If blood sugar is very high, it's important to lower it quickly.

If blood sugar is very high, it's important to lower it quickly.(ISTOCKPHOTO)

If your doctor thinks that you may be able to control type 2 diabetes without medication, waste no time in making improvements in your lifestyle. You may have only three months to prove that you can do it, says Nadine Uplinger, RD, director of the Gutman Diabetes Institute at the Albert Einstein Healthcare Network in Philadelphia.

"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.

"When the sugar has been running high, it creates in and of itself a resistance to other things to bring it down. It's a term we call glucose toxicity," says William Bornstein, MD, an endocrinologist at the Emory Clinic in Atlanta. "So let's say that somebody comes in and their blood sugar's running pretty high and they want to try diet and exercise, it's less likely that the diet and exercise will work to bring it down."

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 sugar—they 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.