Last updated: Aug 01, 2008
insulin-vial
Watching your weight and keeping your blood sugar in check can keep you from having to go on insulin.
(GETTY IMAGES)
If you just found out you had type 2 diabetes, your first reaction might be "Oh no, not insulin!"

When Donna Rivers, 57, of Seattle, left her doctor's office with a diagnosis of type 2 diabetes, she had only one thing on her mind: Needles. Rivers was in such shock, she could barely think of anything else.

She had visited her doctor for a routine checkup in 2005, and learned that her blood sugar was 330 mg/dl—much higher than the normal limit for people without diabetes, which is 70-99 mg/dl after an overnight fast and 70-145 mg/dl after meals.

"I am very needle-phobic, and I never wanted to be on insulin. That was a very scary thing for me," she says.

Most type 2 diabetics don't use insulin
However, people with type 2 diabetes usually produce some of their own insulin, at least at the point of diagnosis. It's insulin resistance that's the problem. Insulin normally ferries glucose from the bloodstream into muscles. When the body loses sensitivity to insulin, it can't transport glucose out of the blood as efficiently, and blood-sugar levels rise.

In contrast, it's most often people with type 1 diabetes—a less common autoimmune disease that is usually diagnosed in childhood—who need insulin shots to survive.

Therefore, a healthy diet (which will help lower blood sugar) and exercise (which lowers insulin resistance) are the "drugs" of choice for many people with type 2 diabetes. In fact, 15% of adults with type 2 diabetes don't take any medication; 57 percent take oral medications alone; 16 percent take insulin only; and 12 percent take both insulin and oral medications.

Diet and exercise alone may work at first
The American Diabetes Association recommends that patients initially treat their type 2 diabetes with lifestyle changes (improved diet, more exercise, and weight loss) and the oral diabetes drug metformin. Losing 5% to 7% of your body weight can considerably improve your blood-glucose levels. For many people, that means losing as little as 7 to 10 pounds.

However, it's not always easy. If you want to try diet and exercise alone, you may only have a few months to see success before you will otherwise need to go on oral medication.

Rivers began exercising regularly and cut sugar and other "white stuff" out of her diet, including the potatoes she loved so much. (While such foods are not off-limits, they tend to raise blood sugar more than fiber-rich food.) Unfortunately, her husband wasn't a big help when it came to food. He continued to bring sweets into the house and eat them in front of her, she says.

However, her husband recently found out he has prediabetes, and his doctor advised him to change his diet to protect his health, too. So now they're both developing diabetes-friendly eating habits. Rivers's husband will need to halt the parade of goodies that made sticking to her diet so difficult: "Now I have something to hold over him. That's gonna change," she says.

Rivers also used to hate physical activity. "I'm the person who used to drive three houses away to my friend's house," she says. After being diagnosed with type 2 diabetes, she made an effort to find exercise that was more appealing.

She bought a stationary bike and set it up in front of the television so she can pedal as she watches TV. In addition, the book lover made a deal with herself that she can only read while she's on the bike.

Sometimes medication is necessary right away
Rivers found out she didn't have to inject herself with insulin when she was first diagnosed, and she still doesn't. She's been able to keep her blood sugar under control by losing weight, exercising regularly, and limiting the types and amounts of carbohydrates she eats.

However, if diet and exercise don't lower blood sugar, you may need medication (the oral diabetes drug metformin is usually the first choice). If lifestyle changes plus metformin don't help you keep your blood sugar under control, your doctor will want to scale up your efforts with additional oral medications or possibly insulin.

And some people have to take medication right away to get blood sugar down to safe levels. Later on, they may be able to get off medication and try to control blood sugar using diet and exercise.