“You’ve got diabetes…” Nearly 2 million Americans hear these sobering words for the first time each year. But if you’ve recently received a diagnosis of type 2 diabetes, there’s a warning that many doctors fail to mention—diabetes medications are not a quick fix.
To really get control of diabetes, you need to know about the potential trap in using medication and the smart habits that can help you avoid diabetes complications.
What’s most frightening about diabetes is the fact that it increases one’s risk for so many serious conditions such as heart disease and kidney disease.
How to fight back: People with diabetes who maintain a fasting blood sugar level of 70 mg/dL to 100 mg/dL—and a hemoglobin A1C (HbA1C) level, a measure of long-term glucose control, below 7%—are far less likely to suffer such diabetes complications.
In a perfect world, people with diabetes would be able to keep their glucose levels under control by eating a nutritious diet and getting adequate exercise. But the truth is, most people with diabetes need medication at some point. My advice…
• Start with an insulin sensitizer. Metformin (Glucophage), which reduces insulin resistance (in which the body becomes less responsive to insulin, increasing blood glucose levels), is widely used for type 2 diabetes. This medication helps prevent diabetes complications.
While metformin is among the least expensive yet most effective drugs for treating diabetes, new research suggests that it may have additional benefits.
Recent finding: There’s some evidence that metformin and other such insulin sensitizers may reduce the risk for cancer and possibly heart disease and stroke—independently of their effects on insulin.
In most cases, metformin doesn’t cause serious side effects. Some people may have diarrhea and/or nausea at first, but this usually goes away within a few weeks. What helps: Taking it with meals.
• Watch out for weight gain. If metformin isn’t enough to control glucose levels, it is often combined with synthetic insulin, a commonly used blood glucose–lowering drug.
Paradoxically, insulin and some of the other frequently prescribed diabetes drugs cause weight gain as a side effect—sometimes up to 10 pounds in the first year. Other diabetes medications that help with blood glucose control but can also cause weight gain include sulfonylureas, such as glipizide (Glucotrol)…and thiazolidinediones, such as rosiglitazone (Avandia).
Weight gain is particularly dangerous because 85% of adults with diabetes are already obese or overweight. Those who are carrying extra weight are more likely to have worse blood sugar control and higher cholesterol and blood pressure. They also tend to need larger doses of insulin or other medications.
Newer options: If your weight is a problem, in addition to adopting healthy lifestyle habits (see below), switching to a newer form of insulin (such as Levemir) that minimizes weight gain may help. Other newer blood glucose–lowering medications that don’t lead to weight gain include oral drugs called DPP-4 inhibitors, such as sitagliptin (Januvia)…and SGLT2 inhibitors, including canagliflozin (Invokana). New injectable drugs, such as dulaglutide (Trulicity), also do not promote weight gain. All drugs, however, may have some side effects. Ask your doctor for advice.
It’s entirely possible to go off diabetes medication if you are able to stabilize your glucose levels with diet and exercise. And even if you still do need medication, there’s a good chance you can get by with lower or less frequent doses. Here’s how…
• Don’t get caught up in finding the perfect diet. There are many good diets to choose from. My favorite is an Asian-style diet that is high in complex carbohydrates and fiber, both of which will help control your weight and glucose levels. This diet is about 70% carbohydrates (mainly complex carbs such as vegetables, legumes and whole grains)…15% protein (such as fish, lean beef and eggs)…and 15% fat (including olive oil, grapeseed oil, avocados and olives).
Other good choices include the DASH (Dietary Approaches to Stop Hypertension) diet, which is designed for controlling blood pressure but also helps with weight and glucose control (it focuses on whole grains, lean meats, fish and poultry, nuts, beans and fruits and vegetables)…and a Mediterranean-style diet, which includes many of the same foods but with a heavy emphasis on olive oil.
My advice: Choose a diet that you can stick to! The best way to do this is to consult a dietitian who has experience working with people with diabetes to choose an eating plan that’s both effective and enjoyable. This is usually covered by insurance if you have diabetes. Three to four sessions are recommended, with annual follow-ups. To find a qualified dietitian near you, check the Academy of Nutrition and Dietetics’ Diabetes Care and Education website.
• Follow a two-pronged approach for exercise. Aerobic exercise (such as biking, fast walking and swimming) helps with weight loss, improves cardiovascular health, increases bone density and even improves cognitive function. But that’s not enough. If you’ve got diabetes, weight lifting and other forms of resistance training (such as exercising with elastic bands) are crucial. These workouts increase muscle mass—and muscle absorbs a large amount of glucose from the blood. Patients with type 2 diabetes who combine resistance workouts with aerobic exercise have a much lower risk for complications.
My advice: Get aerobic and resistance training, preferably for 30 to 45 minutes, most days of the week.
