DIABETES

Wondering why Type 2 Diabetes even Happened? 

Your body uses a hormone called insulin to move sugar (glucose) from your blood into your cells so it can be used for energy. I often explain insulin as a “key” that helps open the door to your cells.

In type 2 diabetes, two things start to happen:

First, your body becomes less sensitive to insulin. It’s like the lock on the cell gets a bit “rusty,” so the key doesn’t work as well. Your body has to make more and more insulin just to keep blood sugar under control.

Over time, the second thing happens—your pancreas, which makes insulin, starts to get worn out. These insulin-producing cells (called beta cells) can’t keep up anymore, and by the time diabetes is diagnosed, they may have already lost a significant amount of their function.

That’s why type 2 diabetes tends to progress over time. It’s not about willpower or doing something “wrong”—it’s a mix of genetics, biology, and factors like activity level, weight, and diet.

The encouraging part is that with the right combination of lifestyle changes and medications, we can slow this process down, protect your organs, and help you feel your best.

Healthy Eating with Diabetes 

There is no one “perfect diabetes diet.” What matters most is building a healthy eating pattern that you can realistically stick with long term.

I usually tell patients to focus on food quality first, not just cutting things out. Try to fill about half your plate with non-starchy vegetables like broccoli, salad, peppers, or green beans. Then choose whole grains instead of refined carbs when you can, like brown rice or whole wheat bread, and include a good source of protein like chicken, fish, eggs, beans, or tofu. Healthy fats like olive oil, avocado, and nuts are also important.

Carbs don’t need to be eliminated—they just need to be managed. They raise blood sugar more than anything else, so it helps to spread them out through the day instead of having a large amount at once. Pairing carbs with protein or fat can also blunt the spike, like having an apple with peanut butter instead of the apple alone.

Portion size really matters too. Even healthy foods can raise blood sugar if the portion is too big. A simple way to think about it is using a 9-inch plate: half vegetables, a quarter protein, and a quarter starch or grain.

And I always suggest limiting sugary drinks like soda, juice, or sweet tea since they spike blood sugar quickly, along with highly processed foods and excess alcohol.

At the end of the day, it’s really about small, sustainable changes—not extreme diets.

My favorite high fiber grains that you can eat instead of pasta or rice: 

• Buckwheat

• Bulgar

• Barley

• Quinoa

They are easy to cook, usually 1 cup of grain to 2 cups water. Add some salt and cook as instructed usually 15 minutes. Easy peasy!

Being Active

Exercise is one of the most powerful tools we have for managing diabetes. It can lower your A1C by about 0.4% to 1.0%, which is honestly similar to what some medications can do.

I usually tell patients to aim for about 150 minutes a week of moderate activity—that’s roughly 30 minutes, 5 days a week. Moderate just means you’re moving at a pace where you can talk, but not sing. Things like brisk walking, biking, swimming, or dancing all count.

Different types of movement help in different ways. Aerobic exercise like walking or cycling helps your body use insulin better. Strength training—like light weights, resistance bands, or even bodyweight exercises—about 2 to 3 times a week helps your muscles use glucose more efficiently.

And honestly, even small things matter. Getting up and moving for just 5 minutes every hour if you’ve been sitting makes a difference.

You don’t need a gym. Walking is one of the best and easiest forms of exercise. Start where you are—even 10 minutes a day is a great start—and build up slowly over time.

And for most people, you don’t need special medical clearance to start something gentle like walking.

4. Diabetes Medications

There are many types of diabetes medications. Here's a simple guide:

Metformin — Usually the first medication prescribed

• How it works: Helps your liver make less sugar and helps your body use insulin better

• Weight effect: Modest weight loss or weight neutral

• Common side effects: Stomach upset, diarrhea (usually improves over time; extended-release form is gentler)

• Benefits: Inexpensive, long track record of safety

• Note it does not cause cancer contrary to popular and incorrect reports

GLP-1 Receptor Agonists (Ozempic,Victoza, Trulicity, Mounjaro)

• You can find more details about these medications in my weight management section.  LINK

• How they work: Mimic a natural gut hormone that helps your body release insulin when needed, slows digestion, and reduces appetite

• Weight effect: Significant weight loss (often 5–15% of body weight or more)

• Common side effects: Nausea, vomiting (usually improves over weeks)

• Benefits: Proven to reduce heart attacks, strokes, and kidney disease in people at risk. These are now considered among the most important diabetes medications available

• It’s also really important to support your body while on them—especially by getting enough protein and including strength training—since you can lose muscle along with fat.

• In my older patients, or anyone already at risk for low muscle mass, I’m more cautious with these medications because significant muscle loss can lead to frailty and increased health risks.

SGLT2 Inhibitors (Jardiance, Farxiga)

• How they work: Help your kidneys remove extra sugar through urine

• Weight effect: Modest weight loss (about 2–3 kg)

• Common side effects: Yeast infections, urinary tract infections, increased urination

• Benefits: Proven to protect the heart and kidneys. Especially important if you have heart failure or kidney disease

DPP-4 Inhibitors (sitagliptin/Januvia, linagliptin/Tradjenta)

• How they work: Help your body use its own insulin more effectively after meals

• Weight effect: Weight neutral

• Common side effects: Well tolerated, light headedness from reduced blood pressure

• Rare side effects:  risk of urinary tract infections (more common in women), ketoacidosis (increased risk with surgery, dehydration, reduced caloric intake), low blood pressure (it causes you to urinate glucose) and reduce volume in the body

• Benefits: Easy to take, low risk of low blood sugar

Sulfonylureas (glipizide, glimepiride, glyburide)

• How they work: Stimulate your pancreas to make more insulin

• Weight effect: Can cause weight gain (1–3 kg)

• Common side effects: Low blood sugar (hypoglycemia) — this is the main concern

• Important: These are older medications. Newer options like GLP-1s and SGLT2 inhibitors are generally preferred because they protect the heart and kidneys and don't cause low blood sugar

Insulin 

• Weight effect: Can cause weight gain (average 2–4 kg)

• Benefits: The most powerful blood sugar-lowering medication available

What to Do If Your Blood Sugar Is Low (Hypoglycemia) 

Low blood sugar (under 70 mg/dL) can happen if you’re on insulin, sulfonylureas, or certain other diabetes medications. It’s important to recognize it early and know how to treat it.

You might feel shaky, sweaty, or notice a fast heartbeat. Some people feel dizzy, confused, very hungry, anxious, or just “off.” You can also get blurred vision or feel weak.

When this happens, I usually tell patients to use the “Rule of 15.”

• Take about 15 grams of fast-acting sugar right away—this could be glucose tablets, half a cup of juice or regular soda (not diet), a tablespoon of sugar or honey, or a few pieces of hard candy. Then wait about 15 minutes and check your blood sugar again. If it’s still low, repeat the same treatment.

Once your blood sugar comes back up, it helps to have a small snack with protein, like crackers with peanut butter or cheese, to keep it stable.

One important thing to remember: don’t use chocolate, cookies, or foods high in fat to treat a low. The fat slows down how quickly the sugar is absorbed, so it won’t work fast enough when you need it most.

When to Use Glucagon

Glucagon is an emergency medication for severe low blood sugar—when someone is too unwell to treat it themselves. This includes situations where a person is unconscious, having a seizure, or unable to safely eat or drink.

If you take insulin, you should have glucagon available at home, and it’s important that people around you—family, roommates, or coworkers—know where it is and how to use it.

The good news is that it’s much easier to use now than it used to be. There’s a nasal spray (Baqsimi) that you simply spray into one nostril, and there’s also an auto-injector (Gvoke) that works like an EpiPen. These are much simpler than the older kits that required mixing.

You would use it if someone is unconscious, too confused to safely eat or drink, or having a seizure.

After giving glucagon, turn the person on their side in case they vomit, call 911, and once they wake up and can swallow, give them something to eat. If there’s no response in about 15 minutes, a second dose can be given.

And an important safety reminder: never give insulin during a low blood sugar episode.

Why Insulin Isn’t the End of the World

A lot of people feel scared or like they’ve “failed” when insulin comes up—but that couldn’t be further from the truth.

Insulin is simply a natural hormone your body already makes. In type 2 diabetes, the body slowly makes less of it over time. So using insulin is really just replacing what your body can’t make enough of anymore—kind of like thyroid medication when the thyroid slows down.

And it’s actually very common. About 1 in 3 people with type 2 diabetes will need insulin at some point, not because they did anything wrong, but because diabetes is a progressive condition.

Insulin is also the most powerful tool we have to lower blood sugar. No other medication works as effectively, and when used well, it helps protect the eyes, kidneys, nerves, and heart long-term.

The good news is that insulin today is much easier than most people think. The needles are very small, many people only need one injection a day, and insulin pens are simple, discreet, and easy to use.

One important thing I always emphasize is that waiting too long to start insulin can actually be harmful, because prolonged high blood sugars can damage the body over time. Starting it when needed can actually help protect remaining pancreas function.

And insulin doesn’t mean stopping other treatments—it's often combined with newer medications that also protect the heart and kidneys and may even help reduce how much insulin is needed.

Understanding Your Numbers

It really helps to have simple targets in mind so you can follow your progress over time.

For most people, a general guide looks like this:

• A1C: usually under 7%, but this is individualized based on the person

• Fasting blood sugar: about 80–130 mg/dL

• 2 hours after meals: under 180 mg/dL

• Blood pressure: under 130/80

• LDL cholesterol: goal depends on your overall heart risk

These numbers aren’t meant to be stressful—they’re just a way to help us see how things are going and adjust your plan if needed.

Protecting Your Feet

This is something that often gets overlooked, but it’s really important—because foot problems in diabetes can become serious if they go unnoticed.

I usually tell patients to check their feet every day for any cuts, blisters, redness, swelling, or sores. Even small changes matter.

Try to never walk barefoot, even at home, and wear shoes that fit well and fully cover your toes. Keep your feet clean and moisturized, but avoid putting lotion between the toes. Trim toenails straight across to avoid ingrown nails.

And if you notice any wound that isn’t healing after a few days, it’s important to let your doctor know early.

Protecting Your Eyes

Eye disease from diabetes is one of those things that can develop silently—you often don’t feel it until it’s more advanced.

That’s why it’s so important to have a dilated eye exam within about 6 months of diagnosis, and then at least every 1–2 years after that, as recommended by the American Diabetes Association Standards of Care.

The key thing I always remind patients is: you can have eye damage without any symptoms, so regular screening is what protects your vision.

Sick Day Rules

When you’re sick, your blood sugar can behave very differently—and this is especially important if you take insulin or medications like Jardiance or Farxiga.

First and most important: never stop insulin completely when you’re sick. Even if you’re not eating much, your body often needs more insulin during illness, not less.

Try to stay hydrated as much as possible and check your blood sugar more often than usual, since levels can rise quickly when you’re unwell.

If you’re taking an SGLT2 inhibitor (like Jardiance or Farxiga), it’s important to pause it during acute illness, especially if you’re vomiting, not eating, or dehydrated. This helps reduce the risk of a rare but serious complication called ketoacidosis.

And please reach out for help if things aren’t improving—specifically if you have persistent vomiting, blood sugars staying over 300 despite treatment, or signs of dehydration.

When to Call Your Doctor

There are a few situations where it’s important to reach out right away:

• Blood sugars staying consistently above 300 mg/dL

• Any signs of diabetic ketoacidosis like nausea, vomiting, belly pain, or fruity-smelling breath

• Severe low blood sugar symptoms, such as confusion, seizure, or passing out

• A foot wound that isn’t healing or is getting worse

• Sudden changes in vision

• Chest pain or shortness of breath

If anything feels “off” or more severe than usual, it’s always better to check in early.