Non-Insulin Therapeutic Option in Management of Diabetes: Life Style Modification; Diet and Exercise

Life style modifications involve guidance regarding dietary alterations and tailored physical activity. Diabetic diets have evolved with changing times. Prior to advent of insulin, caloric restriction and ketogenic diet prolonged the life expectancy to 1.9 to 2.3 years in subjects with type 1 diabetes. However, caloric restriction in obese subjects with diabetes has been recommended throughout the history. Since the availability of insulin, diets for diabetes have been repeatedly debated primarily regarding caloric contribution derived from the carbohydrate content. However, recommendations to avoid ingestion of refined sugar and saturated fats have remained consistent. Finally, diabetic diets are being formulated by nutritionists based on ethnicity, nationality, culture and eating habits of the individual. Caloric content is based on the patient’s body build, weight, energy needs and physical activity and may be adjusted according to individual eating habits, type of insulin regimen, and metabolic derangements. The proportion of caloric sources (fat, carbohydrate, protein) may be altered depending on the presence of secondary disorders. Several small daily meals, including a bedtime snack, are advised. Diabetic diets are often cost-effective, contrary to common belief. Patients should be encouraged to exercise to achieve optimum metabolic control. Active patient participation in the management program is an essential component of therapy.