Type 2 Diabetes Treatments

You have lots of options to manage diabetes. Food, exercise, and medication work together to bring your blood sugar under control.

Your doctor will help you figure out if you need to take medicine, which kind is right for you, and how often you should take it.

Over your lifetime, you'll probably handle your disease in different ways. Sometimes medications stop working, and you'll have to switch. You'll need to adjust to changes in your body as you age. And researchers are looking for new diabetes medicines and ways to treat it.

Type 2 Diabetes Treatments and Medications

M edications are often the first kind of medicine people with type 2 diabetes try when diet and exercise alone aren't enough to keep their blood sugar in a healthy range. There are many of them, and they work in different ways.

  • Biguanides. This group includes metformin, one of the most commonly used drugs to treat diabetes. It tells your liver to hang on to some of the glucose it makes.
  • Meglitinides and sulfonylureas. These medications tell your pancreas to make more insulin.
  • DPP-4 inhibitors keep your body from breaking down hormones that give your pancreas the "go" signal for insulin. This means they work longer when you need to lower your blood sugar after a meal.
  • Thiazolidinediones, TZDs, or glitazones. These medicines help insulin work better. They lower insulin resistance from your cells so your pancreas doesn't have to work as hard.
  • Alpha-glucosidase inhibitors slow the digestion of food with complex carbohydrates like bread, pasta, rice, potatoes, and corn. This keeps your blood sugar from shooting up after you eat.
  • SGLT2 inhibitors work by letting your kidneys pee out extra sugar.
  • Bile acid sequestrants lower your cholesterol and can also help lower your blood glucose.
  • You can take these medications by themselves or in combination with others, including insulin. Some pills have more than one kind of drug.
  • Dopamine receptor agonists work directly on the brain to help it process dopamine. This, in turn, can increase your sensitivity to insulin so your body doesn't need as much of it. Those taking dopamine receptor agonists should also implement some lifestyle changes such as a healthy diet and exercise for the medication to be more effective.

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Injectable drugs slow how quickly food leaves your stomach and make you feel full. And they tell your liver to back off making glucose around mealtimes.

  • GLP-1 receptor agonists help your pancreas make insulin. Some of them you take every day, while others last a week.
  • Pramlintide (Symlin) acts like a hormone, amylin, that your pancreas sends out with insulin. You only take it if you're also using insulin.

Insulin therapy could be a short-term fix for a stressful situation or because other medicines aren't enough to control their blood sugar. Types of insulin are grouped by how fast they start to work and how long their effects last. You might have to use more than one kind of insulin. Some insulins come pre-mixed.

You can take insulin in one of several ways:

  • Injections with a needle and syringe. You fill the syringes from a bottle of insulin and give yourself a shot. You pick a spot and rotate between belly, thigh, butt, and upper arm.
  • Insulin pump . It connects to a tiny needle under your skin to provide a steady stream of insulin throughout the day.
  • Insulin pen. It looks like a pen but has a needle on the end. Some are prefilled with insulin, while others have a container you replace.
  • Inhaler. You breathe in powdered insulin.
  • Injection port. This tube goes under your skin and lets you use a needle and syringe or pen without having to stick yourself in a different spot every time. You keep the port in place for a week and then replace it with a new one in a new spot.
  • Jet injector. This sends a fine spray of insulin into your skin at high pressure instead of using a needle.

Weight loss surgery  gets rid of extra pounds. And that alone will help control your blood sugar. But it also raises the level of hormones in your gut called incretins. These tell your pancreas to make insulin. Over time, you may be able to take less medication. It isn't for everyone, though. Doctors usually recommend weight loss surgery only for men who are at least 100 pounds overweight and women with at least 80 extra pounds.

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Type 2 Diabetes Management

You’ll need to make lifestyle changes to help you successfully manage type 2 diabetes.

  • Weight loss. Losing 5% to 10% of your body weight -- that’s less than 20 pounds if you weigh 180 -- can lower your A1c levels and your risk for cardiovascular disease. It may help you cut back on medications to treat diabetes, high blood pressure, and high cholesterol. Weight loss can also ease symptoms of depression and help with sleep apnea.
  • Healthy diet. There's no one-size-fits-all diabetes diet. You'll need to pay attention to carbs, fiber, fat, and salt to manage your blood sugar and avoid complications of diabetes. How much and when you eat are important, too. Talk to your diabetes team or a registered dietitian to help you plan your meals and snacks.
  • Physical activity. From working out to doing chores, activity lowers your blood sugar. It helps your cells use insulin. It also helps your muscles use glucose. Make sure you check your blood sugar before and after exercise.
  • Better sleep. Not getting enough sleep can raise your odds of getting type 2 diabetes in the first place. The length of time you sleep and the quality of sleep can raise A1c levels, a test doctors use to check your average blood sugar levels over 3 months. That means improving your sleep can lead to lower blood sugar readings.

Diabetes Monitoring

Your doctor will want to see you often to do certain tests to see how well your diabetes is under control. These include:

  • Blood glucose monitoring. You’ll use a blood glucose meter to check your blood sugar when your doctor tells you to or get a gadget that continuously monitors your levels.
  • Regular checkups. The doctor will check your A1c and cholesterol levels, along with doing tests to make sure your thyroid, liver, and kidneys are all working like they should.
  • Regular eye exams. The doctor will check for signs of retinopathy, nerve damage to your eye caused by diabetes.
  • Regular foot exams. The doctor will check for foot problems and nerve damage to your feet.

Your blood glucose number tells you how well your treatment is working. Your doctor will let you know how many times a day you need to check it. It depends on what diabetes medications you're taking.

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

Sources

SOURCES:

University of California, San Francisco: Diabetes Education Online: "Monitoring Your Blood," "Checking for Ketones."

American Diabetes Association. "Standards of Medical Care in Diabetes - 2015," Diabetes Care, January 2015.

American Diabetes Association: "Blood Glucose Control and Exercise," "Weight Loss," "What Are My Options?" "Can Diabetes Pills Help Me?" "Insulin Basics," "Type 2," "Insulin Routines," "What About Insulin?" "Other Injectable Medications."

Joslin Diabetes Center: "Oral Diabetes Medications Summary Chart," "The Truth about Insulin and Type 2 Diabetes."

Medscape: “Antidiabetics, Biguanides.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Insulin, Medicines, & Other Diabetes Treatments,” “The A1C Test & Diabetes.”

Diabetes Care: “Weight Management in Type 2 Diabetes: Current and Emerging Approaches to Treatment.”

CDC: “Sleep and Chronic Disease.”

American Diabetes Association: “Checking Your Blood Glucose.”

Kaiser Permanente: “Schedule for diabetes lab tests and exams.”

UpToDate: "Sulfonylureas and meglitinides in the treatment of diabetes mellitus."

Diabetes UK: "DPP-4 Inhibitors (Gliptins)," "Thiazolidinediones (Glitazones)."

Diabetes.co.uk: "SGLT2 Inhibitors (Gliflozins)."

FDA: "FDA Approves Afrezza to Treat Diabetes."

National Diabetes Information Clearinghouse: "Types of Insulin."

Massachusetts General Hospital: "Bariatric Surgery for People with Type 2 Diabetes and Prediabetes."

University of California, San Francisco: Division of General Surgery: "Type 2 Diabetes."

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