Lifestyle Factors
Physical Activity and Diabetes
All people with diabetes should be asked about physical activity and most should be encouraged to increase activity; suitable educational material is available on the Diabetes UK website www.diabetes.org.uk. See also physical activity section of SIGN 115, Management of Obesity
Improving Health
- All people should be advised to maintain at least moderate levels of activity, e.g. walking.
- A gradual introduction with a low intensity of physical activity should be recommended for sedentary people with diabetes.
- Exercise and physical activity should be undertaken regularly i.e. preferably daily or alternate days. Once a week is of limited benefit.
- Initially encourage an accumulation of 30 minutes moderate activity on most days of the week
- The next stage is to encourage those who are motivated to engage in more vigorous activity at least three days per week.
- Exercise programmes are more likely to be successful if tailored to the individual, and accompanied by on-going support.
- People with complications should seek medical advice before embarking on exercise programmes.
- In people with limited mobility, advice on exercise whilst seated may be appropriate.
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- Above all encourage the individual to choose an activity which they will enjoy.
Coping with Physical Activity
- For people treated with insulin it is advisable to monitor blood glucose before and after exercise.
- Blood glucose levels may fall up to 36 hours after exercise, increasing the risk of hypos overnight or even the next day.
- Additional carbohydrate may be required – quantity, timing, and type of carbohydrate will vary depending on the activity and duration.
- A reduction in insulin dose may also be required depending on the activity and the duration
- For people on oral hypoglycaemic agents, it is usually unnecessary to reduce these although people who are tightly controlled on a sulphonylurea may experience hypoglycaemia during prolonged exercise eg golf.
- People taking part in high intensity sporting activities may require specialist advice. This group of individuals may find the following website useful;
Runsweet.com - Diabetes and Sport
Diabetes and Employment
There are some jobs that are not possible for people who take insulin for their diabetes. It is important for anyone going onto insulin whether Type 1 or Type 2 that these issues are addressed.
People on insulin are not permitted to;
- Join the Armed Forces;
- Hold a PSV licence;
- Hold an HGV licence;
- Join the Merchant Navy in the UK (may be possible for other countries e.g. Libya)
May be restricted in
- Joining the Police force, (although they may be allowed to stay in if insulin becomes necessary after they have joined with certain restrictions on working practices).
- Holding a pilots licence
- Working Off shore.
For other employment it may be possible to continue but with extra considerations around health and safety issues.
- Factory workers particularly if working shifts and or with heavy machinery.
- Other shift workers
- Working at high levels e.g. builders or crane drivers.
- Paramedics; issues here will also include C1 licences -see DVLA website
See also the Patient Information Leaflet
Smoking and Diabetes
Everyone should be aware of all the adverse effects of smoking. Individuals who have diabetes should have education, encouragement and support frequently and unequivocally. For these individuals consider:
- General risks
- Added risks of smoking + diabetes
- Encouragement and support to stop smoking
- Follow-up support if stopped.
General risks are very well documented. Smoking is one of the major avoidable causes of ill health and death. It is an independent risk factor for:
- Cardiovascular disease
- Peripheral vascular disease
- Chronic obstructive pulmonary disease
- Lung cancer
- Other cancers
- Development of Type 2 diabetes
Added risks with diabetes are, perhaps, not as well appreciated by the individual or healthcare professionals:
- Increased risk of cardiovascular disease
- Increased risk of peripheral vascular disease
- Exacerbates neuropathy
- Twice as likely to have micro- and macro-albuminuria, markers for renal failure
- Twice as likely to become impotent as non smokers
- May act as an appetite suppressant
- Deficient in Vitamins B1, B6, B12, and Vitamin C
- Impedes wound healing by
- Causing vaso-constriction
- Interfering with erythrocyte proliferation therefore reducing available oxygen
- Nicotine affects macrophage activity so reducing epithelialisation and wound contraction
- Impedes collagen synthesis.
- Is associated with poorer glycaemic control
Smoking Cessation
There is increased evidence of effectiveness for brief advice and referral for smoking cessation.
All healthcare professionals should be trained in brief advice.
Healthcare professionals should have ready access to information on the current status of their patients and should ensure that smokers have been advised to stop at appropriate opportunities and have been offered treatment to help them to do so.
All smokers making an attempt to stop should have ready access to, and be strongly encouraged to use, dedicated smoking cessation services involving structured behavioural support and pharmacological therapy.
Nicotine Replacement Therapy (NRT)
The benefits of stopping smoking clearly outweigh any risks there may be with NRT. No special precautions for its use in people with diabetes are required in practice.
Bupropion (Zyban)
May produce seizure and is therefore contraindicated in those at risk of severe hypoglycaemia
Varenicline (Champix)
Varenicline is accepted for use in NHS Scotland by the SMC for smoking cessation in adults. It should be used only as a component of a smoking cessation support programme. There is no evidence to suggest that its use should be precluded in people with diabetes.
See Highland Joint Formulary Section 4.10 and Prescribing Guideline for more detail
Support
NHS Highland Smoking Cessation Service have advisers active in all localities see the following links
If you accessing the website from within the NHS Highland network click here for further details
If you are accessing this website from outside of the NHS Highland network click here
Smokeline 0800 84 84 84
Pregnancy and Smoking 0800 169 9169
More information:
Social Issues and Vulnerable Groups
- There should be equitable access to information and multidisciplinary programmes of education
- These should be tailored to individual needs and specific client groups.
Languages other than English
- All materials should be available in a form and language that is understood
- Educational material in several languages is available from Diabetes UK
- The HCP should familiarise themselves with any relevant cultural issues
People with Incapacity
- It may be necessary to educate carers in diabetes management
- Carers should have access to appropriate educational materials and support
- Staff in care homes have a responsibility to acquire the necessary skills and knowledge to deliver an appropriate level of care
Homeless people
- Information on local health services and relevant support agencies should be provided.
- Some GP practices provide special services for homeless people – contact local CHP for more details
People in prison
- These people should have the same level of care as those in the community
