What lifestyle modifications and treatments are recommended for controlling blood sugar levels in patients with diabetes?

Lifestyle Modifications and Treatments for Controlling Blood Sugar in Diabetes

Regular physical activity and dietary modifications are the cornerstone of blood glucose management in diabetes, with patients encouraged to engage in at least 150 minutes of moderate-intensity exercise weekly and follow a personalized nutrition plan to achieve optimal glycemic control.

Physical Activity Recommendations

• Patients with diabetes should perform aerobic exercise regularly, with sessions ideally lasting at least 10 minutes and totaling 30 minutes or more on most days of the week 1
• Exercise should be performed daily or at least with no more than 2 days between sessions to decrease insulin resistance, regardless of diabetes type 1
• Adults with diabetes should engage in 2-3 sessions of resistance exercise weekly on non-consecutive days to improve glycemic control and strength 1
• Children with diabetes should engage in at least 60 minutes of moderate-to-vigorous aerobic activity daily with muscle and bone-strengthening activities at least 3 days per week 1
• Breaking up extended sedentary periods (≥30 minutes) with brief standing, walking, or light physical activity can help improve glycemic control 1

Dietary Management

• Dietary advice must be personalized based on individual preferences and cultural considerations 1
• Patients should be encouraged to eat foods high in fiber such as vegetables, fruits, whole grains, legumes, low-fat dairy products, and fresh fish 1
• High-energy foods rich in saturated fats, sweet desserts, and snacks should be consumed less frequently and in smaller amounts 1
• For individuals using fixed daily insulin doses, carbohydrate intake should be kept consistent regarding timing and amount 1
• Those using rapid-acting insulin should adjust meal and snack insulin doses based on carbohydrate content 1

Weight Management

• Establishing a goal of weight reduction or at least weight maintenance is recommended for patients with diabetes 1
• Modest weight loss (5-10%) contributes meaningfully to achieving improved glucose control 1
• For overweight patients, a weight loss of at least 5% of body weight should be encouraged 2

Alcohol Considerations

• If adults with diabetes choose to consume alcohol, daily intake should be limited to one drink or less for women and two drinks or less for men 1
• To reduce the risk of nocturnal hypoglycemia in individuals using insulin or insulin secretagogues, alcohol should be consumed with food 1
• Moderate alcohol consumption when ingested alone has no acute effect on glucose levels, but carbohydrates consumed with alcohol may raise blood glucose 1

Medication Management

• Metformin remains the most widely used first-line medication for type 2 diabetes, primarily reducing hepatic glucose production 1
• For patients not achieving glycemic targets with lifestyle modifications alone, pharmacotherapy (usually starting with metformin) should be initiated 1
• Highly motivated patients with HbA1c near target (<7.5%) could engage in lifestyle changes for 3-6 months before starting pharmacotherapy 1
• Those with moderate hyperglycemia should start antihyperglycemic medication (usually metformin) at diagnosis, which can later be modified or discontinued if lifestyle changes are successful 1
• The American Diabetes Association recommends avoiding clinical inertia - do not delay intensification of therapy when glycemic targets are not met 2

Blood Glucose Monitoring

• Regular blood glucose monitoring is essential for patients to understand how food, physical activity, and medications affect their glucose levels 1
• For patients with type 1 diabetes, blood glucose should be tested at least three times daily, including before and after exercise, before driving, and at bedtime 1
• Plasma glucose monitoring can help determine whether adjustments in diet will be sufficient to achieve blood glucose goals or if medication adjustments are needed 1

Special Considerations for Exercise

• In individuals taking insulin or insulin secretagogues, physical activity may cause hypoglycemia if medication dose or carbohydrate consumption is not adjusted 1
• Patients may need to consume additional carbohydrates if pre-exercise glucose levels are <100 mg/dL (5.6 mmol/L) 1
• For planned exercise, insulin doses can be adjusted; for unplanned exercise, extra carbohydrates may be needed 1
• Those with diabetic complications, particularly peripheral neuropathy, should wear proper footwear and examine their feet daily 1

Importance of Blood Sugar Control

• Good glycemic control remains crucial in preventing long-term diabetic complications, with HbA1c being the best indicator of long-term glycemic control 3
• The risk of overt nephropathy increases substantially when HbA1c exceeds 9.6%, while the risk of severe retinopathy increases when HbA1c exceeds 8.6% 3
• Controlling blood glucose, along with managing blood pressure and lipids, is recommended to prevent cardiovascular and microvascular complications in patients with diabetes 1

Common Pitfalls to Avoid

• Overemphasis on intensive glycemic control without considering the risk of hypoglycemia, especially in older adults or those with comorbidities 4
• Neglecting the importance of addressing all cardiovascular risk factors, not just glucose control 2
• Failing to recognize that patients often cycle through weight loss and relapse; healthcare providers should remain non-judgmental but persistent in encouraging therapeutic lifestyle changes 1
• Overlooking the need for regular monitoring of medication side effects and complications 2