Walking Makes a Difference in Controlling Type 2 Diabetes

How much walking is needed to produce the best effects for controlling Type 2 diabetes?

Walking or doing other aerobic exercise for 38 minutes - about 2.2 miles or 4400 steps - showed a significant effect for those with diabetes, even if they didn't lose weight. They improved their hemoglobin A1C by 0.4%, reduced their risk of heart disease, and improved their cholesterol and triglyceride levels. They saved $288 a year in health care costs.

The number of walkers with diabetes who needed insulin therapy dropped by 25%, and those on insuling therapy reduced their dosage by an average 11 units per day. They had great improvement in hemoglobin A1C levels of 1.1%, improved cholesterol, triglycerides, blood pressure, and reduced risk of heart disease. They reduced their medical costs by over $1200 per year. Those who didn't walk saw their health care costs go up by over $500 in the two-year study period. Their insulin use went up, as did cholesterol, triglycerides, and blood pressure. There is a huge cost in failing to walk and exercise, especially for those with diabetes.

Exercise and walking have also been shown to reduce the risks of developing Type II diabetes. Whether you have diabetes or not, it is never too soon or too late to begin a walking or exercise program.

Anals of Internal Medicine, July 2006

Diabetes Regular Check Up

How often do you need to visit your health care team & why ?

Periodic testing will help you detect any early signs of complications so you can prevent or delay the progress of problems such as the development of kidney disease, eye disease, cardiovascular disease or wounds in your feet.

Blood pressure
Your doctor must check your blood pressure in every visit. Normal blood pressure is 120/80 mmHg. If you have diabetes you should have below 130/80 mmHg. If you have been diagnosed with hypertension or high blood pressure then work with your doctor to achieve that goal and you will decrease your risk of cardiovascular disease.

Glycosylated hemoglobin test (HbA1C)
This test shows you how well you have controlled your blood glucose levels during the preceding 3 months. You must have it every three months. The goal is to have an A1C level below 7%.

Blood lipids (fats)
Cholesterol and triglycerides are some of the fats in the blood. Cholesterol is a fatty substance that needs vehicles to be transported through our blood. This vehicles are called "lipoproteins", molecules comprised of protein and fat where cholesterol can be transported.

The so-called "bad cholesterol" (Low Density Lipoproteins or LDL) are the vehicles that go from the liver to our tissues filling them with cholesterol and contributing to build cholesterol plaque. The "good cholesterol" (High Density Lipoproteins or HDL) particles are the ones transporting cholesterol from our arteries and tissues to the liver, where it should be used to produce hormones and other compounds.

When you get a lipid profile at the lab, you get the number of total cholesterol, and also the number of good ones and bad ones, the important point here is to have more good ones and less of the bad ones.

The recommended values of cholesterol are:

Study Links Smoking to Diabetes Risk

• Smoking -- long known to increase the risk of cardiovascular disease -- is also associated with an increased risk of developing Type 2 diabetes, researchers have found.

• Smokers are more than twice as likely to develop the condition than non-smokers. "These findings suggest another poor health outcome associated with cigarettes, supporting (the) surgeon general's warnings against cigarette smoking,".

• The researchers examined the relationship between diabetes and smoking among 906 of the participants in the Insulin Resistance Atherosclerosis Trial. The 906 subjects were free of Type 2 diabetes at the beginning of the study, but after five years of follow-up, 25% of the smokers had developed the disease, compared with only 14% of those who had never smoked. (The odds ratio in a multivariate analysis was 2.66; p=0.001.)

• Smoking is known to be a risk factor for cardiovascular disease, but the link with diabetes has been less clear. On the other hand, diabetes and cardiovascular disease share many risk factors, including older age, upper body fat distribution, and physical inactivity. Some studies have found the smoking increases the risk of diabetes, but others have not.

• But the current study has several advantages:

1. It included direct assessments of glucose tolerance, body mass index, cholesterol, and hypertension, where earlier studies tended to use self-reporting.

2. It examined demographic and behavioral factors.

3. And it had roughly equal numbers of men and women and roughly equal numbers of African-Americans, Hispanics and whites recruited from Los Angeles and Oakland in California, San Antonio, Texas, and the San Luis Valley area of Colorado.

• In the study, subjects were divided into three groups -- those who had never smoked, those who had smoked but quit, and those who were currently smoking.

• The risk appears to be "modifiable", since they found that those who had quit smoking "did not have a significantly increased risk of diabetes compared with never smokers."

• Because of that apparent modifiability -- and because 37 of the 128 subjects who smoked at the beginning of the study had quit by the end --sothat the risk they found may actually be understated.

• The study also looked at the dose relationship, and found that those who smoked the most were most likely to develop Type 2 diabetes, even if their glucose tolerance was normal at baseline. The odds ratio for those at the highest level -- more than 20 "pack-years" -- compared to those who didn't smoke was 5.66; the result was statistically significant at the p=0.001 confidence level.

• (Assuming 20 cigarettes per pack, a "pack-year" was defined as the number of cigarettes smoked a day divided by 20 and multiplied by the number of years smoked.)

• The study suggests that smoking "along with its other numerous threats to public health," may be exposing people to an increased risk of diabetes. The link, they say, "is biologically plausible … and gives further credence to current recommendations against the adoption and maintenance of smoking."

Reference:

Foy CG et al. Smoking And Incidence Of Diabetes Among United States Adults: Findings From The Insulin Resistance Atherosclerosis Study. Diabetes Care 2005. 28(10); 2501-07

Diabetes and Sexual life.

• Having diabetes can affect every aspect of your life, including your sex life. While discussing such matters can be embarrassing for some people, sex is a natural part of life, and your health care professional can offer information that can help you keep your sexual life satisfying.

Sexual Activity and Diabetes

• People who use insulin need to consider and plan for the effects of sexual activity on their overall condition, especially the possibility of a low blood sugar after sex. Here are some measures that can help prevent such a reaction.

1. Test your blood sugar before having sex. As annoying as this may seem, it is preferable to having to manage severe low blood glucose afterward.
2. Eat just before or right after active sex, just as you do with exercise.
3. Consider having a snack before going to sleep.
4. People who use an insulin pump may want to unhook it during lovemaking to help avoid a low blood sugar reaction. The length of time the pump can be kept off without an injection will depend on your activity level while off the pump.

General Sexual Issues

• Keep in mind that many people, both men and women, experience sexual problems at some time, whether they have diabetes or not. Although people are often reluctant to discuss such matters with medical professionals, you can be assured that your doctor is used to hearing people=s sexual concerns. Best of all, once your concerns are out in the open, your doctor will very often be able to offer advice or treatment to resolve them.
• Many problems related to sexual performance are caused by physical problems, some may be related to the medications used to treat those problems, and sometimes sexual problems have psychological roots. It is important to share any concerns you have about sexual matters with your doctor or another member of your health care team so the cause can be determined and addressed.

Special Concerns of Women

• In women, diabetes control is often affected by the MENSTRUAL CYCLE, BIRTH CONTROL choices must take diabetes into account, and there are special considerations related to PREGNANCY and MENOPAUSE.
• When blood glucose levels remain high over long periods, nerves or blood flow to sexual organs can be damaged, which can interfere with sexual function. Your health care provider can suggest techniques to overcome these problems.
• Some women with diabetes suffer from poor bladder control, or neurogenic bladder. To prevent problems from occurring with this condition, women should be sure to empty their bladder both before and after intercourse. (This will also help prevent bladder infection.)

Special Concerns of Men

• The major sexual concern of men with diabetes is erectile dysfunction, or handling the anxiety related to this possibility.
• Erectile dysfunction is often the subject of jokes, but as men age (and for many men with diabetes), it is no laughing matter. It is primarily a problem of men in their fifties or older, and men with diabetes are at higher risk. In fact, 50 to 60 percent of men over the age of 50 who have diabetes have some degree of erectile dysfunction. ( refers to the frequent, not occasional, inability to become or stay erect.)
• Erectile dysfunction can have both psychological and physiological causes. Erectile dysfunction with a psychological basis often begins suddenly, whilethat with a physical cause usually comes on slowly, beginning with a less rigid penis and fewer erections, and worsens over time, until the man is unable to sustain an erection. In men with diabetes, it is most often caused by nerve- or blood vessel-related problems of the disease. For example, if blood vessel damage prevents blood flow to the penis, it can no longer become erect, or if the nerves that signal the penis become damaged, the result can be failure to become erect.
• The best way for a man with diabetes to avoid physiological erectile dysfunction is to maintain good blood glucose control, as well as avoid smoking, decrease alcohol intake and keep blood pressure normal. But when erectile dysfunction becomes a concern, a frank discussion with your doctor can get to the root of the problem.
• Determining the cause of erectile dysfunction, which must be done before appropriate treatment can be recommended, may involve a number of different tests. As part of an evaluation, it is also important to inform your doctor about any medications you are taking, including items you buy without a prescription, because some drugs taken for common ailments can contribute to erectile dysfunction. If medication may be causing erectile dysfunction, your doctor may be able to change or adjust it. However, you should never stop taking any prescribed medication without consulting with your doctor. Smoking and drinking alcohol can also contribute to impotence.
• Today, doctors can offer a variety of treatments for physiological impotence, so going through the diagnostic procedures is well worth the effort. Common treatments include injecting a drug directly into the penis to produce an erection lasting 30 to 60 minutes; using a vacuum pump to produce an erection; and implanting a device (penile prosthesis) in the penis to produce erections. Your doctor will discuss the benefits and risks of each of these treatments to help you make a decision about which, if any, of these options is best for you.
• If the impotence is believed to have a psychological basis, your physician can refer you to a therapist who specializes in dealing with sexual issues.
• Sex life is part of healthy life so donot histate to tell your doctor about your concern.

How to Prevent or Delay Diabetes

• Pre-diabetes is a serious medical condition that can be treated.
• The good news is that the recently completed Diabetes Prevention Program study conclusively showed that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity.
• They may even be able to return their blood glucose levels to the normal range.
• While the DPP also showed that some medications may delay the development of diabetes, diet and exercise worked better. Just 30 minutes a day of moderate physical activity, coupled with a 5-10% reduction in body weight, produced a 58% reduction in diabetes.
• The American Diabetes Association is developing materials that will help people understand their risks for pre-diabetes and what they can do to halt the progression to diabetes and even to, "turn back the clock." In the meantime, ADA has a wealth of resources for people with diabetes or at risk for diabetes that can be of use to people interested in pre-diabetes.

Nutrition

ADA's guide to the basics of eating healthy

ADA's statement for health care professionals on nutrition

Exercise

Tips on how to include a healthy amount of physical activity into your daily routine:

Exercise and Diabetes

ADA's statement for health care professionals on exercise

Reference: www.diabetes.org/diabetes-prevention