Most people with type 2 diabetes are overweight.44 Excess abdominal weight does not stop insulin formation,45 but it does make the body less sensitive to insulin.46 Excess weight can even make healthy people prediabetic,47 though weight loss can reverse this problem.48 In most studies, type 2 diabetes has improved with weight loss.49 50 51
Exercise helps decrease body fat and improve insulin sensitivity.52 53 People who exercise are less likely to develop type 2 diabetes than those who do not.54 However, exercise can induce low blood sugar in diabetics taking blood sugar�lowering medications, or even occasionally increased blood sugar.(55 Therefore, people with diabetes should never begin an intensive exercise program without consulting a healthcare professional.
Moderate alcohol drinking in healthy people improves glucose tolerance.56 57 58 59 However, alcohol has been reported to worsen glucose tolerance in the elderly and in people with diabetes in some studies.60 61 People with diabetes who drink have also been reported to have a high risk for eye and nerve damage.62 63
Questions remain about where the line should be drawn regarding alcohol intake. For healthy people, light drinking will not increase the risk of diabetes, and may even reduce the risk of developing type 2 diabetes;64 however, heavy drinking does increase the risk of developing diabetes and should be avoided.65 People with diabetes should limit alcohol intake to two drinks per day. Total avoidance of alcohol in people with diabetes who are not suffering from alcoholism, liver disease (e.g., cirrhosis), gastritis, ulcers, and other conditions made worse by alcohol might actually be counterproductive. In one report, older people with type 2 diabetes who drank daily, but moderately, had a dramatically lower incidence of deaths from heart disease compared with nondrinkers.66 This outcome is not surprising since moderate alcohol intake is associated with protection from heart disease in most other reports. This finding may be of particular importance because heart disease is the leading killer of people with diabetes. In another study, nondrinkers had a higher incidence of type 2 diabetes than did moderate drinkers.67
People with diabetes who smoke are at higher risk for kidney damage,68 heart disease,69 and other diabetes-linked problems. Smokers are also more likely to develop diabetes,70 so it's important for diabetic smokers to quit.
Although most healthcare professionals agree on the necessity of self-monitoring of blood glucose (SMBG) by people with type 1 diabetes, disagreement exists within the medical community regarding the efficacy and necessity of SMBG by people with type 2 diabetes. A controlled clinical trial found that home glucose monitoring strips did not affect the management of type 2 diabetes.71 Moreover, a review of available literature concluded that the efficacy of SMBG in people with type 2 diabetes is questionable and should be tested in a rigorous high-quality trial.72 Advocates of SMBG, such as the ADA, have observed that SMBG by people with diabetes has revolutionized management of the disease, enabling them to achieve and maintain specific goals.73 These observations are well-supported in the medical literature.74 Detractors point out that indiscriminate use of self-monitoring is of questionable value and adds enormously to healthcare costs.75 The ADA acknowledges that accuracy of SMBG is instrument- and technique-dependent. Errors in technique and inadequate use of control procedures have been shown to lead to inaccurate test results.76 Nevertheless, it is likely that self-monitoring of blood glucose, if used properly, can have a positive effect by increasing a person's involvement in overall diabetes care.77 Pharmacists and healthcare practitioners can teach people with diabetes certain skills that will enhance their ability to properly self-manage blood glucose.
Exercise helps decrease body fat and improve insulin sensitivity.52 53 People who exercise are less likely to develop type 2 diabetes than those who do not.54 However, exercise can induce low blood sugar in diabetics taking blood sugar�lowering medications, or even occasionally increased blood sugar.(55 Therefore, people with diabetes should never begin an intensive exercise program without consulting a healthcare professional.
Moderate alcohol drinking in healthy people improves glucose tolerance.56 57 58 59 However, alcohol has been reported to worsen glucose tolerance in the elderly and in people with diabetes in some studies.60 61 People with diabetes who drink have also been reported to have a high risk for eye and nerve damage.62 63
Questions remain about where the line should be drawn regarding alcohol intake. For healthy people, light drinking will not increase the risk of diabetes, and may even reduce the risk of developing type 2 diabetes;64 however, heavy drinking does increase the risk of developing diabetes and should be avoided.65 People with diabetes should limit alcohol intake to two drinks per day. Total avoidance of alcohol in people with diabetes who are not suffering from alcoholism, liver disease (e.g., cirrhosis), gastritis, ulcers, and other conditions made worse by alcohol might actually be counterproductive. In one report, older people with type 2 diabetes who drank daily, but moderately, had a dramatically lower incidence of deaths from heart disease compared with nondrinkers.66 This outcome is not surprising since moderate alcohol intake is associated with protection from heart disease in most other reports. This finding may be of particular importance because heart disease is the leading killer of people with diabetes. In another study, nondrinkers had a higher incidence of type 2 diabetes than did moderate drinkers.67
People with diabetes who smoke are at higher risk for kidney damage,68 heart disease,69 and other diabetes-linked problems. Smokers are also more likely to develop diabetes,70 so it's important for diabetic smokers to quit.
Although most healthcare professionals agree on the necessity of self-monitoring of blood glucose (SMBG) by people with type 1 diabetes, disagreement exists within the medical community regarding the efficacy and necessity of SMBG by people with type 2 diabetes. A controlled clinical trial found that home glucose monitoring strips did not affect the management of type 2 diabetes.71 Moreover, a review of available literature concluded that the efficacy of SMBG in people with type 2 diabetes is questionable and should be tested in a rigorous high-quality trial.72 Advocates of SMBG, such as the ADA, have observed that SMBG by people with diabetes has revolutionized management of the disease, enabling them to achieve and maintain specific goals.73 These observations are well-supported in the medical literature.74 Detractors point out that indiscriminate use of self-monitoring is of questionable value and adds enormously to healthcare costs.75 The ADA acknowledges that accuracy of SMBG is instrument- and technique-dependent. Errors in technique and inadequate use of control procedures have been shown to lead to inaccurate test results.76 Nevertheless, it is likely that self-monitoring of blood glucose, if used properly, can have a positive effect by increasing a person's involvement in overall diabetes care.77 Pharmacists and healthcare practitioners can teach people with diabetes certain skills that will enhance their ability to properly self-manage blood glucose.
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