Recently, I was reading some of the readers’ postings on this Web site. Some of these postings expressed fairly strong opinions about how one should best manage his or her diabetes. Of course, one of the many good things about living in the United States is our right to freedom of speech, and postings such as these certainly get people thinking. However, it’s all too common for misconceptions about diabetes to abound. Whether it’s the belief that eating sugar causes diabetes, or that starting on insulin can make you go blind, or that having to start taking diabetes pills or insulin means that you’re a “bad diabetic,” as a dietitian and diabetes educator, I feel compelled to set the record straight whenever I can.
So, what’s the best way to control diabetes? When it comes to Type 1 diabetes, which accounts for 5% to 10% of all diabetes cases, that’s a no-brainer. A person with Type 1 diabetes must take insulin to survive. His pancreas has—to put it
simply—”pooped out,” meaning that it no longer makes enough insulin. Of course, a person with Type 1 diabetes has choices as to how he takes insulin. The choices nowadays range from the traditional vial and syringe to an insulin pen to an insulin pump to an inhaler. The future holds more possibilities for insulin delivery as well. People with Type 1 diabetes must still incorporate meal planning and physical activity into their daily management.
About 90% to 95% of people with diabetes have Type 2. But Type 2 diabetes is a little less clear-cut in terms of how it’s best managed. The reason is that Type 2 diabetes is a progressive condition. When someone is first diagnosed with Type 2 diabetes, the cornerstones of management are often, initially, what many health-care professionals term “diet and exercise,” or, more appropriately, “lifestyle changes.” In other words, a person in the early stages of Type 2 diabetes may be able to control his blood glucose levels nicely by following a carbohydrate- and calorie-controlled meal plan, losing some weight (if necessary), and fitting regular physical activity into his or her schedule. At this stage of the game, the body is still making enough insulin, and healthy eating and activity help the body use its own insulin quite efficiently.
Over time, however, diabetes progresses, and lifestyle changes simply aren’t enough anymore to control blood glucose levels. At this point, a person with Type 2 diabetes will likely need to start taking medicine in addition to continuing with those healthy lifestyle changes. Medicine is usually in the form of one or more diabetes pills. Many people with Type 2 eventually go on to require insulin.
People with diabetes often feel like they’ve failed because they have to go on diabetes drugs. The truth is that their pancreases have failed them. It’s not their fault. If you’re looking to place the blame on someone, look to your family tree. Genetics plays a big factor in who gets Type 2 diabetes and who doesn’t.
The natural course of Type 2 diabetes is for it to progress to a point where, if the person lives long enough, he or she will have to take insulin. No one is to blame, nor is eating that piece of cheesecake or failing to take a walk after supper. There’s evidence that incorporating healthy lifestyle behaviors may stave off the need to take medicine or insulin for a while, and it’s important for people with Type 2 diabetes to work with their health-care teams on these behaviors. But the bottom line is that Type 2 diabetes will eventually take its course. Family, friends, and coworkers can best help the person with Type 2 diabetes by being supportive and encouraging instead of being hurtful or disparaging.
Hi Amy - I am looking for feedback on what I perceive to be incorrect information in the July/August issue of this magazine.
It was a quiz on glucose management and the question was #2: If your blood glucose level is high first thing in the morning, which of the following reasons may explain why?
One of the correct answers listed was A. late night eating.
UGH!!!! My understanding of physiology is that a meal is gone in 4-6 hours and could not possibly be the cause of high am sugars. If they meant a snack at 2am, they should have specified this.
If you have feedback, I would love to hear it. This is only my second time blogging, so would you use my e-mail if you respond so that I can see it? Many thanks for your column and your time :)
Posted by Emily Evina-Ze | Nov 27, 2006 at 1:18 pmHi Emily,
Thanks for your question. In actuality, the answer is correct–eating before bedtime can sometime cause fasting blood glucose levels to be higher than usual. While it’s true that most food is digested within 2-6 hours, if someone eats a particularly large “snack” (that is more like the size of a meal), or if the snack happens to be somewhat high in fat, digestion may last a little longer, and this, in turn, can cause higher readings in the morning. Another factor is the timing of the bedtime snack; there’s certainly a difference between eating a snack at 9 PM vs. at midnight, for example.
One other reason for high morning blood glucose levels that wasn’t mentioned in the article is the possibility that someone who takes insulin is having hypoglycemia in the middle of the night. The high blood glucose the next morning may be due to a “rebound” from the low blood glucose. If there’s any possibility of this happening, it’s important to set the alarm and monitor at 2 or 3 AM.
Posted by acampbell | Nov 27, 2006 at 4:43 pmMan when I was first diagnosed with Type 2 I was well into the disease and was put on Metformin. At first I did real well I exercised at least 30 minutes 5-7 days a week and cut out all of the carbs. However I trael for a living and it became harder and harder to get he exercise and to stick tot eh strict diet I had imposed on myself. Now I’m one of those all or nothing people. Either I do it all or I find value in none of it. SO as my diet slipped a little and my exercise started to wane I quit both and returned to my old ways. I know deep down that I have to do something but I can’t get started again. I guess if I get 10 more years of living happily instead of 20 years of being miserable its worth
Posted by Kelly | Nov 28, 2006 at 7:23 amI question that diabetes is progressive. Lots of people stay using activity and food choices to manage their diabetes. The only time I see a progression is once meds are introduced. Its like the person needs more and more meds and rarely do I see anyone have good control with meds. I think like most drugs, your body gets use to it so it thereby simply requires more and more to achieve the same affect.
I would like to see diabetics educated in self management instead of medication dependancy to maintain control. Its certainly healthier and also enpowering, creating less depression and hopelessness.
I also take offense when medical personal demean the hard work of D&E controled diabetic by stating that the reason they have control is that they are in the intial stages of a progressive disease.
On one hand we are told to not be fat and control out choices so we can have good BS readings, and then when we do, we are told we must not really have the disease. Its interesting.
Posted by SUSANNAH | Jan 12, 2007 at 8:47 pmI’m new at being a diabetic and to read the article diet and exercise,sure leaves one feeling hopeless. I have read allot of books on the subject and think that I can controll my health and diabetes with diet, exercise and Metformin. Maybe I’m wrong, but I sure think I deserve the right to try. According this article and you it’s not possibible. Not sure I like this magazine yet. Thanks for nothing.
Posted by Bert | Feb 01, 2007 at 4:42 pmHi Bert,
Posted by acampbell | Feb 02, 2007 at 10:04 amI’m sorry if you’re feeling hopeless about your diabetes. There’s a very good chance you’ll be able to control your diabetes through meal planning, weight control, physical activity and metformin. However, it’s important that people with type 2 diabetes be aware of their condition, meaning that, because it does progress, they MAY need to eventually start insulin. A lot of people feel bad about themselves if this happens, and the point of my blog was to help allay the guilt that often accompanies insulin initiation. If you can control your diabetes with your current treatment plan, there’s every reason to be optimistic that you’ll continue to do so.
Hi Susannah,
You’re right - many people are able to manage their diabetes through meal planning and physical activity. However, there are many people who need - and do well with - medication, whether that be pills or insulin. The bottom line is really how well a person’s diabetes is controlled, and that’s primarily determined by their A1C level and presence or absence of complications. And I agree with you that people with diabetes need education in self-management. Unfortunately, many people don’t have the opportunity to receive diabetes education. Hopefully this will change. And while you may encounter medical personnel who demean the hard work you’re doing, I can assure you that most diabetes educators do not. As a dietitian, I’m always impressed and encouraged when people are following and doing well with their meal plan and physical activity plan. Hopefully you’re doing well with yours!
Posted by acampbell | Feb 02, 2007 at 10:13 amI have reading a new book “Reverse Diabetes Now” by Dr. Neal Barnard. In his book he says that a vegan diet, no animal products, will reverse or greatly reduce the need for medication in cases of Type 2. Can you tell me if this is possible?
Posted by Bill Buck | Jun 04, 2007 at 12:35 ammy fiance was just diagnosed with diabetes i am really scared i hear you can control it with meals, exercise, and just controling your blood sugar. We are both really scared and not really sure how to take this? we have 5 kids and a great life we dont want this to put a pitfall in our lives please give me some advice with being so young and dealing with this new situation.
Posted by angela | Jun 18, 2007 at 2:54 pmhow long does a person have to live after being diagnosed with diabetes? is there a certain length of time or is it all up to the person and the medication? I am so scared and i am not even the one with the diabetes. if you have it at the age of 38 whould you still live to be atleast 90 or so. god i am really scared for our family and when you say it will take it course is that like cancer eventually no matter what you do it will soon make you so sick that you will die.
Posted by angela | Jun 18, 2007 at 3:01 pmHi Angela,
While it can be scary at first to find out that someone you love has diabetes, the good news is that, today, there are so many effective treatments, such as medications, a healthy eating plan, and physical activity, that you can live a long, healthy life with diabetes. In fact, many people with diabetes are actually healthier, in many ways, than some people without diabetes. This is because they take such good care of themselves. But it’s normal to be overwhelmed in the beginning. That’s why it’s important to learn as much as you can about the best way to treat diabetes. Your fiance may need medication, or may be able to control his diabetes with meal planning and regular activity. I’d recommend that you and your fiance talk with his doctor and meet with a diabetes educator or attend diabetes classes at your local hospital, for example. Read the postings on this website. The more you know, the less scary it will be. Good luck!
Posted by acampbell | Jun 18, 2007 at 4:23 pmI was diagnosed this week. My A1c was 6.5. Doc wants me to control w/ diet & exercise only. He doesn’t have me checking levels…only every 3 months.No meds other than thyroid, blood pressure/diuretic, & arthritis. How can I make the biggest difference by the time those 3 months roll around? What’s the BEST BREAKFAST to set me up for the rest of the day? I am frightened beyond belief of needles & can pass out when blood is drawn. I am unreasonably fearful of what this disease will do to my life & I can feel depression creeping up around me. I am usually very upbeat, positive & happy person.I’m unhappy now. I am 56 & need to lose that many pounds. I finally found an arthritis med that will alleviate pain enough to allow me to walk for exercise. Is it unreasonable to think that diet & exercise can make enough difference to reverse my situation? to prevent having to ck more than ea. 3 mo.? Please, what is reasonable to hope for. Thanks in advance for your considered responses.
Posted by lisateacher | Mar 09, 2008 at 3:51 pmWhere do I check for my postings and any possible responses? I am having a very rough time today and hope someone might respond!! Thank you.
Posted by lisateacher | Mar 09, 2008 at 5:54 pmHi lisateacher,
Comments on this site are usually moderated Monday through Friday, so if you post over the weekend there can be a slight delay before your comment shows up. You can check back at this page or keep an eye on the “Recent Comments” box on the blog homepage () to look out for responses.
Meanwhile, you may want to check out Amy Campbell’s entries Getting Off to a Good Start with Breakfast: Part 1 and Getting Off to a Good Start with Breakfast: Part 2 for tips on healthy breakfast choices!
Posted by Tara Dairman, Web Editor | Mar 10, 2008 at 9:30 amHi lisateacher,
Posted by acampbell | Mar 10, 2008 at 9:37 amIt certainly can be scary, confusing and even depressing when you’re diagnosed with diabetes. It may help to focus on the positive, though - namely, that your A1C is excellent (the goal for most people with diabetes is less than 7%). Your doctor most likely feels that making some changes in your eating and activity, and losing a little weight can help you control your diabetes. I’d suggest you make an appointment with both a diabetes educator and a dietitian - learn all you can about what you can do to manage your diabetes. Go to http://www.diabeteseducator.org/DiabetesEducation/Find.html to find an educator in your area.
I know a person with a type 2 diabetes condition. First time he was diagnosed with FBS 176, on the next day it was 165- then after five days it was 144. After a week it became 60, then in all other cases below 100. In some instances 100-110. He is in this situation fort half a year. Is he a diabetic?
Posted by Timeless Truth | Jul 17, 2008 at 5:50 amHi Timeless Truth,
Posted by acampbell | Jul 17, 2008 at 3:03 pmI can’t really make a diagnosis for your friend. I’m assuming that his blood glucose levels were done in a lab (and all at the same lab)and not on a meter. Technically, diabetes is diagnosed when a FBS is 126 or higher and the result is repeated on a different day. However, now that his FBS are hovering around 100, it seems like he might have pre-diabetes. He should continue getting his glucose levels checked, and also discuss his results with his healthcare provider. And in the meantime, encourage him to focus on a healthy eating plan, staying at a healthy weight, and being physically active most days of the week.
A year ago, I was diagnosed as a diabetic.
my A1C was 10.2 +/-
My endorinologist advised me to go on insulin immediately. I was heartbroken. I have seen my relatives all have deteriorated health becasue if Type 2.
I begged him to let me attempt to lose that extra weight and see if I could lower it naturally.
I lost 40 pounds within 6 months.
My following A1Cs were
Initial - 10.2
3 mo - 7.2
6 mo - 5.2
9 mo - 5.1
1 year - 5.0
No meds, no insulin. My highest glucose reading is about 150 (after meals) and my highest fasting reading is 105 (ranges from 70-105)
During this whole time, my endocrinologist advises me to go on meds. Now he is telling me that I should go on Januvia…in part becasue he believes that i will one day have more problems. I have resisted this long, and feel that he may just be a prescription pusher. Am I unreasonable to think that I can deny diabetes at the gate?
Posted by michael weinstein | Jul 25, 2008 at 10:28 amHi Michael,
Posted by acampbell | Jul 25, 2008 at 12:45 pmFirst, I’d like to congratulate you. You’ve done an awesome job making lifestyle changes, as evidenced by your weight loss and your A1C levels. Different healthcare providers have different opinions, obviously, on the best way to manage type 2 diabetes. One of the endocrinologists that I work with believes it’s all in the numbers; meaning, that since your A1C is at (and even below) goal (less than 7%), what you’re doing is working, and that there’s no need to change your treatment plan. Perhaps have another talk with your doctor and make a deal: as long as your A1Cs stay at or under your target range, you’d like to hold off on taking diabetes medication. Also, there is some evidence that taking metformin or pioglitazone may help stave off diabetes; I’m not sure that Januvia does the same. Good luck!
I have had Type 2 Diabetes for 4 years. I am 65. No meds yet but numbers are creeping up. I walk 3 miles a day. Now I am having the high morning numbers and am very confused by the yes exercise no don’t do a LONG walk. Confused by the have a snack don’t have a snack!!!! Very depressing. Where do I go for ACCURATE advise tht I can actually use?
Posted by Lee | Sep 11, 2008 at 2:41 pmHi Lee,
Posted by acampbell | Sep 12, 2008 at 8:36 amThat’s great that you’re walking 3 miles per day. I can understand your frustration when you’re doing everything “right” and yet you’re seeing your blood glucose numbers climb up. Since your morning (and I assume you mean fasting) glucose numbers are on the high side, first think about what you’re eating at night. Do you eat a late supper? Are you snacking before bed? Do you think you’re eating too much carbohdyrate? Since you’re not taking medication, you don’t need to eat snacks, since you’re not at risk for low blood glucose. If you want to eat a snack, try to go for lower carb choices, such as nuts or lower-fat cheese, for example. You might try doing your walking after supper, if possible, which can also help lower fasting glucose. And think about asking your physician for a referral to a diabetes educator in your area (they usually have the CDE credential, which stands for Certified Diabetes Educator). You can also find one in your area by calling 1-800-338-3633.
Thanks acampbell. I have been walking after supper and now am wondering if what is happening is the “Dawn thing” where a person goes low during the night because of exercise. So, I am going try and check my blood at about 3 am for a couple of nights.
Posted by Lee | Sep 12, 2008 at 5:17 pmHi Lee,
It’s a good idea to check and see what’s happening overnight. The dawn phenomenon actually is an increase in blood glucose levels in the early morning hours, and occurs due to glucose release from the liver. This is very common in people with type 2 diabetes. Some of the suggestions I gave you earlier may help. Sometimes medication is needed at bedtime, as well.
Posted by acampbell | Sep 12, 2008 at 5:53 pmThanks again acampcell
I have an appointment today to talk to a Diabetes Dietician.
I need to get a good sense of direction here and I go back to my Doctor in a couple of weeks.
Right now I am not on any meds and I sure would like to keep it that way.
Posted by Lee | Sep 16, 2008 at 1:22 pmHi Lee,
I’m glad you’re going to see a dietitian and I hope all goes well for you. Let me know how you make out.
Posted by acampbell | Sep 16, 2008 at 5:44 pmacampbell
- thanks - I found out that I was not eating ENOUGH carbs plus I was walking 3 miles - so my numbers were all over the place
She explained that a woman needs 3 to 4 servings of carbs per 1/3 of the day. That 15 carbs= 1 serving. Since I have been careful with my carbs my numbers are stabilizing again.
Hope to stay off meds for as long as I can.
Posted by jfortmann | Sep 19, 2008 at 3:50 pmHi
I am 42 yrs old South Asian male, diagnosed with high BG about 6 months back, which I am controlling with diet and exercise so far.
I have lost about 9kg since then, bringing my BMI down from 28 to nearly 25. My Hba1c has come down from 13.4 to 7.3 in 3 months and is around 6 now. I monitor my BG regularly at home, and my FG still ranges around 6.2 - 6.5, 2 hr PP around 7.5 - 9.0.
However, every now and then I have a sudden feeling of nervousness and anxiety (similar to a hypoglycemic episode) that goes away on sucking on a candy. It mostly happenes about 3 hrs after breakfast. Interestingly, my BG always comes out normal during these episodes.
I also feel a bit weird after meals esp. lunch and the feeling goes away after 15-20 minutes. Can anyone help me understand what is happening to me? Should I be doing more than my daily 1 hour brisk walk and 1200 cal low-carb diet?
Would appreciate all advise…
Posted by sherman | Oct 29, 2008 at 2:06 amHi Sherman,
Posted by acampbell | Oct 29, 2008 at 3:06 pmFirst, congratulations! Your hard work and efforts have certainly paid off, given your A1C, glucose and weight loss results. As far as your symptoms of nervousness and anxiety, while they can be symptoms of hypoglycemia for some, it’s unlikely that you’re going low, since you don’t take medication for diabetes and these episodes occur after eating. You mentioned that your glucose levels are “normal” when you’ve checked at these times - what is considered “normal” for you? You could be getting these symptoms if your glucose is spiking up too high. On another note, a 1200 calorie diet is actually quite low for a man, so you may not be consuming enough food, particularly enough carbohydrate. You might consider boosting your calories closer to 1500-1800. It’s also possible that your symptoms aren’t related to your diabetes. If they continue, please discuss them with your physician.
I am also new to diabetes. My doctor had been watching my sugar levels for the last two or so years. Until this year, he had me in the pre diabetes class. In July my numbers were 7.3. He now has me on a three month watch. In September my numbers had dropped to 6.1. I go back for another round in December. At this point I’m just doing diet and exercise. I’m 66 years old and my goal is to not have to go on medication. I have lost 15 pounds at this point by cutting out most of my carbs, he said if I could lose another 25 it might just solve my problem.
I’m trying to really keep my carbs under control. So far he has me testing twice a week. I have chosen to do so in the morning before I eat. Is this enough? When is the best time to test? I won’t see him again until December. I also test occassionally at different times during the day to see what’s going on. After eating, how can I know what would be too high numbers?
Posted by Dian | Oct 28, 2009 at 3:20 pmHi Dian,
Sounds like you’re doing very well with your diabetes! As far as testing, or checking, goes, your best bet is to vary the times when you check. If you only check in the morning before eating, you’ll miss other times of the day, including after meals, when your blood glucose may be higher (or lower). I’d suggest you vary the times: alternate by checking before each meal over a few days, and then check two hours after meals and before bedtime on other days. Fasting and pre-meal blood glucose targets are 70-130, and 2 hours after meals, no higher than 180. Bedtime readings should be around 110-150. However, your A1C is really the more important number, as that tells you how your blood glucose has been doing over the past three months. The goal is to keep your A1C under 7% — so you’re on the right track!
Posted by acampbell | Oct 28, 2009 at 3:31 pmThank you, that was very helpful to me
Posted by Dian | Oct 29, 2009 at 12:12 pm