play the biggest role from a nutrition standpoint in regulating blood sugar levels”. 

Taking a deeper dive, let’s consider what you are eating. Carbohydrates are our bodies’ preferred fuel source, so rather than cutting out carbohydrates and sugar entirely, Kaitlin recommends that her clients focus on the quality of carbohydrates. This includes choosing complex carbohydrates over refined carbohydrates, looking at the fiber content of grain-based products, and choosing low glycemic index foods. The quality and combination of other foods eaten including protein, vegetables, fruits, and fats are crucial in building a blood sugar-balanced meal.

When you are eating refers to the timing of meals. Do you have large gaps greater than 4-6 hours between meals? Are you consuming regular meals and snacks throughout the day? Our bodies like regularity, and by having a consistent eating pattern, we can help prevent blood sugar spikes. Long-term spikes in blood sugar put stress on organs (such as the pancreas) whose job it is to produce insulin and our cell receptors that uptake the sugar for use. Over time, this can contribute to insulin resistance. 

Just because carbohydrates impact your blood sugar does not mean you can’t eat them. How much carbohydrates you are consuming at a time is very individualized. Kaitlin helps clients determine the portion size best for them to ensure satiety and blood sugar control. Building a plate with the following breakdown can act as a start to determining portion sizes: ½ the plate filled with non-starchy vegetables, ¼ filled with plant or lean animal sources of protein, ¼ filled with complex carbohydrates, and 1-2 tablespoons of healthy fats.

When combining what (quality), when (timing), and how much (quantity), you can enjoy all foods and still prevent or manage type 2 diabetes.

 

References
Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2018;42(Suppl 1):S1-S325 

Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Braun B; American College of Sports Medicine; American Diabetes Association. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010 Dec;33(12):e147-67. doi: 10.2337/dc10-9990. PMID: 21115758; PMCID: PMC2992225.

Liu, Y., Ye, W., Chen, Q., Zhang, Y., Kuo, C.H. and Korivi, M., 2019. Resistance exercise intensity is correlated with attenuation of HbA1c and insulin in patients with type 2 diabetes: a systematic review and meta-analysis. International Journal of Environmental Research and public health, 16(1), p.140.

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