Just joined and I have a question: can diet and exercise alone control diabetes?

Having lurked my way through some topics this evening before and after joining, I thought that I would introduce myself and pose my question. I was diagnosed with T2 diabetes in August 2015 after spending 4 months in a wonderful free course called Building Resistance to cardiovascular disease and diabetes. I had been told that I was prediabetic prior to starting the course unfortunately my A1C result of 8.8 meant that I was no longer considered pre! I continued the course along with continuing the exercise group 3 times a week after the course was finished and was able to bring my A1C down to 7.6 then 7 followed by 6.4 using diet and exercise only. My fasting blood sugars have never been great…rarely below 8… the diabetes nurse and educator say I have a leaky liver! Recent tests have shown a reversal with an A1C of 8.2 and current blood sugars as high as 24 and fasting as high as 18 but normally around 10. My exercise has fallen off after I suffered 2 falls between October and January but I’m starting to build regular walks and swimming along with a return to the group fitness back into my routine. I am taking early retirement at the end of the month and plan to mae my job for the next year becoming fit and healthy. I really want to avoid medication…maybe I’m being foolish but… can moderate exercise and a primarily lower carb diet control diabetes?

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Yes. I have been maintaining numbers in the normal range with diet and exercise only for just over a decade now…Low carb does the trick in combination with even moderate exercise, preferably a little after every meal—or a lot once/day! I exercise about 60-75 minutes/day everyday. And, though it was very vigorous a decade ago, it is restricted now due to health issues. But my numbers remain okay because my way of eating has never changed…Bedtime for me. I’ll check in tomorrow sometime…Blessings…Judith in Portland…

PS—something nobody ever mentions—if you are eating low-carb—vacuuming is exercise. Up and down the stairs to do laundry is exercise—etcetcetc!

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I applaud your goals. Welcome to the group. I hope you change your mindset that drugs are bad. Type 2diabetes is a progressive disease. Eventually you may need medication. No one is a failure. Exercise is a great way to control your numbers along with low carb eating. Nancy

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Hi Fernsk. Seems like you have two different questions or assumptions represented here, and neither of them have a simple, correct answer. Before anything, welcome! I know you probably don’t want to be here, but there is a lot of experience with dealing with diabetes in this forum. So, on to your actual post:

May I ask why? For most diabetics, medication is necessary (at some point) in order to achieve healthy blood sugar or maintain healthy blood sugar. Achieving and maintaining healthy blood sugars is absolutely, critically important for diabetics of any type, since high blood sugars are directly or indirectly responsible for the complications that can make diabetes such a terrible thing. Everything from blood vessel issues in the eyes to loss of sensation in the extremities (neuropathy) to CV damage, stroke, and heart attacks result from consistently high blood sugars. Really high blood sugars can result in diabetic ketoacidosis, which is fatal if untreated.

It is usually considered best practice to treat Type 2 with medication (either orals, insulin, or orals and insulin) to bring the BG into a “normal” range as quickly as practical, and then some people maintain that with diet and exercise if they can. Key point: not everyone (probably not even most people) can maintain “healthy” blood sugars on diet and exercise alone, although some people do so for extended lengths of time.

The most common drug used to treat initially diabetes in Type 2 cases is Metformin (or Glucophage), which is one of the most safe and well-studied drugs humans use for anything at this point. It does have some irritating GI side effects that usually subside within a few weeks, although for some people they do not (I am one of those people). It is also used in some Type 1 cases these days, and many of us here (myself included) take it to help control our diabetes.

Short answer is: it depends on the specific person. There are a lot of cases reported on blogs, in print journalism, and maybe even by word on people who successfully control or “reverse” their diabetes with diet and exercise. There are some diabetic persons who can maintain blood sugar in a healthy range using only diet and exercise, but they seem to be few and far between. Partially because the diet and exercise necessary are usually quite intense, and partially because Type 2 diabetes mellitus is progressive and will almost always get more serious over time. What works now may not work in six months or six years.

Have you consulted with a doctor? An A1c of more than 8 is definitely full-blown Type 2, and those elevated blood sugars are doing damage to your body. Most doctors will want to help you get that under control now, and then re-evaluate through time. Starting medication to help bring blood glucose down doesn’t mean you’ll be on those medications for ever. And doing well on diet and exercise doesn’t mean you’ll always do well on diet and exercise alone.


Medication is a tool in combating a really serious disease. Diet and exercise are also tools, and are necessary for most of us to live well. But few of us it is safe to say, over the long run, have been able to successfully manage our diabetes with diet and exercise alone.

For myself, I was initially diagnosed Type 2 May of last year, and between Metformin ER, diet, and exercise, quickly got into a better A1c (below 6.0%). There were some other issues, however, and it became clear with further testing that I’m not Type 2, but rather a slow-onset version of adult Type 1. So my personal experience isn’t really applicable to your case. But what I can say is this: diet and exercise are critically important to maintaining a good blood sugar range for me, but I want to use all the tools I have available. I want to live a long, healthy life, and will use whatever medications are necessary for me to do so.

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Good morning. Thanks for the information and the questions you have posed. I guess that I truly haven’t gotten over the diagnosis…still deep down feeling that I “failed” at the Building Resistance course and associating having to take medication as a further failure. I am overweight and have a mindset that I’ve caused my diabetes by not managing to get to a healthy weight. I know that fit people can have diabetes but …

I think that the “failure” concerns play a big part in my reluctance to take medication but I also have some concerns about the side effects of metformin especially the gastrointestinal ones… I have GERD which is being treated with Nexium and I don’t want to do anything that makes the GERD worse.

My doctor had encouraged me to use diet and exercise but has said that if my results continue to be high we will need to reassess the use of medication. I am to do blood work this week and see her in early May. Today I have a meeting with my diabetes educator so I will talk with her about my issues.

Thanks again…

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You didn’t fail. Most recent scientific evidence (and I’m a scientist, so that’s how I tend to think) indicates that Type 2 diabetes is a genetic disorder with autoimmune inflammation preceding weight gain and blood sugar issues. Society (and sometimes even doctors) tell us it’s “our fault” for being diabetic, but the evidence is definitely contrary to that.

But please do remember this: diabetes is terribly serious, and can be both debilitating and fatal in both the short and long terms. One thing you might consider while you and the doctors figure out what is best for you: eating a very low carb diet and doing resistance training can indeed help lower BG (and help with losing weight, which isn’t always directly related to BG). So, I encourage you to keep working out (it’s a huge component of my own management strategy)! And also you might look into nutritional ketogenic, Atkins, or other such very low carb diets. They really do help a lot of us diabetics, regardless of weight, type, or other factors. There is plenty of information here, but you can also find some really good weight loss / nutritional inspiration and advice at www.reddit.com/r/keto. It’s not for everybody, but it works really well for many people.

Best of luck, and please keep us updated! Remember, you are not a failure, and we here can help by sharing our experience and encouragement.

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Do not be discouraged! Diabetes is not your fault. I have always been thin, always very active and yet I have insulin resistance. Who can I blame? My loving and fun family! Yep, all those Uncles with TD2! A few cousins are now diagnosed.

I am not on medications yet. I am avoiding everything, but insulin because I have celiac disease (autoimmune damaged small intestine) and it is hard to digest food, let alone medications. But I do not need insulin yet. I eat to my meter (too many carbs spike me) and tested like crazy the first few months after my diagnosis to help develop my personalized low carb, high fat diet. My SIL has a healthy gut and had TD2. She does well in Metformin and a low carb, high fat diet (me too, but gluten free because of my celiac disease).

This is your chance to research and take charge. You can manage your diabetes. It does not have to manage you! :blush:

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Some general points…

David Mendosa recently did a column about the progression of T2. It is not necessarily progressive. There are too many variables now to make that such a broad generalization…

Meds are indeed nothing to be afraid of, but from everything I have learned here, I will go right to insulin—if my body needs insulin, then that is what I will give it. Besides, I am a petrie dish for side effects—if there is one out there it will find me and the possible side effects of metformin are not an add-on I need, what with my other health issues…

The difficulty of maintaining a low-carb way of eating is a myth. Yes, it is often difficult to get started. But once you think of it as the way you are going to eat, you realize that you can eat like royalty—from protein sources to sweets. And now, there are entire websites devoted to yummy low carb recipes…

CyclingLady gave us the real Rule #1 for every one of us: “Eat to your meter.” In the beginning I tested 8-10 times per day as I figured out what I could eat safely. Now I test 3-7 times per day—more only when there is an anomaly that needs to be figured out…

Keep at it. We were all confused and scared in the beginning. You can do this.

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Fernsk, Welcome to the group.

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It might be for you, but others really struggle with it! As with so many things, diet, exercise, and meds are a matter of Your Diabetes May Vary. If you look at the statistics, the vast majority of Type 2s use medications (eventually) to control their blood sugars. If you can do it without and that is satisfying, that is fantastic! But the OP has an A1c close to 9.0 (8.2) with BG as high as 24 mmol/l. That is not “diet, exercise, and wait and see” range, considering serious damage could be done now. In such cases, the best practices are to use medication to bring A1c and BG down into a "well-controlled’ state, and then patients might work on maintaining with or without certain medications.

All of us vary in how we deal with this, and it’s important to not make any kind of absolute statements. Some Type 2s manage without meds, most take some kind of meds, and many Type 2s are eventually diagnosed as something else (like me). It just takes some time to figure out what works for each person.

Where we all agree is that:

  1. meds aren’t signs of failure;

  2. OP can do it!

There is no reason that any Type of diabetes these days can’t be well controlled with treatment.

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As I said, clearly, I thought, meds are one excellent pathway to control. Most folks who can’t sustain a low carb diet approach it as a Diet. For a diabetic, moderating carbs to some degree is a given—it’s not a diet; it is a way of eating for life. And once you realize your numbers are so positively impacted, it is quite easy to sustain, learning as you go.

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I don’t have much time to spend on this at the moment (excessively busy morning), but there’s one possibility no one has mentioned yet (forgive me if someone did and I missed it in the rush).

This is a long shot and very low probability, but when you’re dealing with diabetes it’s best to do all the due diligence you can and eliminate everything that can be eliminated. You say you were diagnosed as T2. How, exactly, was that diagnosis arrived at? Were antibody tests done? The question is worth asking if only to eliminate it because a small but significant percentage of T1/LADA people are initially misdiagnosed as T2. One of the clues is increasing difficulty in maintaining good numbers as time goes by, which seems to be one of the factors in your equation. If you really are LADA, for example, the management and insurance options are quite different. It pays to have the correct diagnosis.

@Melitta, one of our members, has written extensively on this. I’m hoping she’ll see this reference and chime in.

Again, the odds are against this, but it’s a finite possibility. If you can eliminate the possibility, you’re that much further ahead of the game. And it’s the only game in town.

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Hi Fernsk: I am chiming in as @David_dns asked. Typically, doctors will simply diagnose an adult with new-onset diabetes (fasting BG >125 mg/dl) as having Type 2 diabetes, without doing the appropriate tests. For example, about 1 in 10 adults (10%) diagnosed with Type 2 diabetes will test positive for autoantibodies that indicate the person actually has Type 1 diabetes, and the treatment for Type 1 diabetes is exogenous insulin. So I think it is worth doing autoantibody testing (and a fasting c-peptide test) to rule out Type 1. Then, the bigger issue that I see is your blood sugar levels are just too high. It seems that the diet and exercise are insufficient, and you need medication. For example, a fasting BG of 18 mmol (325 mg/dl) is just too high and you will want to discuss with your doctor ways to bring that down. Best of luck to you! There is lots of good information and support here at TuDiabetes. Finally, below I have provided some information on autoantibody testing–if I were in your shoes I would request these tests from my doctor:

If you have been diagnosed with diabetes (fasting blood sugar greater than 125 mg/dl) and suspect you may have Type 1 diabetes/LADA, testing for glutamic acid decarboxylase autoantibodies (GAD), islet cell cytoplasmic autoantibodies (ICA), insulinoma-associated 2 autoantibodies (IA-2), and zinc transporter 8 autoantibodies (ZnT8) is warranted. It is important to get the full suite of autoantibody tests, not just GAD. If a single islet autoantibody or multiple islet autoantibodies are detected, the diagnosis of Type 1 autoimmune diabetes is confirmed. The c-peptide test is also useful for showing how much endogenous insulin your body is producing. The appropriate medical treatment for a person who has autoimmune diabetes is exogenous insulin.

From the Medical Laboratory Observer, “When the clinician cannot clearly differentiate Type 1 diabetes from Type 2 diabetes based upon clinical features, islet autoantibody testing is warranted because the correct diagnosis affects the selection of therapy, the patient’s prognosis, and the need for testing for associated autoimmune diseases” [i.e., autoimmune hypothyroidism (Hashimoto’s Disease) and celiac disease].

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Hi,
Lots of good information here.

Bottom line, I think, is to control your blood sugar to as close to normal as you can. For some low carb diet (or variation thereof) and exercise may be enough. For others medications are needed. Oral meds or insulin. Remember also that even with medications, diet and exercise are key to management.

Considering a non-diabetic hba1c is less than 5.0 and with average blood sugars running well below 100 (typically in the 70s to 90s range), your current hba1c and blood sugars put you in the advanced diabetes range. Hba1c of 8 gives you an average sugar of somewhere just over 200. Nearly 3x normal and certainly heading towards complications in the future. Probably you will need medications. At least in the short term, I would be encouraging you to be aggressive in normalizing your sugar levels, even if that means meds. Your Doctor is doing you a grave disservice by allowing you to continue with sugar levels so high.

You mention 2 falls… could these be due to changed sensation / neuropathy.

There is no failure in having diabetes. But it is up to you to do your best to manage this aggressively. Learn as much as you can, and go for it, so you can enjoy your retirement.

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“aggressive in normalizing your sugar levels even if it means meds.”…I agree.

Many folks have gone on meds, adjusted diet and exercise over time and gone off some or all meds or not. If not–that’s perfectly okay…

As I recall—current science dictates that wild swings are far worse than a little high or low for awhile…

As I have said many times over a decade: “If you want to treat diabetes by the book, you must write a new book for every diabetic.”…that’s why TestTestTest is vital, along with eat to your meter!

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Thank you all for the information that you have shared. I met with the exercise therapist/programmer yesterday and have a new game plan:

I will:

  1. Since I have the requisition for blood work, go asap and then book an appointment to see my doctor to go over the results along with my personal monitor results.
    When I see my doctor I will tell her that I feel out of control and unable to control my blood sugars asking for her to determine which medications I should be looking at based on my A1C, fasting blood sugars and the results of my personal testing.
    I will also ask her to confirm how my diagnosis was reached and whether further testing should be done
  2. Rebalance my diet using between 40-60 grams of carbs per meal maximum grams of carbs each day not to exceed 180 and make certain that I’m including a good source of protein at each meal. Instead of testing as frequently as I have been, which is stressing me out since the numbers are high, for the next week I will test once a day using pattern 1 for self monitoring of blood glucose tools, including the test results on my diet sheets. I’ll take these in to see my doctor.
  3. Starting in May when I’m off work I will attend exercise sessions when my exercise therapist is there, she will start logging both my blood pressure and we will test blood before and after my exercise for 3 days a week.
    Until I see my doctor I will use both patterns 2 & 3 for self monitoring of blood glucose tools and bring this with me when I see her

Exercise therapist will:

  1. Include me in the "morning " sessions on Monday Wednesday & Friday starting on May 3 (paperwork done)
  2. Book an appointment for me with a diabetes educator

I feel much better having read all of the information and encouragement that you’ve all provided and having met with Blanche I feel like I’m moving forward

Thanks again

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Hi Fernsk,

Glad to hear you are taking it seriously, and I’m sure everything will be manageable once you get to talk to your doctor about it. One thing in your plan I noticed that, if it were me, would receive just a wee tweak…

An important caveat: I am not making a suggestion! When I was first diagnosed, I was given similar dietary advice (150-200g per day of carbs, lots of “whole grain,” low fat, and pretty intense calorie restriction) as to what it looks like you’ve received. I found out quickly that my blood sugars became more unstable (I probably ended up eating more carbs). Since diabetes, and Type 2 in particular, is a metabolic condition in which the body can’t efficiently deal with consumed carbohydrate, it turns out one of the quickest and simplest ways to reduce blood glucose quickly is to restrict carbohydrate consumption. I found this information online after a “nudge nudge” hint from my CDE. When my
blood sugars got worse in the first two weeks, she said:

“I can’t tell you to eat a very low carbohydrate diet, but some people reportedly find ketogenic diets of below 50g of carbs a day to be extremely useful. I hear they’re online.”

So, I looked online, found some info, and changed my eating habits toot sweet. My fasting and postprandial BG got in line pretty quick after that (also taking Metformin at the time). I mention this because of your point 2:

That’s actually a fairly moderate-to-large amount of carbs for someone presumably on a 2,000 or less calorie per day eating plan. I can only speak for me, but even with my current routine (and an A1c of 5.2), if I were to eat that many carbs my blood sugars would be regularly over 200 mg/dL after meals, especially in the morning. My fasting BG would start to rise shortly thereafter. Just as a reference point to think about what people mean when they say “low carb:”

  1. “Strict” Nutritional Ketogenic diets (often used by Type 2s and some Type 1s; used by some non-diabetic athletes): 25g or less per day of total carbs (see www.reddit.com/r/keto for reference)

  2. “Lazy” Keto dets (used by many diabetics and lots of people losing weight): 50g or less net carbs per day (see /r/keto again)

  3. Low carb diets: 50g-100g net carbs per day (I think Atkins diets often end up here, but are higher in protein than keto diets)

  4. Moderate carb diets: 100g-150g net carbs per day

I only mention this because I found that eating fewer than 50g of net carbs per day after diagnosis was a great way to get my BG in shape fast (along with taking my medication). I eat a bit more than that now in order to maintain my BG and weight, but a lot has changed for me in the last year: I was diagnosed as LADA Type 1; I kicked up my exercise routine into “amateur athlete” range; and I inadvertently lost a lot of weight I didn’t want to because of insulin insufficiency

Simple version of what I’m saying: you might use the carb limits suggested by your trainer as a starting point. If your BGs are still being stubborn, you might find reducing your carb intake further will help. Not everyone here does that, but many of us have found it very effective (at least initially).

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@david49 has given you good advice concerning daily carb consumption. 40 to 60 grams of carbs would also spike me over 200. This is dangerous and will result in further deterioration of your condition. Also remember all carbs are not created equal, some like sugar and starch hit your bloodstream very quickly and overwhelm your pancreas, others like from non starchy vegetables hit slowly.

Just because David and I cannot tolerate 40 to 60 grams per meal doesn’t mean you can’t. The way to find out is to test your blood sugar before and after each meal. This will tell you your individual tolerance for specific carbs. If you search for “Eat to Your Meter” you will find many discussions concerning this topic. I personally try to limit my spikes to less than 140. Others try for less.

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Thanks very much for the information…I wish that I had discovered this site a year ago! More research but I will modify my carb intake.

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That exact thing happened to me. I was diagnosed type 2. I am actually low weight. My diabetic nurse wanted to do the GAD 65 test so I did. I was way over the number I should be. My doctor never believed I was a type 1 since I was 50 when diagnosed diabetic. Anyway, I switched doctors because I was losing too much weight. Now my new doctor says I am a type 1 without a doubt. Thank you for opening people’s minds!

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