Diabetes Medication

Early Intensive Treatment: Start Strong, Last Long

If we hit diabetes hard at first, our bodies will keep on making insulin for a long time.

That’s the gist of study by researchers at the University of Texas Southwestern Medical Center. The full text of the study, which will appear in the July issue of Diabetes Care, is online at “β-Cell Function Preservation After 3.5 Years of Intensive Diabetes Therapy.”

Their research shows that when people who just found out that they have type 2 diabetes take either insulin injections or a combination of three oral medications right away they manage their diabetes better. With either of these two intensive treatments our beta cells keep on making the insulin we need for as long as the researchers studied us, three and a half years.

But the standard guidelines recommend going much slower. They suggest a stepwise approach.

For example, the American College of Physicians would have us “make lifestyle modifications, including diet, exercise, and weight loss” before we start taking any diabetes medication. The American Diabetes Association suggests that we start with “lifestyle intervention and metformin.”

Almost no one doubts that the keys to managing our diabetes are a better diet, more exercise, and losing weight. And metformin as a well-deserved reputation as being one of the safest, powerful, and least expensive pills that we can take to help us bring down our blood sugar.

We can even manage our diabetes without any drugs. Diet, exercise, and weight loss alone will do it, particularly when we follow a very low-carb diet. But they kick in slowly.

At first, we need a little help from our friends, the medicine. We have to quickly get our blood sugar level down to normal.

Dr. Ildiko Lingvay
Dr. Ildiko Lingvay

The problem is that “the stepwise approach exposes patients to long periods of high blood sugar, which leads to complications,” says Ildiko Lingvay, M.D., assistant professor of internal medicine and the study’s corresponding author. “Unless dietary changes are significant and sustained long-term, diabetes is a progressive disease in which the body’s ability to produce insulin declines.”

For years I have argued that diabetes doesn’t have to be a progressive disease, as I wrote in this 2007 article, “Is Diabetes Progressive?” Diabetes is not progressive with the right diet and exercise.

But diabetes does get progressively worse when we follow the standard recommendations. We have to use every tool we have to get our blood glucose level down to normal as soon as we can.

This article is based on an earlier version of my article published by HealthCentral.

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  • Ann September 11, 2012 at 7:54 pm

    I absolutely agree with early, intensive intervention. The challenge for me has been finding a doctor to help me do this. I live in Northern California about an hour north of San Francisco and haven’t been able to find a doctor who supports this. I have been reading Dr. Bernstein’s book and your blog…but I need the right doctor!

  • Anna August 19, 2012 at 2:35 pm

    David, I read your linked article and have a question. You say that “Diabetes is not progressive with the right diet and enough exercise.” I intervened immediately after my diagnosis with the right lifestyle changes. However, I often hear about people whose diabetes has worsened over the years despite excellent disease management (and I mean having kept truly normal blood glucose levels, i.e. lower that the ADA recommended levels). As much as I would like to believe that maintaining tight control will keep my type 2 diabetes from progressing, it does appear to progress in some people despite their best efforts (and initial success). What do you think of this?

    • David Mendosa August 25, 2012 at 12:25 pm

      Dear Anna,

      If we keep our blood sugar levels down into the normal range — not the average range of Americans, which is unfortunately well above normal — our blood sugar levels won’t cause complications of diabetes. But it remains true that other things, including genetics, can cause the same complications. For example, about half of Americans who have neuropathy get it because of their diabetes, and we can that diabetic neuropathy. But the other half don’t have diabetes. We had no guarantees in life, but our odds are much better when we keep our blood sugar level normal. Mine is most recently 5.1 according to my A1C test. I am beginning to think that normal is around there, or perhaps even lower, and I keep trying to reduce it into the 4s.