Managing Type 2 Without Meds: 3 Stories
It had been about a year since Akua Jitahadi felt like herself. But she was 51 and expected menopause to kick in soon. Plus, she and her daughter had just moved to oppressively hot Arizona. So she brushed off the tired, sluggish feeling as a side effect of being a middle-aged woman adjusting to sweltering temps. And then, overnight, her vision dimmed. Something was most definitely wrong.
The verdict from her doctor: type 2 diabetes and high blood pressure. "Of course, I broke down in tears," Jitahadi, now 55, says. "I wasn't ready to hear this. I always associated diabetes with 'Oh no, it's really bad.' "
After Jitahadi spent a few weeks on medication, her vision cleared and she began to feel better. It didn't last long. "I hated metformin. I had all the colon and digestive issues on it," she says. "I never knew if I would be OK on it or if I'd be nauseous. I'd question whether I wanted to go out with my friends." When she asked for an alternative medication, her doctor said metformin was the best drug for the job, so Jitahadi stuck it out for a year. After that, she decided to make major lifestyle changes in hopes of quitting her medications.
That proved more difficult than she had imagined. She hadn't seen a diabetes educator. The only dietitian covered by her insurer was too far away. And her doctor's sole advice was for Jitahadi to watch what she ate. "I was scared in the beginning," says Jitahadi. "It was through friends and starting to read [about diabetes] that I knew I could do this. I could get through this."
Jitahadi bought books on diabetes, nutrition, the glycemic index, and diabetes-friendly meals. Instead of slightly modifying her diet, Jitahadi decided to completely overhaul it. "I started realizing that what ['watch what you eat'] really meant was I needed to eat healthier, more balanced meals," she says. She wrote down everything she ate. And instead of dining out, she cooked meals from scratch. Jitahadi swapped white sugar for lower-glycemic sweeteners, traded in white rice for brown, lowered the amount of sodium she consumed, cut a lot of carbs, and made veggies the mainstay of each meal. (Her favorite: grated cauliflower sautéed with veggies and chicken or egg for low-carb fried "rice.")
Only looking back could Jitahadi see how self-destructive her old eating habits were. At the time, she had a three-hour daily commute and had just lost one of her daughters. Healthy eating wasn't a top priority. "I realize how much I wasn't taking care of myself, and if I wanted to be here for my other daughter, I needed to turn this around," she says.
And she has. Jitahadi says her old favorites don't tempt her the way they used to. That said, she does indulge from time to time, something she's no longer ashamed about. "If you're going to have it, please enjoy it," she says. "Don't eat it feeling guilty."
Jitahadi's lifestyle overhaul was a two-part process: diet and exercise. The latter happened more slowly because her high blood pressure, vision problems, and lack of energy prevented her from taking more than a slow stroll at first. Once her doctor gave her the go-ahead, though, Jitahadi got down to work.
She joined Zumba, a Latin-inspired, dance-centric aerobics class, at a community center. What she learned surprised her: Working out was actually fun. Soon she was exercising three to four times a week. Two years after her type 2 diagnosis, Jitahadi's A1C was down to 5.8 and she went off her medications.
From Couch to Course
Steve Phelps always had a sweet tooth. He blamed that weakness for his weight, the 360 pounds that were too much for his 5-foot, 7-inch frame. He was shocked, then, when the food journal he'd been keeping—a tool he'd started to use after he was diagnosed with type 2 diabetes—revealed otherwise. "I was under the misconception that my diet was fine [except that] I liked sweets and I ate a lot of sweets," he says. "I discovered quickly that it wasn't just eating cake or pie that was making me fat. It was all the other stuff, too." Fried chicken. Mashed potatoes. Fast food. Phelps ate as much as he wanted without much thought.
When his doctor and dietitian urged him to make changes to improve his diabetes control, Phelps, then 57, took the challenge seriously. He weighed everything he ate to gauge portion size. And he went slow, knowing that abrupt changes to his diet had never worked in the past. Instead of giving up desserts, he focused on smaller quantities and better-quality foods.
To avoid fast food, a convenient temptation, he prepped meals in advance. "A lot of it, especially as I lost a lot of weight, had to do with saying, 'I just walked x miles and burned x calories, do I really want to ruin it by popping in and having a burger?' " he says. "After a while, it got a little easier. Now I drive by [fast-food restaurants] and I don't even give them a second thought."
Phelps also made significant changes to his exercise routine, which went from 1/3-mile walks around his neighborhood (it took him 40 minutes and three rest stops the first time) to walking a half marathon a little under a year later. As he lost weight and became fitter, Phelps got addicted to triathlons. At 64, he's now set his sights on Ironman races, which he hopes to compete in next year.
The result of his hard work? He lost 160 pounds in two years, normalized his high blood pressure and high cholesterol, has an A1C of 5.6, and no longer takes metformin and glyburide. His advice to others with type 2: "You need to have a plan, and you need to be consistent," he says. "[Diet and exercise are] something you need to do to survive and control it. Look at it as the same thing as taking a pill or insulin."
While some people attempt to manage their type 2 diabetes with diet and exercise alone, this may not work for everyone. In fact, though the Centers for Disease Control and Prevention estimates 16 percent of people with diabetes don't take medication, the majority of people with diabetes require insulin or oral meds at some point, often at diagnosis.
According to American Diabetes Association (ADA) recommendations, it may be appropriate for people with type 2 diabetes whose A1Cs are close to target to manage diabetes with lifestyle changes alone for three to six months—provided their doctor deems them "highly motivated." If that doesn't work, metformin is typically the first in a long list of type 2 blood glucose–lowering medications to add to the diet and exercise plan.
But contrary to a tossed-about diabetes myth, a lack of motivation isn't always a factor behind a person's need for medication. Type 2 diabetes is a progressive disease, and it's not always possible for people to control their blood glucose levels with diet and exercise alone over time. People with prediabetes or type 2, however, are encouraged to embark on lifestyle changes such as losing at least 5 to 7 percent of their body weight, exercising more, and choosing healthier foods with fewer calories.
"Many people with type 2 have had type 2 for a while prior to diagnosis," says Anne Peters, MD, director of the University of Southern California Clinical Diabetes Program and an author of the ADA's position statement on the management of type 2. A person who has had diabetes for five years before being diagnosed may have complications that require good blood glucose control—pronto. It will most likely take medications to achieve a quick improvement. Plus, you can always stop a medication once you've started it if lifestyle changes lead to on-target blood glucose levels—with your health care provider's guidance, of course.
And keep in mind: Going on medication does not mean failure. "There are no failures in diabetes," says Peters. "It's a progressive process that requires treatment. It's no different than somebody who needs antibiotics for pneumonia."
Fast Foods to Family Meals
Charlene Crawford has spent more than half of her life with diabetes. At 14, she was diagnosed with prediabetes. By 18, she had type 2. She was prescribed medication, which she barely took, and advised to make lifestyle changes, which she didn't do. But when she got pregnant, her priorities shifted. "Having a child makes you see things differently," says Crawford, a mother of two. "I wanted to be there for him and not be so tired and be active when he needed me."
After the birth of her oldest son, Crawford went on Weight Watchers. Eight months later, she had dropped 40 pounds, had an A1C of 5.2, and was able to stop diabetes and blood pressure medications. Her workouts started with daily walks and progressed to cardio and strength training three to four times a week. "I was able to do things I couldn't do before," she says. "I can do push-ups. I can do sit-ups."
Another essential element of Crawford's new lifestyle: her new food philosophy. "If you want something good for yourself, it's worth the time to invest in cooking," she says of her switch from eating out to staying in. "I let go of the processed foods and rely on foods as a whole. Everything we need is in our backyard." Crawford, now 30, tries to eat seasonally, makes fresh produce the center of her meals, and prefers organic food over conventional.
Her passion for whole foods has influenced the diets of her husband and two sons. She's also shared her nutrition knowledge with her mother, who has type 1 diabetes but was simply told to avoid sugar when she was diagnosed years ago.
Crawford says the reward for all of the hard work she puts into her healthy lifestyle is the ability to take care of her family and keep up with her kids. But there's an emotional aspect, too. "I had very low self-esteem," says Crawford. "I hated looking in the mirror. I don't feel that way anymore."
Making Changes Stick
A major reason why many people who attempt to control type 2 diabetes with diet and exercise turn back to medications is that lifestyle adjustments are hard to maintain over the long term. Jitahadi became a licensed Zumba instructor with this in mind. "I said, 'I know me and I don't want to let life get in my way of taking care of myself because I've done that before,' " she says. She's a Zumba instructor at her local YMCA. For the past year, she's also been a diabetes prevention lifestyle coach there, helping others reduce their risk for the disease.
Since her diagnosis in 2008, Jitahadi has lost 65 pounds and gained muscles she never imagined she'd have. "I see my body getting stronger. I feel my body getting stronger," she says. "There are so many ways to measure yourself, and the scale doesn't tell the full story."
She still plans to lose more weight, but she knows that slow and steady beats the quick loss (and equally quick regain) she experienced on countless fad diets in her past. Because she's not trying to drop a dress size—she wants to change her life. "My goal is to be as healthy as I can," she says. "If something happens and one day I'm back on medication, my goal is still to be healthy."