Preventing the Progress of Type 2 diabetes

Preventing the progress of type 2 diabetes involves first, achieving lifestyle changes looking at weight management and physical activity; second (though often simultaneously) starting medications to address the insulin resistance and insulin deficiency; third, regular review and response by your diabetes team through an organised and structured care process will prevent progress.

“Type 2 diabetes is a chronic disease that will progress – if you do nothing to alter its course”.

To better understand this progress, we can think in a linear fashion:

• Progressive metabolic dysfunction of the pancreas and increase in blood glucose level leads to
• Progressive addition of medications and
• Progressive increases in complications and diabetes related events.

Though this cascade is linear the metabolic dysfunction is present at every level of progress. Stopping this metabolic dysfunction – or if unable to do this at least containing it – will stop or slow the progressive addition of medications and prevent or delay complications.

What Changes are Necessary for Preventing the Progress of Type 2 Diabetes?

1. Don’t Smoke

When a smoker with diabetes stops smoking their insulin resistance normalises after 8 weeks. In smokers with newly diagnosed type 2 diabetes it has been found that smoking cessation was associated with an improvement in metabolic parameters.

The longer you stay an ex-smoker the better:

• By 1 year: excess risk of coronary heart disease, heart attack and stroke drops to less than half that of a smoker.
• By 5 years risk of a subarachnoid haemorrhage declines to 59% of risk while still smoking. Studies have shown that the negative effects of smoking start to decline after 5 years of non-smoking.
• By 15 years of non-smoking, risk of a heart attack will be the same as never having smoked. By not smoking you are protecting your kidneys and heart from vascular events.

2. Weight Management

• Lose weight – aim for at least 8-10% weight loss.
• If unable to lose weight – do not gain weight.
• The process you use to achieve this will depend on the guidance and support you can access, your willingness to change, and the physical activity you are able to do.

3. Understanding & Controlling Macro-nutrients

Macronutrients refers to fat, carbohydrate and protein. These have a different effect on blood glucose and all have different energy values per gram. Understanding these will differences will help you to manage your diet and your blood glucose levels.

4. Physical Activity

• A ½ hour brisk walk daily can reduce the incidence of diabetes by 30% and each extra kilometre walked per day on a regular basis reduces this incidence by another 6% per kilometre.
• Exercise and increased activity are helpful for reducing cholesterol levels and increasing HDL. It is important to increase daily activity and have a good regular exercise routine.
• If you have elevated blood pressure, regular exercise can help reduce blood pressure by as much as 30%.
• Exercise independent of weight loss (meaning even if you lose no weight) improves BGL control and lowers HbA1c by 0.6%.

How active do we need to be?

• 3 hrs per week is for health and preventing the progress of chronic disease.
• 3-5 hrs per week is for health, preventing the progress of chronic disease, and weight maintenance when you combine it with controlling your food intake.
• More than 5 hrs per week is for health, preventing the progress of chronic disease, and weight loss when you combine it with controlling your food intake.

5. Adopt an Organised & Structured Care Process

Being organised with your diabetes simply means getting the information you need, transforming this information into knowledge, then using this knowledge to understand what you need to do to take care of yourself. In other words, being better organised will help you self-manage your diabetes.

A structured plan is often seen by people as very restrictive. This can be debated. It has structure and there is always flexibility within that structure. Simply keep in mind that the more flexibility you want in your daily routine, the more work you will probably need to do.

If you wish to have more flexibility in your food choices or the timing of your meals, you will probably have to make more daily decisions and monitor your blood glucose more often. You will need to know how to compensate for the flexibility.

That is the trade-off, and only you can decide if greater flexibility is worth the extra work you need to do.