"If the expected outcomes aren't there within a three-month period, then medication needs to be added," she says. "Lots of people feel they can do it with diet and exercise, and sometimes physicians play a little game with patients, delaying the start of medications because patients are resistant to them. They say 'Give me another month, or another three months. I'll work harder.'"
However, the longer you go with out-of-control high blood sugar, the more harm you can do to your blood vessels, which can cause heart attack, stroke, and other problems.
Sometimes early medication is necessary
If your blood sugar is very high when you are diagnosed, you may need to take oral medication or insulin to get blood sugar into a safe range, which can actually increase the effectiveness of lifestyle changes.
Once medication brings the blood sugar down, then you might be able to stop the drug and try diet and exercise. Lifestyle changes are more likely to be successful in those who are overweight and sedentary to begin with, says Dr. Bornstein.
"If somebody comes in and they're already at ideal body weight and they're already doing a lot of exercise and their sugar's running high, then we've got less to work with in that regard and we're more likely go directly to medication," he says.
Even with medication, lifestyle is key
If you do need to take oral medications or insulin immediately or at some point, you still can't ignore the importance of diet and exercise.
"Once people begin to take a medication, whether it's a pill or insulin, it's not a reason to stop watching what they're eating and being physically active, because it's all connected," Uplinger says. "People think, 'My blood sugar is fine,' when they're put on a medication, and they go back to former bad habits."
A good diet and regular exercise do more than just lower your blood sugarthey also keep your weight down and protect your heart and brain, which is an extremely important benefit since roughly two-thirds of people with diabetes die of heart disease or stroke.