November is American Diabetes Month

By Parul Kharod

World Diabetes Day is on November 14, which is the world's largest diabetes awareness campaign reaching a global audience of over 1 billion people in more than 160 countries.

Diabetes is such an epidemic worldwide that we cannot talk enough about it. As we know Asians are genetically at a higher risk to develop insulin resistance and thus diabetes is more prevalent in our community. It is important that we continue to be aware of any new research and updates on this subject.

In January 2019, The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) published an annual update to their joint algorithm for the management of Type 2 diabetes.

This update also highlights obesity and prediabetes as underlying risk factors for development of diabetes. So the recommendations are not just for treatment but also for prevention of diabetes and other related diseases such as obesity and heart disease.

According to the joint AACE/ACE update, the principles of treatment for diabetes are broadly divided into these two categories:

1. Lifestyle Therapy – making changes to daily habits for overall health
2. Using algorithm for treatment of high blood sugars – detailed steps for medications and insulin as needed. Additional medications as needed to treat high blood pressure, high cholesterol and other health concerns.

Let's talk a little more about the Lifestyle Therapy because that is the only thing we have in our control.

According to the AACE/ACE guidelines, lifestyle therapy is divided into five categories:

1. Nutrition
2. Physical Activity
3. Sleep
4. Behavior support
5. Smoking


• Maintain optimal weight with good eating habits and regular physical activity
• Lose weight if you need to. People who are overweight should strive for at least 5-10% weight loss
• Move toward a plant-based diet
• Avoid or limit animal foods
• Choose high fiber foods such as variety of whole grains and beans
• Eat plenty of non-starchy vegetables
• Eat whole fruits
• Eat healthy fats from nuts and seeds
• Avoid saturated fats (meat, cheese, paneer, butter) and trans fats (shortening, Dalda, hydrogenated oils, palm oil)
• Get nutrition counseling from a Registered Dietitian
• Make sure to get advice from a licensed healthcare professional with formal training in the nutritional needs of individuals with diabetes
• Get continued help by going to follow up visits
• Follow advise to reduce simple sugars in the diet and learn how to eat healthy carbohydrate foods
• Attend diabetes group classes for more education

Physical Activity

• 150 minutes per week of exercise with moderate exertion
• This could be done as 30 minutes 5 days per week
• It can include any form of exercise such as walking, jogging, swimming, biking, aerobics classes, yoga, etc.
• Strength training a few days per week using weight, resistance bands or gym equipment
• Use a structured program such as classes or coach/trainer if needed
• Use devices and technology such as pedometer, Fitbit or apps to measure physical activity
• Ask your doctor; get medical clearance if needed.


• Get about seven hours of sleep every night
• Practice best sleep hygiene
• Limiting daytime naps to 30 minutes. Napping does not make up for inadequate nighttime sleep. However, a short nap of 20-30 minutes can help to improve mood, alertness and performance.
• Avoiding stimulants such as caffeine close to bedtime.
• Avoid strenuous workouts close to bedtime.
• Avoid heavy or rich foods, fatty or fried meals, and carbonated drinks in the evening.
• Get out in the sunlight during the day and create a calm dark atmosphere at night, as this helps to maintain a healthy sleep-wake cycle.
• Establish a regular relaxing bedtime routine. This could include taking warm shower or bath, reading a book, or light stretches.
• If there is suspicion of Sleep Apnea, it should be diagnosed by doing a Sleep Study, and treated as needed

Behavior support

• Reach out to family and/or friends for emotional support
• Join community groups dedicated to a healthy lifestyle for emotional support and motivation
• Seek psychological counseling if needed for anxiety and depression
• Seek counseling needed for alcohol or other substance abuse addictions


• Stop smoking
• Avoid all forms of tobacco products


Diabetes affects every cell and nerve of your body. Steps should be taken to prevent it as much as possible. Steps should be taken to effectively treat it using a team approach. Lifestyle changes should be ongoing, and should engage the entire healthcare team including doctors, nurses, dietitians, pharmacists, and physical therapists. Lifestyle therapy should begin with nutrition counseling and education. All patients should strive to attain and maintain an optimal weight through a primarily plant-based meal plan. Lifestyle therapy should include medical nutrition therapy, regular physical activity, and sufficient amount of sleep, behavioral support, and smoking cessation with avoidance of all tobacco products.

Parul Kharod, MS, RD, LDN is a registered dietitian and licensed nutritionist and works as a Clinical Dietitian with Outpatient Nutrition Services at WakeMed Hospital in Cary and Raleigh. She can be reached at