"Virtually every physician would agree that the ideal treatment for diabetes is exercise and eating right to lose weight," says Robert Rizza, M.D., past president of the American Diabetes Association. The same goes for preventing diabetes, especially in those with prediabetes.
A recent Diabetes Prevention Program study found that doing 30 minutes of moderate exercise a day, combined with losing 5% to 10% of body weight, reduced the risk of developing diabetes by 58%.
Dietary recommendations for diabetics are very similar to those for the general public, says David M. Nathan, M.D., director of the Diabetes Center at Massachusetts General Hospital in Boston. Diabetics should eat plenty of fruits and vegetables but limit white potatoes; replace unhealthy fats with vegetable oils; opt for whole grains; boost fiber intake; choose lean sources of proteins such as beans, nuts, fish and poultry; and limit salt and alcohol intake.
Type 2 diabetics sometimes need medication. Esther's blood sugar was so high by the time she was diagnosed, she was prescribed metformin (Glucophage) right away. This drug is almost always the first line of treatment for type 2.
To ensure that they are controlling their condition, diabetics typically have their average blood glucose levels measured every three months with the hemoglobin A1C test. This sophisticated blood test reveals the patient's average blood sugar level for the past two or three months. The goal is to get the A1C level below 6%—Esther's was 9.8% when she was diagnosed. Every percentage point drop reduces the risk of complications by 40%.
At the same time, diabetics are encouraged to watch their blood sugar on a daily basis through finger-prick tests. A recent study found that self-monitoring reduces the risk of fatal and nonfatal complications. At Esther's recent checkup her blood sugar was still very high. So she was started on a second medication. She also takes a statin to lower her cholesterol, since her father and brother died of heart attacks at a young age.
Meanwhile, Michele is making great strides toward preventing full-blown diabetes. She's made changes to her diet and heads out for 30-minute walks daily and jogs on a treadmill a few days a week. She knows getting her weight under control is a life-and-death issue.
"I see so many people dealing with the complications that I'm trying to avoid," says Michele. "Diabetes can shut your body down in so many ways—you can lose your kidneys, your eyesight. I want to see my 11- and 4-year-old daughters grow up."