Are Lifestyle Changes Better Than Diabetes Medications?

Often, patients come to us feeling guilty about their food choices and lifestyle habits. Though guilt rarely is a helpful emotion, remorseful clients can be wonderful to work with when they’re ready to make significant lifestyle changes. But what should we do when clients with newly diagnosed type 2 diabetes are so motivated to reverse the course of their disease with diet and exercise that they refuse medications prescribed by their doctors? I know the power of lifestyle changes, and of course, I want to support my patients’ decisions. But I can’t agree with this choice. Here’s why.

While I truly appreciate the desire to avoid medications and their potential side effects, I know that time is of the essence. I understand what insulin resistance and type 2 diabetes do to the body, how the problem is progressive, how insulin resistance likely has occurred for years before the diabetes diagnosis, how it affects multiple systems in the body, harms the heart and blood vessels, and raises the risk for certain types of cancer.

My quick reply to the “What should I do?” question is to use every tool available. Don’t wait. Work toward permanent lifestyle changes now and take your medications now. Though there are possible side effects to taking medications, there also are side effects to not taking medications. People who successfully manage type 2 diabetes from the time of diagnosis are the ones most likely to have good outcomes years down the line.

I advise my clients to combine lifestyle changes and diabetes medications. Only when they’ve made solid lifestyle changes do I suggest they talk to their health care provider about reducing or eliminating medications.

Combine Lifestyle Changes With Diabetes Medications
Years ago, primary health care providers told patients to work on lifestyle changes for a few months before they prescribed diabetes medications. Today, because of solid research, more providers prescribe lifestyle changes and medication at the same time.

  • Type 2 diabetes, characterized by insulin resistance, is a progressive disease. In most cases, by the time someone is diagnosed with type 2 diabetes, insulin resistance had been going on for many years. Because of its progressive nature, taking control as early in the game as possible has benefits many years down the road. That window of opportunity closes ever so slightly every day. An individual’s greatest chance to make the biggest difference is today.
  • Clients who manage diabetes early on are less likely to develop heart disease in the coming decades.
  • Research suggests that when metformin, the most commonly prescribed medication at diagnosis, is taken soon after diagnosis, it may preserve the pancreas’s ability to produce insulin, thus slowing further disease progression.
  • Metformin, which reduces insulin resistance, usually is the drug of choice because of its safety profile and low risk of causing low blood sugar when taken without other diabetes medications. In addition, taking metformin often helps people lose a few pounds and improve cholesterol levels. Emerging research even suggests that metformin may decrease the risk of developing some cancers.

Lifestyle Changes for Diabetes Management
Lifestyle still rocks! Swallowing diabetes pills without making smart diet and lifestyle choices limits overall effectiveness. I help my patients make an honest appraisal of several lifestyle domains.

  • Exercise: I prefer that my patients get at least 30 minutes of moderate exercise most days of the week. Every bout of exercise improves insulin sensitivity for two to 72 hours. Both cardiovascular exercise and strength training help with diabetes control and overall health.
  • Sedentary behavior: The American Diabetes Association recommends limiting sedentary behavior. They advise sitting for no more than 90 minutes at a time. Many of my clients break up sitting with one to two minutes of walking, toe raises, or doing push ups against the wall.
  • Diet: Many types of eating patterns benefit diabetes management. I have to help my patients resist the temptation to focus only on blood sugar levels and weight. Type 2 diabetes is linked to many complications, including heart disease. They must eat for overall health.
  • Sleep: Getting too little sleep harms insulin sensitivity and blood sugar control.
  • Stress: Excessive stress may or may not have a direct effect on blood sugar management, but it certainly has a way of distracting us from our good intentions to eat well, exercise, and get to bed on time.

The bottom line is that type 2 diabetes is a progressive disease linked to many health problems. Using medications that impact insulin resistance and other common defects in the disease along with insulin-sensitizing lifestyle behaviors today can impact an individual’s health for decades.

— Jill Weisenberger, MS, RDN, CDCES, FAND, CHWC, is a freelance writer and a nutrition and diabetes consultant to the food industry, including Dow AgroSciences and Egg Nutrition Center. She has a private private practice in Newport News, Virginia, and is the author of several books, including Diabetes Weight Loss — Week by Week.

4 Comment

  1. Nice post, Jill. I agree that best practices are to do everything possible to effectively manage diabetes early on. The decision on whether to start medications or focus solely on lifestyle change is very important especially from a patient-provider relationship standpoint. Threatening with meds does little to build rapport as does strong-arming what we know to be ideal (you were not encouraging either of these strategies). If we can assess the patient’s understanding of the disease process, and with permission, fill in the knowledge gaps, we are in a good position to let the patient decide. If it is their decision to start meds, and we are supportive, the likelihood for adherence to the medications prescribed is better. If they decide not to start meds, we can always explore under what conditions they would consider beginning them. This puts us in a good position to have a productive follow-up visit.

  2. This is a really great article and I agree….unfortunately, in an effort to encourage lifestyle changes, practitioners tell patients that if they eat right, exercise, lose weight etc, they can control their Diabetes (or risk) without medications–using meds as a threat rather than explaining the big picture that Diabetes is a progressive disease and the months or years they spend fighting a losing battle could have been spent preserving their pancreas leading to better overall outcomes.

    1. Couldn’t agree more! Medications – pills or injections – shouldn’t be used as a threat. Likewise, people with diabetes shouldn’t feel guilty about needing medications either.

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