Can a low-carb diet reverse diabetes in a 44-year-old?

Question

Hello doctor,

I am 44 years old and recently diagnosed with type 2 diabetes. My HbA1c (glycated hemoglobin) is 8.1%, fasting sugar is 172 mg/dL, and triglycerides are slightly high at 230 mg/dL. I have been started on Metformin 500 mg twice daily, but my sugars are still high after three weeks.

Should I be worried about early insulin resistance?
Do you recommend adding another medicine like Sitagliptin now or waiting for some more time?
Also, my creatinine is 1.3 mg/dL, does that mean my kidneys are already getting affected?
Can diet changes like low-carb meals really reverse diabetes, or is medication always required?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Regarding medications, if your sugars remain persistently high after two to three months of optimal diet and exercise, then an additional agent such as Sitagliptin may be considered. For now, I would advise continuing Metformin, strictly following diet and exercise, and rechecking sugars in four to six weeks. Your creatinine of 1.3 mg/dL is borderline high. It does not necessarily mean definite kidney damage, but it does warrant close monitoring since diabetes can affect the kidneys over time.

A urine albumin-creatinine ratio test will help assess if there is any early kidney involvement. Lifestyle has a huge role. Weight control, regular exercise, avoiding refined carbohydrates and sugary foods, and preferring high-fibre vegetables and lean protein can significantly improve sugar control.

In some people, intensive lifestyle measures can reduce or even put diabetes into remission, but medication is often required initially to protect long-term health. My advice is to continue Metformin regularly. Recheck fasting sugar, post-meal sugar, and HbA1c (glycated hemoglobin) after six to eight weeks.

Get the urine albumin-creatinine ratio for kidney screening. Adopt a low-carb, balanced diet and daily physical activity. Avoid alcohol, excess salt, and fried foods to protect both heart and kidneys. Have a follow-up with your doctor to reassess if another medicine is needed.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.