Although the genes you inherit may influence the development of type 2 diabetes, they take a back seat to behavioral and lifestyle factors. Data from the Nurses’ Health Study suggest that 90 percent of type 2 diabetes in women can be attributed to five such factors: excess weight, lack of exercise, a less-than-healthy diet, smoking, and abstaining from alcohol. (8)
Metformin is likely effective for as long as 10 years, based on long-term follow-up of patients in the Diabetes Prevention Program (DPP). In this trial, investigators randomized 3234 at-risk patients to 3 groups: metformin 850 mg twice daily; lifestyle modification (7% weight loss, 150 minutes of physical activity per week, and a one-to-one 16-lesson curriculum covering diet, exercise, and behavior modification); or placebo.4 At a mean 2.8-year follow-up, the incidence of diabetes was 31% lower in the metformin group (95% confidence interval [CI], 17%-43%) and 58% lower in the lifestyle modification group than in the placebo group (95% CI, 48%-66%; P<.001 for both comparisons).
Eat every two to three hours. Spreading your energy needs throughout the day allows for healthier choices to be made and your blood sugar to stabilize. Work towards achieving a healthy meal pattern of breakfast (the first meal), followed by a small snack, then lunch (mid-day meal), another snack, dinner (last-meal of the day) and sometimes a small end of the day snack.
The result of his hard work? He lost 160 pounds in two years, normalized his high blood pressure and high cholesterol, has an A1C of 5.6, and no longer takes metformin and glyburide. His advice to others with type 2: "You need to have a plan, and you need to be consistent," he says. "[Diet and exercise are] something you need to do to survive and control it. Look at it as the same thing as taking a pill or insulin."
What to drink in place of the sugary stuff? Water is an excellent choice. Coffee and tea are also good calorie-free substitutes for sugared beverages (as long as you don’t load them up with sugar and cream). And there’s convincing evidence that coffee may help protect against diabetes; (33, 34) emerging research suggests that tea may hold diabetes-prevention benefits as well, but more research is needed.
Of course, carbohydrate types, amounts and frequencies still matter. Setting up a routine is best so the body can become more regulated, and medications can be more easily adjusted with medical guidance. For example, a “consistent carbohydrate diet” may include 4-5 carbohydrate servings (60-75 grams) per meal, with 3 meals spaced 4 or 5 hours apart. The inclusion of an evening snack may be recommended pending morning glucose trends. If morning sugars are running under 70 mg/dl, it may be a wise choice to have a 2-carbohydrate evening snack about 1 hour prior to retiring to bed.
Checking your blood glucose levels several times a day helps you understand how your body responds to medications, exercise, and the foods you eat. When first starting out, keeping your glucose within a tight margin can often feel like hitting a moving target. It can suddenly spike with no reason or plummet the next day despite total adherence to your treatment.
Regular physical activity helps the body cells take up glucose and thus lower blood glucose levels. Regular physical activity also helps with weight loss as well as controlling blood cholesterol and blood pressure. You need to let your doctor and dietitian know about the kinds of physical activities you do regularly. Your doctor and dietitian will help you balance your physical activity with your medication and diabetic meal plan. If you are not physically active now, your doctor may recommend that you increase physical activity. Important benefits of a regular aerobic exercise program in diabetes management include decreased need for insulin, decreased risk of obesity, and decreased risk for heart disease. Exercise decreases total cholesterol, improves the ratio of low-density lipoprotein (LDL) to high-density lipoprotein cholesterol (HDL), and reduces blood triglycerides. It may also decrease blood pressure and lower stress levels. Walking is one of the easiest and healthiest ways to exercise. This is one activity that anyone can do for a lifetime without special equipment and with little risk of injury. Talk to your doctor about exercise. Supervised activity is best because of the risk of an insulin imbalance. Use the buddy system when you exercise.[71,72,73,74,75,76,77]
If you are like me, going to the gym is not your favorite pass time. Physical activity with diabetes is so beneficial. Being active, however, does not mean having to work out. There are tons of ways to sneak in exercise in your everyday activities. For example, when grocery shopping, park at the end of the lot so you have to walk a longer distance to and from the store. If you enjoy watching tv, stand up and walk in place during the commercials. Take the stairs instead of the elevator as often as you can. If you enjoy dancing, instead of at- home work out videos, put on your favorite tunes and dance away! There are so many different ways to be active without “working out”!
Sugar and processed carbohydrates should be limited, says Massey. That includes soda, candy, and other packaged or processed snacks, such as corn chips, potato chips, and the like. And while artificial sweeteners like those found in diet sodas won’t necessarily spike your blood sugar in the same way as sugar, they could still have an effect on your blood sugar and even alter your body’s insulin response, though more research is needed to confirm this.
After the birth of her oldest son, Crawford went on Weight Watchers. Eight months later, she had dropped 40 pounds, had an A1C of 5.2, and was able to stop diabetes and blood pressure medications. Her workouts started with daily walks and progressed to cardio and strength training three to four times a week. "I was able to do things I couldn't do before," she says. "I can do push-ups. I can do sit-ups."
Animal products contain fat, especially saturated fat, which is linked to heart disease, insulin resistance, and certain forms of cancer. These products also contain cholesterol and, of course, animal protein. It may surprise you to learn that diets high in animal protein can aggravate kidney problems and calcium losses. Animal products never provide fiber or healthful carbohydrates. A vegan diet is one that contains no animal products at all. Therefore, you’ll have to avoid red meat, poultry, fish, dairy products, and eggs.
Other medications such as metformin or the DPP4 drug class are weight neutral. While this won’t make things worse, they won’t make things better either. Since weight loss is the key to reversing type 2 diabetes, medications won’t make things better. Medications make blood sugars better, but not the diabetes. We can pretend the disease is better, but that doesn’t make it true.
So you go to your doctor. What does he do? Instead of getting rid of the toxic sugar load, he doubles the dose of the medication. If the luggage doesn’t close, the solution is to empty it out, not use more force to . The higher dose of medication helps, for a time. Blood sugars go down as you force your body to gag down even more sugar. But eventually, this dose fails as well. So then your doctor gives you a second medication, then a third one and then eventually insulin injections.
Today’s widespread availability of oral diabetes medications has decreased the number of adult diabetics taking long-term insulin. However, as we learned in Chapter 5, those diabetes medications carry serious side effects with them. Furthermore, why would you want your condition to deteriorate, requiring progressively more potent medications with increasingly serious side effects? It sounds like it is definitely time for a better solution. The good news? Hintonia to the rescue!
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
That proved more difficult than she had imagined. She hadn't seen a diabetes educator. The only dietitian covered by her insurer was too far away. And her doctor's sole advice was for Jitahadi to watch what she ate. "I was scared in the beginning," says Jitahadi. "It was through friends and starting to read [about diabetes] that I knew I could do this. I could get through this."
To hit your blood sugar level target, eat a variety of foods but monitor portions for foods with a high carbohydrate content, says Alison Massey, RD, CDE, the director of diabetes education at Mercy Medical Center in Baltimore. “[Foods high in carbohydrates] have the most impact on blood sugar level. This is why some people with diabetes count their carbohydrates at meals and snacks,” she says.
The problems behind the numbers are even more alarming. Diabetes is the leading cause of blindness and kidney failure among adults. It causes mild to severe nerve damage that, coupled with diabetes-related circulation problems, often leads to the loss of a leg or foot. Diabetes significantly increases the risk of heart disease. And it’s the seventh leading cause of death in the U.S., directly causing almost 70,000 deaths each year and contributing to thousands more. (4)
If you choose to drink alcohol, remember: To drink with your meal or snack (not on an empty stomach!), to drink slowly or dilute with water or diet soda, that liqueurs, sweet wines and dessert wines have a lot of sugar, to wear your Medic Alert (Alcohol can cause hypoglycemia/low blood glucose), reducing alcohol can promote weight loss and help you lower your blood pressure.