How to control blood sugar without medicine

If two patients come in to see me with the same condition, one might walk away with a prescription for a medication, the other for a prescription for diet and exercise. Why? Because I tailor treatment to my patients. Some people feel more secure taking a pill for a condition. Others want to try lifestyle changes first to see if they can safely manage the problem without taking a medication. In many cases, either option is a fine one.

If you have high blood sugar (but not diabetes), there is plenty you can do through diet and exercise to lower that number and keep from getting diabetes. Even if you have already been diagnosed with diabetes, with a very strict diet and exercise program, you might be able to limit your need for medication. Here's what a recent Harvard Health Letter article said on the subject:

Although a recent study cast some doubt about how low blood sugar levels should go, and by what means, it's still important to keep them under control. Regular physical activity is a powerful brake on blood sugar levels because well-exercised muscle becomes more receptive to the insulin that helps it pull sugar in from the bloodstream — sugar that the muscle tissue needs as "fuel" to function properly.

Eating fewer sweets and easy-to-digest carbohydrates, both of which are quickly turned into blood sugar, also helps keep the lid on blood sugar levels. Many studies have shown that people whose blood sugar levels have crept up, but haven't yet reached diabetic levels, can avoid full-fledged diabetes with a combination of exercise and diet — without any medication. One of the largest of those studies randomly assigned people to take metformin (Glucophage) or to make lifestyle changes that included a goal of weight loss (7% of body weight) and two and a half hours of exercise a week. Nearly twice as many people in the metformin group wound up with diabetes compared with those in the lifestyle group. The difference was even greater in people older than 60. When it comes to developing diabetes, it's not just that exercise is good for you. It's more potent than any medicine yet invented.

Whether exercise and diet alone can control blood sugar levels once people are diabetic is harder to answer. The American Diabetes Association (ADA) used to recommend that people newly diagnosed with diabetes try exercise and diet first before moving to medication. Now the ADA says people should start taking metformin right away. The reasoning is that few people were able to keep their blood sugar levels in line with exercise and diet and that failure winds up making the underlying diabetes harder to manage. Overall, that may be true, but the ADA also encourages doctors to tailor their treatment to the individual patient. People with diabetes who want to try to control the disease with exercise and diet alone should talk to their doctor. At the very least, it might be worth a short trial.

Are you able to manage your diabetes with lifestyle changes alone? Tell us about what you do to help keep your blood sugar under control.

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

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