Information
Editors
MerjaK.Laine
HanneleYki-Järvinen
Lifestyle Education in Type 2 Diabetes
1. Assess the patient's situation
- Requires a separate visit by the patient to the nurse, doctor or a group; reserve an adequate amount of time.
- Patient history, clinical examination and laboratory investigations
- Other illnesses, gestational diabetes
- Current medication
- Earlier operations
- Cardiovascular diseases in the close relatives
- General health, weight, height, blood pressure, heart rate, observations concerning possible associated diseases
- Review of examinations
- What are the particular problems: hypertension, hyperglycaemia, dyslipidaemia, obesity/sleep?
- The patient's motivation and functional capacity
- Lifestyle assessment
- Eating habits. Ask the patient for each meal what and how much he/she usually eats and drinks and at what time, does he/she snack between meals and what does he/she drink when thirsty.
- Consumption of ”fast sugars” (sugar-sweetened beverages, energy drinks, sweets, sweet desserts), fructose (particularly harmful for persons with diabetes or overweight) and foods high in saturated fat (butter, butter-containing spreads, sausages, other fatty meat products, fatty cheeses, pastries, fatty yoghurts and other sour-milk products).
- Salt intake. Does the patient add salt at the table, or consume foods high in salt - salted fish, crisps, sausages, pickles? Use of salt, stock products and ready-made spice mixes in cooking? Salt contents of bread?
- Habits concerning physical exercise and its strenuousness. How many times a week does the patient exercise so that he/she becomes short of breath and sweats? How long is an exercise session? Physical exercise at work, exercise during going to and returning from work, exercise during free-time?
- Sleep. At what time does the patient go to bed and when does he/she wake up? Does he/she feel well-rested when waking up? Are there any nocturnal apnoeas? Any snoring? Daytime tiredness and/or lapses into sleep? Sleep Apnoea in the Adult
- Use of tobacco products Smoking Cessation
- Alcohol consumption
- Weight reduction is aimed at in an overweight or obese patient, and through it remission may be achieved or it may even be curative Intensive Weight Management for Remission of Type 2 Diabetes (see Conservative (Non-Surgical) Treatment of Obesity)
- The goals should be the patient's own and they should be important for him/her, rather small than big and, preferably, concrete and observable, related to behaviour.
- Examples of concrete goals that have been agreed on jointly with the patient. They should be recorded in the patient record, given to the patient in writing, and their realization should be monitored (over the phone or during visits).
- Stop using soft drinks with sugar and energy drinks.
- Consider very carefully use of sweets.
- Change dairy products (milk, yoghurt, sour milk, curd milk) to fat-free versions.
- Halve the use of cheese and sausages.
- Use oil in cooking and soft margarine as spread on bread (60-70 % fat).
- Walking or some other pleasing form of heart rate increasing exercise 4-5 times a week, additionally muscle strength exercises.
- In a normal-weight patient, the aim is to improve the quality of the diet and/or increase physical activity Dietary Advice and Exercise for Type 2 Diabetes Mellitus. Essential lifestyle modifications are the same as in overweight or obese patients except the reduction of total calorie intake.
- Stopping consumption of tobacco products is always useful; see Smoking Cessation.
- Sufficient and good-quality sleep is aimed at primarily through non-pharmacological treatment Insomnia; rule out and treat sleep apnoea, as necessary Sleep Apnoea in the Adult.
3. Offer guidance to achieve personal targets
- Tips for implementing a recommended diet Dietary Advice and Exercise for Type 2 Diabetes Mellitus, Dietary Advice for the Prevention of Type 2 Diabetes Mellitus in Adults
- Advice the patient to choose varying and colourful food.
- Plenty of whole grain products, vegetables, berries and fruit (2-3 handfuls daily)
- Avoidance of energy-dense nutritional substances (e.g. sweets, sugar-sweetened soft drinks, energy drinks, hamburgers, pizzas, fatty [over 17%] cheeses and sausages)
- Avoidance of sugar and fructose
- Low-fat or fat-free dairy products
- Fish to be used frequently (a couple of times a week); lean meat
- Fat to be used sparingly: vegetable margarine or fat mixture on bread, oil for cooking, ½-1 tablespoons of oil-based dressing or vegetable oil for salads
- Appropriate meal size in proportion to the patient's weight
- Weight changes indicate whether meal sizes are correct.
- Estimate the energy need.
- Provide a sample meal or a picture of a recommended meal.
- Meals are to be enjoyed without hurrying.
- Unhurried eating pace helps in recognizing the feeling of fullness.
- Fixed meal times in order to support weight control
- Hunger will easily lead to extra snacks or to a larger meal than had been planned, or to uncontrolled eating, during the next meal.
- Most patients are comfortable eating a light breakfast, a lunch, a light afternoon snack, a dinner and a small evening snack.
- Increasing physical activityExercise and Diet for Preventing Type 2 Diabetes Mellitus, Exercise for Type 2 Diabetes Mellitus, Dietary Advice and Exercise for Type 2 Diabetes Mellitus
- Consider how the patient's activity level can be increased during normal daily activities. This will increase energy consumption and facilitates weight reduction and weight management as much as planned exercise. All forms of exercise that the patient likes and that are feasible for him/her are suitable.
- Several shorter periods of exercise give almost the same benefit as one longer period. The patient may be motivated to keep on exercising regularly, for example by keeping an exercise diary.