Type 2 diabetes is one of the many chronic diseases that often can be managed entirely without medication, particularly when it is diagnosed at an early stage.
Among people with insulin resistance, a precursor to diabetes, nearly all can reverse it with the same changes. Even with longstanding diabetes, many patients can discontinue most of their insulin/oral drugs when they make significant dietary and other lifestyle changes.
About 24 million Americans have type 2 diabetes (once known as adult-onset diabetes), and at least 57 million have prediabetes, an intermediate condition in which levels of fasting glucose (blood sugar) are between 100 milligrams per deciliter (mg/dL) and 125 mg/dL. What they have in common: An inability to effectively utilize insulin, the hormone produced by the pancreas that allows glucose to move from the bloodstream into the body’s cells.
Most people with diabetes are first diagnosed via a fasting blood sugar test. But by the time glucose levels are high, the disease already has progressed — and the cells that produce insulin may have suffered irreversible damage.
Better: The fasting serum insulin test. Cost: About $50 (which may be covered by insurance). High levels of insulin indicate insulin resistance, a condition that precedes sharply elevated glucose.
Anyone with diabetes risk factors, including obesity, high blood pressure, elevated cholesterol or a waist circumference of more than 40 inches in men or 35 inches in women, should have the fasting serum insulin test.
Those who have diabetes or are at risk for diabetes should consider making the following lifestyle changes. People sometimes complain about the “restrictive” nature of the changes needed to control diabetes. It does take some effort, but far less than dealing with the complications of the disease — which may include blindness, nerve damage and amputation.
One study found that 21 of 23 patients were able to discontinue oral diabetes drugs after switching to a mainly meatless diet — of those on insulin, 13 out of 17 were able to quit taking the insulin.
A plant-based diet is high in fiber, which slows digestion and the rate of glucose absorption into the blood. This causes the pancreas to secrete less insulin, and it makes cells more sensitive to insulin’s effects. People who consume little or no meat also tend to have lower cholesterol and blood pressure — important for minimizing the cardiovascular complications of diabetes.
The Diabetes Prevention Program study found that people at risk for developing type 2 diabetes who exercised regularly and ate a Mediterranean-style diet — mainly fruits, vegetables, legumes (beans, lentils) and whole grains, with only small amounts of meat a few times a month — decreased their risk of developing diabetes by 58%. In contrast, trying to prevent diabetes by using the popular medication metformin lowered the risk of developing diabetes by 31%.
Carbohydrate counting is among the most effective ways to control diabetes. Main steps…
Calculate net carbohydrate. This is the amount of carbohydrate in a food minus fiber content. One cup of Kashi GoLean cereal, for example, has 30 grams (g) of total carbohydrates, but because this includes 10 g of fiber, the net carbohydrate is actually 20 g. You can find all of this information on food labels.
Identify “carbohydrate choices.” One carbohydrate choice equals 15 g of net carbohydrates. Example: A slice of whole-wheat bread is one carbohydrate choice (about 15 g of net carbs).
Eat 9 to 13 carbohydrate choices daily for optimal control. Most people are advised to have three to five carb choices for breakfast.
Sample breakfast: One cup of old-fashioned oatmeal with milk or milk alternative, such as soy milk (two carbohydrate choices)… one cup of berries (one carb choice)… egg or tofu scramble with vegetables, such as mushrooms, bell peppers and onions (one carb choice)… one slice of toast with nut butter (one carb choice).
Have three to five carbohydrate choices at lunch and zero to three at supper. Eating lighter at night helps stabilize overnight and morning blood sugar levels.
Carbohydrate counting is confusing initially, but people quickly memorize the carbohydrate contents of the foods that they tend to eat most often.
Helpful: I advise patients to eat meals at the same time every day… and to eat about the same portion sizes to keep blood sugar levels stable.
Some carbohydrates elevate blood glucose almost instantly — others much more slowly. The Glycemic Index (GI) is a measure of how quickly carbohydrates elevate glucose. A lower number indicates a slower glucose rise — and better glucose control.
Example: White bread has a GI of 73. It is transformed very quickly into glucose, which causes blood sugar levels to surge. A serving of carrots, on the other hand, has a GI of 32. The glucose conversion happens slowly, which causes steadier levels of blood glucose.
Recommended: Mainly consume foods with GIs of less than 55. Foods that are minimally processed, such as legumes and whole grains, generally have lower GI numbers. (See www.glycemicindex.com for a complete guide to the glycemic index.)
Helpful: Aboveground vegetables, such as grains and leafy greens, typically have lower GIs than below-ground vegetables, such as potatoes and radishes. Fruit from the temperate climates, such as apples, pears and peaches, have lower GIs than tropical fruits, such as bananas.
Also, if you feel like eating a food with a high GI (such as white bread), combine it with a low-GI food, such as peanut butter, to reduce the glucose surge.
Exercise helps people lose weight, which improves insulin sensitivity and reduces cardiovascular risk factors.
Even without weight loss, exercise is very effective for managing diabetes, particularly when you exercise after meals. Exercise after meals makes it easier for muscle cells to absorb glucose from the blood. Patients who check their blood sugar two hours after eating, then test it again after a brisk 20-minute walk, typically see a drop of at least 30 points.
Strength training also is helpful. People who lift weights or engage in other forms of resistance exercise (such as push-ups) two or three times a week have an increase in muscle tissue, which increases metabolism and insulin sensitivity.
In an emergency, the body releases cortisol, the “fight-or-flight” hormone that increases blood glucose to produce a quick surge of energy. Unfortunately, the same thing happens in people with daily stress. Their cortisol — and glucose — remains at chronically high levels, making diabetes more difficult to control.
Stress management is critical if you have diabetes. Most people find that a daily walk keeps them calmer. In addition, hobbies are a good way to defuse tension and stress. Others learn to meditate or practice yoga. Whatever you find relaxing, make time for it at least a few times a day
