When Your Type 2 Diabetes Treatment Isn’t Working

Type 2 diabetes is a progressive disease. If you’re like most people, you’ll reach a point where your treatment isn’t working the way it once did.

If that happens, you and your doctor will have to come up with a new treatment plan.

There are plenty of ways to make that happen.

Pills

You may take one to lower your blood sugar. There are several classes of noninsulin medicines to choose from that hit type 2 diabetes in different ways. Because these drugs can work together, your doctor may prescribe you more than one.

These can include:

  • Metformin, which works in your liver
  • Thiazolidinediones (or glitazones), which improve sugar removal from your blood
  • Secretagogues, which help your pancreas make more insulin
  • Starch blockers, which slow down how your body absorbs sugar from the food you eat
  • Incretin-based therapies, which help your liver make less sugar. They also slow how you absorb food. They can be pills or shots.
  • SGLT2 inhibitors (or gliflozins), which cause your kidneys to release excess sugar into your pee

You might also take one pill that mixes two types of medicine. That's known as combination therapy.

Injectable Drugs

You inject some noninsulin drugs rather than swallowing them. These drugs fall in one of two types:

GLP-1 receptor agonists: These help your body make insulin. They also help your liver make less glucose. There are several types you can talk with your doctor about. You inject some every day, and you get others once a week.

Amylin analog: This type slows your digestion. That keeps your glucose level down and helps your liver leave the numbers low. You inject these before meals.

Insulin Therapy

You may not have to take insulin if you have type 2 diabetes, but sometimes it’s needed. What type of insulin you would take depends on what's going on with you.

You might take insulin for type 2 diabetes because:

You need to control your blood sugar for a short time. You may need insulin to treat temporary high blood sugar because of things like:

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Lifestyle changes and pills haven't helped. If you've tried diet, exercise, and an oral diabetes drug and your blood sugar is still high, your doctor might prescribe insulin.

Your current treatment doesn’t work anymore. Over time, diabetes damages the cells in your pancreas that make insulin. Weight gain and chronic stress can speed this damage and make your body less responsive to insulin. Your pancreas may pump out more insulin at first, but eventually it won't be able to keep up with your body's demand for this hormone.

You haven't stuck with your treatment. Diet, exercise, and oral medicines will control your diabetes only if you use them. Missed doses and dietary lapses could derail your blood sugar control to the point where you need insulin.

There are a few types of insulin, based on how long it takes to start working and how long it lowers your blood sugar.

The main groups are:

Fast-acting insulin: It goes into your system within 30 minutes and works best to control blood sugar during meals and snacks. There's also "rapid-acting" insulin that starts to work in about half the time, but doesn't work as long.

Intermediate-acting insulin: It takes longer for your body to absorb than the fast-acting kind, but it lasts longer. It's good at controlling your blood sugar overnight and between meals.

Long-lasting insulin: This type can make your glucose level stable for most of the day. It works overnight, between meals, and when you’re fasting. In some cases, it can work even longer than 24 hours.

There are also mixtures of insulin that combine long-lasting and fast-acting. These are sometimes called combination insulin.

Talk to your doctor to figure out which type is best for you.

You and your doctor also need to choose which way to get insulin may work best for you. Your insurance coverage might play a role, too.

Here are some choices:

Syringe: You'd use this to give yourself insulin shots. You may put them in your:

  • Belly
  • Thigh
  • Buttocks
  • Upper arm

Pen: These have a needle at the tip. The idea is the same as a syringe, but you may find it easier to use.

Pump: This is a machine that you carry in a small pocket or pouch on your belt. It’s connected by a thin tube to a needle that goes into your skin. You get a steady dose of insulin.

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Surgery

Bariatric surgery, which you may know as gastric bypass, isn’t specifically a treatment for type 2 diabetes. But if your doctor says your body mass index (BMI) is higher than 35, you may want to consider this weight loss surgery. It's important to note that long-term effects from it on type 2 diabetes are unknown. Talk to your doctor if you're considering it.

Researchers are still studying the effects, but most people who had the surgery lost a significant amount of weight and saw their blood sugar get back to normal or nearly normal.

Artificial Pancreas

The idea behind this is to develop a single system that will watch your blood glucose level 24/7 and give you insulin or other drugs automatically when you need them.

A type called the hybrid closed loop system won approval from the FDA in 2016. It tests your glucose level every 5 minutes and gives you insulin when you need it.

Artificial pancreas research has focused mostly on people with type 1 diabetes. It may help people with type 2 as well.

WebMD Medical Reference Reviewed by Michael Dansinger, MD on December 01, 2019

Sources

SOURCES:

Diabetes Care, August 2006.
National Institute of Diabetes and Digestive and Kidney Diseases: "Insulin, Medicines & Other Diabetes Treatments."
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