The lifestyle changes,diabetes treatment will not be successful without

- Medical topics - The lifestyle changes,diabetes treatment will not be successful without
Izmena životnog stila, bez kojeg lečenje dijabetesa neće biti uspešno

Is it possible that there is something new in the lifestyle recommendations for people with diabetes? Do the recommendations apply only to them, or is it something any healthy person should accept?

This is the original chart appeared in the American and European Diabetes Association guidelines in 2022.

Very colorful and nice, but the light and dark color shades are immediately noticed. Light shades refer to activities during the day. Dark shades refer to activities during the night.

Daily activities

Sitting and breaking up prolonged sitting time.
The activities of modern man today are mostly related to sitting. Those activities, especially if they are related to work, cannot be avoided. But it is possible to change them. The length of sitting can be limited. Breaking up prolonged sitting time (every 30 min) with shorter, slower walks or resistance exercises improves glucose metabolism. It does not affect HbA1c, blood pressure and lipids. But it may improve tissue response to insulin. Each of us should imagine how to apply this recommendation in our lives, regardless of the existence of diabetes or another disease. Maybe it’s not a bad idea to take a walk while talking on mobile phone.


It is necessary to motivate yourself to >150 minutes of moderate, rhythmic activity per week (engagement of large muscles) or >75 minutes of intense physical activity per week, divided over 3-5 days, with no more than 2 days of rest in between. Moderate physical activity is the one that maintains a heart rate that is 50% of the maximum heart rate. Maximum heart rate is obtained when years of life are subtracted from 220. Intense physical activity for one person is the one that achieves a heart rate that is 70% of the maximum heart rate.

Also, 2-3 sessions of balance and stretching exercises should be added to this activity.

Physical activity that leads to increased heart rate and mild sweating, lowers blood sugar levels, improves tissue sensitivity to insulin and lowers HbA1c. Also, it reduces the level of cholesterol and triglycerides in the blood. It improves general physical fitness, reduces depression and improves the quality of life. This isn’t anything new. So, what is new?

New is the realization that people with diabetes, especially those over the age of 60, cannot achieve the same goals in physical activity as their peers. People with diabetes have a recognizable body shape, also called a phenotype. They are obese with increased concentration of fat, especially visceral, and with reduced muscle mass. With age, they become more fragile and prone to injuries. The exercises they can perform are the exercises easily performed by people 10 years older than them.


Step counting via a mobile phone is somewhat accurate; it is if the phone is in the back pocket of trousers, and it is not if it is in a bag. Different watches, connected to a mobile phone, are more accurate. People with longer stride have less number of steps on average. It would be optimal to take 7000 – 10000 steps per day. Usually, people who work and go to work by car take about 4,000 steps a day. Increasing the number of steps by 500 per day is associated with 2-9% reduction in the risk of cardiovascular diseases and all-cause mortality. Each step extends life! Walking improves the mood and the quality of life.

The beneficial effects on glycemia are more pronounced if steps, intermittent sitting, resistance exercises and aerobic activities are applied in postprandial period, preferably about 45 min after eating.

Strengthening the muscles

Resistance exercises (any activity that uses body weight or resistance work) improve insulin sensitivity and glycemic levels. Tai-chi and yoga also help, while maintaining flexibility and balance at once. Any attempt to strengthen the muscles, that is, any aerobic exercise, improves glucose metabolism and reduces HbA1c. It should be kept in mind that these exercises are not for everyone! If they are difficult or monotonous, they can have a depressing effect.

Night activities

Sleep length

Any sleep period shorter than 6 hours, or longer than 8 hours, has negative effect on diabetes control. A person should determine when is the optimal period for them to sleep, considering their biorhythm and the work they do. Ideally, sleep should always happen at the same time, even on weekends. Sleeping less than 6 hours is associated with the need for sweets and higher calories intake. Extending sleep improves insulin sensitivity. Catching up on sleep over the weekend cannot correct the negative effects of insufficient sleep during the weekdays.

Sleep quality

Healthy sleep is the key to good health and good diabetes control. Non-REM and REM sleep are equally important. Avoid exercise, large meals, alcohol, coffee, chocolate and cigarettes before going to sleep. Alcohol with dinner relaxes, but it can reduce the REM sleep period. Irregular sleep, due to insomnia, sleep apnea or neuropathic pain in T2D, negatively affects glycemic levels.


Night chronotypes (owls – go to bed late and get up late) suffer more from physical inactivity and have worse T2D control than diurnal chronotypes (they go to bed early and wake up early).

In conclusion, daytime and nighttime activities are equally important for diabetes control. It is important to remember the following:


  • Length of sitting: <30 min.
  • Steps: +500/day
  • Activities that lead to sweating are the most “cardio-metabolically” beneficial
  • Muscle strengthening: the best is to be done in postprandial period
  • 5-6 minutes of brisk walking every day prolongs life
  • Sleep: > 6 hours but < 8 hours

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