Diabetes Diet or Insulin? How to Best Control Blood Sugar

Chopping fresh vegetables on a cutting board

Finding out you have type 2 diabetes can be overwhelming to say the least. Your diet suddenly becomes even more important, as you closely track and learn to what to eat to control your blood sugar. Darlene Turner, ARNP, CDE, UnityPoint Health, offers diabetes diet tips and also discusses when it might be necessary to use insulin.

Diabetes Diet or Medication?

Type 2 diabetes occurs when the body becomes more resistant to the insulin naturally produced and released by the pancreas. The pancreas becomes overworked when large amounts of carbohydrates are consumed, and the body can’t keep up with the amount of insulin needed. Turner says type 2 diabetes management depends on whether the diagnosis is made early or late in the disease process.

“Sometimes, we find type 2 diabetes early, and we can treat it with diet changes and possibly oral medication,” Turner says. “However, sometimes we diagnose it when the person has already had it a long time, and the pancreas is hardly making any insulin. In that case, we need to have insulin from the beginning in order to gain control of their blood sugars.”

Turner says that many people with type 2 diabetes who manage the condition for years will still need insulin at some point, due to the natural progression of the disease.

Diabetes Diet Tips to Start Today

There are three parts to type 2 diabetes management: dietary changes, an activity plan and medication. Turner recommends learning all you can about diabetes to get it controlled quickly, before more insulin resistance is created from high blood sugar levels.

“Our bodies respond better to lifestyle changes early in the disease process, rather than allowing uncontrolled diabetes to go on for a few years before getting serious about taking care of the condition. Lifestyle changes largely include a healthy food plan, but becoming physically active helps our bodies to reduce insulin resistance as well,” Turner says.

Learning to reduce the amount of carbohydrates you eat means your blood sugar will be lower, as the intake of carbs is directly tied to your blood sugar value. While she wishes it could be different, Turner says there’s no getting around this.

“There’s no way to take enough medication to eat as much food as you want. If we consume too many carbohydrates, then we end up also storing the extra glucose as fat, which increases our insulin resistance. Unfortunately, it creates a vicious cycle of poor diabetes control,” Turner says. To get you started on making healthy diet changes, Turner offers these six, simple tips:

  1. Drink more water. Substitute water for any sugar-containing beverages you currently consume, including regular soda, sweet tea, fruit juice, etc. These carbohydrates pass through the stomach into the blood stream quickly, which can cause high blood sugars. 
  2. Watch your carb consumption. Limit your carbohydrate intake to 30-45 grams per meal, or two to three carbohydrate servings. Don’t cut out carbs completely; carbohydrates are still needed in limited amounts because glucose is what fuels the body. Examples of carbohydrate servings include 1 cup milk, 1 slice of bread, 1 medium apple or ½ cup potatoes. Learning portion sizes is also important.
  3. Close the kitchen. Stop eating after 7 p.m., and “shut down” your kitchen after that time. 
  4. Stop eating fast food. Fast food restaurants are convenient but come with large portion sizes filled with foods containing lots of carbohydrates but empty calories. 
  5. Plan a menu. Outline your meal plans at home by choosing foods to help control diabetes. Also, make a habit writing down everything you eat to learn where your problem foods/habits are occurring and identify changes that can be made.
  6. Think green and crunchy. Snack on non-starchy vegetables that fit the “green and crunchy” description, such as celery, green peppers and snap peas. 

“It’s hard to make all these changes and stick with them. Instead, decide on one change and work on that first. Trying to master one change is more manageable than changing everything you’ve done for years,” Turner says.

When to Use Insulin & Other Medications to Control Blood Sugar

If a person with diabetes has tried lifestyle changes through a diabetes diet plan and an increase in physical activity for three months without improving blood sugars to an A1c of less than seven, Turner says an oral medication would be suggested to help with glucose control.

There are several different medication groups to help lower blood sugar levels, which work in different ways in our bodies by:

  • Stimulating the pancreas to produce more insulin
  • Aiding your body in using insulin better
  • Making your liver release less glucose
  • Helping your kidneys remove extra glucose
  • Slowing down carbohydrate absorption 

Turner says typically, more than one oral medication is needed to get and keep blood sugars down.

“It’s not a failure on the part of the individual that leads to the need for insulin. It is the failure of the pancreas to make enough insulin to meet our needs that leads to the need for insulin,” Turner says.

Insulin is available as injections or as continuous infusion with an insulin pump. There is also an inhaled form of insulin, but there are no oral forms of insulin at this time, though research is being done. The insulin that health providers prescribe directly replaces the insulin a person with diabetes is no longer making. Turner says care teams work to teach people with the disease to be able to do the same thing a healthy pancreas does on its own. Providers help people figure out how much insulin it will take to match what their glucose levels are, which varies according to food intake and activity level.

“Regular medical follow up is part of life for someone with diabetes. As health care providers, we monitor a lab value called the A1c, which is a value that assesses what the average blood sugar has been for the past 12 weeks. We use this in our goal setting and treatment plans to optimize diabetes care,” Turner says.

Preventing Type 2 Diabetes

Prediabetes is an early indicator that the pancreas is decreasing insulin production and that lifestyle changes are needed to reduce stress on the cells in the pancreas that make insulin. The goals for prediabetes treatment include:

  • Reducing weight by five to seven percent of the starting body weight (10-14 pounds in a 200 lb. person).
  • Establishing an activity pattern of at least 150 minutes every week, with walking being a common and effective option.
  • Participating in activity five to seven days per week to both burn calories and increase feelings of well-being. 

Turner calls the diagnosis of prediabetes a “golden opportunity” to delay, or hopefully prevent, the start of type 2 diabetes.

“Once people are diagnosed with diabetes, they always wish they could change what they had been doing in the past. We need to be on the lookout for prediabetes and help them avoid ever getting that diagnosis in the first place,” Turner says.

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