Diabetes Treatment: Diet and Exercise

Dietary considerations

Carbohydrate

People with type 1 diabetes, because they experience absolute insulin deficiency, must use insulin to control glucose excursions after meals. Since 1994, the American Diabetes Association (ADA) has recommended that, for patients with type 1 diabetes, 60-70% of total calories come from carbohydrate and monounsaturated fat. Although some studies have considered whether a preponderance of calories from unsaturated fat or carbohydrate may be more beneficial, there is no consensus on the relative amount of each.

Recommendations for carbohydrate consumption for people with type 2 diabetes are similar to those for patients with type 1 diabetes. Carbohydrate and monounsaturated fat should comprise 60-70% of total calories. However, there is some concern that increased unsaturated fat consumption may promote weight gain in obese patients with type 2 diabetes and thereby decrease insulin sensitivity.

Protein

Although the majority of clinical focus on the management of diabetes is on carbohydrate metabolism, protein metabolism in the state of diabetes is also abnormal. Patients with type 2 diabetes exhibit a more negative nitrogen balance than individuals without diabetes. Protein degradation appears to be exacerbated by hyperglycemia and improved by controlling glucose levels with insulin therapy.

Patients with type 1 diabetes can and do convert amino acids into glucose depending on the level of insulinization; therefore, protein consumption may cause hyperglycemia.

Studies of patients with type 2 diabetes, however, have demonstrated that protein consumption does not increase plasma glucose concentrations and that endogenous insulin release is, in fact, stimulated by protein consumption.

Dietary Fat

Recommendations regarding fat in the diet of people with diabetes are similar to those for patients with coronary artery disease. This is primarily because studies have shown that the risk of myocardial infarction in diabetic patients is similar to that of nondiabetic patients who have already suffered a myocardial infarction. Because saturated fats are the major dietary determinants of serum LDL cholesterol levels, people with diabetes should strive to keep saturated fat consumption to < 7% of total daily calories and to minimize consumption of trans-fatty acids. Cholesterol consumption should be < 200 mg/day

Exercise

Patients with type 1 or type 2 diabetes have an increased risk of coronary artery disease. The ADA recommends that patients who plan to begin a moderate- to high-intensity exercise program undergo screening for cardiovascular disease if they are > 35 years of age. Patients who are > 25 years of age should also be screened if they have had type 2 diabetes for > 10 years or type 1 diabetes for > 15 years, have an additional risk factor for coronary disease, or have microvascular disease, peripheral vascular disease, or autonomic neuropathy. Decisions regarding screening of patients who plan low levels of physical activity, such as walking, are left to the discretion of the treating physician.