David Mendosa suggests that all type 2 diabetics can manage their illness without drugs. I’m not quite that optimistic, but probably a majority can, if they have the knowledge, discipline, and willpower. I haven’t looked in depth at David’s diet recently so I don’t know if it’s paleo or not; it’s more likely LCHF (low-carb, high-fat). Here are some snippets from David’s blog:
You can use drugs to bring your A1C level down to normal. That’s a good thing. But this strategy does have its costs, and those costs aren’t just money out of your pocket or your checkbook. The worst of those costs are the potential side effects of the drugs.
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But some of us think we have a safer strategy of managing our diabetes without drugs. Back in 2007 I joined this group with the encouragement of a good friend of mine who is a Certified Diabetes Educator. Before that, I had 14 years of experience taking a wide range of diabetes drugs, including two different sulfonylureas (Diabeta and Amaryl), Glucophage (metformin), and Byetta. For the past six years I haven’t taking any diabetes drugs, and yet I keep my diabetes in control with an A1C level usually about 5.4.
I had to make three big changes in my life when I went off the diabetes drugs, and they are hard at first. But now they are a routine part of my life, and I would never go back to my old ways. The changes that I had to make are those that almost everyone who has diabetes has to make. In order of importance, I had (1) to lose weight, (2) eat fewer carbohydrates, and (3) exercise more.
Read the whole enchilada. It’s brief.
Steve Parker, M.D.
Paleo Diabetic 
Dear Dr. Parker:
Thank you for picking up on my new diabetes article.
I did suggest that all of us who have type 2 diabetes can manage it well without drugs. However, my suggestion may have gone too far in two respects. The main limitation is psychological in that we have to be willing to give up the shortcut to control, which is what drugs are, and exercise the considerable self-discipline needed to avoid grains and sugar — which is, of course the same challenge in switching to a paleo diet. The other limitation is that to manage diabetes without drugs we do have to have sufficient beta cells. The situation here is that some people with type 2 diabetes also have type 1 diabetes (or are well on the way there), and will have to rely on exogenous insulin.
Yes, my diet is very low-carb and high fat. And it is also quite close to being a paleo diet. I avoid all grains and sucrose/fructose (except in a little fruit, mainly blueberries). However, I do eat yogurt as well as a little cheese, but no other dairy.
Thanks for your input, David. If I had type 2 diabetes, my approach to it would be very similar, if not identical, to yours.
-Steve
Wonderful discussion here- very practical and very important! Is the ADA on board with LowCarb (LCHF) now?
AJ
http://lowcarboptometrist.blogspot.com/
Richard Feinman blog: http://feinmantheother.com/2013/12/27/american-diabetes-association-embraces-low-carbohydrate-diets/
AJ
Oops…guess this was just a rant- here’s hoping some day!
AJ
Yeah, AJ, I got suckered for a few minutes at the Feinman blog, too. I had read the original ADA position statement previously and started questioning my sanity.