Introduction
Diabetes is a term for a group of conditions where there is an elevated level of glucose in the blood. This is caused by the body’s inability to produce insulin (a hormone that controls blood glucose levels) or to use insulin effectively, or both.
There are three main types of diabetes:
- Type 1 diabetes, where your body doesn’t produce any insulin.
- Type 2 diabetes, where your body doesn’t produce enough insulin or doesn’t use it properly.
- Gestational diabetes, where diabetes develops during pregnancy.
There is a related condition called pre-diabetes. This is where blood glucose levels are higher than is healthy, but not high enough to be diagnosed as type 2 diabetes. Pre-diabetes can be seen as a ‘warning sign’ as it significantly increases a person’s risk of developing type 2 diabetes.
Having pre-diabetes does not mean that a person will automatically develop type 2 diabetes. In fact, its onset can be delayed or even prevented by making healthy lifestyle changes.
In this article, we will discuss the behavioural adjustments that can help you do this.
Diabetes risk factors
Although the exact cause of type 2 diabetes is not known, factors that increase the risk of developing the condition have been identified. Some are modifiable (meaning they can be changed) and others are non-modifiable (they cannot be changed).
Modifiable risk factors include:
- Having pre-diabetes.
- Living in a larger body size.
- Having a waist measurement greater than 80cm for women and 94cm for men.
- Engaging in a low level of physical activity.
- Having high levels of triglycerides (a type of fat in the blood) and LDL cholesterol.
- Having high blood pressure.
- Smoking.
Non-modifiable risk factors include:
- Having a close relative with type 2 diabetes.
- Having an ethnic background of Aboriginal and Torres Strait Islander, Pacific Islander, Asian (including Chinese and the Indian sub-continent), Middle Eastern or North African.
- Age (the risk of pre-diabetes increases after age 35).
- Having Polycystic Ovarian Syndrome (PCOS).
- Having had gestational diabetes.
How can behavioural adjustments affect diabetes risk factors?
Behavioural adjustments play a crucial role in managing and mitigating the modifiable risk factors for type 2 diabetes.
For most people, these adjustments mean eating healthily, being physically active and maintaining or reaching a healthy weight. It’s also helpful to manage your stress levels, make sure you get enough good-quality sleep, avoid excessive alcohol consumption and, if you smoke, to quit.
Lifestyle changes to lower diabetes risk
Dietary adjustments for diabetes prevention
Having an unhealthy diet – one that’s high in processed foods, sugars and unhealthy fats – is a major risk factor for type 2 diabetes. This is mainly due to the effects of such a diet on blood glucose levels and the likelihood of it leading to unhealthy weight.
In terms of a healthy diet, the Australian Dietary Guidelines and the Australian Guide to Healthy Eating recommend eating a variety of items from the following five food groups every day:
- Vegetables and legumes/beans
- Fruit
- Grain and cereal foods, aiming for mostly wholegrains, low-GI and/or high-fibre varieties
- Lean meat and poultry, fish, eggs, tofu, nuts, seeds, legumes and beans
- Milk, yoghurt, cheese and/or alternatives, aiming for mostly reduced fat and fortified alternatives.
People who are living with pre-diabetes will benefit from eating a range of foods from these groups, especially those that are high in fibre and low in the glycaemic index (GI). The glycaemic index shows how quickly the carbohydrates in a food are absorbed into the bloodstream. Foods with a high GI cause a rapid rise in blood glucose levels, which may promote cravings and overeating. Foods with a low GI result in a slower rise. Foods that are high in fibre can help regulate blood glucose by slowing its absorption into the bloodstream.
Foods that are both low GI and high in fibre include:
- oats (rolled, steel-cut or oat bran)
- grains (for example, wheat pasta, vermicelli/soba noodles/udon/hokkien noodles, white or brown long grain such as basmati, quinoa, barley)
- legumes (for example, lentils, split peas and chickpeas)
- most types of fruit.
When following a pre-diabetes diet plan, it is important to know what foods you should avoid.
Physical activity and diabetes risk reduction
Exercise can improve the body’s use of insulin, reduce blood glucose levels and enhance mobility and mental well-being. It can also help maintain a healthy weight, lower blood pressure and reduce the risk of heart disease.
The Australian Government guidelines recommend that adults do at least 30 minutes of moderate intensity physical activity most days. Moderate intensity exercise is any activity that causes your heart to beat faster and makes you breathe harder. Some examples are:
- cycling
- brisk walking
- swimming
- mowing the lawn.
Alternatively, you could do three short bursts of 10–15 minutes of activity.
Resistance training supports weight management by improving the body’s muscle mass and increasing the metabolism. Resistance training is any activity that makes your muscles work harder than usual; examples include exercising with free weights, doing squats and push-ups and using a resistance band.
Ways to incorporate more exercise into your daily life include:
- planning when you’re going to exercise
- doing exercise you enjoy
- exercising with a friend or family member.
Speak to your doctor or a physical activity health professional (Exercise Physiologist/Physiotherapist) before starting any new type of physical activity.
Sleep and diabetes risk
Poor-quality or insufficient sleep can significantly influence the risk of developing type 2 diabetes. Both can lead to glucose intolerance and insulin resistance, where the body struggles to break down glucose and respond effectively to insulin. These conditions can result in elevated blood glucose levels.
Also, sleep disorders such as apnoea and restless legs syndrome are more common in people with diabetes.
Maintaining good sleep hygiene is essential. This can be achieved by, for example, consistently going to bed and getting up at the same time, relaxing before going to bed and avoiding stimulants like caffeine close to bedtime.
Smoking cessation and diabetes risk
Smoking is a modifiable risk factor for type 2 diabetes. Compared with non-smokers, cigarette smokers have a 30-40% higher chance of developing the condition. Smoking also complicates diabetes management and heightens the likelihood of severe complications.
When a person stops smoking, the risk of diabetes decreases over time. After approximately 10 years, the heightened risk vanishes entirely.
Quit.org.au can provide resources and support for people who would like to quit smoking.
Alcohol consumption and diabetes risk
Excessive alcohol consumption can increase the risk of developing type 2 diabetes. Another risk factor associated with alcohol is weight gain.
Direct Line provides confidential support to people who would like to decrease the amount of alcohol they consume.
Stress and diabetes risk
When a person experiences stress, their body releases the hormones adrenaline and cortisol. Cortisol causes the body to decrease its insulin secretion, which can result in elevated blood glucose levels.
Stress can also indirectly affect the risk of diabetes through its impact on lifestyle. People who are under stress are more likely to experience poor-quality sleep, eat a less healthy diet and exercise less.
Steps that you can take to manage stress include:
- making sure that you’re active
- practising relaxation techniques such as deep breathing, meditation and mindfulness
- eating a healthy diet
- maintaining your social life
- prioritising self-care.
Monitoring and accountability
Being consistent with healthy habits is crucial for type 2 diabetes prevention. Having support systems and ‘accountability partners’ (people who support another person to maintain progress towards a goal) can be helpful in maintaining motivation.
Regular health check-ups are beneficial for people who are making lifestyle changes to reduce their diabetes risk. Healthcare professionals can monitor your blood glucose levels and provide an opportunity to check the effectiveness of your current prevention strategies and make any necessary adjustments.
Practical tips for overcoming common challenges and setbacks
Challenges and setbacks are normal parts of the process of behaviour adjustment, and they can be overcome.
If you experience a setback, have a think about why you wanted to adjust your behaviour in the first place. This will put you in touch with your core motivation. Try to see a setback as a detour in your journey rather than the end of it. Realise that all is not lost, and that your efforts have not gone to waste. Think about what you can learn from the setback and reflect on what you would do differently next time.
For more information on how to deal with challenges and setbacks, see here.
Conclusion
Making and sustaining the lifestyle changes that can reduce your diabetes risk is a lot easier if you have support.
That’s where the Life! program can help.
Life! is a free healthy lifestyle program that helps you improve your eating habits, increase your physical activity and manage stress. The program is for people who are at risk of developing type 2 diabetes, heart disease and stroke. If you are already living with diabetes, you are not eligible for the program, however there are other programs that can help you.
Life! is run by experienced health professionals, including dietitians and exercise physiologists, who guide and support you to make healthy lifestyle changes.
The program includes 7 sessions delivered over a 12-month period. You can choose from a group course or our telephone health coaching service. Learn more about the program at www.lifeprogram.org.au
You can check your eligibility for the Life! program by taking a quick online test here.
Sources
About the Australian dietary guidelines – Eat For Health
Anxiety. Symptoms, treatment and causes – health direct
Can Overeating Cause Sleep Disturbances? – Sleep Foundation
Cigarette smoking and diabetes mellitus: evidence of a positive association from a large prospective cohort study – OUP Academic
Consequences of Alcohol Use in Diabetics – PMC – National Center for Biotechnology Information
Depression and Mental Health – Diabetes Australia
Diabetes – Pre-diabetes – Better Health Channel
Pre-diabetes – Diabetes Australia
Dietary and nutritional approaches for prevention and management of type 2 diabetes – The BMJ
Glycaemic index (GI) – health direct
High-fibre foods and diet – health direct
What To Do If You Have Pre-diabetes – The Life! Program
Diabetes and healthy eating – Better Health Channel
Diabetes and Alcohol – Effects of Alcohol on Diabetes – WebMDAlcohol consumption and risk of pre-diabetes and type 2 diabetes development in a Swedish population – Diabetic medicine : a journal of the British Diabetic Association
Diabetes in Australia – Diabetes Australia
General Social Survey: Summary Results, Australia, 2020 – Australian Bureau of Statistics
National Study of Mental Health and Wellbeing – Australian Bureau of Statistics
Diabetes Prevention – Diabetes Australia
Diabetes: Australian facts, Diabetes risk factors – Australian Institute of Health and Welfare
Diabetes: Australian facts, Smoking – Australian Institute of Health and Welfare
Exercise & diabetes – Diabetes Australia
Goal setting – health direct
Healthy diet for diabetes – Diabetes Australia
Choose Health: Be Active – Department of Health and Aged Care
Diabetes – types, symptoms and treatment – health direct
Diabetes and exercise – Better Health Channel
Diabetes and healthy eating – Better Health Channel
Diabetes Overview – Australian Institute of Health and Welfare
Diabetes: Australian facts – Australian Institute of Health and Welfare
Diabetes: Australian facts, Treatment and management
Exercise – everyday activities – Better Health Channel
Exercise programs – Better Health Channel
Exercise safety – Better Health Channel
Improving Sleep Quality: How Is It Calculated? – Sleep Foundation
New research investigates links between stress, diet and type 2 diabetes – Diabetes Australia
Nicotine – Alcohol and Drug Foundation
Nutrition and Sleep: Diet’s Effect on Sleep – Sleep Foundation
Physical activity and exercise guidelines for all Australians – Australian Government Department of Health and Aged Care
Physical Health and Sleep: How are They Connected? – Sleep Foundation
RACGP – Type 2 diabetes and the medicine of exercise
Sleep and diabetes – Diabetes Australia
Top 7 tips for safe drinking – health direct
Smoking and Diabetes – Centers for Disease Control and Prevention
Stress as a driver of diabetes – Diabetes Australia
Stressors and bodily pain, 2020-21 – Australian Bureau of Statistics
The Health Effects of Nicotine Use on the Brain and Body – Addiction Resource
Tobacco, Alcohol, Drugs, and Pregnancy – ACOG
Type 2 – Diabetes Victoria
Type 2 Diabetes Risk Factors – Diabetes Australia
Type 2 Diabetes: Symptoms, Causes and Treatment – Health direct
Waist measurement – Heart Foundation
What are the effects of smoking and tobacco? – Australian Government Department of Health and Aged Care
