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Diet and Exercise Can Help You Manage Diabetes

Many people can manage diabetes that appears later in life through careful attention to what they eat and their physical activity.

Being told you have a chronic health problem like type 2 diabetes can be frightening. It often triggers a cascade of prescriptions intended to manage diabetes and keep blood sugar under control.

Using Diet and Exercise to Manage Diabetes:

What if, instead, doctors steered patients to experts that could help them change their lifestyle? The usual response from physicians is that patients aren’t willing to make the necessary adjustments.

However, when they do, the results can be spectacular, as this reader recounts.

“My husband’s blood sugar level had been slowly rising as the years passed. Statins seemed to aggravate the situation. When he turned 60, an HbA1c result of 6.5 revealed he had type 2 diabetes. He discontinued the statins, but his A1c stubbornly remained at 6.5. He was alarmed, as my sister had just died from kidney failure caused by poorly controlled type 2 diabetes.

“We decided, rather than start on glyburide (which was the recommended course of action), to try a high-protein, lower-carb diet, exercise and weight loss. I took diabetes education classes with him, reasoning that since I prepared our meals, I’d better know what to do. The dietitians recommended he limit himself to 60 grams of carbohydrate at each meal with 15 carb snacks between meals to control his episodes of hypoglycemia.

“For the first six months, we measured and weighed every carb he put into his mouth. I composed a lower carb, high protein dietary plan (I’m a retired nurse) for all of his favorite meals.

The Results:

“Two years later, he had lost 20 pounds and his doctors were amazed. His A1c levels began steadily dropping and settled at the upper end of the normal range. They have stabilized at 5.6 – 5.7.

“He no longer has the diagnosis of type 2 diabetes. Instead, he completely reversed it through diet and exercise. Now he doesn’t exercise quite as regularly as he used to, but he has stuck to the diet. What’s more, he can estimate how much he can eat of a higher carb item just by looking at it. All we know is that it worked, and at this time it’s not particularly difficult to stick with.

“During those first six months, he weaned himself off sugar. He decided it was better to re-educate his taste buds than attempt to placate his sweet tooth by using artificially sweetened products. That part took some self-control, but after six months, he no longer craved sugar. In fact, naturally sweet items, such as a navel orange, taste very sweet to him now.

“He’s retiring soon and looks forward to continuing a daily exercise routine. If more people took their initial diagnosis seriously and changed their dietary and exercise habits as promptly as my husband did, perhaps this country could reverse the trend of rising adult-onset diabetes. The secret is not to ignore your symptoms or lab work. To manage diabetes, you need to do what makes your body stay healthy. It’s so worth it in the long run!”

If You Can Manage Diabetes with Lifestyle Changes, You May Also Have Better Job Prospects:

A ten-year study published in JAMA Internal Medicine shows that intensive lifestyle intervention to improve type 2 diabetes also improves people’s ability to get a job and earn a living (JAMA Internal Medicine, Aug. 14, 2023). Because this was a randomized trial, we don’t have to wonder if people who are better at changing to a healthier lifestyle are also better workers.

The 3,091 volunteers were between 45 and 75 years old at the start of the study. The intervention was regular sessions with exercise trainers, dieticians and behavioral therapists, People in the control group participated in group-based diabetes education session three times a year during the first four years. Employment increased by about 3 percent for those in the intervention group. So people not only got healthier, they also had better work outcomes.

How You Can Manage Diabetes, Too:

We applaud this reader and her husband. Exercise, diet and behavior modification are essential if you want to manage diabetes well (Cleveland Clinic Journal of Medicine, July 2017).

Statins can make it more challenging to control blood sugar. So can some standard diets that are high in carbohydrates. Although experts have not achieved consensus on the most appropriate eating plan for people with type 2 diabetes, a recent meta-analysis shows that a high-fat low-carb diet can be helpful (Nutrition & Diabetes, Nov. 30, 2020). Medications can lower blood sugar if diet and exercise alone are not effective.

What Do We Mean by a Low-Carb Diet?

Q. I am so confused about the best diet for people with diabetes. I have read that it is important to avoid fat as much as possible. But then I have read in your column that a low-carb approach is better. I do eat a lot of carbs in the form of vegetables like Swiss chard, kale, squash and collard greens.

Did you mean simple carbs like white bread, cookies, crackers and cake? Or are you including vegetables as well?

A. A diet low in processed carbohydrates can help reduce insulin resistance (American Journal of Clinical Nutrition, Jan. 2022).  Some vegetables, including the ones you are so fond of, are a great addition to a diet to help you manage diabetes.

Starchy vegetables and fruit can pose problems for some people, however. These include potatoes, winter squash, carrots and corn. Occasionally, individuals will react to onions or tomatoes, or find that certain fruits do not elevate blood sugar. The best way to figure out exactly how diet affects your blood sugar is to keep records of your blood sugar measurements and your meals. Your primary care provider or diabetes specialist will also check on your HbA1c, aka A1c, every few months.

Making Sense of A1c:

Q. I developed diabetes 25 years ago. After suffering several years with side effects of metformin, the doctor put me on insulin.

I fingerstick at least twice a day, or more. The doctor who diagnosed me said that if I could keep my blood sugar numbers around 126, she would be happy. I think that equates to an A1c of 6.0. At the time of diagnosis my A1c was closer to 8.0. So, for the past twenty years the goal was 6.0.

My primary care provider retired last year, and my new PCP is not happy with 6.0. She said it’s too low. She told me to reduce the insulin dose, which I did. Despite that, and eating more “forbidden” carbs, my most recent A1c was 5.7. I have lowered my insulin dose again. I did add CoQ10 to my supplements, which has lowered my blood pressure significantly.

Why does my new doctor think 6.0 is too low for a diabetic, when that has been the magic number for every other doctor for the past 20 years?

A. We are just as puzzled as you are. The “A1c” refers to the percent of  hemoglobin in red blood cells that has sugar attached to it. In general, lower  is better, so long as the measurement doesn’t drop much below 5 (International Journal of Epidemiology, Aug. 30, 2021). The CDC considers an A1c “normal” if it is below 5.7%. Prediabetes is 5.7% to 6.4%, and diabetes is a reading over 6.5%. Trying to raise your HbA1c seems counterproductive to us. A second opinion from a diabetes expert might be advisable.

Learn More:

For people who would like to learn more about natural approaches to managing blood sugar, we offer our eGuide to Preventing and Treating Diabetes. In it, we describe how to keep track of meals and blood glucose. We also offer a long list of best-bet veggies.

Our interview with endocrinologist Kasia Lipska of the Yale School of Medicine also has a great deal of useful information to help you manage diabetes. It is Show 1173: How Is Diabetes Diagnosed and Treated?

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies..
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  • Huckfeldt PJ et al, "Association of intensive lifestyle intervention for type 2 diabetes with labor market outcomes." JAMA Internal Medicine, Aug. 14, 2023. doi:10.1001/jamainternmed.2023.3283
  • Kirwan JP et al, "The essential role of exercise in the management of type 2 diabetes." Cleveland Clinic Journal of Medicine, July 2017. DOI: 10.3949/ccjm.84.s1.03
  • Yuan X et al, "Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: a systematic review and meta-analysis." Nutrition & Diabetes, Nov. 30, 2020. DOI: 10.1038/s41387-020-00142-z
  • Ebbeling CB et al, "Effects of a low-carbohydrate diet on insulin-resistant dyslipoproteinemia—a randomized controlled feeding trial." American Journal of Clinical Nutrition, Jan. 2022. https://doi.org/10.1093/ajcn/nqab372
  • Inoue K et al, "Low HbA1c levels and all-cause or cardiovascular mortality among people without diabetes: the US National Health and Nutrition Examination Survey 1999-2015." International Journal of Epidemiology, Aug. 30, 2021. DOI: 10.1093/ije/dyaa263
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