How to Find the Right Type 2 Diabetes Treatment

When you and your doctor are thinking about the best way to control your blood sugar, you've got a lot of options to choose from. Insulin and other medicines, including shots and pills, can help keep your levels in a healthy range. So which ones are right for you? 

Here are some of the things you and your doctor will consider when you’re deciding on a treatment.

Your blood sugar levels. If they stay too high for too long, you’re at risk for complications of diabetes, like eye problems or kidney disease. If your blood sugar is above where it should be, your doctor may add another drug to your treatment plan or increase your dose to get you to a healthy range.

How long you’ve had diabetes. If you’ve had the condition for more than 10 years, some diabetes pills may not help you. But if you’ve just been diagnosed, your doctor might not make insulin the first treatment you try. Also, your treatment plan may change over time, because some medications get less effective the longer you take them.

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Other health problems. Some conditions you might have along with diabetes can affect how well your drugs control your blood sugar, including:

  • Obesity
  • High blood pressure
  • High cholesterol
  • Heart disease
  • Kidney disease
  • Sleep apnea or other sleep problems
  • Depression
Do You Need Insulin?A doctor explains what treatment might look like for someone newly diagnosed.104

JENNIFER GILLIGAN: When people

are first diagnosed with type 2

diabetes, often lifestyle

adjustment and exercise,

and sometimes some pills,

can be very helpful in making

the glucose levels more normal

or at least controlled.



Over time, because we know

that even at diagnosis about 50%

of the pancreas

is not really producing,

over time that amount tends

to decline further.

And what we'll see

is that on the same therapy,

with making the same choices

and maybe the same exercise

regimen, the person is going

to come back and the sugars are

higher, higher, higher.

And that tells us

that the medications are losing

effectiveness,

likely because the function

of the pancreas

is continuing to decline.

And typically that

is an indicator that insulin is

needed.



So then we try to get someone

comfortable with the idea

because there is so much fear

around starting insulin.

But I try to remind people

insulin is the thing that you're

missing in your body

when you have type 2 diabetes.

So it isn't something to be

feared.

It's a natural progression

of the disease.

And it's a great therapy

because it really well controls

the blood sugars.



When someone is going to start

insulin, typically we'll start

them on just once a day insulin.

One, because usually that's

the only thing that's needed.

Someone generally won't go

from being on pills

and lifestyle management

to needing full replacement

of their insulin production.



Medication needs change often

in diabetes.

Again, it's very important

to follow up with your doctor.

And, you know, I usually

say to patients,

look we need to stick our finger

in the wind and figure out which

way things are blowing,

because that's where your best

care is.

We have to be flexible

and revisit what we're doing all

the time.

Jennifer Gilligan, MD<br>Endocrinologist/delivery/aws/ef/5b/ef5b51f7-c6bd-397b-9118-807450b80865/091e9c5e81dc004e_funded-expert-feature-do-you-need-insulin-for-type-2-diabetes_,4500k,2500k,1000k,750k,400k,.mp412/19/2019 10:20:0018001200photo of glucometer/webmd/consumer_assets/site_images/article_thumbnails/video/do_you_need_insulin_video/1800x1200_do_you_need_insulin_video.jpg091e9c5e81dc004e

Some medications that treat diabetes also may help you treat other health problems or lower your odds of having them. For example, medications called GLP-1 agonists help you feel fuller longer after you eat. This may help you lose extra pounds if you're overweight. Studies show that the drugs also help protect against heart disease and kidney disease.

How active you are. Exercise can lower your blood sugar levels. That’s a good thing, but you need to factor it into your treatment plan. Talk to your doctor about how much you move each day. You may need to change the dosage of some diabetes drugs if you're more active in your daily life or at work.

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Do you drink? Alcohol can lower your blood sugar levels for hours, so it affects how well insulin or diabetes pills work. Tell your doctor how much you drink and if you want to be able to sip a beer or cocktail from time to time. You may need to take extra steps to be sure that it doesn’t interfere with your meds.

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Fear of needles. If you can’t stand shots, you may be less likely to give yourself shots when you need them, which is key for blood sugar control. So talk to your doctor if you’re afraid of needles or don’t feel confident about injecting yourself.

Some diabetes drugs come in devices that are like pens and are easier to use than syringes and vials of medicine. Your doctor or nurse can show you how to use them. You might also be able to take a type of insulin that you inhale through your nose.

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on October 19, 2020

Sources

SOURCES:

American Diabetes Association.

National Institute of Diabetes and Digestive and Kidney Diseases.

American Association of Clinical Endocrinologists Diabetes Resource Center.

UpToDate: “Glucagon-like peptide-1 receptor agonists for the treatment of type-2 diabetes mellitus.”

U.S. Department of Veterans Affairs: “Diabetes, Drinking and Smoking: A Dangerous Combination.”

Joslin Diabetes Center.

Grant, R. Diabetes Care, published online, March 2007.

The Lancet Diabetes & Endocrinology: “Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials.”

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