This document discusses a holistic approach to lifestyle management for diabetics. It presents various modalities of diabetes care including non-pharmacological/non-interventional approaches like exercise, stress management, foot care, education, self-monitoring of blood glucose, smoking cessation, and diet. These lifestyle factors are interconnected and impact glycemic control and health. Regular physical activity, stress management, foot care education, self-monitoring, and smoking cessation can all effectively, safely, and affordably improve health outcomes for diabetics when implemented as part of a comprehensive care program.

1. New Concepts in
Lifestyle Management
of Diabetics
DR. EMAD HAMED
EIDC – NAGA-HAMMADY
QENA

2. Lifestyle Management of Diabetics
Lifestyle = Diet + Exercise
NO
Lifestyle is much broader than that.
I believe we need a different approach to a
holistic lifestyle management.
The one I’m going to present is different,
but I think it may be more logic from the
practical point of view

3. Diabetic Patient Care
Non-Pharmacological
Non-Interventional
Exercise
Stress
Management
Foot Care
Education
SMBG
Smoking
Cessation
Diet
Pharmacological
Interventional Care
Oral Hypoglycemic Drugs
Insulins
Insulin Analogs
Interventional Foot Care
Interventional Cardiology
Etc….
Education

7. Exercise
Increase
B-Endorphins
Metformin
Stress
Management
Improve ……..
Mood
Insulin Resistance
Glycemic Control
1
3 2
4
Many Modalities of Diabetes Care are Interconnected
(Beta-Endorphins May be one of the Links)

8. Endorphins
These are often classified to be the happy hormones.
Any form of physical activity leads to the release of these
feel good neurotransmitters. The increase in endorphins
secretion leads to a feeling of euphoria, modulation of
appetite, the release of different sex hormones and an
enhancement of immune response. This helps combat the
negative effects of stress.

9. Metformin increases insulin sensitivity and plasma
beta-endorphin in human subjects.
In conclusion, metformin causes a
significant parallel increase in insulin sensitivity
and plasma beta-endorphin level in human
subjects.
Reference
Ou HY1, Cheng JT, Yu EH, Wu TJ. Metformin increases insulin sensitivity and plasma
beta-endorphin in human subjects. Horm Metab Res. 2006 Feb; 38(2):106-11

10. Exercise

11. LS11 Encourage increased duration and frequency of physical
activity (where needed), up to 30-45 minutes on 3-5 days per
week, or an accumulation of 150 minutes per week of moderate
intensity aerobic activity
Adults with diabetes should be advised to perform at least 150
min/ week of moderate-intensity aerobic physical activity (50–
70% of maximum heart rate), spread over at least 3 days/week
with no more than 2 consecutive days without exercise. A
Both aerobic and resistance exercise are beneficial for patients
with diabetes, and it is optimal to do both types of exercise. At
least 150 minutes per week of aerobic exercise, plus at least two
sessions per week of resistance exercise, is recommended.
Adults and older people: 150 minutes (two and half hours)
each week of moderate- to vigorous-intensity physical
activity. Muscle-strengthening activity should also be
included twice a week.
Exercise

12. Endorphins and exercise
Elevated serum beta-endorphin
concentrations induced by exercise have been
linked to several psychological and physiological
changes, including mood state changes and
'exercise-induced euphoria', altered pain
perception, menstrual disturbances in female
athletes, and the stress responses of numerous
hormones (growth hormone, ACTH, prolactin,
catecholamines and cortisol)

13. Stress
Management

14. Stress in Diabetics
Stress within the Family
Stress in the work
Other stresses
Stress due to Diabetes

15. PS2 Explore the social situation, attitudes, beliefs and
worries related to diabetes and self-care issues. Assess
well-being (including mood and diabetes distress),
periodically, by questioning or validated measures
Psychosocial screening and follow up may include, but are
not limited to, attitudes about the illness, expectations for
medical management and outcomes, affect/ mood,
general and diabetes related quality of life, . E
In both type 1 and 2 diabetes, interventions that target
families’ ability to cope with stress or diabetes-related
conflict should be included in educational interventions
when indicated (Grade B, Level 2)
Stress, whether physical stress or mental stress, has been
proven to instigate changes in blood sugar levels, which
for people with diabetes can be problematic.*
Stress Management

17. Reference
1. Surwit RS, van Tilburg MAL, Zucker N, McCaskill CM, Parekh P, Feinglos MN, Edwards CL,
Williams P, and Lane JD. Stress management improves long-term glycemic control in Type 2
diabetes. Diabetes Care, 2002; 25: 30-34.
Stress Management improves long-term glycemic
control in Type 2 diabetes

18. Foot Care
Education

19. Effectiveness of foot care education among people
with type 2 diabetes in rural Puducherry, India
We found that even 5-6 min of time devoted to
individual patient education improved their foot care
practice. When consistently reinforced, this education is
likely to result in healthy habit formation, which may
prevent disability and reduce medical expenditure in the
long run.
Reference
Suman Saurabh, Sonali Sarkar, Kalaiselvi Selvaraj, Sitanshu Sekhar Kar, S. Ganesh Kumar, andGautam
Roy. Effectiveness of foot care education among people with type 2 diabetes in rural Puducherry,
India. Indian J Endocrinol Metab. 2014 Jan-Feb; 18(1): 106–110.

20. Foot care education in patients with diabetes at
low risk of complications: a consensus statement
The key educational elements for diabetes patients at low risk of
complications are captured with the mnemonic CARE:
Control: control blood glucose levels (in accordance with recommendations
from your healthcare professional).
Annual: attend your annual foot screening examination with your healthcare
professional.
Report: report any changes in your feet immediately to your healthcare
professional.
Engage: engage in a simple daily foot care routine by washing and drying
between your toes, moisturizing and checking for abnormalities.

21. Foot care education in patients with diabetes at low
risk of complications: a consensus statement “cont”
Educational initiatives, based on the CARE framework
above, should be tailored to the individual and take into account
their health beliefs, motivation to change and personal
circumstances. The importance of reinforcing the principles of
the CARE framework on a regular basis cannot be overstated.
Reference
A McInnes, W Jeffcoate, L Vileikyte, F Game, K Lucas, N Higson, L Stuart,§ A Church, J
Scanlan, and J Anders. Foot care education in patients with diabetes at low risk of
complications: a consensus statement. Diabet Med. 2011 Feb; 28(2): 162–167.

22. Smoking
Cessation

23. Effectiveness of smoking cessation
counseling
Smoking cessation is one of the few interventions that
can safely and cost-effectively be recommended for all patients,
and it has been identified as a gold standard against which other
preventive behaviors should be evaluated. A number of large
randomized clinical trials have demonstrated the efficacy and
cost-effectiveness of certain forms of provider and behavioral
counseling in changing smoking behavior of primary care and
hospitalized patients.

27. SMBG

28. Strategies for improving glycemic control:
effective use of glucose monitoring “SMBG”
Self-monitoring of blood glucose (SMBG) is one strategy for
improving glycemic control; however, patient adherence is
suboptimal and proper education and follow-up are crucial.
Patients need to understand:-
 why they are being asked to self-test
 what their glycemic targets are
 what they should do based on the results of self-monitoring
Patients also must be taught proper technique and must
be given specific recommendations regarding frequency and
timing for self-monitoring.

29. Strategies for improving glycemic control:
effective use of glucose monitoring
SMBG should include postprandial monitoring to:-
 identify glycemic excursions after meals
 indicate the need for lifestyle adjustments
 provide patient feedback on dietary choices.
Situations in which SMBG is essential or should be more frequent
include:-
 self-adjustment of insulin doses
 changes in medications
 lack of awareness of hypoglycemia
 gestational diabetes
 Illness
 when hemoglobin A1c (HbA1c) values are above target
Reference
Davidson J. Strategies for improving glycemic control: effective use of glucose monitoring. Am J
Med. 2005 Sep;118(Suppl 9A):27S-32S.

30. Education

31. ED1 Make patient-centered, structured self-management
education an integral part of the care of all people with type 2
diabetes.
ED4 Ensure that education is accessible to all people with diabetes,
taking account of culture, ethnicity, psychosocial, and disability
issues.
People with diabetes should receive diabetes self-management
education (DSME) and diabetes self-management support (DSMS)
when their diabetes is diagnosed and as needed thereafter. B
People with diabetes should be offered timely diabetes education
that is tailored to enhance self-care practices and behaviors
(Grade A, Level 1A).
Managing diabetes can be exceedingly demanding, often requiring
you to make lifestyle changes – stopping smoking, changing your
diet and physical activity levels, taking medication and monitoring
your blood glucose levels.
Education

32. Development of a Therapy
“Drug Mesh”
Effectiveness
Safety
Affordability

33. Exercise
Stress
Management
Foot Care
Education
SMBG
Smoking
Cessation
Diet
Education

34. In Conclusion
All mentioned
“Non-Pharmacological/Non-Interventional”
modalities of Diabetes Care are
Effective, Safe and can be affordable.

35. In Conclusion
It is the right of
every Diabetic
to have
a real comprehensive care
particularly the modalities that are
effective, most safe and can be easily affordable

36. In Conclusion
If we can offer our Diabetics such care
This is excellent
If we don’t have the time or the “Know How”
We have to develop a system to deliver such care
This is their RIGHT
& Our Mission