Questions About Diet and Exercise Alone for Control

[Achilles]

I know that everyone is different, but I have a question for the Type II's out there who manage to control their blood glucose levels with diet and exercise alone. The reason I ask is that maybe there is some hope for me based on numbers I am seeing.

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?

To quickly recap my situation, I was diagnosed about 3 weeks ago with a fasting plasma glucose of 262 mg/dL. I am 5'-10" and about 180 lbs. I could probably lose a few lbs but not severely overweight. I did very little exercise besides cutting grass once / week. Also used to love eating high carb meals like blueberry muffins for breakfast or pancakes. An entire 12 inch subway sub for lunch ~ 100 grams carbs, etc.

Since diagnosis, I have been taking Metformin 500 mg/day at night for the first two weeks. I also take Chromium Piconolate tablet 400 mcg and a GNC mega man multivitiman in the morning.

Been working out very vigorously almost every day with weight training and interval cardio training. I will work out with weights doing a set with only about 30 seconds rest before going to the next set. I use a weight that I can probably do about 12 repititions with but only do about 8 - 10 reps per set until the final set where I go to exhaustion.

I started a low carb diet where I believe I'm eating maybe 50 - 60 grams of carb per day. I haven't actually started counting to "a tee" yet.

This past few days, my morning numbers have been (upon waking up), 109, 98, 110, 118, & 111.

An example of my day yesterday. Woke up to a 118. Had 3 hard boil egg whites and a piece of turkey sausage for breakfast with coffee. Went shopping at the mall for Mother's Day and to get a new mountain bike. Ate Subway for lunch, 6 inch BMT on wheat (still ~45 g carbs though). Two hours later when I got home tested and I was 160 a little high but too many carbs for lunch! Went work out and tested one hour later and was back down to 118 mg/dL. For dinner, I had a piece of grilled chicken, and stir fry with cauliflower, asparagus, mushrooms, spinach and a handful of nonsalted almonds. Two hours after this dinner, my BG was 130 mg/dL.

I was feeling pretty good and I've worked really hard the past three weeks. Not a drop of alcohol in over three weeks. I didn't take my Met last night because I wanted to go out. The previous day I only took 500 mg. So basically I only took 1000 mg of Metformin for about 4 days in a row.

So I go out to get away from the house and meet up with some friends. I have 3 low carb beers over the course of 3.5 hours. I know, one more than I'm supposed to have so I slipped up a little. Felt fine though and I was being very cautious.

Got home and tested. BG was 155 mg/dL. Ate a low carb tortilla with homemade chili and tested one hour after that. BG was down to 127 mg/dL. I hardly felt any effects of the alcohol. Went to sleep.

Woke up this morning to a surprising 111.

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.

I'll probably take 500 mg of Metformin tonight and keep monitoring my BG numbers. I know I am not following Dr. orders exactly, but he didn't even want me to start testing myself yet. This is all a big experiment right now.

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.

[paulT2]

Hi Achilles,
I think you are doing well - half the battle is paying attention to how your body reacts to food and exercise etc ...

We are all different so YMMV - what worked for me was to do as my doctor suggested ... I took one metformin 500mg every day before breakfast - for a whole year.
I also worked hard on a balanced diet (not low carb - not high carb) plenty of veggies.
I think portion control is the single best thing I can suggest you pay attention to.
Your BMI works out at 26 - you could loose 20/30 pounds and still be healthy ... or at least replace any fat with muscle - muscle uses up that glucose more efficiently.

A year after my diagnosis, with my doctors agreement, I stopped taking medication ... that was about seven months ago. So far, my control remains good.
I eat a sensible diet and exercise regularly (I like to run and am currently 'training' for my first half marathon)
Its early days for me but I think I have made and am continuing to make improvements to my lifestyle that I will maintain for the rest of my life. Slow, steady and continued progress ... so far so good!

My doctor explained to me the reason for the metformin was to aggressively attack the early signs of diabetes. It also significantly contributed to me losing about 30 pounds.(apparently metformin was originally designed as a weight loss pill!)

In answer to what constitutes good control, for me I aim for as near 'normal' numbers as possible. I don't always get them but I always aim for them. I don't accept the argument that goes "you are diabetic so you will have diabetic numbers". If my control slips at some point in the future I will consider taking meds again but I hope to use long term lifestyle changes to maintain my good control.

This is just what works for me, we all have to find our own path through the diabetes jungle.
Some must use meds, others probably don't need them but are not prepared to put the work into lifestyle changes that would remove their need for them.

Anyway this is just my 2 cents worth.

Good luck and keep testing!

[Achilles]

Thanks for the response and advice PaulT2. That gives me some hope that this can be done. A goal to aim for if my body allows.

Congrats on your progression too. You are doing extremely well.

I forgot to mention that my Dr. wanted me to increase to 1000 mg Met after the first couple of weeks. I did so for 4 days but taking it all at once at night made me have trouble sleeping. I was taking one in the morning and one at night after. I might just go back to 500 mg at night for another week and see if the numbers keep coming down. I don't want to have to take 1000 mg if I don't need to. I'll call the office after a week and ask then. I'll have an A1c done in two months. That will also help tell a tale of how I'm doing.

[Evermont]

If your numbers are close to good - and you're committed to doing what must be done, you should go for it.

At Dx my doc was getting out the Rx pad, I told her "I want to try diet and exercise - no meds". She said; OK. If it doesn't work out, then meds. Of course.

I think that running slightly bad numbers, for long enough to tell if efforts are working, won't usually cause problems. How's that for weasel words?

My doc is simply stunned by what I have accomplished with what she terms "behavior modification". I'm stunned that more people don't choose to do it. Alas, there are those among us, and too many of them, that could not get all the way there with just exercise and diet. For them, exercise, diet and meds are the way. Sadly some cannot exercise, meds for them are a lifesaver.

More of us CAN do this THAN do this. But if you can, then do!

[Achilles]

I think that running slightly bad numbers, for long enough to tell if efforts are working, won't usually cause problems. How's that for weasel words?

More of us CAN do this THAN do this. But if you can, then do!

Just in three weeks, I feel so much better. Hardly anymore tingling in the feet, my ankle edema has gone away, I have more energy during the day, feeling less stressed, less anxiety, etc. all of the symptoms I was having before diagnosis.

I have no idea what my BG numbers were before diagnosis but I'd be willing to bet I was peaking in the 300s or something especially after pigging out on pizza for lunch or spagetti and meatballs for dinner with cheesecake after that. I felt like I could eat whatever I wanted and wasn't gaining weight (unknown to me that I had the D). It wasn't till the tingling in the feet, edema, and fatigue finally caught up with me that I realized something was wrong and that's when I suspected diabetes before I even saw the Dr.

So yes, running slightly "bad" numbers for now is a far improvement over where I was a few weeks ago. Continued diet / exercise / low dosage of Met hopefully things will continue to improve.

Only time will tell for me. I am commited though. Good control numbers will I guess be A1c < 6.5, postprandial numbers < 140 like some others have. I'll have to discuss this with the Dr.

Exercise for today will be cut the grass for 1.5 hours in this 88 deg F Louisiana heat with 70% humidity. Push mower no cheating with a autodrive unit. Heat index is 97 deg F. Then I'm going to change the oil in my truck. I still like to do this myself for some reason:D

[BrianSCohen]

Achilles,

Everyone is different. They have different goals, and everyones body is different. It is also true that everyone has a different ability to commit to a plan. I would tell you that for myself at 5'11'' and 205 lbs, I have committed to dramatic changes with mixed results. I lost weight and built muscle mass through exercise. I changed my diet to dramatically reduce carb intake. Yet despite my best efforts, my fasting blood sugar still are outside of what I deem acceptable. I often find my morning levels are at 120-130 mg/dL. I already take metformin, but will very likely in the near future will choose to take more aggresive medication.

I guess I would say that diet and exercise may or may not help you reach your goals alone. For a type II, certainly the two primary treatments should be diet and exercise. However, diet and exercise alone may not be suffiicient to put your diabetes in remission and often, in the end you willl need to accept more aggresive medication and insulin therapy. But by no means, should you ever give up on diet and exercise as your primary defense against the big D.

[LoDeSp]

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.

[Scrabblechick]

I'm on Metformin right now, but my goal is to come off the meds in the next year or so, if that's possible for me. I'm not sure how intense my insulin resistance is.

With 46 pounds down and a bunch more to go, I'm in this thing for the long haul. I look at the Met, right now, as a means to an end. Being on it now means I may be able to bring my numbers down low enough to quit it later on. Since I'm so woefully out of shape and hate exercising so badly (mostly because I'm so pathetic at it), I'm working up to a more intense exercise regimen, but it may take a while.

My BG numbers are improving, and I hope to get them to a near normal status in the next several months, as well.

[Achilles]

To everyone that has replied.. thank you very much for the encouragement. I am very grateful for you all taking the time to respond and share your experiences. Taking the time to write things to help total strangers is a gift that I appreciate very much. It helps me cope with what I'm going through. The detailed responses are all very much being consumed in my mind. In my opinion, the things that you may read in a book or hear from a medical professional are just an appendage to hearing it first hand from the people who actually live it.

I may be going through some denial again. It has only been 3 weeks for me so far. It may be human reaction to believe that I can exercise and diet this thing off but down deep inside I know that isn't going to happen. I just have to play the cards that have been dealt to me just like you all and everyone else who is a part of this forum. Do I want to hold them or do I want to fold them? Maybe I'll keep a few and ask for a couple... you know what I mean. All of the cards aren't that bad...

I have some other issues such as feeling guilt but these are more psychological in nature. Things could be a lot worse and I realize that I don't have a terminal cancer or handicap, etc. I can lead a somewhat normal life with this manageable disease. I have been on top of the world for a while career wise, financially, and with other things and this has made me realize just how human I am.

Once again, thanks. It really means a lot.

[adiantum]

What works for me may not work for others. My doctor wouldn't commit to allowing me to go med free & said it was all to do with my A1C results. If that goes up then I'll have to go on meds.
I'd not cope on the limited carbs you are eating.I have 45carbs for breakfast & then walk. 30carbs for lunch & do some serious gardening etc then 45carbs for dinner & an evening walk.
I'm not into going to a gym etc . The most strenious activity I have is climbing up & down the stairs at a local railway station.
It's working so far & I want to keep it that way

[Achilles]

Well I wound up not taking any Metformin again yesterday just as a continued miniexperiment. I did take one this morning though to get back on track.

Yesterday I did test 10 times!

After cutting the grass and losing 1.5 lbs of water (according to my scale...it sure was hot and humid) I was a 108 mg/dL.

For dinner, had 1/4 left over ribeye steak, medium sized salad with spinach leaves, 1/2 cucumber, 1/2 cup of chicken breast, and mushrooms with a olive oil / basalmic vinegar dressing. Also had a low carb tortilla with the homemade low carb chili again and finished it off with a Dannon sugar free and fat free blueberry yogurt. Felt pretty full after this meal.

1/2 hour after eating, BG was 145. One hour after eating, BG was 153. Two hours later, I was back down to 114. I didn't take any Metformin again last night.

Woke up this morning still sore from the workout 2 days ago (did some new exercises that work muscles from different angles) and tested at a 107. My six day morning average has been 108. Ate breakfast, 2 egg whites again and 1 turkey sausage link and a piece of provolone cheese. It sure would be nice to have a whole wheat waffle. I bought some just haven't tried to see how they affect me yet. I did take 500 mg of Metformin after breakfast to get back on track with my meds. At this point, I wish I knew how much the Met was helping me out vs. just the diet and exercise alone as I've read it takes a few weeks for Met to start working. I've decided to get back on it though and follow what the Dr. has asked me to do.

I'd like to work more carbs into my diet too. I've felt a little weak at times during the past few weeks because of the heavy workouts and limited carbs. I believe my body is getting readjusted to all of this. Just a low carb diet would make one feel different for a while as the body readjusts.

The exercise part of this regimen has huge upside for me as I pretty much was a couch potato for a couple of years. I did mention this to my Dr.

I'll keep experimenting with the food / carbs and keep posting.

[art]

Achilles: if you're going to alter your meds TEST!!
A lot.
You could accomplish what you want but you can't risk going high. I hope it works out for you. It didn't for me. But to stay under control taking 2 lousy pills a day is no biggie.

As someone here pointed out recently Gumbo without rice is obscene. But it's the price we pay. as for the 3 beers. I've done a lot ore with no effect. But then, we are all very different.

Art

[volleyball]

I was eating like you before I knew what I had and I had a whopping A1C. I never took metaformin after diagnosis even though my doctor suggested it. I was active and did a lot of right thing and some wrong things.
Going medicine free means you do have to stay vigilent. It also means good control not tight control. I am happy with a number that some would gasp at. But this is a long distance race. Who care who's leading in the early laps, it's how you finish. Five years now with no medicine and people tell me I look younger than I did before.
We are all different and we have to decide what road we will follow and deal with the consequences. I am hoping that I made the right choice for me. That forgoing pills now means I am not on insulin in the future, That I never burn out my pancreas because I pushed it too much when I was younger. Like how some of the hard bodied youths who exercised all the time become some of the fattest slobs as they get older and the moderate person now looks better

[Achilles]

But to stay under control taking 2 lousy pills a day is no biggie.

As someone here pointed out recently Gumbo without rice is obscene.

Art

You are absolutely correct. Two lousy pills / day isn't all that bad. I really think I was going through denial again this weekend. It could be a lot worse.

Only tested twice today. 112 this morning and 102 just now as I came home from work. I've been taking my Metformin too.

I miss my gumbo with rice and jambalya! Those are two of my favorite dinner meals to cook. I bought brown rice but haven't attempted to cook and test it out with those yet. If the Met allows me to eat that brown rice (just a little) then that would be a big positive in my book. Also, if it helps delay the burnout of my beta cells then that would be another big positive.

I read somewhere that most Type 2's eventually have to get on insulin due to beta cell burnout? I'm really concerned about this as I have a safety sensitive job and cannot afford to go hypo. I guess I shouldn't be worried about what happens in the future though. I need to focus on now and what I can do each day to stay in control one day at a time.

[Evermont]

...I bought brown rice but haven't attempted to cook and test it out with those yet...

You may already know this, but just to avoid a crunchy jambalaya, brown rice takes notably longer to cook. Experiment with a little but by itself to get the feel for it. The thing that makes it take longer to cook is the same thing that makes it take longer to digest.

[volleyball]

Taking 2 lousy pills is nothing. Neither is eating a big bowl of rice. It's the effect on you that is the problem.

[art]

The thing about the D is there isn no really clear path of what will happen. I kow a guy that's 82. Been a type 2 for over 20 years. He's never been on insulin. There's just no telling.

As for fustration. Mothers day night a bunch of us went out for Thai food. I was just in a screw it mood. Crab Rangoon, Shrimp in won ton wrappers and my personal BS elevator brown rice.

Next morning "honey get the Novolin". It was worth it.
I wasn't up in the 200's. Just a little over my allowable range.

Sometimes you gotta.

Party on

AFS

[Sunfire]

I just wanted to chime in here and say that YES, Type 2 Diabetes can be controlled with diet and exercise alone. My husband was diagnosed in September 2005. Initially he was prescribed Glyburide. We hit this disease head on and he made diet and exercise changes the first day. He was off the Glyburide in a week because of low's (50's). That was scary!

Anyway, when diagnosed his fasting was 204 and A1C was 7.4. Since then all A1C's have been in the mid 5's. He walks at least 40 minutes a day and everything I buy/cook is mostly low carb and heart healthy. I buy low carb bread, pita's, & tortillas so he can still have sandwiches for lunch. I buy Dreamfields pasta's so he can still enjoy our favorite Italian dishes and Lasagna too! The potatoes can be a little iffy....I mostly make things using red skins because they're lower glycemic. As with anything, moderation is the key.

I also know of someone who has been Type 2 for 15 years and he's still controlling with diet and exercise.

So....the moral of the story is it can be done with determination and hard work!

[Achilles]

It has been about a month since I posted on this thread. I've been taking my Metformin every day twice a day (500 mg ER) and seems like I have hit an impasse. I ocassionally test below 100, maybe 10 - 15 % of the time (testing about 4 times a day). My past 14 day average has been 124 mg/dL. This includes morning fasting numbers which are usually 95 - 110, and pre and post meal (usually dinner), and before going to bed. I seem to have some trouble being lower than 140 mg/dL 2 hours post prandial, but get there after 3 hours. I'm never over 200 after eating. I'm usually in the 120's when I go to sleep.

I've still been very diligent with working out and I don't think I could work out any harder. Also increased my carbs a little and eating Dreamfield's pasta and small portions of brown rice. I'm probably having around 80 grams of carb / day but I really should count them exactly and monitor. I feel like I'm doing pretty good though so I'm just waiting for my first A1c in another month or so to see what that number looks like.

Not sure what will happen when I visit the Dr. He may increase me to 2,000 mg / day of Met or tell me to cut back to 500 mg / day. I guess it will be based on the A1c.

It is getting a little easier; I'll just keep moving along with what I've been doing.

I have to travel for work for the first time tomorrow through Friday. That is going to be interesting.

[LoDeSp]

It has been about a month since I posted on this thread. I've been taking my Metformin every day twice a day (500 mg ER) and seems like I have hit an impasse. I ocassionally test below 100, maybe 10 - 15 % of the time (testing about 4 times a day). My past 14 day average has been 124 mg/dL. This includes morning fasting numbers which are usually 95 - 110, and pre and post meal (usually dinner), and before going to bed. I seem to have some trouble being lower than 140 mg/dL 2 hours post prandial, but get there after 3 hours. I'm never over 200 after eating. I'm usually in the 120's when I go to sleep.

I've still been very diligent with working out and I don't think I could work out any harder. Also increased my carbs a little and eating Dreamfield's pasta and small portions of brown rice. I'm probably having around 80 grams of carb / day but I really should count them exactly and monitor. I feel like I'm doing pretty good though so I'm just waiting for my first A1c in another month or so to see what that number looks like.


IANAD (well, I am, but not a medical doctor), but that seems pretty reasonable to me. I had similar numbers after going on a moderate-carb diet (after ditching the ADA's high carb, low-GI diet). My numbers would be ~100 fasting and ~130-140 2 hr pp. Then about two months ago, my numbers took a dive, and now I average ~90 fasting and ~100-120 2 hr pp. And this was without any change to my diet or exercise routines. So it might just take time for your body to adjust. I don't think you necessarily need to work out any harder, but definitely keep doing what you're doing.