There are numerous treatment options for diabetes. Traditionally, the so-called “diabetic diet” and exercise are recommended first. Soon after, however, most people with blood sugar problems are prescribed pharmacologic treatments. These range from pills to insulin injections, and we will discuss them all here.
The “Diabetic Diet”
The diabetic diet has been prescribed millions of times. The problem is that it doesn’t work. We have to go back to the origins of the disease to understand why, but suffice it to say that the same old, tired recommendation we physicians have been giving our patients for years does not address the underlying problem, namely insulin resistance.
Once your blood sugar is elevated, it is imperative to fight the cycle of insulin resistance and allow your pancreas to “re-set”. The only way to do this is to drastically cut the amount of carbohydrates in your diet. The classic “diabetic diet” tells us to limit starches and carbohydrates to no more than about 25% of our daily calorie intake (by counting calories, or counting carbohydrates, or dividing our dinner plate into sections, etc.). With this approach, the pancreas (already stressed out by years of poor eating) is never able to rest and catch up, and the disease is left to continue to worsen.
For many people, following a classic “diabetic diet” will slow down the disease just enough to improve the blood sugar readings marginally. Don’t be fooled into a false sense of security! Until we truly allow the pancreas to rest, the disease will continue its relentless progression and it will only be a matter of time before the blood sugar readings go up again.
If you are interested in stopping the progression of the disease, and the possibility of even using a natural cure for diabetes, then take a look at the diabetesless diet and see what hundreds of my patients have found that really works.
The truth about exercise
It is undoubtedly true that exercise is crucial for maintaining good glycemic (blood sugar) control. The type of exercise that you do doesn’t matter, just do something.
My patients have lots of questions about how far they should jog or how fast they should walk, but the most important facets of exercise can easily be understood with three simple terms: intensity, duration, and frequency.
PLEASE NOTE that you should consult with your doctor before beginning any exercise regimen. Start slowly and build up to these recommendations!
Intensity–to get the most out of your exercise, you should work to achieve and maintain the proper exercise intensity. How do you know if you are exercising with enough intensity? If you can answer “yes” or “no” questions, but are unable to carry on a conversation, then you are breathing hard enough to ensure that you are achieving adequate aerobic intensity in your exercise.
Duration–again, always start low and go slow, but eventually you should be able to exercise for 20-30 minutes without stopping. This may take several weeks or months to achieve, but try to do a little more each week until you are able to move without stopping (at the intensity outlined above) for at least 20 minutes. Thirty minutes is even better!
Frequency–this is probably the most important of the three. Any exercise (even if the intensity or duration doesn’t meet the criteria above) is good exercise. But to really get the most from your time spent, the frequency of your exercise should be at least 4 days per week. Any less than this and you are really not having a significant, long-term impact on your insulin resistance and pancreatic function.
Medications for Diabetes
There are numerous options for pharmacologic treatment of diabetes. Unfortunately, we physicians all too often turn to drugs early in the disease, when the right diet and exercise are all that is really needed to stop the progression of the disease, and sometimes even reverse diabetes.
There are times, however, when medications are required. Various professional societies and diabetes groups have recommendations regarding the order in which these medications are prescribed, and there is a large degree of consensus in terms of which medications should be used first, etc.
We will discuss each of these in turn, and I have tried to demystify the way they work. Click on the medication you are taking or have questions about to read more about it. Please understand that this information is meant to be a supplement to what your doctor has told you, and is not meant to replace any specific, personalized recommendation that he or she has made for you. Some medicines have more than one use and many medications can be used either alone or in combination for diabetes, so the general information provided here may not be pertinent to your specific situation. If you have any questions, please consult your doctor.
- Sulfonylureas and Glinides-GLIMEPERIDE, GLIPIZIDE, GLYBURIDE
- GLP-1 Agonists-VICTOZA, BYETTA
- Alpha-glucosidase inhibitors–PRECOSE
- DPP4-inhibitors–JANUVIA, ONGLYZA, TRADJENTA
- Sodium-Glucose Cotransporter 2–INVOKANA
- Thiazolidinediones (TZD’s)-ACTOS