[LoDeSp]

Originally Posted by Achilles

My basic question for folks who are controlling their Type 2 D with diet and exercise alone is how good of control do you seek for a goal?

I was in a similar situation to yours about a year ago, though probably not as advanced with the big D. My fasting was 114 when diagnosed and my A1C was 6.8. I was also about 100 pounds overweight. I now have adequate control through diet and exercise only (and losing 70 pounds, but how much this helped me is debatable).

My targets are 80-100 fasting, <140 two hours after eating, and an A1C of around 5.0. Over the last three months, my averages are 94 fasting and 130 after eating, and my last A1C was 5.6. So I think those are reasonable goals, though they will likely be very difficult for you to achieve at first. Until you think they are achievable, I would set a goal of keeping your BS levels as low as possible. The important thing is not to get discouraged -- this is partly why the ADA used to recommend shooting for an A1C less than 7.0. They thought that 6.0 would discourage too many people, who would then not manage their diabetes at all.

Been working out very vigorously almost every day with weight training and interval cardio training.

I've only been lifting for about 7 months, but I think it's been very helpful for decreasing my insulin resistance. I also use my elliptical on days when I don't lift. So you look to be on the right track here.

I started a low carb diet where I believe I'm eating maybe 50 - 60 grams of carb per day.

This sounds a bit low to me, but you'll need to discover how many carbs you can tolerate. I'd also recommend using one of the online calorie counting websites to track your carb intake by day and by meal, at least for a while. If you link those records to your BG test records, you should be able to come up with an estimate for how many carbs you can handle in day. With me, it's been about 150 per day, and more importantly, I can feel satisfied eating that way.

So what's going on is what I'm wondering. Do Dr's. put people on Metformin right away because of fear that the patient will not be diligent with maintaining a low carb diet and exercising? I know that is tough to do in the long run, but when you have diabetes, it is a required life style change if you want any chance of staying off the meds.

My doctor started me on Metformin 500 mg/day at first as well, but after my A1C dropped below 6.0, he let me stop it. But yeah, I think Doctors prescribe Metformin to the newly-diagnosed because they hear a lot of people say "I'll lose weight" or "I'll eat better" and then not follow through. My stepdad and mother-in-law are both like this. They were diagnosed about the same time I was and haven't really changed their eating habits or lost much weight. As a result, they're still on the Metformin and getting fasting readings above 130 and post-meal readings above 200... when they even bother to test.

Thanks for any advice! Is diet and exercise >>>> Metformin for some people? How good is "good" control here? I don't want to take more Met than I have to and hopefully as I build more muscle and lose more fat through exercise I can maybe eliminate it altogether if my Dr. agrees.

Diet and exercise works for me. It might not work for you, for a variety of reasons. It's possible that you'll be able to get off the Metformin, but if that doesn't happen, don't see it as a failure. The important thing is to keep your BS under control, whether you do that with diet, exercise, drugs, and/or insulin.

From what you described, I think you're on the right track. You're already over the most important hurdle -- changing your life so that you control your diabetes. Most people can't do this (my stepdad and mother-in-law for example). Your increased exercise should help as should your dietary changes.

But diabetes is different for everybody, so you need to test often and try to see what foods work for you and what foods don't. I found it very helpful to take a weekend day and test every half-hour. This gave me an idea of how my blood sugar changes in reaction to food -- how soon do BS levels peak after a meal, how does it react to (light/moderate/strenuous) exercise, etc. If you can spare the strips, I think it's a worthwhile exercise.

Best of luck to you, and let us know how it's going.