It is recommended that patients suffering from type 2 diabetes should undertake a moderate aerobic exercise for an average of 150 minutes and resistance exercises 3 times each week. A combination of dietary measures and physical activity has shown to reduce haemoglobin levels by about 60 per cent (Umpierre, Daniel, et al, 2011).
Ample evidence exists backing up the premise that dietary changes can solve the problem of glucose tolerance to diabetes (Tuomilehto, Jaakko, et al, 2001 and Knowler, W.C., et al., 2002). The optimal dietary approach in controlling hyperglycemia in type 2 diabetes is however not known (Cao, Yumei, et al, 2009). The correct proportional combination of carbohydrates, fat and protein that is recommended still remains unclear (Ajala, O., English, P., & Pinkney, J., 2013).
The level of carbohydrate intake is the primary determinant of blood sugar levels. There is, however, scanty evidence on the recommendations of carbohydrate intake in type 2 diabetes. Low carbohydrate diet has shown to provide superior glycaemic control compared to low-fat diets. According to Bantle, John P., et al, (2008) Fibre-rich carbohydrates also score high in the low glycaemic index and are recommended for people with diabetes.
Pete's biochemistry profile:
Blood test Current results Normal ranges
HbA1c 102 mmol/mol (11.5%) 48-53 mmol/mol (6.5-7%)
Cholesterol 7.2 mmol/l 5 mmol/l or LESS
HDL 0.8 mmol/l Triglycerides 3.2 mmol/l Random blood glucose 16.8 mmol/lThis table shows that Mr Pete's blood results are away from the healthy ranges. The reason behind that could be referred to his eating pattern. By looking at his usual dietary intake, many issues can be observed and linked with his abnormal profile. The saturated fat was consumed with each meal whether in the form of whole milk, butter, cheese or red meat. These food items may result in elevating the level of blood cholesterol and LDL. The amount of carbohydrate intake that is high glycaemic index increases the level of glucose and triglycerides in the blood which affects HbA1c. Although HbA1c is affected by dietary intake, physical activity and weight management are also contributed as discussed above.
Diet, mass control and bodily activity stand as the only first line treatment for diabetes patients. However, tablets such as Metformin are also advisable if blood glucose levels still remain high despite lifestyle measures to reduce glucose levels. This tablet works by reducing glucose levels produced by the liver and increase insulin sensitivity which helps in glucose mobility into muscle cells. It also aids in reducing major cardiovascular incidences in patients suffering from type 2 diabetes (Hong, J., et al., 2013).
Simvastatin is among the medications aimed at preventing and reducing stroke and heart attacks. It works by reducing blood cholesterol levels. For it to be effective, a low-fat diet combined with lifestyle changes should be undertaken.
Atenolol, a beta class of drugs, treats high blood pressure by impeding the actions of certain natural body chemicals in the heart and blood vessels. Its effect is to lower blood pressure, the heart rate and too much strain on the heart. Blood flow to the fingers and legs will, however, be hampered. To be effective, the patient should put on warm clothing and stop tobacco smoking.
Nitrates group of drugs dilates blood vessels making blood flow easier. The working mechanisms of Isosorbide and Atenolol could, however, lead to hypertension. Isosorbide mononitrate does not, however, treat angina attacks that have already begun though they can help in preventing these attacks.
The overall aims of treatment in type 2 diabetes are to relieve acute symptoms, reduce the risk of micro and macrovascular complications and to improve the quality of life. These aims can be achieved by different ways depending on the patient's condition. For this patient, and according to his blood results, dietary pattern and lifestyle, some goals should be achieved within a short period (short term). These goals include maintaining blood glucose and blood lipids near-normal levels and encouraging moderate physical activities. The long term goals are to achieve weight goals and avoid diabetes-related complications such as cardiovascular diseases, nephropathy and neuropathy complications.
To achieve these goals, dietary measures and lifestyle changes need to be considered. Excessive fat intake and obese conditions lead to metabolic complications (Tierney, Audrey C., et al., 2011). Strong evidence exists that suggest that replacement of saturated fats with unsaturated ones reduces CVD risks and these are the recommendations across Europe and US (Dyson, P. A., et al., 2011.
Conflicting results from various studies have been delivered, showing negative and positive correlations between carbohydrates intake with a propensity to diabetes. Fibre, wholegrain seeds, glycemic index and simple sugars in beverages are the important elements when considering qualitative features in dietary carbohydrates. High dietary fibre boosts glycaemic control and lowers lipid concentration in plasma in type 2 patients. Green leaf vegetables, peas, beans among a range of other foods are high in fibre content.
Type 2 patients are also encouraged to increase fruit and vegetable intake. Though studies do not place a direct link between fruit and vegetable intake with reduced diabetes incidences, diabetes is a high-risk factor for cardiovascular diseases and high fruit and vegetable intake reduces cancer and cardiovascular incidences. Fruits and vegetables, on their part in fighting diabetes, are rich in fibre and low in calories which help in the glycaemic control and helps in weight control (Lopez-Miranda, Jose, et al., 2010).
Regarding salt intake, it is important to minimize the intake by 6g or lower as it is responsible for hypertension. Although his wife tends to do most cooking at home, they should restrict adding salt during cooking and taking it away from the table as well. Drinking alcohol, on the other hand, should be reduced to moderate amount (3-4 unit per day). According to Diabetes UK, drinking alcohol makes hypoglycaemia more likely to occur, especially if diabetes is cured with insulin or certain Type 2 diabetes treatments. Furthermore, alcohol can raise blood pressure and since it contains calories which could contribute to weight gain.
Lifestyle changes are as important as diet for diabetes management. Therefore, physical activity, smoking behaviour and healthy food choices should be considered. Family members education could be a helpful way to improve the patient's nutritional status. Providing them with information about the importance of fruits and vegetable intake and the side effect of fat and salt intake in terms of what those foods may cause.
For inducing physical activity,it is recommended to start with low level and lower time of exercise and increase it up gradually to reach the recommended level of 150 min per week, Asking patient to go to work by walking instead of a car or public transport and also social group exercise might be a motivating factor that would improve his activity performance.
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