Take 5: Diabetes
Our diabetes expert answers five questions about lifestyle and blood sugar control.
3. How do stress and sleep affect diabetes management?
There's emerging evidence that people who are chronically sleep-deprived tend to eat more and gain weight, so sleep can be important for diabetes management. There is definitely a biological connection between stress and managing diabetes, too. [The levels of] stress hormones like cortisol and epinephrine go up when people are stressed, and we know those hormones tend to elevate blood sugar.
It's also difficult for people to focus on managing their diabetes when they're distracted by work problems, family issues, or other kinds of stress.
Many doctors' offices and hospitals have diabetes education programs that will help people develop skills for managing diabetes. Try stress reduction techniques, and don't forget that exercise is wonderful for helping to manage diabetes and can relieve stress, too.
4. Why do I need to exercise?
There's evidence that exercise can have profound effects on blood sugar control -- even if you don't lose weight. When you exercise, insulin's ability to help bring glucose into the cells improves. Aerobic exercise, like running on a treadmill, bicycling, or jogging as well as weight or resistance training can help control blood sugar. Some studies indicate that weight training may be even more effective than aerobic exercise, which is a bit surprising.
It's interesting to note that exercise is effective at improving insulin sensitivity even in older people -- those in their 60s, 70s, and 80s who get into a regular exercise program.
The key is to exercise on a regular basis: 30 minutes a day, at least five days a week. That recommendation comes from the Diabetes Prevention Program study, which was designed to see if we could prevent diabetes in people who are at high risk. The lifestyle intervention included a low-fat, reduced-calorie diet and 30 minutes a day of moderate-intensity physical activity -- mostly people did brisk walking. The intervention was very effective at reducing the rate of diabetes -- by 58% -- in people who were at high risk.
Check with your doctor before beginning an exercise program to find out which exercise is best for you, and whether you need to make changes to your medication.
5. Are there any promising treatments ahead for type 2 diabetes?
The most promising treatment is something that's gotten some play in the news recently, and that's bariatric or weight-loss surgery. It obviously can lead to dramatic weight loss, [and] in most cases reverses diabetes completely, which is an amazing thing. Even before people have lost any significant amount of weight, blood sugar levels often dramatically improve. It probably has to do with alteration of hormones that are secreted within the intestine, and factors that regulate appetite and energy expenditure.
Not everybody who is overweight or obese would want to have weight-loss surgery or would be appropriate for it. But what we're learning about how these procedures can radically change how the body handles calories and regulates appetite may lead to new insights that will result in other treatments.