What is your approach to managing T2 on diet and exercise only?

I have not seen many discussions on this, so please add your thoughts

I have been off medications for three years (out of six) last A1c 6.0

After years of testing I pretty much know what foods do to my BS. I eat three meals and two snacks each day. I try to be as consistent as I can with the amounts of carbs and protein, same amount at the same time each day. I typically consume 120 to 160 carbs a day, weighted more to the morning with dinner having the least carbs. No food after dinner.
No car so I walk a couple miles each day, up and down the hills of San Francisco. I run a couple of miles 2 to 3 times a week and work with a trainer once a week. Never been one for extreme exercise, but like to keep moving, One of the reasons I retired is to be able to have this life style.

My initial a1c was 12.0 as I said now 6.0. So it took some work.
Fasting bs range from 80 to 115.

I am far from perfect, I have had a couple 200 plus, when I eat way more food than I should. Buffets at a gathering are my nemesis. I guess I cant talk and count carbs at the same. )

At least this what works for me, responses please from other diet and exercise only. Thanks.

It definitely does take some work but it’s worth it if you have the self discipline (as you do). When I was diagnosed in 12-08, my A1c was 9 & the first doctor I saw said, “You need insulin,” then he left the room & returned with a presciption for “Janumet” and a pamphlet with an 1800 calorie/day diet that included suggestions for what to eat at fast-food joints. I couldn’t help but notice the drug ads on each page. I took the Janumet as directed for one week while doing research, then stopped taking it & followed a diet recommended by Dr. Joel Fuhrhman. Three months later, my A1c was 6.0, I’d lost 40 lbs. & my new doctor said there was no need for any medication. My constant heartburn & acid reflux completely disappeared.

Even though I lost another 40 lbs. my blood sugar has gone up in the past year. I don’t know if it’s due to stress (plenty of that lately) or my diabetes just got worse. Last year my doctor suggested 10 units of insulin before bed.

I controlled my BG with diet and exercise for a long time before starting meds, and my opinion is that if it works, it works. Not everyone has tremendous luck with diet and exercise only, but if your A1c is within range, there's no reason to change.

A number of years ago my bgs were spiking to 290 and my weight had suddenly ballooned to 225 lbs. I just stopped eating carbs. My diet consisted of all the beef, chicken, pork, fish, greens, roasted cauliflower, roasted broccoli, and almonds I could eat but nothing else. A year later I weighed 155 and my bgs were normalized, as were my cholesterol and blood pressure as well.

For the next two years I resumed a typical American diet, checking my bgs periodically to ensure nothing was getting out of hand. A couple of years later they did get out of hand again with fasting bgs still good but post meals rising and my weight up to 200.

I'm in the 'repeat' phase of 'lather, rinse, repeat'. Back to the original meal plan. A week into it post meal bgs are around 110 where a week ago a spike was 220. Already dropped close to 10 pounds. The key for me is low enough carbs to reach a fat burning state called 'ketosis'.

This approach is too extreme for some, perfect for others. Just letting you know what works for me. Only you and your meter can decide what works for you.

Obviously; if one can control with diet and exercise only - great!

On the other hand as the body ages and any other organ/hormone level that wanders off optimum; the drugs such as insulin, metformin and others may be needed
to tune up an aging body!

After 16 years of managing my type 2 with diet and exercise only I think I am in a position to say that it is doable, but does require a good plan and quite a bit of self discipline.
My personal plan includes using the Glycemic Index and limiting my carbs to those with a GI rating below 40, going for a brisk walk immediately after each meal and as much as possible using whole and unprocessed foods (being retired it is now easier to get the time to shop and do food prep). As the previous poster pointed out age does take its toll and my hba1c is now up to 6.8 after staying in the low 5s for many years. However, both my doctor and my endocrinologist say I'm still good to go without meds or insulin, so there is definitely hope. And, what I was told to begin with, by numerous online posters, that 'diabetes type 2 is progressive, no way you'll be able to do this more than a year or two' was obviously not correct, to be frank.

I started out 8 years ago with an A1C of 9. I cannot "exercise" because my severe neuropathy has affected my ability to walk. I found out my balance was compromised when I tried riding a bike instead. I do get some exercise every day because I show chickens and have to lift 40 lb sacks of feed and clean pens. When I was younger I walked a lot and rode my horses every day, can't do that anymore. I did do water aerobics 3 times a week last year. I put a lot of effort into the classes, but it did nothing for me except take 3 hours out of my day, so I stopped. Personally I find the value of exercise overrated. When it doesn't work for us, we think we haven't done enough of it.

I have kept my blood sugar low, however, by diet alone. My last A1C was 4.9. I try to stay below 30g of carb per day, and below 1000 calories. I don't recommend this for anyone else, but it works for me. When I've tried to add more food, not carbs, just food, I gain weight and then my A1C goes up. The good news is that on a very low carb diet I'm seldom hungry. I take supplements to make sure I'm getting all the vitamins and minerals I need, but I have needed no diabetes, cholesterol, or blood pressure medication.

So far whenever I've had a bobble, I've found that keeping closer track of calories and carbs for a while brings things right back into the range I want it, which is a morning blood sugar in the low 80s and an A1C not much over 5.0.

The only problem I have with eating like this is cooking small enough portions, and eating high enough fat. I don't like fat, I have to force myself to eat it. Also it's so calorie-dense, if I'm not careful with it I'll use my daily allotment of calories too early in the day.

If this sounds like a lot of work, consider that I never have highs, I never have lows. And my grocery bill is pretty cheap.

Understand, everyone is different. I was never really overweight and am probably within 15-20 lbs of my weight of when I was diagnosed nearly a decade ago. I still fit in the suit I got married in.

I spent my first few years bouncing back and forth between diet and exercise alone and single and double medications (metformin and eventually byetta). My conclusion was that using a very low carb diet such as recommended by Bernstein and exercising essentially got me all the improvements I would ever see from the mainstream drugs. While drugs such metformin help you handle meals with carbs if you eat very few carbs it won't do much to further improve your control. In the end my overall diabetic career was strict diet and exercise which probably improved my A1c 2%, then drugs in a whole range of combinations. Those drugs never dropped by A1c more than about 0.5%. And then finally I moved to insulin where I have been able to normalize my medication.