Doing exercise to help manage your stress and sleep levels can help when it comes to controlling diabetes

Alex Ballard, who lives in Bishop's Stortford and works as a specialist dietician in West Essex, pens the second part of her Diet Talk column on diabetes...

Until writing part one of this diabetes duo, I hadn't quite realised just how much I have to say about the topic. I now have nine years' experience in the field of dietetics and over this time period advice has altered and trends have fallen in and out of fashion. However, one thing has always remained reliable and constant – diabetic control is multifactorial.

As discussed in my last article, carbohydrate awareness is a key factor for controlling both type 1 and type 2 diabetes; whether that is via carbohydrate counting and insulin management, using lower glycaemic index options or reduction. However, carbohydrates may not always be the only factor to consider when getting blood glucose levels in check.

Weight, as with many conditions, is another element worth pondering. If overweight, gradual weight loss may improve the ability to utilise insulin in type 2 diabetes and reduce the need for increasing insulin doses in type 1 diabetes. This might be assessed via body mass index (BMI), waist circumference measurements or discussing weight history. Even if you are still of a healthy BMI, weight gain away from someone's normal, comfortable set point can cause elevated blood glucose levels.

It is important to focus on a diet that is both healthy and maintainable, as extreme methods often cause yo-yo dieting and can be nutritionally inadequate, socially awkward and pricey. More achievable options could include a lower carbohydrate, reduced fat or Mediterranean dietary approach. Some individuals may also adopt fasting methods; either by limiting the window in which they eat (for example having their first meal at 10am and the last meal at 6pm), or restricting calorie intake on a few days per week (such as the 5:2 method).

Hefty alcohol consumption can also clock up excess calories and consequently cause weight changes. Trying to incorporate more alcohol-free days and avoiding drinking more than 14 units of alcohol per week is important for overall wellbeing. Lower calorie and carbohydrate options include single measures of spirits (one measure = one unit) with diet or no-added-sugar mixers.

Exercise is also a critical piece to the diabetic control puzzle and should be a key consideration for everyone irrespective of weight. Moving our bodies helps to use excess glucose sitting in the blood as a fuel, both whilst exercising and for hours afterwards. This could be in any form that feels enjoyable such as yoga, walking, gardening, weights, resistance bands, cycling, swimming, line dancing, walking football, chair-based exercises or squash. A good aim is to move our bodies every single day. Build this up gradually and try to incorporate a mixture of both aerobic and resistance exercises for a full range of benefits.

The two forgotten 's' words also warrant a mention here – sleep and stress. Both can play havoc with hormone and blood glucose levels if out of kilter.

Many find it a struggle to nod off and pause whirring brains for a peaceful night's sleep. If this sounds familiar, try to keep really well hydrated throughout the day, focus on regular exercise and limit caffeine-containing beverages from lunchtime onwards. Avoid alcohol, smoking, heavy meals and screens too close to bedtime. Instead, create a regular routine involving set bedtimes, loose-fitting clothing and relaxation (such as calm music, reading, mindfulness, meditation or gentle yoga). Additionally, sleep in a dark, well ventilated, clutter and pet-free (sorry!) room.

Turning off stress can seem like an impossible task. However, trying to limit ongoing and daily strain is a positive stepping stone towards better health. Some suggestions include animal therapy, new hobbies or skills, socialising, music, exercise, fresh air, breathing techniques, organisation, work-life balance, talking to friends and family or seeking professional help.

Some individuals with diabetes will also be at risk of blood glucose levels going too far the other way. Hypoglycaemia, or hypos, can be triggered by missing meals, eating too little carbohydrate, administering too much medication, exercise and drinking alcohol on an empty stomach.

Those susceptible can still exercise and try different diets where appropriate (such as lower carbohydrate and fasting), however they should be more cautious and always work alongside a healthcare professional to make sure their medication is adjusted safely.

Diabetes UK has lots of online information about the above topics, including meal plans and recipes. Have a chat with your GP surgery before making big adjustments (especially if at risk of hypos), if you want to access support or seek out local diabetes education sessions.

You can follow Alex on Instagram @alextalksdiet.