Imagine sitting on a barstool.  What if someone cut off one of the legs?  Would you still want to sit on the stool?  Probably not.  The stool would be off-balance, and you'd come tumbling down, possibly injuring yourself in the process.

Treatment for type 2 diabetes requires a 3-pronged approach

A three-legged stool is nice and stable.  If one of the legs is shorter than the other, the barstool becomes wobbly.  If one leg is missing, the whole thing falls apart.

Like the barstool, type 2 diabetes needs a three-pronged approach to stay in balance, too.  The three "legs" used to manage type 2 diabetes are:

• Carb counting

• Physical activity

• Medication (for most people, but not all)

If we cut one of those "legs" short, blood sugar management gets wobbly. If you have diabetes and you count carbs and take your medication, but you don't exercise, you're missing out on the blood sugar-stabilizing effect of regular physical activity. You've got a wobbly barstool.

There are times when exercise isn't possible. For some people, physical limitations make exercise impossible all of the time. For those times and those people, either carbohydrate intake has to be decreased and/or medication has to be increased to keep blood sugar in check.

There are times when you'll eat more carbs than you're allotted on your eating plan. At those times, you'll need to increase your physical activity and/or increase your medication (with your doctor's advice) to keep your blood sugar in range.

This picture might help illustrate how the 3 prongs of diabetes management work together:

Treatment of type 2 diabetes requires flexibility

Blood sugar levels fluctuate constantly.  Just when you think you've got it right, along comes a virus or a stressful deadline or even a picnic to get your blood sugar out of whack.  Knowing that it's normal for your numbers to go up and down will help you keep your cool when it does happen.  Which leg (or two) of your stool do you need to adjust to get back in balance?

Medication can be a lifesaver in the treatment of type 2 diabetes

I have a lot of patients who feel guilty and ashamed of themselves when they need to take medication to control their diabetes. Do you feel that way? If you do, would you feel that same guilt and shame if you needed medication for gout or arthritis? I'm guessing you wouldn't. Let go of the guilt — it's not serving anyone, especially you.

If you're waiting for your blood sugars to improve "when you get the weight off" or "when you start exercising", stop waiting. Damage to your eyes and kidneys is happening right now while you wait. If this is a particularly stressful time in your life and you know that you just can't start to exercise or change your eating plan right now, tell your doctor just that. Be blunt, and use the words, "I'm not able to change my lifestyle right now. I think it would be better if I started on a medication."

I'm a Registered Dietitian Nutritionist and a Certified Diabetes Care and Education Specialist. I'm all for changing your eating and exercise habits, but...my goal is to help you manage your blood sugars, not to shame you into starving yourself or taking up triathlons. What I want most is to prevent you from losing your vision or needing dialysis in the future. The worst thing you can do is go another year between check-ups with your blood sugar out of control while you lose vision and kidney function. There's no shame in doing what you need to do to take care of yourself, including talking with your healthcare provider about medication.

Action Items:

1. Think about the "three-legged stool" of managing type 2 diabetes.

   • Eating plan

   • Physical Activity

   • Medication

2. Is your stool balanced, or is one leg "shorter" than the others?  Maybe you have an eating plan, but you're not following it.  Do you forget to take your medicine more often than not?  Do you have every intention of exercising in the evening, but just never get around to doing it?

3. If your "stool" has a short leg, write down your very specific plan for lengthening it.  For example, if you have trouble remembering your medicine because it's not in a convenient location, you could write something like this:  "I will leave my medicine beside my toothbrush so I will see it and take my medicine when I brush my teeth."  Great job — now put your words into action!