Even if you can manage your diabetes now by just eating well and being active, you may need medication someday.
We've come far since the 1920s, when insulin was first used to treat diabetes. There's no magic pill yet, but you have more options than ever before to help control your blood sugar. And more are coming.
Sometimes, living with diabetes can seem like a full-time job -- trying to keep up with everything you need to do for proper diabetes care.
"Diabetes is a very time-consuming disease to manage well," says Karmeen Kulkarni, MS, RD, CDE, and former president of health care and education for the American Diabetes Association. "The medication, the food, the physical activity -- you add life in general to that whole picture and it ends up being quite challenging."
Most type 2 diabetes drugs work by helping your body make insulin or use it better. Some new medicines are different because they don't have anything to do with insulin.
Your kidneys try to keep glucose, a kind of sugar your cells use for energy, out of your pee. Proteins called sodium-glucose transporters (SGLTs) help your kidneys keep glucose in your blood instead of your pee.
But with type 2 diabetes, if your blood sugar level is already creeping up, you don't need the glucose in your body. Pills known as SGLT2 inhibitors turn off one of those proteins so that you pee it out instead.
These drugs have some extra benefits, says John B. Buse, MD, PhD, director of the Diabetes Care Center at the University of North Carolina at Chapel Hill. "You're losing calories through urine, so there is weight loss -- usually about 5 to 10 pounds in 6 to 12 months."
When you take them, you lose a little bit of salt, too, which can help with your blood pressure.
These drugs aren't perfect, he says. "The downside is that, because there is sugar in your nether regions, women have a higher risk of yeast infections, and uncircumcised men can get foreskin infections."
To avoid the risk of dehydration, Buse says that elderly people with kidney disease and people who are taking diuretics, pills that make you pee out extra water, shouldn't take SGLT2 inhibitors.
Another downside in taking SGLT2 inhibitors is that you could run the risk of developing ketoacidosis, a condition where your body produces high levels of blood acids. If this happens you may require hospitalization.
In addition, canagliflozin has led to reduction in bone density in some patients which puts you at risk for bone fractures.