Intensive and sustained advice on appropriate lifestyle, particularly in the areas of dietary change, aerobic exercise and smoking is crucial. General measures to achieve a healthy lifestyle should be reinforced to patients at each visit. Individual targets shoulde be set with patients and progress assessed at regular intervals.
Concordance with lifestyle advice is more likely if the whole family, rather than just the individual patient, is encouraged to make behavioural changes.
- Provide with weight reduction diet if BMI > 25
- Advise on low fat / high fibre diet, especially if dyslipidaemia present
- Advise regarding a 'no added salt' policy, if hypertension present
- Encourage Regular Excercise
- Encourage to stop smoking
Dietary Advice
- Limit Alcohol consumption; Female - 14 units, Male - 21 units per week, or fewer if weight reduction needed. Discourage consumption of 'diet beers' especially in patients on insulin, as these are high in alcohol content, or low alcohol beer as this is high in sugar content.
- See Tayside Diabetes MCN Handbook Section on Dietary Advice
- See patient information leaflet on Healthy Eating
Exercise
- All patients should be encouraged to be more physically active, as this improves general levels of fitness and glycaemic control. It may aid weight loss and improve lipid and blood pressure control.
- See National Physical Activity Pathway for recommended levels and raising the issue
- Exercise advice should be realistic and include information on local facilities, e.g. swimming, health clubs, exercise prescription programmes and should also include the cost of such activities.
- For those unaccustomed to exercise or those with significant diabetic complications, medical advice should be obtained.
- Online resources are available to support healthcare professionals in raising the issue: Raising the Issue eLearning module, Motivate 2 Move for GPs
- For further information see:
Patient information leaflet on Diabetes and Exercise
Dundee Active for Life Programme
University of Dundee Exercise and Diabetes Programme
Perth & Kinross Live Active Activity Referral Programme
Angus Exercise Referral Programme
Patient information section of website on local activities
Smoking Cessation
- Encourage to stop smoking. Smoking has been shown to be an even more significant risk factor for cardiovascular disease in those with diabetes than in the non diabetic population. Therefore the dangers of smoking and diabetes cannot be stressed too often
Guidelines from the Health Education Authority (HEA) recommend that:
- GPs continue to opportunistically advise smokers to stop smoking at least once a year, give advice on and / or prescribe effective medicines (NRT or bupropion) and refer patients to specialist cessation services where extra support is considered necessary. They should also record the response to that advice and arrange follow up uwhere appropriate.
- Primary health care teams and hospitals should create and maintain accessible records and the current smoking status of patients
- Practice nurses should be prepared to encourage known smokers to stop and offer help where possible
- GPs and practice nurses should receive training to enable them to encourage patients to give up smoking and should be able to provide accurate advice on NRT and bupropion.
- Other Healthcare professionals should be encouraged to ask patients about smoking and advise smokers to quit
For further information:
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