The 2023 American Diabetes Society Standards of Medical Care, which are nearly 300 pages long, are pretty extensive. Weight loss is a central theme, given the strong connection between diabetes and obesity. What other changes can be made for the 37 million Americans with diabetes?
Collaboration is critical to lifestyle changes.
According to Dr. David M. Nathan from Harvard Medical School, this update has remained the same. Nathan was also the co-author and chair of earlier versions of some guidelines published yearly for over three decades. The majority of diabetes lifestyle recommendations are the same as what your grandmother used to tell you: Eat your vegetables, exercise, and sleep enough.
However, Dr. Nathan, the director of the Diabetes Center at Massachusetts General Hospital, has noticed a subtle shift in the advice the association has given over the past five- to ten years. He says this means working with your doctor to find a lifestyle and medication plan that suits you. Doctors are not there to tell you what to do, but they can sit at your table and by your bedside. While they can help you make informed decisions and plans to improve your diabetes management, you must take an active role.
Five tips for diabetes management
Dr. Nathan says that there are five main takeaways from these guidelines that type 2 diabetics should be aware of. People with type 1 diabetes can also use these tips. However, those with type 1 should consult their doctors for specific advice.
Get sound sleep every night. Experts know that obesity is linked to poor sleep. There is mounting evidence that insomnia problems can also be linked to diabetes risk. Dr. Nathan states that altered sleep patterns can impact blood sugar control. A frequent cause of disturbed sleep is obstructive sleep apnea. This is a severe disorder that causes short, irregular pauses in breathing during the night. It’s more common among people with diabetes, especially those with obesity, so anyone with the following symptoms: loud snoring and snorts, gasps during sleep, daytime sleepiness, and snorting should be evaluated. Ask your doctor for a home-based test to rule out sleep apnea.
Don’t “diet. You don’t have to “diet.” Many popular diets include keto, intermittent fasting, and paleo. These diets can help you lose weight. Most people gain weight loss once they stop following the diet. Dr. Nathan says it is much better to slowly shift towards a healthy eating pattern that you can maintain over the long term. The Mediterranean eating plan and the closely related DASH diet are good choices. People with diabetes should avoid sodas and sugary drinks. Reduce the number of desserts, sweets, and fatty foods you eat and eat more high-fiber carbohydrates like whole-wheat bread, brown rice, and whole-wheat bread.
You can safely exercise. Diabetes patients should pay particular attention to selecting the right shoes and regularly checking their feet for any redness, blisters, or sores. This is because neuropathy, a condition that causes numbness and paralysis due to nerve damage, can lead to a loss of sensation in the feet and toes. These can lead to more serious foot problems that could result in amputations.
Achieve a healthier weight. Many people who are obese need medication to lose significant weight. Metformin is the most common drug prescribed to lower blood sugar. It may help you lose approximately five pounds. Even though a modest weight loss can improve diabetes and its complications, such as Type 2 and Type 3, more considerable losses can be even more beneficial.
The two new diabetes drugs, semaglutide, Ozempic, and tripeptide, can help people lose between 15 and 20 pounds. They can also reduce hemoglobin A1c levels by up to two percentage points. (A1c, the average three-month blood sugar measurement, is also known as hemoglobin A1c.
Dr. Nathan says that these drugs, administered by once-weekly injections, are stimulating and should be considered an option to metformin for those with diabetes and obesity. They are not affordable (roughly $1,000 per month before insurance) and must remain indefinitely, so they are only feasible for some. Metformin, however, costs just $4 per month.
Set your treatment goals. Dr. Nathan says that even if you don’t lose weight, this goal will reduce your risk of serious complications such as vision, kidney, and neuropathy.
Your risk of developing heart disease is also increased by diabetes. The target blood pressure should be below 130/80mm Hg. LDL cholesterol target should be reduced by at least 50% (or 70 mg/dL). The guidelines recommend a target LDL of 55 mg/dL for heart disease patients. Dr. Nathan says that many of my patients take cholesterol-lowering statins and that I sometimes increase their dosages to reach a lower target. Sometimes, a combination of cholesterol-lowering medications can help lower stubbornly low LDL.
