Modified Lifestyle Management of Type-2 Diabetes Mellitus in Old Age

Prof. Dr. Vipin MishraMBBS, MD, PhD, DM (Endocrinology) AIIMSCommonwealth Fellow in Endocrinology (UK)

DirectorInstitute of Diabetes & Endocrinology

Jaypee Hospital, Noida

www.drvipinmishra.com

Type-2 Diabetes Mellitus

• Chronic metabolic disease.

• Leads to serious long term complications.

• Lifestyle management is the basic and most important aspect of treatment

• Early and intensive treatment is the key to have an active, enjoyable long life

Lifestyle Management of T2DM• Diet• Exercise• Yoga• Fixed diurnal routine• Sound sleep• Financial security• Enjoy vacations• Pursue hobbies• Have friends• Have family• Have work• Love humour• Have a Guru• Manage the mind• Know yourself

Lifestyle Management of T2DM

• Diet• Exercise• Yoga• Fixed diurnal routine• Sound sleep• Financial security• Enjoy vacations• Pursue hobbies• Have friends• Have family• Have work• Love humour• Have a Guru• Manage the mind• Know yourself

Dietary Considerations

• Eat proper food, and Eat less• Food should be easily digestible• Calorie restriction, avoidance of sugars and fats,

limitation of proteins• At some point of time, limitation or avoidance of

uncooked cellulose• Small multiple meals / or 2-3 regular meals

Dietary Considerations

Food must be divided in four classes –– A. Prohibited Foods: Sweets, Fried food, fats, red meat

and high caloric vegetables like potato, Arbi

– B. Minimum Intake: Carbohydrates like bread, rice, pasta, noodles etc.

– C. Normal Intake: Proteins (Milk and milk products, white meat, pulses) and seasonal fruits

– D. Liberal Intake: Salad, green vegetables, clear vegetable soup, sprouts, lemon water

No overeating ever

Distribution of calories

• Calories should come from different sources as follows –• Complex carbohydrates: 50-60%• Proteins: 20-25%• Fats : < 25% : Saturated 5%, PUFA 5-8%, MUFA 12-

15%• High fiber content – soluble and insoluble

Lifestyle Management of T2DM• Diet

• Exercise• Yoga• Fixed diurnal routine• Sound sleep• Financial security• Enjoy vacations• Pursue hobbies• Have friends• Have family• Have work• Love humour• Have a Guru• Manage the mind• Know yourself

Exercise

• Aerobics increases insulin sensitivity• Blood sugar is reduced significantly• Improves cardio-vascular, musculo-skeletal, respiratory

and digestive systems• Improves sleep• Improves feeling of well being• Retards ageing• Walk, cycling, outdoor games, swimming

Exercise

• Other forms of exercise are also equally important• Pressure exercises help build muscle tone and bulk. This

improves peripheral glucose disposal.• Stretching and movement improves functions of the

muscles and soft tissue• Pressure exercises should not be initiated in seventies or

when there are many co-morbidities

Lifestyle Management of T2DM• Diet• Exercise

• Yoga• Fixed diurnal routine• Sound sleep• Financial security• Enjoy vacations• Pursue hobbies• Have friends• Have family• Have work• Love humour• Have a Guru• Manage the mind• Know yourself

Yoga

• Yoga is pure magic, Improves every aspect of metabolism

• Retards ageing, Prevents complications• Maintains weight, Maintains figure• Postures keep the soft tissue flexible and supple• Pranayam has strong metabolic effects• Meditation gives peace and tranquility and avoidance of

phases of excitement and depression

Lifestyle Management of T2DM• Diet• Exercise• Yoga

• Fixed diurnal routine• Sound sleep• Financial security• Enjoy vacations• Pursue hobbies• Have friends• Have family• Have work• Love humour• Have a Guru• Manage the mind• Know yourself

Fixed Diurnal Routine

• All body functions are rhythmical

• Maintenance of bio-rhythms improves every aspect of metabolism and retards ageing

• Regular sleep wake cycles ensure ideal hypothalamic functions

• Minimizes glycaemic variability

Lifestyle Management of T2DM• Diet• Exercise• Yoga• Fixed diurnal routine

• Sound sleep• Financial security• Enjoy vacations• Pursue hobbies• Have friends• Have family• Have work• Love humour• Have a Guru• Manage the mind• Know yourself

Lifestyle Management of T2DM• Diet• Exercise• Yoga• Fixed diurnal routine• Sound sleep

• Financial security• Enjoy vacations• Pursue hobbies• Have friends• Have family• Have work• Love humour• Have a Guru• Manage the mind• Know yourself

Lifestyle Management of T2DM• Diet• Exercise• Yoga• Fixed diurnal routine• Sound sleep• Financial security

• Enjoy vacations• Pursue hobbies• Have friends• Have family• Have work• Love humour• Have a Guru• Manage the mind• Know yourself

Lifestyle Management of T2DM• Diet• Exercise• Yoga• Fixed diurnal routine• Sound sleep• Financial security• Enjoy vacations

• Pursue hobbies• Have friends• Have family• Have work• Love humour• Have a Guru• Manage the mind• Know yourself

Pursue Hobbies

Do what you love doing as much and as frequently as possible

This tends to transform your system in a big way When you whole-heartedly follow your passion, your

consciousness moves to a different level of existence It is not like doing anything. Action becomes inaction.

Effort is effortless.

Lifestyle Management of T2DM• Diet• Exercise• Yoga• Fixed diurnal routine• Sound sleep• Financial security• Enjoy vacations• Pursue hobbies

• Have friends (Vitamin-F)• Have family• Have work• Love humour• Have a Guru• Manage the mind• Know yourself

Lifestyle Management of T2DM• Diet• Exercise• Yoga• Fixed diurnal routine• Sound sleep• Financial security• Enjoy vacations• Pursue hobbies• Have friends

• Have family• Have work• Love humour• Have a Guru• Manage the mind• Know yourself

Have Family

• Blessed are those families where 3 or 4 generations live together

• Every generation benefits by this loving co-existence

• Senior people must though be all accepting; and non-demanding

• Family enthuses feelings of security and love

Lifestyle Management of T2DM• Diet• Exercise• Yoga• Fixed diurnal routine• Sound sleep• Financial security• Enjoy vacations• Pursue hobbies• Have friends• Have family

• Have work• Love humour• Have a Guru• Manage the mind• Know yourself

Lifestyle Management of T2DM• Diet• Exercise• Yoga• Fixed diurnal routine• Sound sleep• Financial security• Enjoy vacations• Pursue hobbies• Have friends• Have family• Have work

• Love humour• Have a Guru• Manage the mind• Know yourself

Lifestyle Management of T2DM• Diet• Exercise• Yoga• Fixed diurnal routine• Sound sleep• Financial security• Enjoy vacations• Pursue hobbies• Have friends• Have family• Have work• Love humour

• Have a Guru• Manage the mind• Know yourself

Have a Guru• Complete knowledge is an impossibility. Knowledge as a

rule is always incomplete

• There are –– The known knowns

– The known unknowns

– And the unknown unknowns (the unknowable)

• Guru is the one who attracts towards change

• With a Guru, ego evaporates

• You get a real Guru by chance / luck (karmphal); It is though impossible to get a Guru if you don’t want one.

• The Guru is always close to you whom you can’t recognize because of: your own ego

• Never discuss about your Guru with others

Lifestyle Management of T2DM• Diet• Exercise• Yoga• Fixed diurnal routine• Sound sleep• Financial security• Enjoy vacations• Pursue hobbies• Have friends• Have family• Have work• Love humour• Have a Guru

• Manage the mind• Know yourself

What Causes Diseases

• Genetic Factors

• Psychic Factors

• Lifestyle

• Environment

What Causes Diseases

• Genes don’t cause diseases on their own• There is crosstalk between genes and the

internal environment (blood chemistry) (Epigenetics)

• Genes cause diseases only when the blood chemistry gets altered upto a critical level

• Blood chemistry gets altered because of the psychic factors, lifestyle and environmental factors

• Finally lifestyle and environment also ultimately depend on the psychic factors

What Causes Diseases

• The real disease determining internal factor is the ‘Psyche’

• It forces the person to choose a specific lifestyle

• National or group psyche determines the standards of environment

What Causes Diseases

• The ideal psychic state could be described as a situation when the person is in absolute sync with the external situation

• As and when a person is out of sync from the external environment, it is stress

• All changing emotions are stressors

What Causes Diseases• Chronic subtle or gross stress tends to modulate –

– Neuro-peptide secretion– Hypothalamic functions– Hypothalamic – Pituitary – Adrenal axis– Sympathetic / Parasympathetic drives (Cardiac, GI

functions)– Immune system– Inflammation / Fibrosis– Neuromuscular function

• Adverse psychic factors (stress) lead to chronic tissue damage that is slow, steady, progressive, accumulative and irreversible

• Main damager at physical level is inflammation

An ideal mind1. Naturally and spontaneously happy mind

2. Peaceful (non-anxious) mind

3. Satisfied mind

4. Loving mind

5. Positive mind

6. Balanced mind

7. A non-reactive mind

8. Progressive and ever keen to change mind

9. All accepting mind

10.A mind full of gratitude

11.A self-centered mind

Lifestyle Management of T2DM• Diet• Exercise• Yoga• Fixed diurnal routine• Sound sleep• Financial security• Enjoy vacations• Pursue hobbies• Have friends• Have family• Have work• Love humour• Have a Guru• Manage the mind

• Know yourself

Know: Who You Are

You are not just a body and mind phenomenon The physical body and the mind are in a state of

constant flux Behind your changing form is your unchanging real self There is some aspect in your system that is still the

same, as it was when you were born;AND YOU KNOW THAT

Realizing your real self revolutionizes life. Disease and death are impossibilities

Thanks for Your Attention