There are a number of lifestyle changes which patients are encouraged to make to control blood glucose (DESA)
These are combined with medications to reduce the risk of macrovascular/microvascular complications (LAP)
Lifestyle Changes
- Diet
- Specialised diet therapy from a dietician
- Aim for low fat/sugar/sodium, high starch/fibre
- Low glycemic index
- Regular meals are advised
- Alcohol avoidance
- Avoid ‘diabetic foods’ as there’s not much benefit
- Exercise – This works in 2 ways
- Half an hour five days a week helps to:
- Reduce obesity so indirectly improve metabolism
- Increases insulin sensitivity directly
- Half an hour five days a week helps to:
- Smoking cessation is key
- Alcohol
Medications for complication prevention:
- Lipids
- Statins are used for 1º prevention if there is a QRISK >10% (this is in 2015 guidelines)
- There is some controversy over statins causing diabetes but this is rare and the benefits far outweigh the risk
- Statins are used for 1º prevention if there is a QRISK >10% (this is in 2015 guidelines)
- Anticoagulation
- Aspirin is used if
- There are any complications (microvascular/macrovascular) complications
- Patient has had diabetes >10 years and is >50y/o
- Clopidogrel is used if aspirin is contraindicated or patient has had a stroke
- Aspirin is used if
- Blood Pressure – maintain ≤130/80 in all diabetics – this greatly helps against all vascular complications and thus improves life expectancy and quality
- Antihypertensives are the mainstay (ACE inhibitors are 1st line) – see preventing macrovascular complications