The onset of diabetes is recognized when a patient has an overly high blood sugar level. This means that his or her body does not produce enough insulin to maintain a healthy amount of sugar in the blood. The cells in the pancreas of a person with diabetes gradually wear out and their capacity to produce insulin gradually and continuously falls. Eventually he or she will not have enough insulin to maintain normal blood sugar and the sugar will start to rise. Doctors and patients have many resources available to help people with diabetes maintain healthy sugar levels. The most powerful tool is a combination of diet and exercise. It requires education, motivation, and teamwork on the part of the doctor and patient.

When a person without diabetes exercises and loses weight, his or her body requires less insulin to maintain sugar levels. This holds true for people with diabetes as well: while they have a decreased capacity to produce insulin, they may frequently be able to use diet and exercise to reduce their requirements for it and their sugars will come back down to normal. By maintaining a healthy lifestyle, they will decrease the amount of insulin their bodies need to maintain normal blood sugars. If they can lower their insulin requirement sufficiently, their limited capacity to produce insulin may be sufficient to maintain normal sugar levels. This is analogous to a person who experiences a pay cut, and compensates by cutting down on expenses (for example, purchasing fewer luxuries and taking fewer vacations) but can still pay for his necessities without borrowing any money.

Unfortunately, diabetes is a progressive disease. This means that as time goes on, a person with diabetes will have less and less capacity to produce insulin naturally. Even with the adoption of a healthy lifestyle, a diabetic’s sugar levels will likely start to elevate again after a time. Just as there is a limit to how much you can cut down on expenses and still have the bare necessities of living, diet and exercise alone cannot work indefinitely for every person with diabetes. If a patient has been eating and exercising appropriately but experiences a rise in sugar levels, his or her doctor may next offer medications that lower his or her body’s need for insulin. Patients must still maintain the healthy living habits that they have previously implemented in order to keep insulin requirements as low as possible.

While a combination of diet, exercise, and medications may work for a long time in many patients, it may not work indefinitely for every person with diabetes. When the patient is doing a great job with diet and exercise and is appropriately taking medications but the blood sugar levels continue to rise, an insulin regimen will be an appropriate next step. While it seems to be a very logical solution-taking insulin because the body cannot produce it naturally-patients and their physicians will resist using it because it requires injections, may lead to hypoglycemia (low sugars), and some people think it causes weight gain. (For more information about the relationships between insulin and hypoglycemia/weight gain, please see my other articles on these topics.)

Many patients would prefer having sugar levels higher than those recommended by the American Diabetes Association and the American Association of Clinical Endocrinologists if the elevated levels do not cause overt symptoms and it means they can avoid self-injecting. However, mild elevations in blood sugar levels may increase the risk of visual impairment, kidney damage, heart attacks, strokes, and foot complications that may lead to amputations. Individuals with slightly elevated levels also face a much higher risk of sugar level spikes during unrelated illness. The patient and the doctor must work together to balance the inconvenience and risk of using insulin against the threat of these complications, and develop a system that is appropriate for the individual.

Many people with diabetes are able to follow the diet and exercise recommendations prescribed by their physician; however, others have difficulty following through with making and keeping healthy lifestyle habits. Because these patients are unable or unwilling to adopt the diet and exercise plan recommended by their doctor, they are depriving themselves of the first and most powerful tool to treat their diabetes. In order to help them with the diet portion of their regimen, my daughter Tova Searleman and I have established a website to provide a free 24/7 resource to help patients acquire appropriate cooking skills and gain practical information about this disease. People with diabetes will be able to use the site to learn basic information about diabetes, be informed about the latest developments in diabetes care and research, learn how to shop for nutritious foods, read nutrition labels, and watch videos in which Tova provides step-by-step demonstrations on how to prepare delicious meals that are appropriate for people with diabetes and their families. Please visit our site, and let us know how we can further serve you.