Diabetes - lifestyle

For a person with diabetes, understanding how aspects of lifestyle can impact on their condition and learning to manage these is essential to better control of their diabetes and the prevention of complications.
This page provides selected resources on different aspects of lifestyle that require special consideration in relation to diabetes as well as general health and wellbeing.

You can find out more about the impact of lifestyle issues in the RCN learning area Diabetes essentials: Treatment of diabetes.

These resources were last accessed on 30 October 2012. Some of them are in PDF format - see how to access PDF files.

They are arranged under headings.

Alcohol 

Diabetes UK: alcohol and diabetes
Outlines what you need to be aware of when drinking alcohol, for example the affects it can have on blood glucose levels  and the importance of never drinking on an empty stomach - see Hypoglycaemia. The section also tells you how to calculate units for different types of alcoholic drinks.

Drinkaware: alcohol and diabetes
Drinkaware is an independent UK-wide charity which works with drinks companies and retailers to help tackle alcohol misuse and with various organisations as part of the charity’s educational, community and awareness campaigning function.

YouthHealthtalk: diabetes type 1 - drinking and alcohol
This section of the YouthHealthtalk website provides information and advice about drinking and alcohol for young people with diabetes.

Blood glucose monitoring

For related learning on blood glucose levels, measurement and self-management of blood glucose control see the RCN learning area Diabetes essentials: managing diabetes.

Cochrane Library Database of Systematic Reviews

For further information about Cochrane reviews see How to use the Cochrane Library. 

Diabetes UK: HbA1c (Glycated haemoglobin)
The HbA1c test indicates blood glucose levels over a two to three month period. This page describes how it is measured.

Diabetes UK (2012) Position statement:  Self-monitoring of blood glucose (SMBG) for adults with type 1 diabetes
In this statement, Diabetes UK provides a rationale for access to self-monitoring of blood glucose (SMBG), and outlines the debate around routine SMBG in relation to clinical and cost effectiveness.

NICE (2009) Type 2 diabetes - newer agents (partial update of CG66)
The advice in this new guideline (CG87) includes the monitoring of glucose, lipid (blood cholesterol and fat) and blood pressure levels, and the use of medications in relation to these.

NICE Pathways: Diabetes overview
NICE Pathways is an online tool for health and social care professionals that brings together all related NICE guidance and associated products in a set of interactive topic-based diagrams. One of the topic areas is on  Blood-glucose-lowering therapy for type 2 diabetes.

Diet and nutrition

Cochrane Library Database of Systematic Reviews:

The above is not necessarily a comprehensive listing of relevant reviews. For further information about Cochrane reviews and how to search for them see How to use the Cochrane Library. 

Diabetes UK: Food and diabetes
A range of advice and position statements on aspects of food and nutrition. See also Eating well with type 1 diabetes and Eating well with type 2 diabetes.

ISPAD (International Society for Pediatric and Adolescent Diabetes): Clinical practice consensus guidelines 2009: Nutritional management in children and adolescents with diabetes
Chapter nine of the ISPAD guidelines is about nutritional management which the guideline describes as 'one of the cornerstones of diabetes care and education.' The chapter provides detailed guidance for children and young people.

National Library of Medicine MEDLINEplus: Diabetes: meal planning
This interactive multimedia tutorial has been published by the Patient Education Institute in the USA and is presented in different versions. 

NHS Choices: The eatwell plate
The eatwell plate is a general guide to a balanced diet. It shows the different types of food we need to eat – and in what proportions – to have a well balanced and healthy diet. 

NICE quality standard: Diabetes in adults: Quality statement 2: Nutrition and physical activity advice
NICE quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care.

Obesity and weight management

Selected sources of information from the different UK countries.

Department of Health (2011) Healthy lives, healthy people: a call to action on obesity in England
This document sets out how the new approach to public health will enable effective action on obesity and encourages a wide range of partners to play their part. For information on new policy and activities around obesity from the Department of Health see Obesity.

The other UK countries have brought together strategies, action plans and resources at:

NICE clinical guidelines (2006) Obesity:the prevention, identification, assessment and management of overweight and obesity in adults and children
This guideline (CG43) covers assessment of and care and support for people who need to lose weight as well as guidance for a range of professionals on support for improvement of diet and increase in physical activity. There are accompanying quick reference guides and information for the public, patients and carers. 

Scottish Intercollegiate Guidelines Network (2010) Management of obesity (SIGN 115)
This guideline provides evidence based recommendations on the prevention and treatment of obesity within the clinical setting, in children, young people and adults. The focus of prevention is on primary prevention, defined here as intervention when individuals are at a healthy weight and/or overweight, to prevent or delay the onset of obesity.

Emotional wellbeing

Diabetes UK: Emotional well-being
This section of the Diabetes UK website explains how diabetes can impact on emotional  and wellbeing. It includes information about depression and its treatment and psychological support and counselling. 

Diabetes UK and NHS Diabetes (2010) Emotional and psychological support and care in diabetes: report from the emotional and psychological support working group of NHS Diabetes and Diabetes UK
The report describes the range and complexity of emotional and psychological support needed by people with diabetes. It makes recommendations in areas such as commissioning, organisation of care, provision of services, workforce, policy and research.

Diabetes UK (2008) Minding the gap: the provision of psychological care and support
This reports the findings of the first detailed survey of the availability of psychological care for people with diabetes in the UK. It makes recommendations round the development and commissioning of services, skills and training required and the development of appropriate screening tools and guidelines.

NHS Diabetes: Areas of care: Emotional and psychological support
NHS Diabetes is collaborating with many organisations to develop a comprehensive model of care for the emotional and psychological support for people with diabetes.

Employment and driving

Diabetes UK: Employment and diabetes - your rights at work
Diabetes UK have created this advocacy pack about rights and possible discrimination which also points to further sources of advice and information. 

Diabetes UK - Driving
This section of the Diabetes UK website provides detailed information about safe driving and the legal situation and describes some of the recent changes for both Group 1 (cars and motorbikes) and Group 2 (larger vehicles, and some passenger-carrying vehicles) licences.

GOV.UK: Driving with a disability or a health condition
Relevant legislation and advice. The list of health conditions and driving provides quick answers on health conditions and driving.
Diabetes and driving describes what is required for the driving of different types of vehicle for: diabetes treated by tablets; diabetes treated by insulin; diabetes treated by diet.

Physical activity

Cochrane Library database of Systematic Reviews

The above is not necessarily a comprehensive listing of relevant reviews. For further information about Cochrane reviews and how to search for them see How to use the Cochrane Library.  

Department of Health (2009) Be active, be healthy: a plan for getting the nation moving
This establishes a new framework for the delivery of physical activity alongside sport for the period leading up to the London 2012 Olympic Games, Paralympic Games and beyond. The plan also sets out new ideas for local authorities and primary care trusts to help determine and respond to the needs of their local populations, providing and encouraging more physical activity.

Diabetes UK: Keeping active
This section of the website identifies issues around increasing activity and what it means to individuals with diabetes.

National Diabetes Information Clearinghouse (NDIC): Diabetes Prevention Program
The Diabetes Prevention Program (DPP) and its findings, a major multicentre clinical research study, found that "participants who lost a modest amount of weight through dietary changes and increased physical activity sharply reduced their chances of developing diabetes". 

NICE Public health guidance (2006) Four commonly used methods to increase physical activity: brief interventions in primary care, exercise referral schemes, pedometers and community-based exercise programmes for walking and cycling
This guidance (Public Health Intervention Guidance number two) examines only a small number of possible approaches to increasing individual activity levels. 'The broader environmental and organisational changes needed are the subject of future programme guidance being developed by NICE.'

NICE quality standard: Diabetes in adults: Quality statement 2: Nutrition and physical activity advice
NICE quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care. 

Physical Activity and Health Alliance (PAHA)
The Alliance is a joint initiative of NHS Health Scotland and the Scottish Government. It supports the health improvement workforce in implementing the 2003 national physical strategy Let's make Scotland more active. The website includes case studies of local initiatives which can be accessed via context and age group.

Physical Activity and Nutrition Networks Wales
This website contains information about the Nutrition Network for Wales and the Physical Activity Network for Wales, latest news and events, research and evaluation, policies and strategies, target groups, campaigns, community initiatives, sources of funding and workforce development.

Smoking cessation

Cochrane Database of Systematic Reviews:

The above is not necessarily a comprehensive listing of relevant reviews. For further information about Cochrane reviews and how to search for them see How to use the Cochrane Library. 

NHS Choices: Stop smoking
Practical, quick and simple steps to help with stopping smoking.

NHS Health Scotland (2010) A guide to smoking cessation in Scotland
This guide contains three document: Helping smokers to stop: brief interventions; Planning and providing specialist smoking cessation services; Brief interventions flowchart.

NICE Public health guidance (2006) Brief interventions and referral for smoking cessation in primary care and other setting
The guidance (Public Health Intervention Guidance number one) considers whether brief smoking cessation interventions are effective at encouraging individuals to quit smoking.

NICE Public health guidance (2008) Preventing the uptake of smoking by children and young people
The recommendations in the guidance focus on mass-media and point-of-sales measures.  These should be combined with regulation, education, cessation support and other activities as part of a comprehensive strategy.

Stop smoking Wales
Provides information and details about the support available.

Want 2 stop!
This site from the HSC Public Health Agency in Northern Ireland has information and tips about stopping smoking and about cessation services.

Travel 

Diabetes UK: Travel
This section of the Diabetes UK website provides advice on what needs to be thought about when planning to travel, and dealing with illness while abroad. 

Fit for travel - diabetes mellitus and travel
This Scottish web page provides advice on diabetes mellitus and travel, including: preparing for travel; during the trip; food and drink; climate; foot and skin care; advice on insulin and blood and glucose monitoring.

GOV:UK: Passports and travelling abroad
Information is organised under a range of headings. Requirements around Essential medical supplies in hand luggage are described in the section on Your rights at the airport.

NHS Scotland: my diabetes my way: Travel
Tips and information to help make travelling trouble free.