Type 2 diabetes diagnosis means meds - right away

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I was diagnosed with diabetes six weeks ago. I'm 52 years old. Other than being about 25 pounds overweight, I consider myself to be healthy. I get up a couple of times per night to urinate, but that has been the same for over a year. My doctor wants me to start medication now, but I prefer to wait. If I eat less and lose some weight, do I really need pills?

Your doctor is correct. The American Diabetes Association recommends starting medication when a new diagnosis of type 2 diabetes is made. Keeping blood sugars as close to normal early in the disease decreases the risk of heart attack, stroke, kidney disease and other complications later in life.

Type 2 diabetes was called adult onset diabetes or non-insulin dependent diabetes. However, today children are being diagnosed with type 2 diabetes and many people with type 2 diabetes need insulin. In the past, your doctor would likely have suggested a trial of diet and exercise. If your blood sugars were coming down after three to six months, he or she might have waited another three to six months. Now, we know that this is not the best strategy; patients should start medication immediately.

This doesn't mean diet and exercise are not just as important as before. As blood sugar gets under control, medicine can be tapered. In some cases, it can be discontinued. For most people with new onset, metformin should be the first medicine. This is especially true if a person is obese. I choose this drug when a patient has a body mass index (BMI) of 25 or more. (Overweight is a BMI of 25 to 29.9. Obese is a BMI of 30 or more.)

There are some people who might not be good candidates for metformin. People with impaired kidney function probably should avoid metformin. Caution is advised with heart failure and some types of severe liver disease.

For people with type 2 diabetes for years, tight control of blood sugars does not have the same impact at improving outcome. And risks such as severe low blood sugar reactions (hypoglycemia) exist.

People with long-standing diabetes should continue to keep their blood sugar under reasonable control with diet and exercise. Piling on more and more medicines to bring down blood sugar is not the answer. Whether you were diagnosed with type 2 diabetes yesterday or 20 years ago, you want your blood pressure less than 130/80. Your LDL cholesterol should be less than 100 (preferably closer to 70). Achieving these goals decreases the risks of heart attack and stroke and helps protect the kidneys.