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Clinician’s Corner: Type-2 Diabetes lifestyle modification

Since the first line treatment of Type-2 diabetes is lifestyle modification (diet and exercise) let’s discuss the benefits of exercise this week.

Obesity is now killing triple the number of people who die from malnutrition as it claims more than three million lives a year worldwide, according to a landmark study. http://www.telegraph.co.uk/health/healthnews/9742960/Obesity-killing-three-times-as-many-as-malnutrition.html

According to data by Marketdata Enterprises, Americans spend over $66 billion annually to try to lose pounds, on everything from paying for gym memberships and joining weight-loss programs to drinking diet soda. (2017 data)

Benefits of Exercise:

  • Exercise lowers blood sugar levels, improves insulin sensitivity, and strengthens the heart.
  • Strength training, which increases muscle and reduces fat, may be particularly helpful for people with diabetes.
  • The challenge with Diet and Exercise is that a review of the adherence literature suggests that as a group, patients with diabetes are reluctant to start an exercise program. In one early study, only 7% of the diabetic patients were judged to be “fully adherent with all aspects of their regimen”. Which put another way 93% of our patients will NOT adhere to diet and exercise in the treatment of Type-2 diabetes.  Because of this, the American Diabetes Association recommends starting metformin therapy at the first visit. http://care.diabetesjournals.org/content/20/2/215.full.pdf).

Use it or Lose it Study

To do this, ten healthy young men decreased their daily activity level from a mean of 10,501+/-808 to 1,344+/-33 steps/day for 2 weeks. After two weeks of this inactivity the results were:

  • energy expenditure was reduced
  • body weight increased
  • decline in lean body mass in the trunk and legs
  • 6–7% reduction in cardiorespiratory fitness
  • 17% drop in peripheral insulin sensitivity. Which means, by simply increasing a patient’s activity level, they can have about a 17% decrease in the insulin they require.

Source: J Appl Physiol. 2010 May;108(5):1023-4.

Talk to your Physician before starting an exercise program:

  • GOALS: Patients should aim to get at least 30 minutes of aerobic exercise most days of the week. Thirty minutes can be broken up into chunks—10 minutes here and there. Build up to 30 minutes gradually.
  • PUMPING UP: Lifting weights for 20-30 minutes two or three times a week is enough to get the full benefits of strength training.
  • INCREASES HDL: A 5-10 percent weight-loss can result in a five-point increase in HDL cholesterol (good cholesterol).
  • LOWERS TRIGS: Losing 5-10 percent of body weight was shown to decrease triglycerides by an average of 40 mg/dl
  • LOWERS BP: By losing 5-10 percent of one’s weight, blood pressure, both systolic and diastolic, decrease by 5 mmHg on average
  • LOWERS HbA1c: A 5-10 percent weight-loss can decrease HbA1c by half a point on average. (HbA1c is a 3 month average for blood sugars)
  • IMPROVES SLEEP: A 5-10 percent weight-loss may improve sleep apnea and sometimes if the apnea was not very severe, one can be weaned from the CPAP breathing machine.

EXERCISE ADHERENCE:  Unfortunately, a 10-year study of 255 diabetic patients enrolled in a diabetes education program that emphasized exercise, 80 percent at six weeks were still exercising to less than 50 percent at three months to less than 20 percent at one year.

TEST BLOOD SUGARS: If the pre-exercise blood glucose is <100 mg/dL, insulin- or sulfonylurea-treated patients should ingest extra food, in the form of 15 to 30 grams of quickly absorbed carbohydrate (such as glucose tablets, hard candies, or juice), 15 to 30 minutes before beginning exercise. Easy to remember 15-30 GM ingested 15-30 minutes before exercising if finger sticks are below 100.

Encourage your patients to follow all aspects of their physician’s treatment plan.  We pharmacists are the “adherence experts” as well as the drug experts.  With only 7% of our patients adhering to drugs, diet and exercise we can make a big impact in their treatment of Type-2 diabetes.

Your Thompson Pharmacist is a diabetes expert.  Your pharmacist can guide you along the pathway toward a healthier you.  He can point you toward appropriate socks, footwear and even get you a pedometer to count your steps!  Go ahead an ASK… At Thompson Pharmacy… it’s all for you!!