Lifestyle changes for type 2 diabetes

Over four million people in the UK live with diabetes. Type 2 diabetes refers to a chronic (long-term) condition where the levels of sugar (glucose) in your blood become too high. This happens because your body’s pancreas doesn’t produce enough of the hormone insulin and/or your body’s cells don’t respond to insulin as they should (insulin resistance).

Type 2 diabetes can be managed and, in some cases, even reversed with lifestyle changes. Likewise, prediabetes can also be reversed and stopped from developing into diabetes with lifestyle changes. Here, we’ll explore those lifestyle changes, including diet, exercise, sustainable weight loss and stress management.

What is prediabetes?

Prediabetes refers to elevated blood sugar levels due to an inability of cells in your pancreas to make enough insulin or a reduced ability of cells in your body to respond to insulin. 

However, the abnormally high levels of blood sugar in prediabetes don’t meet the threshold for a diagnosis of diabetes. Nonetheless, prediabetes will in most cases develop into diabetes without significant lifestyle changes — it is, therefore, an important warning sign that you are at high risk of developing diabetes and need to act as early as possible. 

Dietary changes for type 2 diabetes 

One of the main contributing factors for prediabetes and type 2 diabetes is excessive weight. If you are overweight or obese, your risk of developing diabetes is higher. 

Conversely, following a diet that helps you maintain a healthy weight and lose any excess weight will help you better manage your diabetes and, in some cases, reverse it. 

The Mediterranean diet is often recommended if you have diabetes. This involves following a diet rich in whole grains, lean protein (eg white-fleshed fish and skinless chicken or turkey), nuts, seeds, pulses and fresh vegetables that are high in fibre (eg artichokes, beetroot, broccoli, carrots and greens). 

A high-fibre diet will slow the absorption of sugars into your bloodstream and, therefore, help you avoid sudden spikes in blood sugar levels. Consequently, fruit juices should be avoided as they are high in sugar and lack the fibre present in whole fruits, which leads to sudden, large spikes in blood sugar levels. 

While eating fresh fruit is part of a healthy, balanced diet, if you have diabetes, you need to be careful to avoid fruits that are high in sugar. Instead, try eating fruits such as avocados, grapefruits, oranges, lemons, limes, strawberries, blueberries and blackberries, which are lower in sugar. 

You should also avoid highly processed foods as these often contain large amounts of sugar, salt and fat, which make losing excess weight more difficult. Similarly, avoid sugary drinks, such as fizzy soda and cola. 

Smoking and alcohol

Smoking increases your risk of developing diabetes and also increases your risk of diabetes-related complications. If you have prediabetes or already have diabetes, it is important to quit smoking as soon as possible. Your GP can provide you with information on your local stop smoking service (LSSS) provided by the NHS. 

Alcohol is also linked to an increased risk of developing diabetes and is often high in empty calories ie provides a large amount of calories without providing nutrition. Drinking too much alcohol can, therefore, cause you to gain excess weight, which makes managing your diabetes harder. 

Limit your alcohol intake as much as possible and stay within NHS guidelines ie no more than 14 units per week spread across at least three days. 

Exercise

Regular exercise can help manage your diabetes by helping you maintain a healthy weight and improving the sensitivity of your body’s cells to insulin. NHS guidelines recommend at least 150 minutes of moderate to vigorous exercise spread across the week eg 30 minutes of exercise every day. 

Moderate to vigorous exercise refers to exercise that significantly raises your heart rate and breathing — a sign that you are exercising at the right level is that you can talk while exercising but can’t sing. 

However, if you have a heart condition, it is important to speak to your doctor or specialist nurse before starting any new exercise regime, especially if you aren’t used to taking part in moderate or vigorous exercise. 

To build the habit of exercising regularly, start gradually. If you don’t think you can manage 30 minutes of exercise five times a week, start with three minutes of exercise five times a week for the first week, then five minutes, 10 minutes, and so on. After six to 12 months, you will soon find that you are exercising 150 minutes every week. 

In addition to cardiovascular exercise that raises your heart rate, you can also incorporate yoga to help manage your stress levels and improve your sleep; better sleep can improve the sensitivity of your body’s cells to insulin. 

Also, 10–15 minutes of strength training every week can help you maintain muscle mass, which decreases with age. Increased muscle mass is known to increase how much sugar is absorbed from your blood and improve the sensitivity of your body’s cells to insulin. 

Weight management

Following a healthy, balanced diet and regular exercise will both help you reach and maintain a healthy weight. By calculating your body mass index (BMI), you can determine whether your weight is broadly healthy for your height. Your gender and ethnicity are factored into what BMI range is considered healthy for your body when using the NHS BMI calculator. 

If you have prediabetes, an even more helpful measure of whether your weight loss efforts are reducing your risk of developing diabetes is your waist circumference. 

For women, the waist circumference should be less than 80 cm and for men it should be less than 94 cm; however, if you are a man of South Asian descent, it should be less than 90 cm. If you’re losing weight but not around your abdomen, it is likely that your body’s insulin resistance (ie inability to respond properly to insulin) is not improving. 

Weight management programmes for diabetes

If you have been identified as at high risk of developing diabetes, your GP can refer you to the NHS National Diabetes Prevention Programme for a nine-month lifestyle change programme. This includes a variety of interventions including a three-month dietary intervention to reduce your weight and waist circumference by following an ultra-low-calorie diet. 

If you already have type 2 diabetes and have had it for fewer than six years, your GP can refer you to the NHS Type 2 Diabetes Path to Remission programme. This programme also includes a three-month ultra-low calorie diet to reduce your weight and waist circumference, with the ultimate goal of reversing your diabetes. 

It is important that when you start on a weight loss programme you set realistic targets for yourself. A reasonable target is to lose 5–7% of your body weight over the first six months. Even modest weight loss can reduce your risk of diabetes by up to 60% and significantly increase your chances of reversing pre-existing diabetes. 

Stress management

When you’re stressed, your body reduces your insulin levels to make more sugar available in your blood. While this may be helpful if you are dealing with an immediate threat or emergency, it is damaging to your body when you are dealing with persistent stress levels. 

Stress also leads to poor sleep, which makes your body’s cells less sensitive to insulin, as well as food cravings that lead to poor food choices, excess weight gain and ultimately an increased risk of cardiovascular problems. 

It is, therefore, important to manage your stress levels to help better control your diabetes and improve your quality of life. As mentioned earlier, regular exercise, including yoga to relax your mind, can help reduce your stress levels.  

Other techniques to manage stress include mindfulness, deep breathing techniques, meditation and a healthy bedtime routine to ensure you get seven to nine hours of good quality sleep every night. 

You can also speak to your GP about cognitive behavioural therapy to manage your stress levels, as well as anxiety. 

What if lifestyle changes alone aren’t effective?

If you have already made significant lifestyle changes but are still at high risk of diabetes, your GP may prescribe the drug metformin. Metformin won’t necessarily help you lose weight but will improve the sensitivity of your body’s cells to insulin. 

If you have type 2 diabetes and lifestyle changes aren’t enough to help you meet your weight loss targets and stabilise your blood sugar levels, your GP may refer you to the NHS Type 2 Diabetes Path to Remission programme. They may also prescribe metformin alone or alongside other drugs that can help lower your blood sugar levels. 

If these drugs are not effective and you meet appropriate criteria, your GP may prescribe a weight loss injectable or ultimately insulin.