Rethinking Lifestyle Change
If you have type 2 diabetes, chances are you've heard the mantra "diet and exercise" so many times that it's become background noise. You know you should do it, but how is the question. In this morning's New York Times, Gina Kolata asks "Should diabetes specialists even bother to advise patients to try helping themselves through diet and exercise first, before prescribing drugs?"
In August, the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) issued a joint consensus statement that changed the way type 2 diabetes is treated right out of the starting gate. The oral drug metformin now joins diet and exercise as the front line treatment for those newly diagnosed with type 2. While acknowledging the power of even minor lifestyle changes in improving diabetes control, the authors of the consensus statement stated that " the limited long-term success of lifestyle programs to maintain glycemic goals in patients with type 2 diabetes suggests that a large majority of patients will require the addition of medications over the course of their diabetes."
Now, that question may be extended to prediabetes, as new studies confirm the preventative power of oral diabetes medications. Will the diet and exercise message be diffused even further with the promise of an easier solution? Behavior change is tough, and if you take away the motivation, it gets even tougher.
So are we being realists or defeatists in turning to medication as our first line of defense against diabetes? Will the new guidelines improve control or make diet and exercise an even lower priority? How do we harness the tremendous potential of diabetes medications while promoting healthy habits? We want to hear what you think....comment below!
Comments
- At 03:37 PM on Wed, Oct 3, 2007 Mike wrote:
Just received results from blood tests...sugar was 6.1. Does this qualify me for the label "Diabetic" ???
I would appreciate any advice or help in this matter.
God Bless
Mike - At 02:51 PM on Tue, Oct 24, 2006 Pam Smith wrote:
Hi,
I went to my dr's office and told him that I had a "sugar" problem and he didn't belive me. I had been checking my sugar with a blood monitor for over a month and it was as high as 377 !!!!
After he ran the tests and saw that my A1C was 8.7, then he believed me.....he wanted to put me on meds right away, but I said no! let me try to get it down..he gave me four months...well, I surprised him !!!!! When I came back, after four months, I had lost 40 llbs and my A1C came back 6.1. ....now, after one year, I have lost about 70 lbs, and my A1C is 6.2. I now eat fruit every day, watch my diet like a hawk, and exercise.....My doctor is so surprised at how well I have done.......not only has my A1C dropped but my blood pressure is now 100/60 total chol is now 150 and trigl. are 66 !!!!!! I am on NO medication and almost 50 years of age.....No, all I got was a brochure at the doctor's office.. I got the Adkins book for Diabetics and read it cover to cover...I have taught myself what to do and I feel great...and the best part....I have went from a size 17 to a 4 !!!!!!!!! I haven't been a size 4 since I was a kid !!!!!!!!!!!! Remember, with determination, it CAN BE DONE....don't give up...!!!!!!!!!!
Pam :-)
- At 01:29 PM on Mon, Oct 23, 2006 Barbara Henley wrote:
Diagnosed as Type II in January 2006, my mother was given pills and sent home with very little information, save a brochure. We began to educate ourselves through books and the internet. And D-Life was a Godsend, honestly I don’t know what we would have without this wonderful program!
We developed a diet and exercise plan (turns out I was pre-diabetic). Now 9 months later, we have each lost 100 lbs., her A1C has fallen to 5.2 from a dangerously high level.
Newly diagnosed diabetics must receive better education from their doctors and basic information! And the insurance companies need to better cover their portion of this education. Education is A LOT cheaper than treating diabetes.
So many times this disease can be controlled through diet. And how many people could have avoided diabetes in the first place if only they had been given a general class on nutrition?
EDUCATION, EDUCATION, EDUCATION and if proper nutrition and exercise does not help enough, then by all means medication should be prescribed.
Our lives have been changed forever and we have made the best of a bad situation. We are now working with others to work towards a healthy lifestyle so hopefully others will never have to find out about this disease.
- At 02:10 PM on Sun, Oct 22, 2006 marcia roper wrote:
Hi, I am an RD and CDE and was happy to see your article. I have developed a program that reverses type 2 diabetes. I have worked with Native Americans for 5 years and an example of success: HA1c 11.4, now 5.4 with no med. The word "progressive disease" only applies to those taking medications. It is totally reversible. I will send you a program if you are interested.
Marcia Roper
- At 12:00 PM on Sun, Oct 22, 2006 susan wrote:
Hi I was diagnosed with type 2 diabetic about four months ago. I got will mad at frist did any one feel that way at the beginning? Latly it has been harder to controll how much and what I should eat. I have lost over fourty pounds. But now my doctor whats me to not take metfromin. I am afraid that I'll gain thw weight back.Has any body felt this way? If so write back thanks susan
shart25@cox.net - At 11:51 AM on Sun, Oct 22, 2006 susan wrote:
Hi I was very depressed from the beginning knowing that I have diabetes didn't know what to do or turn. But I finually got ahold of my weight and depression and six months later I have never felt better or more control of my life.So if I can encourage someone out there that if I can do it> Then I know that you can do it to. It is very scary at first but after the shock you can do it!
friends susan - At 04:32 PM on Fri, Oct 20, 2006 Charles Keyserling wrote:
I read the consensus report and the information appears to be very accurate and well done. The problem with this report is that it does not emphasis what I have been told is the best treatment for type-2 diabetes, the development of lean muscle. It also doesn't address what I consider an important issue, slowing the progression of type-2 diabetes and it doesn’t expressly state the best way to prevent long-term complications. Most diabetic complications are tied directly to CVD. Exercise is the most effective way for non-diabetics to prevent CVD and works even better for a person with diabetes. Cardio level exercise increases heart strength, lowers blood pressure, improves cholesterol by lowering LDL and raising HDL, improves the quality of life and reduces depression by releasing endorphins. In addition, for the type-2 diabetic with insulin resistance, exercise builds muscles and burns fat, which lowers insulin resistance and burns glucose improving glycemic control and reversing or slowing down the progression of type-2 diabetes. In addition, exercise is a great reason to go shopping, play golf, play tennis, go swimming, walk on the beach, go to the gym etc. So one of the basic questions not addressed in report as a separate issue from diet is why most diabetics don’t exercise and aren’t able to gain long-term success with exercise. This report ignores the possibility that one can convert fat to muscle and not lose a lot of weight but still have good glycemic control plus the physical fitness is a great way to delay or prevent CVD. Exercise, some diet control and TZD medication has worked well for me, but doesn’t make it as a suggested recommendation in the Consensus Report. .
Lets try to answer the question about why most people with diabetes don’t exercise. The answer is they can’t because for muscles to function properly they need the glucose that remains in the blood because of insulin resistance. The report suggested that the best thing is to limit the fuel source the liver with Metformin or almost starve to lose weight, but such treatments make hard cardio exercise almost impossible. The TZDs enable more of the glucose to get to the cells that need the glucose allowing harder, longer exercise routines and a much faster recovery. Such an approach lowers insulin resistance and the need for so much insulin thus slowing the progression of type-2 diabetes. So why aren’t TZDs recommended for the person that is committed to exercise and some diet control! I think it is very unfortunate that the consensus report overlooked this possibility. While for some diet, exercise, and Metformin will work best, there are better approaches for those that want exercise as the main focus of their diabetic treatment. Some individuals have been able to achieve good control with only diet and exercise and maintained this control for many years and into the senior stage of their life.
- At 06:51 AM on Fri, Oct 20, 2006 Roger Dorn wrote:
I was diaganosed with type 2 diabetes in March 2005 at age 55. My Dr. immediately put me on Metformin 500 twice a day and set me up with the hospital educator. I attended diabetes and nutrition classes, where we set up a diet and exercise program. At the time, my HbA1C was 7.9 and I weighed 275 lbs. By following the exercise plan and nutritional guidelines, I now weigh 180 lbs and my HbA1C is 5.2. I take Metformin once a day, and my 14 day average is 94.
I know too many people with diabetes that don't take care of themselves, eat wrong and feel that all they need is a little extra insulin.
I come from a family history of diabetes, and I was really not surprised that I was diaganosed as a diabetic. But I also did not want to be like my grandfather, who I watched while growing up, lose his battle "a little piece at a time" with all of the amputations he had. Granted, diabetes control is 100 fold better now, but seeing him die like this opened my eyes to this disease.
You only have one life to live, and only you can decide what you are going to do with it. I decided that I was going to admit to this disease, control it to the best of my ability and be the best person I can be.
- At 12:29 PM on Thu, Oct 19, 2006 Joanne Nedwick wrote:
I was diagnosed as a type II diabetic mid August 2006. My AC1 test was 9.1 in August. I have since brought it down to 6.8 through diet and exercise alone. No medications have been prescribed yet. I do have some concern.....are my glucose numbers good enough at this time to prevent damage/complications? Is it safe to wait to prescribe medication?
- At 10:43 PM on Wed, Oct 18, 2006 jaws3d1948 wrote:
I've had a hard time controlling my sugar levels due to my diet and exercises. But I learned the hard way not to play with the treatments recomended by our doctors, because it's very easy to get kick on the behind with a sudden and cold blooded complication. I rather put up with a diet and exercise. Trust me I've seen a lot of people with horrible complications at the hospitals, so horrendous it brought the message to me loud and clear. Please educate yourself on this illness. Don't think you know it all because you don't. Don't wait for any complication to hit you. Please listen to the educators, the doctors, the people in the know,specially those that have been devastated by this for not listening and doing what you all been taught and told about it.
- At 07:00 PM on Tue, Oct 17, 2006 Judy Barnhart wrote:
I was told today by my doctor that I hve moved into the Type 2 Diabetes circle. I was sad and scared. I have an RX waiting for me at the pharmacy and all the testing items to start checking things on a daily basis. I am scared of the changes in my life right now to get this under control. Diet, I guess I can do it. Exercise, I can do that too with determination. I willt ake the meds, as I am on so many others for other things. I hoope the doc knows what she is doing in my plan for better health.
- At 12:48 PM on Tue, Oct 17, 2006 Tom Woolworth wrote:
I have a couple of comments ...
I was diagnosed as a Type 2 in April 2004. Our family physician wanted to prescribe oral meds ... I asked if I could try diet and exercise ... of couse he was skeptical ... he gave me six months to show improvement ... I weighed 292 lbs when diagnosed ... Today I weigh 180lbs with good control of Blood Glucose levels ... I took the opportunity to control my DIABETES. It would have been easy for me to take the oral meds ... but I accomplished something ... I can control MY DIABETES.
I know many DIABETICS who CANNOT control their Blood Sugar with diet and exercise. To take the diet and exercise option away and prescribe oral meds from the start ... well for me that spells being a defeatists.
I am a realists .. I know that some day my DIABETES may require me to take oral meds or insulin shots ... but NOT TODAY ... All I am saying ... people should be given a chance to take OWNERSHIP of their DIABETES .. the option for 6 months to see if they can take ownership. There is no shame in trying ... and who know DIABETES may be an instrument for lifestyle change ... DIABETES saved my LIFE ...
Thank you
Tom Woolworth
Tom, great comments! I am 36 years old and was diagnosed Type 2 on June 18th, 2007. That was only 4 months ago and at the time I was only 35. I had no symptoms, my elevated A1C was discovered during routine bloodwork for a new job I was starting (as a nurse!) I was DEVASTATED and cried for an hour straight. Then I DECIDED to make a change. Now, I eat <100 carbs a day, mostly from fruits and vegetables, eat lots of protein, and exercise (walking) 2 or 3 times per week. I have lost 35 pounds (from 223 to 188) and still losing. I feel great and thank God daily for my early diabetes diagnosis. I just had my A1C drawn yesterday and can't wait to hear the results. I am very proud of myself and of everyone who chooses to change bad lifestyle habits. As a nurse, I see everyday the effects of diabetes and it's one of the ugliest diseases out there. To others, let fear motivate you, because you should be afraid of your future if you don't control your blood sugar and your weight. Make a decision to make a change!!!