2013

The effects of lifestyle for the management of patient with

Diabetes Mellitus type 2.
 ABSTRACT
Diabetes Mellitus Type 2 is a metabolic disorder that is characterized by increase in
blood glucose due to insulin resistance which leads to relative insulin deficiency. It is also
known as a disease of modern lifestyle. It is a health issue that is spread around globe and is a
major contributor towards mortality and early age death. The disease has increased concern
by health care practitioners all over the world. It has risen rapidly on account of obesity,
chronic stress and presence of sedentary lifestyle. This is very harmful for the patients who
are already suffering from it and may lead to severe complications resulting in heart, kidney
disorders and death in a few cases. This justifies the relevance of chosen topic for given
research work.
The present report is primarily aimed at identifying the factors behind this rise so as to
suggest lifestyle practices in management of patient with diabetes mellitus type 2. The
research is based on an underlying aim to provide the best advices for the same. It begins
with introduction about prevailing problem followed by critical evaluation of seminal works
in form of literature review so as to arrive at conclusions and recommendations. The key
points contained in literature review suggest that Diabetes Mellitus Type 2 makes for 90
percent of Diabetic patients in the world. This type of Diabetes can develop in an individual
due to three major reasons i.e. insulin abnormalities, genetic factors and environmental
factors. The environmental factors including an unhealthy lifestyle wherein there is lack of
physical activity, high stress level or unhealthy eating habits are anticipated to be the major
reasons behind developing Type2 Diabetes. This type is not incurable and can be controlled
by taking appropriate measures like making apposite dietary changes, weight management,
physical activity and adopting a healthy lifestyle. Search strategy is based on key search
words, rationale for choosing for selection of subtopics and the findings that have been
derived from them. It has been represented in form of table to reach at proper analysis and
evaluation. Findings are presented in form of several themes that are based on key points
mentioned in literature work.
Thus it can be concluded that presence of sedentary lifestyle which lacks good diet
and exercise is the major contributor towards the disease. In order to prevent life threatening
complications in patients it is advisable to follow a good dietary as well as weight
management plan. This also involves regular exercise, quitting of smoke and alcohol so as to
lead a healthy and quality life even after occurrence of disease.
TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION 1

CHAPTER 2: LITERATURE REVIEW 3

CHAPTER 3: SEARCH STRATEGY 12

CHAPTER 4: FINDINGS AND DISCUSSION 16

CHAPTER 5: RECOMMENDATION 20

CHAPTER 6: CONCLUSION 23

REFERENCES 26
TABLE OF FIGURES
Figure 1 Proportion of Type 1 and Type 2 Diabetes..................................................................3
Figure 2 Graph on insulin impairment in Diabetes Mellitus Type 2.........................................4
Figure 3 Diabetes Mellitus Type 2.............................................................................................5
 CHAPTER 1: INTRODUCTION
Diabetes Mellitus type II is a health issue that is spread around globe and is a major
contributor towards mortality and early age death. There is a high variation of this disease
among the populations due to differences with respect to genetic susceptibility and other risk
factors. Diabetics Mellitus is a metabolic disease and is concerned with increase of glucose
level in the blood which is formerly named as hyperglycemia. This disturbs the glucose
metabolism due to reduction in insulin secretion by pancreatic cells of body (What is Type 2
Diabetes, n.d).
This includes features like lack of healthy exercise regime, smoking, alcohol, bad
eating habits, increase in fast food intake are among a few causes of the same. Genetic factors
like family history of Diabetes and others like old age and race are also probable causes. Thus
changing lifestyle pattern is the main factor towards increase in diabetes especially among
young people (Mc Culloh, n.d). According to federal estimates released, the disease is being
tied to increase in obesity rates of children. More than 20, 000 teens are suffering from this
disease where none was observed 20 years ago. The occurrence could rise up to 400 percent
by 2050.
No cure for type two diabetes mellitus has been observed till date. But prevention and
better management of the present condition can be suggested which is the focus of present
research. The disease related complications suggest that management of type2 Diabetes is
only possible by proper healthcare management. The necessary changes in life style, side
effects linked with medications makes for self monitoring of the disease along with education
of people to control this disease. Modification in lifestyle is a very effective means to keep
the life threatening disease under control. On medical terms, improvement in blood sugar
control can slow the development of long term consequences that are linked after advent of
diseases in patients.
Therefore the current research focuses on lifestyle management to control the long
term and life threatening consequences that are linked with the disease (Eriksson and et.al.,
2001). Small changes of multiple types can lead to keeping diabetes under control and there
can also be a decrease intake with respect to medicine. Diabetic patients and those with a
family history are required to follow a lifelong plan which can act as a good opportunity to
take charge of one’s health.
The rationale behind selection of this research topic is due to the fact there are around
145 million patients in the world that are suffering from diabetes and this number is expected

1
to rise up to 300 million in the coming 15 years. The prevalence of this disease is also being
observed among young people which are the indicator about severity of disease. It is also
linked with premature death and morbidity due to cardio vascular complications that result
from stroke and myocardial infarction. The increase incidence of this problem is a
characteristic feature due to changes in lifestyle of a person (Crandell, Knowler and et. al,
2008).
The main aim of focusing on the given research topic is to provide best advice for the
management of type 2 diabetes. The objectives for research project are as follows;
 To identify the lifestyle factors behind increase occurrence of Diabetes Mellitus Type
2.
 To improve the quality of lifestyle of patients suffering from Type 2 Diabetes.
 To suggest methods for reducing the impacts of complications due to unhealthy
lifestyle.
The current report hence has been prepared to address the issues related to

management of patient with diabetes mellitus type 2 with the help of proper changes in
lifestyle to avoid further complications. The research is based on the aim to provide best
solutions for management of Diabetes Mellitus type II by bringing significant modification in
lifestyle pattern. It also provides answers to question as to what is the possible impact of
lifestyle for the management of patient with diabetes mellitus type 2 ? Whether better way of
healthy living can reduce future complications or not? In addition to this, the literature review
will throw a light on the problem and how it can be managed.
The literature and seminal works will be critically evaluated so as to arrive at
conclusions and recommendations. The literature section of current report tries to cover all
the relevant aspect of given research topic which is to have a brief overview about the effects
of lifestyle for management of patients who are currently suffering from Diabetes Mellitus
Type 2. A critical literature review is very important to be conducted for this research report
as it will help in identifying what has and what has not been explored as well as investigated
in the domain of Diabetes Mellitus Type2. In addition to this, it will also help in developing
common justifications for observed variations regarding this field of study. Another purpose
of conducting a critical literature review for this study is that it will help in identifying
prospective relationships among varied concepts and thereby discover researchable
hypothesis. The literature review will assist in learning how different researchers have
described and determined key concepts pertaining to Type2 Diabetes. Moreover, key data

2
sources used by other researchers will be identified and alternative research designs can be
developed related to this area of study. On undertaking a literature review it will be
determined that how this piece of work is related to that of others and are there any potential
gaps that need to be filled. Search strategy used in the research has been prepared in form of a
table which includes areas like key words used, rationale behind selection of sub areas and
the findings that have been derived from them. The findings are based on literature review
and have been presented on basis of themes to so as to arrive at proper recommendations and
conclusions. The report finally consummates with a recommendations and a concluding
paragraph.

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 CHAPTER 2: LITERATURE REVIEW
According to Flink, 2004, “literature review is one of the most significant parts of
research that pays attention towards the evaluation of past published articles and research
papers that have been written by different authors” (Flink, 2004). It helps the researcher to
develop a brief outline about given study topic through varied sources of literature. In the
present report, focus has been given to analyze the incidence of Diabetes Mellitus type II in
present population. The aim of literature review is to provide best advice for the management
of type 2 diabetes. It tries to focus on how the disease is developed and is increasing due to
present lifestyle patterns adopted by individuals. It will also analyze the significant changes
that can be brought in lifestyle so as to reduce the impact of lifelong complications that are a
part of this disease.

Occurrence of Diabetes Mellitus Type 2

Figure 1 Proportion of Type 1 and Type 2 Diabetes

(Source: Facts about Diabetes and Insulin, 2009)

The given figure reflects that diabetes Mellitus type 1 occurs in 10% of cases. On the
other hand, Type 2 makes for the remaining 90 percent of Diabetic patients. According to
Haheim, 2011, “type 2 Diabetes Mellitus is a chronic and systemic disease related to
metabolic function of body which results from resistance to insulin and impairment of its
secretion by pancreatic glands”. It is linked with abnormal metabolism of protein, fats and
carbohydrate. The disease has been diagnosed among millions of people who belong to non-
Hispanic white Americans and Hispanic/Latino Americans races. Diabetes mellitus is
basically of two types on basis of insulin dependency (Haheim, 2011). Type one is insulin
dependent whereas type two is non insulin dependent. In present report Diabetes Mellitus
type 2 is a part of study which is can be precipitated by obesity or severe stress and can be
controlled by diet and exercise rituals as well as use of hypoglycemic agents without taking
injections of insulin (Norris, and Lau, 2002).
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 Figure 2 Graph on insulin impairment in Diabetes Mellitus Type 2
(Source: Natural History of Type 2 Diabetes, n.d)

According to above figure, in case of Type 2 Diabetes, at first the insulin level
continues to increase along with progressive development of insulin resistance. But as soon
as level decreases two lines develop due to separation between insulin resistance and its level
which represents impairment of Beta cells and shows onset of diabetes. This means that cells
present in body are unable to use the insulin properly or there is insufficiency on account of
beta cells to produce good amount of the peptide hormone (Type 2 diabetes, 2012). The gap
widens in the upcoming years therefore type 2 Diabetes is also referred to as a progressive
disease. As time goes on, supply and demand of insulin gets worse and leads to more
complications.

Insulin resistance
This term refers to decreased sensitivity of tissue present in pancreas to make insulin
which further gets less effective in stimulating glucose uptake according to Reaven and Laws.
(Reaven and Laws, 1999). This increases the need for more insulin production as a counter
mechanism. The beta cells of pancreas develop insulin secretary impairment that progresses
as time passes. This happens because the cells cannot meet up with the increased demand for
insulin. The ultimate result is that there is not enough insulin to meet the needs of body which
results in hyperglycemia followed by Diabetes Mellitus type 2.

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 Figure 3 Diabetes Mellitus Type 2
(Source: Diabetes Mellitus Pathophysiology, 2012)

According to Barnett and Kumar, 2009, “obesity issues play a significant role to
develop insulin resistance which subsequently results in Diabetes Type 2”. Pathogenic
activity linked to free fatty acids and excessive amount of adipocytes are connected to
mismatch in insulin secretion. This can be delayed or even prevented via use of weight
control techniques and increased participation in exercise regimes (Barnett and Kumar,
2009).

Causes of Diabetes Mellitus Type 2

Diabetes is basically a disease which bears high risks to people over 45, individuals
with obesity, high blood pressure, low HDL cholesterol, high triglyceride levels who usually
are inactive with respect to exercise and healthy lifestyle. There has been a dramatic increase
with respect to the onset of this disease and are linked to sedentary lifestyle factors that also
trigger genetic elements which causes this disease (Goldstein and Wieland, 2008). This is the
reason why Diabetes is referred to as lifestyle disease. Thus a combination of environmental
and genetic causes linked to the disease is as follows;

Insulin Abnormalities
The features shown by most of the patients with type 2 diabetics are insulin resistance by
cells, normal or excessive level of insulin that drops the overall insulin production. This
impairment is due to;
 Elevation in level of free fatty acids and hormones like resistin and leptin in different
phases which is usually seen in obese individuals.
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  Variation in formation of Calpin protein plays a key role in insulin secretion and
action (Crandell, Knowler and et. al, 2008).
 Elevation in growth hormone during puberty increases insulin resistance especially in
case of obese adolescents.
 According to Flink, 2004, “high levels of interleukin and C-reactive protein are found
in diabetic patients. These substances are major factors behind inflammation and
damage to immune system”. Such inflammatory factors contribute to development of
diabetes (Flink, 2004).

Genetic factors
 According to studies variants of TCF7L2 gene increases susceptibility towards type 2
Diabetes. People with two copies of the gene have 80% higher chances for
development of this disease. According to Diabetes Prevention program, even in
population that possess the variant gene; healthy diet and physical activity can delay
onset of diabetes (Norris, and Lau, 2002).
 A defective lipoprotein lipase gene may also pose an increased risk towards coronary
artery disease and type two diabetes among patients.
 Researchers have identified a defective fatty acid binding protein known as FABP2
which may establish a critical link between obesity and insulin resistance in some
people.
Environmental factors
According to thrifty phenotype hypothesis postulated by Hales and Baker in 1992,
there are environmental factors acting in early life which includes under nutrition in
particular might influence risk of developing type 2 diabetes in the coming years (Lindsay
and Bennett, 2001). Other than this factors like high amounts of stress, barriers or absence of
physical activity and unhealthy food are the major contributors towards this illness
particularly at a very early age.

Impact of Diabetes Mellitus type 2 on population

Diabetes is a very fatal disease which has severe implications on overall functioning
of the body. These lead to eye blindness, nerve damage as well as kidney failure. These are a
result of small vesicular damage referred as micro vascular syndrome. It is also a very
important factor behind arteriosclerosis which further leads to complications like strokes,
coronary heart disease etc. According to Melisa Stoppler and William Sheil, 2012, “this

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deadly disease affects approximately 26 million lives in US with about 79 million pre
diabetic patients. Most of the people may be suffering from the disease and are not aware
about it”. (Stoppler and Sheil, 2012).
Diabetes Mellitus type 2 has severe implications on the health status of the affected
individual. There is impairment in the physical fitness of the patient due to presence of cardio
vascular morbidity which further complicates with longer duration in disease. Morbidity is
one of the major factors that results in decreased life expectancy of patient. Individuals with
disease are more prone to micro and macro vascular complications. The ailment also has an
impact on everyday social interactions on part of patients. There is a restriction to types and
amount of food to be ingested (Type 2 diabetes, 2012). There is a requirement to monitor
blood glucose levels several times in a day. Medications are also necessary at times when
individual engages in social activities. Early treatment may delay the complications and also
lead to improved quality of life. The financial expenditure and health costs that are associated
with the illness can also reduce substantially.

Implication of unhealthy lifestyle towards progression of Diabetes Mellitus Type 2

The epidemic of type II diabetes mellitus is on a rise and is driven by modern and
sedentary manner of lifestyle adopted by individuals. According to Tolonen and Raaste, “a
fast food diet which is high in fats as well as calories is being eaten by people who prefer car
rather than walking”. This not only increase incidence of disease but also lead to lifelong
complications in those who are already affected by the ailment (Tolonen and Raaste, n.d).
The disease is irrespective of the gender and is mainly caused due to following an unhealthy
lifestyle. This increases the incidence of chronic and metabolic disease. Along with this it
also brings with itself a large number of complexities in form of eye and visual problems,
impairment with respect to sensation in nerve cells as well as gangrene in severe cases of
injury. These complexities affect the patient in later stages of life but the chances are more if
there is a presence of unhealthy eating habits in form of fast food and lack if regular physical
exercise. The factors that lead to problems in the patients are mentioned below.

Obesity
According to most of the surveys, out of the people who have been diagnosed with
type 2 diseases, about 90% were found to be obese. If individual already have type 2
Diabetes, then obesity may cause peaks and drops in blood sugar levels.
This shows a clear cut link between diabetes and obesity. Intake of saturated fat in form of

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cheese, ice cream, hot dogs, sausage, bacons, butter, chocolate, pork lard etc. are the ones that
make people obese (Diabetes - type 2 - Lifestyle Changes, n.d). These portions are high in
calories and low in nutrients. The scientific reason is that overweight individuals pose extra
stress on their body which also delays maintenance of proper glucose level. An obese
individual causes the body to become insulin resistant. This implies that the body needs to
take more insulin in order to transport sugar to cells (A Codependent Relationship: Diabetes
& Obesity, n.d). It is also found that individuals with more fats in their tissues are less
sensitive to insulin. This increases the requirement to maintain and regulate the blood glucose
level of body. Fat cells release a protein called pigment epithelium derived factor that triggers
a chain of reactions leading to development of Type Two Diabetes (Critical Link between
Obesity and Diabetes Discovered, 2009).

Lack of physical fitness

Physical activity is basically defined as a bodily movement that occurs due to
contraction of skeletal muscle which increases expenditure of energy. The term is used
interchangeably with exercising. There is an understanding with respect to people that
absence of any form of physical activity leads to obesity. Thus lack of fitness can be
considered as a major precursor and also complicates the life of patients with Diabetes
Mellitus type 2. Absence of exercising leads to increase in fat of central belly which triggers
a series of interactions related to insulin resistance and finally worsens type 2 diabetes.
(Turner, 2012). From the studies it is clear that if physical activity is reduced even by 50%
for three days without changing food habits then it doubles the chances of increasing blood
sugar levels after meals. Reduction in physical fitness interferes with natural control of blood
sugar levels by body. It plays a significant role in development of type 2 diabetes as well as
increases risk of heart attack and strokes. Thus even a small bout of exercising on a daily
basis helps to control the rise in blood sugar levels that usually happens after meals (Mirkin,
2011).

Stress
Having the right regime of diet and getting body into motion on an everyday basis are
considered to be major pillars for managing diabetes. The third and a key element to reduce
the complications of the deadly disease is stress management. It is found from recent studies
at Duke University of Durham that when diabetic patients use relaxation therapies then blood
sugar level drops significantly over a period of few months (Norris, and Lau, 2002).These

9
also help to keep a control on the drug intake. The reason is that when in stress the body tends
to release some hormones like cortisol which increases blood sugar. It also contributes
towards difficulties with pancreatic glands to secrete insulin. Stress is also a major factor
behind weight gain as it makes people eat more (3 ways stress affects diabetes, n.d). Chronic
stress that goes on for days and weeks is not at all healthy for diabetic patients as there is no
requirement for additional glucose to be released form blood stream on a continual basis. So
if blood sugar is already higher which is the case with type 2 Diabetes Mellitus patients, then
stress leads the adrenaline gland to shoot up increasing blood sugar to even higher levels.

Effects of changes in lifestyle for patients with diabetes mellitus type 2

            Diabetes mellitus type 2 is a major concern for health care professionals all around the
world as the epidemic is rising on a global level. There is an urgent need to devise strategies
to curb the rising impact of disease. Slight modifications in life style in form of moderate
weight loss and exercising on a regular basis can reduce the complications associated with
this disease by 50% especially in patients who are suffering due to impaired glucose tolerance
commonly known as IGT (Younis, Soren and Farook, 2004). Specific changes related to
lifestyle can be suggested for patients with diabetes mellitus type 2. National Institute of
Health has launched a major clinical trial to determine whether lifestyle intervention is
effective in preventing conversion from impaired glucose tolerance to diabetes mellitus type
2. More than 200 papers have been published on prevention and management of type 2
diabetes by lifestyle modification (Crandell, Knowler and et. al, 2008). Studies are of the
view that both physical activity and diet help improve and maintain glycemic control for
people diagnosed with diabetes mellitus 2. These have been shown to reduce blood pressure,
improve serum lipid level and positively impacted other risk factors.

Dietary changes
            People with type 2 Diabetes are at a risk of developing medical complications in form
of heart and kidney related disease. Suggesting a strict dietary intake is a method to reduce
the counter effects due to disease. It is advisable that individuals should develop their own
dietary plan by taking help of a dietician to meet one’s own health needs (Goldstein and
Wieland, 2008).
 Carbohydrates should be 45% to 65% of total calorie intake. The best choice is
food rich in vegetables, whole grains, beans, fruits and high fiber content.

10
  Fats should account for 25% to 30% of daily calorie in form of mono saturated
and omega-3 poly unsaturated fats. These can be derived from canola oils, olives,
walnuts, flake seed etc. There should be limited amount of Trans fat like fried
foods and bakery items (Diabetes - type 2 - Lifestyle Changes, n.d).
 Protein amount intake should vary according to health requirement of an
individual. For example patient suffering from kidney disorders must take less
than 10% of protein. They should also prefer fish, poultry and soy as compared to
red meat.
            Adapting to healthy dietary regime can even prevent or reverse the impact of disease
in a long run. Thus healthy nutritional regime along with adequate intake of all nutrients in
right amount can play a key role to balance the elevated blood sugar and help to reduce
further complications in patients with Diabetes Mellitus type 2 (Colditz, Manson and et al.,
1992).

Weight management
            Being overweight in Diabetes increases the chances for further complication that are
linked with the disease. Food with high fats consumed in large amount along with some
carbohydrate rich food may consequently result in weight gain. A diet with unsaturated fat  
obtained primarily from plant along with whole fish sources may be beneficial in preventing
type 2 Diabetes. High amount of mono-unsaturated fat in diet may add to problems in
diabetes mellitus type 2. If weight is lost on a moderate basis then there are chances of
attaining significant control on Diabetes. It can reduce risk factors related to development of
heart disease. It is advisable for patients to lose weight if they have a body mass index of 25-
39 or even higher. Thus according to recommendations given by American Diabetes
Association the patient should aim for weight loss by 1 pound in a week. They must follow a
diet plan that supplies at least 1000 kilo calories per day for women and 1,200 kilo calories
per day for men (Diabetes diet, n.d).

Exercise
            The new age lifestyle regimes in form of sedentary lifestyle are one of the major
contributors towards development and further complications in Diabetes. In such case,
several lifestyle management practices in form of regular exercising are a must. Light to
moderate exercise performed on a regular basis is beneficial. It helps in decreasing the

deposition of fat which further helps in the management of diabetes mellitus type 2. These

11
can be in form of brisk walking; stretching etc. can improve insulin sensitivity (National
service frameworks and strategies, n.d). Moderate to intense level of physical activity for at
least ninety minutes every week is recommended to bring blood sugar under control.
Avoiding exercise even for 2 days on a consecutive basis is not advisable. Strength training
will also help to increase muscle and cause reduction in unwanted fats. This will lower the
stress on body which is usually caused by fat accumulation in excessive amount (Dunning,
2008).

Other measures
            In order to manage the counter effects caused by Diabetes on the body, several other
lifestyle management techniques can be suggested. These are as follows;
 Avoid alcohol which is associated with increasing risk of hypoglycemia.
 It is also advisable to avoid intake of certain drugs like beta blockers as they make it
difficult to recognize if there is increase in hypoglycemia (Flaherty, 2012).
 It is essential to avoid injuries and wounds especially to feet area of body. Wearing
good and protective footwear is advisable.
 Researches also suggest that lack of sufficient amount of sleep may impair insulin
usage and also increase the risk of obesity. In such a situation it is advisable to
improve sleep habits to reduce complications (Management of diabetes, 2010).
 Cigarette smoking should be avoided at all costs as it may increase blood
concentration and insulin resistance. From studies it is clear that women who smoke
more than 25 cigarettes every day have 42% greater risk of developing diabetes as
compared to those who are not involved in smoking (Charles, 2000).

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 CHAPTER 3: SEARCH STRATEGY

Author/ Key Search Date Rationale for selection of final Results of Literature Search
Website Words research paper

Haheim Diabetes 09-01-2013 This research work has been Type2 Diabetes Mellitus is a chronic and systemic
selected primarily to gain proper disease related to metabolic function of body which
understanding about diabetes. results from resistance to insulin and impairment of its
secretion by pancreatic glands”. It is linked with
abnormal metabolism of protein, fats and carbohydrate.

Goldstein Diabetes and 10-01-2013 This paper has been primarily The results of the literature search reveal three main
and Wieland causes selected to acquire knowledge causes of diabetes type2. They are insulin abnormalities,
relating to the causes of diabetes genetic factors and environmental factors. The features
type2. shown by most of the patients with type 2 diabetes are
insulin resistance by cells, normal or excessive level of
insulin that drops the overall insulin production.
According to studies variants of TCF7L2 gene increases
susceptibility towards type 2 Diabetes. People with two
copies of the gene have 80% higher chances for
development of this disease. Factors like high amounts
of stress, barriers or absence of physical activity and
unhealthy food are the major contributors towards this
1
 illness particularly at a very early age.

Stoppler and Impact of 09-01-2013 This paper has been selected as it Diabetes Mellitus type 2 has severe implications on the
Sheil Diabetes provided sufficient information health status of the affected individual. There is
Mellitus type regarding the impact of Diabetes impairment in the physical fitness of the patient due to
Mellitus Type2 on population.
2 on presence of cardio vascular morbidity which further
population complicates with longer duration in disease. Individuals
with disease are more prone to micro and macro
vascular complications. The ailment also has an impact
on everyday social interactions on part of patients.
Barnett and Diabetes and 10-01-2013 The rationale behind selecting this Out of the people who have been diagnosed with type 2
Kumar Obesity work is that it provided ample diseases, about 90% were found to be obese. If
information regarding the lifestyle individual already have type2 diabetes, then obesity
factors which led to diabetes type2. may cause peaks and drops in blood sugar levels.
Intake of saturated fat in from of hot dogs, sausages etc.
are the ones that make people obese. The scientific
reason is that overweight individuals pose extra stress
on their body which also delays maintenance of proper
glucose level. An obese individual causes the body to
become insulin resistant. Fat cells release a protein
called pigment epithelium derived factor that triggers a

2
 chain of reactions leading to development of type2
diabetes.

Turner Physical 09-01-2013 The purpose of choosing this work Absence of exercising leads to increase in fat of central
exercise and is that it provides sufficient belly which triggers a series of interactions related to
diabetes information regarding how lack of insulin resistance and finally worsens type 2 diabetes.
physical activity contributes to (Turner, 2012). From the studies it is clear that if
type2 diabetes. physical activity is reduced even by 50% for three days
without changing food habits then it doubles the
chances of increasing blood sugar levels after meals.
Reduction in physical fitness interferes with natural
control of blood sugar levels by body. It plays a
significant role in development of type 2 diabetes as
well as increases risk of heart attack and strokes.

Eriksson, Stress and 10-01-2013 This paper has been chosen as it When in stress the body tends to release some hormones
Linddtrom diabetes gives information regarding stress like cortisol which increases blood sugar. It also
and and its role in augmenting the contributes towards difficulties with pancreatic glands
Tuomilehto disease. to secrete insulin. Stress is also a major factor behind
weight gain as it makes people eat more. Chronic stress
that goes on for days and weeks is not at all healthy for
diabetic patients as there is no requirement for

3
 additional glucose to be released form blood stream on a
continual basis. So if blood sugar is already higher
which is the cause with type 2 Diabetes Mellitus
patients, then stress leads the adrenaline gland to shoot
up increasing blood sugar to even higher levels.

Crandell and Lifestyle 09-01-2013 This research work has been It is advisable that individuals should develop their own
Knowler changes and chosen because relevant dietary plan by taking help of a dietician to meet one’s
diabetes information relating to different own health needs. A diet with unsaturated fat   obtained
control lifestyle changes which can help primarily from plant along with whole fish sources may
prevent the problem of diabetes is be beneficial in preventing type 2 Diabetes. Avoiding
given. excessive drinking and smoking is also recommended.

4
 CHAPTER 4: FINDINGS AND DISCUSSION
On the basis of the above Literature Review and the problems thus identified certain
findings have been inferred. These findings have been explained in detail in form of themes
mentioned below:
Theme 1: Majority i.e. 90% of the diabetic patients are suffering from Diabetes Mellitus
Type2.
As can be construed from the literature review, round about 90% of the people
suffering from diabetes have type 2 diabetes. This reflects the unhealthy lifestyle patterns of
people. This chronic ailment affects majority of the world’s population and many people are
not even aware about this disease until it starts affecting them severely. In addition to this
there are several people who are potential diabetic patients because of their bad lifestyle. This
disease is growing at a fast pace. Though it runs in families as well but it can be avoided by
adopting a healthy dietary plan and doing physical activities. These days even young adults
and children are becoming the victim of this disease. This can be mainly contributed to their
unhealthy eating habits and chronic stress. 85% of the children all over the world suffer from
Type 2 diabetes. Prevalence of diabetes is more in men as compared to women. Pre diabetes
is also growing among world’s population. However, by losing weight and increasing
physical activities people can avert or postpone type2 diabetes.
Findings: It is clearly indicative that the number of people suffering from Diabetes Mellitus
Type 2 is very large and continuously increasing. This number will not fall until and unless
people keep ignoring their health. Awareness regarding this disease is not much which results
in people ignoring the symptoms at a very young age.

Theme 2: Obesity, lack of exercise and severe stress are the main reasons for occurrence
of Diabetes Mellitus Type2.
As per the extensive literature search, it has been inferred that the major reasons of
occurrence of type 2 Diabetes are severe stress, obesity and lack of exercise. Majority of the
people in today’s world are too busy in making money. In quest for a better future, people are
ignoring their present. The stress level is too high in young people these days, be it students
or professionals. They lead an unhealthy lifestyle in which there is excessive dependency on
junk food. Advancements in technology have made human beings too much dependent on
machines due to which majority of world’s population has become stranger to exercising.
90% of the people who were diagnosed with type 2 Diabetes were also obese. The blood
sugar level increases and the body become insulin resistant. If a Diabetic patient takes stress
1
then it further aggravates the problem. As mentioned in the literature search, Diabetes
Mellitus Type 2 is caused due to some insulin abnormalities. These abnormalities get
intensified due to an individual’s unhealthy lifestyle.
Findings: Leading an unhealthy life and taking unnecessary stress are bound to shoot up the
blood sugar level and reduce the sensitivity towards insulin. Fatty foods such as pizza,
burgers, hotdogs and etc. delay the maintenance of adequate glucose levels which triggers the
incidence level of Diabetes Mellitus Type 2.

Theme 3: Diabetes Mellitus Type 2 can be managed by bringing appropriate changes in

the lifestyle.
As can be interpreted by the above literature search, the main triggers of type 2
diabetes are stress and an unhealthy lifestyle, making significant changes in the living
patterns can to some extent control the disease and also its occurrence. Makings changes in
the amount and type of food intake can be helpful for diabetic patients to improve their blood
sugar control, lose weight and lower the cholesterol level. Doing some physical exercise can
also prove to be effective in prevention of type 2 diabetes mainly if done after having a meal
rich in carbohydrates which shoots up the blood sugar level. Having excessive fatty foods
magnifies the risk of drop in insulin sensitivity while on the other hand foods rich in fiber and
low glycemic index can minimize the impact. Changes in everyday habits are a necessary
component of a diabetes management plan. Curbing stress is also very important as stress
results in weight gain and subsequent reduction in sensitivity towards insulin.
Findings: Modifications in the lifestyle can be very effectual in keeping diabetes under
control. Improved blood sugar control as a result of healthy lifestyle can dissuade the
progression of complications in the long term. A number of small modifications in day to day
life can result in improvement in diabetes control which will also decrease the requirement
for medication.

Theme 4: Weight management, dietary changes and exercising are proving to be some
of the most effective methods of controlling type2 diabetes.
Being obese and having diabetes further enhances the complications related with the
ailment. High levels of unsaturated fat in the food heighten the problems related to Diabetes
Mellitus Type 2. However, if a diabetic patient loses weight on a reasonable basis then
considerable control can be achieved on the disease. Inactive lifestyle also contributes
significantly to the further enhance the impacts of type 2 diabetes. Regular exercise or

2
physical activity is imperative to control and prevent the occurrence of the disease. Regular
exercising burns the extra calories and hence decreases the deposition of fat which helps in
managing the disease properly. Diabetes can also be controlled by eating healthy. Adequate
amounts of all nutrients i.e. protein, vitamin, carbohydrates, fiber and fat are helpful in
keeping the blood sugar level in control and hence increase the sensitivity towards insulin.
Apart from this, a diabetic patient also needs to take care of things such as proper sleep and
avoidance of injuries.
Findings: Adapting a proper dietary regime can even check or reverse the impact of disease
in the long term. Thus healthy nutritional regime along with adequate intake of all nutrients in
right amount can play a key role to balance the elevated blood sugar and help to reduce
further complications in patients with Diabetes Mellitus type 2. Along with proper weight
management and exercise plus keeping check on other things are very helpful in averting type
2 Diabetes.

Theme 5: Avoiding drinking and smoking can help in proper management of diabetes.
Alcohol consumption is associated with the risk of hypoglycemia. Avoiding excessive
drinking is mandatory for keeping a check on diabetes. About 25% of the individuals recently
diagnosed with diabetes are ardent smokers. Smokers are diabetic are at high risk of death
from strokes and heart attacks, high bad cholesterol level, deteriorated blood sugar control
and kidney diseases. However, if smoking is quitted then the associated risks also decrease.
Blood sugar level is not affected by consuming justified amounts of alcohol. Patients who are
taking oral medicines do not necessarily need to adjust their medicines if they consume
alcohol in moderate amounts. Nonetheless, excessive drinking is can be fatal for diabetic
patients.
Findings: Smoking can be very lethal for a diabetic patient and it should be avoided
completely. Drinking in moderate amounts can be beneficial for diabetic people and the risk
of having diabetes is very much in heavy drinkers as well as non drinkers.

Theme 6: Deprivation and Gestational diabetes also indirectly cause the disease
Deprivation is highly connected with high levels of obesity, smoking, unhealthy diet,
poor blood pressure control and physical inactivity. All of these elements are indirectly
connected with the risk of contracting diabetes or the threat of severe complications for
people who have already been diagnosed with the disease. People who are deprived have two
times more vulnerable of contracting the disease at any age. Likewise Gestational diabetes

3
which arises at time of pregnancy is also common among women. It occurs in some women
due to the inability of body to produce adequate insulin to be able to meet the additional
requirements of pregnancy. Women who are already obese or overweight have a higher risk
of getting diabetic.
Findings: Deprivation due to social status is also an indirect link to obesity and hence it can
be said that poor people are generally at a higher risk of getting diabetes as compared to rich
people. Gestational diabetes is also a major problem among pregnant women and the risk of
developing Diabetes Mellitus type 2 remains for lifetime.

Theme 7: The complications of diabetes type2 are even life threatening

Type2 diabetes causes nervous damage, heart and blood vessel disease, kidney
damage, osteoporosis, eye damage, Alzheimer’s disease and foot damage. The blood sugar
control if deteriorates then it causes dementia by obstructing the blood flow to the nervous
system. This causes strokes. Diabetes may also result in a fall in the bone mineral density and
hence increases the risk of osteoporosis. A number of different ailments occur as a result of
diabetes.
Findings: Not having a control over diabetic situation can cause life-endangering diseases. A
healthy lifestyle becomes very important to control and prevent diabetes.

Theme 8: Screening is very important for preventing and controlling diabetes.

When there are no risk factors, patients should be screened every three years after the
age of 50 years. When there are some risk factors then screening should begin 10 years
earlier. For patients having a medical history of gestational diabetes, impaired fasting
glycemia and weakened glucose tolerance are required to get screening done every year.
Findings: Timely screening can help the patients control and manage their diabetic condition.

4
 CHAPTER 5: RECOMMENDATION
A wide range of recommendations can be suggested so as to improve the overall
health of a diabetic patients and foster long as well as healthy living. The best way is to
reduce the gap between what is effective for a diabetic patient and what care is being
provided at present. Following steps are recommended for nursing practice which is based on
extensive literature review so as to increase effectiveness with respect to managing the
lifestyle of patient who is currently suffering from diabetes (Tolonen and Raaste, n.d).

Structured education in patients with type 2 Diabetes Mellitus

This recommendation is based on the principle to provide patient empowerment and
learning about the disease. It will help to improve psychological well being, reduce stress and
bring an improvement in the overall quality of life. Health care as well a welfare service
provider should deliver training sessions through health educators. Paying more attention to
patient education by achieving a partnership between suffering and general practice team will
lead to better management of diabetes (Norris and Lau, 2002).

Regular screening of patients

For patients with no risk factors the individuals must been screened from 40 years on
a three yearly basis. When there is presence of risk factors then screening should commence
from 30 years. People suffering from history of impaired glucose tolerance, fating glycemia
or gestational diabetes screening should be performed on a yearly basis. The recommended
test for screening is fasting venous plasma glucose. Diabetic patients are advised to undergo
retinal and foot screening as well to avoid complications that may lead to ulcer formation and
blindness (Tracey, 1992).

Proper diet management

The nursing practitioners must recommend reducing down on intake of simple and
refined carbohydrates. Increasing consumption of vegetables, fruits, lean proteins, whole
grain and food rich in fiber is also advisable. It is also important to have a check on
cholesterol and blood lipid on a regular basis. This awareness will help to reduce the chances
of stroke or heart attack. The patients should be told to avoid appetizers and snacks full of
sugar or saturated fats. Instead there are required to prefer a mix of fiber, protein, fat and
carbohydrates (Colditz, Manson and et al., 1992). They can be recommended to eat raw fruits
and vegetables, crushed berries mixed into ricotta cheese, frozen grapes etc. Thus a consistent
5
diet with same amount of calories on an everyday basis will help the professionals in
prescribing correct dosage of medication to be taken.

Avoid Dieting while suffering from Diabetes

Dieting in patients who are suffering with Diabetes reduces the intake of fibers,
vitamins and minerals. It also reduces the important calories that are required for proper
functioning of body. There is also an increased risk of hypoglycemia. Hence it is
recommended to avoid dieting at all costs (Non-Pharmacological Management of Diabetes,
2005).

Physical activity is essential component of Diabetes Management

Regular physical activity is a very essential part of management with respect to
Diabetic patients. Thus health care professionals should suggest exercise programme must be
in accordance with individual capacity and disability of patients. Wearing of appropriate
footwear will help in avoiding injuries (Brand and Petocz, 2003). It is recommended to
follow a step by step exercise regime on a regular basis to increase the overall physical and
mental improvement. It will be essential to consult professionals before starting any exercise
regime. They can provide valuable suggestions with respect to type and amount of exercise to
be practiced safely so as not to worsen the condition (Norris, and Lau, 2002).

Assessment of patient’s knowledge

The health practitioners should assess the ability of patient to control blood glucose
level via proper monitoring of glucose, injecting insulin and with the help of dietary, exercise
and weight control regimes.

Weight reduction
It is recommended that proper measures for reducing weight of obese patients
suffering from diabetes must be suggested by health practitioners. Changes in behavior so as
to achieve strict adherence towards the proposed diet regime is also necessary. Increased
physical activity will also help in expending energy. It will be necessary to achieve cure via
reducing adipose deposits on tissues followed by restoration of tissue sensitivity towards
insulin (Anderson and Kendall, 2003).

Elimination of smoking and alcohol usage

It is a well known fact that reducing uptake of alcohol and eliminating smoking can
reduce the amount of triglycerides present in blood. In such a situation help of a health care
6
professional can be taken so as to help the patient in quitting of smoke and reducing the
intake of alcohol to minimal levels (Drucquer, and Mc Nally, 1998).

7
 CHAPTER 6: CONCLUSION
On the basis of the above findings it can be concluded that Diabetes Mellitus Type2 is
the most prevalent in people of the modern day world. This type develops when the body can
make insulin but not sufficient enough or when the insulin which the body produces does not
function in a proper manner. The incidence of type2 diabetes is very high in males. This type
of diabetes normally develops in people who have crossed the threshold of 40 years. Off late
many children have also been diagnosed with this condition some of them even being just 7
years old. Almost 85% of children throughout the world are suffering from type2 diabetes. In
majority of the cases, this disease is connected with being obese or overweight.
Diabetes Mellitus Type 2 is more common of the two diabetes types as roundabout
90% people are suffering from this type. The statistics are alarming and establish diabetes as
one of the major health challenges in the world (Critical Link between Obesity and Diabetes
Discovered, 2009). There are thousands of people who have diabetes but have not been
diagnosed yet with the disease. Pre diabetes is also a very prevalent condition among
individuals over 20 years of age. This condition involves blood sugar level higher than
normal but not too high to be regarded as diabetes (Reaven, and Laws, 1999).
Almost all the studies on this type of Diabetes suggest that obesity is one of the
biggest reasons for its occurrence. This is the reason why children as young as seven years
old are suffering from the ailment. Obesity is mainly because of two reasons i.e. eating
unhealthy and junk food and secondly because of deprivation. This confirms that lower
income class is more vulnerable to the risk of diabetes. However, middle and upper income
group people have unhealthy diet plans and eating habits which make them prone to the risk.
According to the findings, out of the people who have been diagnosed with type 2 diseases,
about 90% were found to be obese. If individual already has Diabetes Mellitus type2, then
obesity may cause tremendous fluctuations in blood sugar levels and dilute the control over
this (Eriksson, Linddtrom and Tuomilehto, 2001). The link between diabetes and obesity
becomes very apparent because of this. Unhealthy food such as pizzas, hamburgers and etc.
have high amount of unsaturated fats which makes people less sensitive to insulin.
Hence, the body of obese people becomes insulin resistant. Fat releases a type of
protein which further triggers a chain reaction which develops type2 diabetes. Eating good
and healthy food with proper nutrient intake lessens the risk of contracting diabetes to a great
extent and people who already have it can control their situation. Along with proper weight
8
management and exercise plus keeping check on other things are very helpful in averting
type2 Diabetes (Brand and Petocz, 2003).
Likewise, from the findings it can also be inferred that physical activities are also very
important in reducing the chances of diabetes. Physical activity just after a rich carbohydrate
meal is important to maintain the blood sugar level. Exercise will help in losing weight,
promoting cardiovascular fitness, improving lipid profiles and lowering high blood pressure.
If regular physical activity is combines with a healthy diet then it can help in preventing
type2 diabetes in some cases (Younis, Soren and Farook, 2004).
Smoking can be very dangerous for people with diabetes. It can cause life-threatening
implications such as premature death due to strokes or heart attacks, nervous system
breakdown, worsened blood sugar control and kidney related ailments. Hence, a diabetic
patient must religiously avoid smoking. Drinking in moderate levels can be helpful in
controlling the blood sugar levels. People who drink moderately are less prone to getting
diabetes than people who drink excessively or people who don’t drink at all (Lindsay and
Bennett, 2001).
The Nurses’ Health Study suggested that gestational diabetes is also becoming
increasingly prevalent among pregnant women. It involves a lifelong risk of contracting the
disease. Due to hormonal changes taking place in a women’s body during her pregnancy, all
women have some extent of weakened glucose intolerance. This implies that their blood
sugar might be higher than usual but not too high to have diabetes. However, in the later
stages of pregnancy, these changes may make a woman vulnerable to gestational diabetes.
Diabetes Type2 can result in life threatening implication to the patient if not kept
under check. The major risk is of contracting Alzheimer’s disease and osteoporosis.
Screening is very important to be conducted for people suffering from diabetes or have any
past medical history.
As per a study done by the American Diabetes Association, everything just sums
down to leading a healthy lifestyle and eating good food. The awareness among people
related to this disease is not very much. This results in many people being left undiagnosed at
an early stage. Having blood sugar is not taken by people as a symptom of contracting
diabetes at a later stage and hence they do not take any kind of medication or precaution. This
further aggravates the problem and makes them diabetic at a later stage. Managing the blood
sugar level on a daily basis is very complicated. It includes oral medication and a
meticulously planned diet. Diabetic patients may be required to take heavy medications all

9
through their lives. However, this can be avoided if people follow a healthy lifestyle right
from an early age. A nutrient rich diet can help in preventing the onset of Diabetes Mellitus
Type 2 (Anderson and Kendall, 2003). Diabetic patients can also lead a normal and active
lifestyle if they take a balanced diet, follow the medical advice and exercise regularly.
Maximum adults and children are leading a very inactive life. Though, being fit is a fad in
developed nations, people are becoming increasingly inactive. If this rising health issue is to
be curbed and a fall in the number of people dying from this disease is to be witnessed then
awareness needs to be increased relating to its risk. In addition to this, comprehensive
modifications in the lifestyle have to be brought about by people and they ought to learn
about self management (Tolonen and Raaste, n.d).
According to The Nurses’ Health Study, Type2 Diabetes Mellitus has strong
associations with lifestyle factors like improper diet, lack of physical activity and obesity.
Unhealthy lifestyle factors have a major role to play in elevating the risk of this type of
Diabetes. The study projected that 85% of Diabetes Mellitus Type2 can be prevented by
maintaining the body mass index below the level of 25, regular exercise and a healthy diet.
Body mass index is associated with lifestyle, genetics and nutrition transition which has
accompanied the transition to a relatively inactive lifestyle. All such factors contribute to the
present obesity as well as unceasing disease endemic. As suggested by Brimblecombe and
et.al, there is a close relation between diabetes risk and BMI. They discussed that people who
are lean are less prone to developing Type2 Diabetes.
Hence, overall it can be concluded that leading a healthy lifestyle can prevent the risk
of developing diabetes type2 and for people who already have the disease can effectively
manage it.

10
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Barnett, T., and Kumar, S., 2009. Obesity and Diabetes. John Wiley & Sons.
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Charles, M. A., 2000. Diabetes management: complication risk assessment, diagnosis, and
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Colditz, G. A, Manson, J.E. and et al., 1992. Diet and risk of clinical diabetes in women.
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