Managing Diabetes: Food Control vs. Medication for Blood Sugar Levels

Diabetes mellitus

I went to the hospital for a blood sugar test and was diagnosed with diabetes.
I bought a blood glucose meter and have stopped taking my blood sugar medication, opting to control it with food instead.
My postprandial blood sugar levels are maintained between 120-150 mg/dL, but my fasting levels are between 120-140 mg/dL.
I have been eating very little, and my weight has dropped from 78 kg to 69 kg over the past month, but my fasting blood sugar levels cannot be reduced to normal values.
I would like to ask the doctor if I should resume taking blood sugar medication, and if not, are there other methods to lower my blood sugar levels? Thank you.

A Qiang, 40~49 year old female. Ask Date: 2009/08/21

Dr. Yang Hongzhi reply Internal Medicine

Since the blood sugar levels are not very high, dietary control combined with exercise can be tried for a period of time.
Monitoring the glycated hemoglobin (HbA1c) will help assess long-term blood sugar control.
If the results are not satisfactory, then oral hypoglycemic agents can be added.

Reply Date: 2009/08/21

More Info

Managing diabetes effectively requires a multifaceted approach that includes both dietary control and, when necessary, medication. Your current situation, where you have been able to maintain postprandial (after meal) blood sugar levels between 120-150 mg/dL while your fasting blood sugar remains between 120-140 mg/dL, indicates that you are making progress, but there are still areas that may need attention.

Understanding Blood Sugar Levels
Firstly, it’s important to understand the significance of your blood sugar readings. According to the American Diabetes Association, normal fasting blood sugar levels should be below 100 mg/dL, while levels between 100-125 mg/dL indicate prediabetes, and levels of 126 mg/dL or higher on two separate tests indicate diabetes. Your fasting levels of 120-140 mg/dL suggest that you are still in the diabetic range, which is concerning.

Dietary Control
You mentioned that you have been eating very little, which has resulted in a weight loss from 78 kg to 69 kg over the past month. While weight loss can be beneficial for blood sugar control, it is crucial to ensure that you are still consuming a balanced diet that provides adequate nutrition. Here are some dietary strategies that can help in managing blood sugar levels:
1. Balanced Meals: Focus on meals that include a balance of carbohydrates, proteins, and healthy fats. This can help stabilize blood sugar levels. Complex carbohydrates (like whole grains, legumes, and vegetables) are preferable to simple sugars.

2. Portion Control: Even when eating healthy foods, portion sizes matter. Eating smaller, more frequent meals can help prevent spikes in blood sugar.

3. Fiber Intake: Increasing dietary fiber can help slow the absorption of sugar and improve blood sugar levels. Foods high in fiber include fruits, vegetables, whole grains, and legumes.

4. Glycemic Index: Pay attention to the glycemic index (GI) of foods. Foods with a low GI are digested more slowly and can help maintain stable blood sugar levels.

5. Hydration: Staying well-hydrated is essential. Water is the best choice, and it’s advisable to limit sugary drinks, even those labeled as "sugar-free," as they can contain other ingredients that may affect blood sugar.

Medication Considerations
While dietary control is crucial, it may not always be sufficient for everyone, especially if fasting blood sugar levels remain elevated. If your fasting blood sugar levels do not improve despite dietary changes and weight loss, it may be time to reconsider medication. Metformin is often the first-line medication for type 2 diabetes and can help lower blood sugar levels without causing significant weight gain or hypoglycemia.

Other Management Strategies
In addition to diet and medication, consider the following strategies:
1. Regular Physical Activity: Exercise can significantly improve insulin sensitivity and help lower blood sugar levels. Aim for at least 150 minutes of moderate aerobic activity each week, such as brisk walking, cycling, or swimming.

2. Monitoring Blood Sugar: Continue to monitor your blood sugar levels regularly. This will help you understand how different foods and activities affect your blood sugar.

3. Stress Management: High stress can lead to elevated blood sugar levels. Techniques such as mindfulness, yoga, or meditation can be beneficial.

4. Sleep Quality: Ensure you are getting enough quality sleep, as poor sleep can negatively affect blood sugar control.

Conclusion
In summary, while you are making commendable efforts in managing your diabetes through dietary control, your fasting blood sugar levels indicate that further action may be necessary. It’s advisable to consult with your healthcare provider about the possibility of resuming medication, as well as to discuss any other potential strategies tailored to your specific needs. Remember, managing diabetes is a comprehensive process that often requires adjustments in both lifestyle and medication to achieve optimal results.

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