When Sandy Narayanan was a child in India, she watched her father work hard to manage his type 2 diabetes. She remembers his needles and insulin and weekly visits to the doctor to check his blood sugar.
In 2008, at age 43, Narayanan herself was diagnosed with diabetes. Her first reaction was worry and dismay.
"I thought, 'Oh my gosh, for the rest of my life I’m going to be on needles,'" she says.
Then Narayanan thought of the lessons from her father. That included exercising regularly and limiting carbohydrates and starches. So Narayanan got expert help with her diet, kept a food log, and learned to adjust her eating portions.
Narayanan’s efforts paid off quickly. Her A1c, or blood sugar, levels dropped by five points, allowing her to quit insulin and stay off it for good.
"I was literally on insulin for (just) 10 weeks,” says Narayanan, who’s now a dietitian and certified diabetes educator.
Prescription: Healthy Habits
Type 2 diabetes isn't like strep throat, where you take one medicine and get better. Medicine is only one part of your treatment. Watching what you eat, staying active, and managing your stress can be equally important, if not more. These lifestyle changes can help slow your beta cells from burning out. That’s when insulin-producing cells in the pancreas get overworked and die, which makes it harder for you to control your blood sugar levels.
"Lifestyle plays a huge role in type 2 diabetes," says Deena Adimoolam, MD, an assistant professor at the Mount Sinai Icahn School of Medicine in New York. "If you do well enough with your lifestyle and lose weight, you can potentially come off your medications."
Eat for Diabetes
There's no special diet for diabetes. But there are two important rules to follow:
1. Eat less carbs, especially refined ones like sugar and white flour.
"That's going to affect blood sugar the most," says Jason Baker, MD, an endocrinologist at New York-Presbyterian/Weill Cornell Medical Center.
You don't have to count carbs, except to get your insulin dose right. To avoid temptations, keep sugary treats out of your house. Make it hard to indulge in junk food, Baker says.
2. Watch your serving size. Most likely, this means shrink your food portions. Also, aim to fill half of your plate with veggies, a quarter with protein, and the rest with carbs and starch. Not all carbs are equal. Those from vegetables, fruits, whole grains, and beans pack more nutrients than white bread, pasta, or rice.
Fill up on veggies and protein first, and eat your carbs last, suggests Yumi Imai, MD, associate professor of internal medicine at the University of Iowa Carver College of Medicine. That way, your body absorbs carbs more slowly. "Even if you eat the same amount of food, your blood sugar will not go up," Imai says.
A glucose sensor or meter can help keep your nutrition on track. Check your blood sugar after you eat. Glucose spikes are a sign that your diet needs some changes.
Get Fitter and Stronger
With diabetes, a daily dose of fitness belongs in your treatment plan.
"I always describe exercise as a drug," Baker says. When your muscles contract, they take in glucose to use for energy, which lowers your blood sugar temporarily. Exercise also helps you lose weight and makes your body respond better to insulin, which lowers your blood sugar over the long haul.
No need to turn into a fitness buff. Get off the elevator a few floors early. Park farther away from your favorite store. Walk for 15 minutes before you head out for your job. Do anything that you enjoy and keeps you moving, whether it's yoga, dance, or basketball.
Add in some strength training to build muscle. "Muscle is one of the most sensitive tissues for taking up sugar," Baker says.
Exercise has another benefit -- it reduces stress. "Living with diabetes is really stressful," Adimoolam says. "It's hard every single day to think about what you eat and make sure you're taking your medications."
When your body is under stress, it releases cortisol, a hormone that raises blood sugar and makes your cells less responsive to insulin. These combined effects make diabetes harder to control. Stress also increases your appetite and makes you crave sweet or fatty foods.
Find a stress-relief method that works for you. Narayanan has a pre-bedtime relaxation routine. "I stretch and take a moment to breathe and relax," she says. Meditation, yoga, and walking are all good stress-busters.
About 1 in 4 people with diabetes also have depression. If you feel overwhelmed, talk to family or friends. Or seek out a support group through the American Diabetes Association. For one-on-one help, visit a therapist or psychologist.
Sleep is also critical. "When people sleep better, they notice their level of stress is lower," Baker says. He suggests that you shut down your phone and stop checking emails and texts 2 hours before bedtime. Blue light from these devices can keep you awake.
Stick to Your Plan
Your treatment plan should serve as your roadmap. Stick to it, and you’ll be more likely to avoid diabetes complications like heart disease, blindness, and nerve damage.
See your doctor for regularly check-ups. If any part of your treatment doesn't work for you, ask your doctor what you should do.
"It's really important to find a good balance that helps you manage your diabetes and avoid these potential issues," Adimoolam says. "The best way to do that is to make sure you have good communication with your treatment team."
Narayanan motivates herself by focusing on the big goal: To stay healthy and to prevent serious complications that can often come with uncontrolled diabetes.
"It's about reminding myself every morning that I have to watch what I eat and I have to exercise, because over the long run there are a lot of implications to not doing that," she says. "This is for life."
Deena Adimoolam, MD, assistant professor, division of endocrinology, diabetes, & bone disease, Mount Sinai Icahn School of Medicine.
American Diabetes Association: "Blood Sugar and Exercise."
Jason Baker, MD, endocrinologist, New York-Presbyterian/Weill Cornell Medical Center.
Current Diabetes Reports: "Diabetes and Depression."
Diabetes Care: "Cortisol secretion in patients with type 2 diabetes."
Diabetes Forecast: "Do Beta Cells Burn Out?"
Endotext: "Nutritional Recommendations for Individuals with Type 2 Diabetes."
Yumi Imai, MD, associate professor, department of internal medicine, University of Iowa Carver College of Medicine.
Mayo Clinic: "Diabetes."