Treating Diabetes with Diet and Exercise

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.

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Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

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