Understanding Your Treatment Options for Type 2 Diabetes

There are standard treatments for type 2 diabetes, but each person's needs are different. Your healthcare team will consider many factors when determining the right treatment for you.

This article will review the different non-medical and medical treatments for type 2 diabetes, including exercise, diet, oral pills, and injectable medications.

Diet

Diet is a major part of a diabetes treatment plan. Your diet can help you get your blood sugar under control. Your blood sugar levels go up after you eat a meal high in carbohydrates. This is especially true if the meal contained high glycemic index foods, which cause a big increase in blood sugar.

Examples of these foods include:

• White bread
• Potatoes
• White rice
• Processed foods
• Soft drinks

Eating high glycemic index foods can be especially harmful if you have diabetes and blood sugar dysregulation.

Exercise

Another essential part of a treatment plan for most people with diabetes is exercise. The basic recommendation is to get 150 minutes of moderate physical activity weekly.

Getting regular physical activity if you have diabetes can help lower blood sugar levels, but the benefits don't stop there. Regular physical activity also helps:

• Achieve and maintain a healthy weight
• Lower blood pressure
• Improve cholesterol
• Improve sleep, mood, and energy levels

Some people with diabetes have physical differences or frailty that limit the amount and type of exercise they can do.

In these cases, water aerobics and chair exercises might be an option. These activities help maintain muscle mass, as well as maintain or improve balance—both of which are important for people with peripheral neuropathy and muscle wasting (conditions that can be caused or made worse by diabetes).

Oral Medications

Most people with diabetes need medication in addition to diet and exercise to control their blood sugar. While people with type 1 diabetes require insulin, people with type 2 diabetes can often be treated with oral medication.

There are several classes of oral diabetes medications. Each type works differently and can have different side effects ranging from gastrointestinal symptoms to low blood sugar. The various classes of oral diabetes medication and examples are listed below:

• Alpha-glucosidase inhibitors like Precose (acarbose) and Glyset (miglitol)
• Biguanides like metformin
• Dopamine-2 Agonists like Cycloset (bromocriptine)
• DPP-4 inhibitors like Januvia (sitagliptin) and Tradjenta (linagliptin)
• Glucagon-like peptide-1 (GLP-1 ) agonist Rybelsus (semaglutide)
• Meglitinides like Prandin (repaglinide) and Starlix (nataglinide)
• SGLT2 Inhibitors like Brenzavvy (bexagliflozin), Jardiance (empagliflozin), and Farxiga (dapagliflozin)
• Sulfonylureas like Amaryl (glimepiride) and Glucotrol (glyburide)
• Thiazoladinediones like Actos (pioglitazone)
  

Oral medications can be combined when one medication alone is not enough to lower blood sugar.

While oral medication can control blood sugar for some people with diabetes, it doesn't always work for everyone. If more aggressive treatment is needed, insulin and other injectables are the next steps. This is especially true for people with very high blood sugar levels and people who have had diabetes for many years.

Insulin

Insulin is rarely used as the sole therapy for diabetes. It should be combined with dietary changes and exercise. In people with type 2 diabetes, insulin can be given in addition to oral diabetes medications.

In a person with type 1 diabetes, the pancreas does not make insulin which means injectable insulin is required. In type 2 diabetes, starting insulin is recommended when a person's blood sugar is very poorly controlled (A1C >10% or blood glucose >300 mg/dL) or when three months of triple oral combination therapy has not resulted in blood sugar control.

Other Injectables

In addition to oral medications and insulin, there are several injectable medications to help control blood sugar. These include:

• Amylin mimetic Symlin (pramlintide)
• GLP-1 agonists like Ozempic (semaglutide) and Victoza (liraglutide)
• GLP-1 + Glucose-dependent insulinotropic polypeptide (GIP) agonist Mounjaro (tirzepatide)

These medications can be injected as often as before every meal to weekly, depending on the specific medication. GLP-1 agonists have weight loss as a possible side effect, which can be beneficial for people with type 2 diabetes and obesity.

When prescribing an injectable medication for diabetes, your healthcare provider will work with you to outline a plan that also includes diet, exercise, and oral medication.

Surgery

Studies have shown that bariatric (weight loss) surgery significantly improves blood sugar control in people with diabetes and obesity. For some people, the weight loss even results in diabetes remission.

One year after bariatric surgery, between 33% and 90% of people are considered to be in remission and do not require blood sugar-lowering medications.

People with diabetes who have a body mass index (BMI) of ≥ 35 kg/m2 might be candidates for bariatric surgery.

While surgery is more invasive than medical therapy, it has the following advantages:

• Weight loss
• Blood sugar control
• Decreased blood pressure
• Mortality benefit
• Decreased diabetes complications
• Improved quality of life

Summary

There are several options for treating type 2 diabetes. Lifestyle changes like diet, exercise, and maintaining a healthy weight can help lower blood sugar and are recommended for most people with diabetes.

Medications are often needed in type 2 diabetes to achieve blood sugar control. Options include oral medications, injectables, and insulin. Bariatric surgery can be beneficial for people with both diabetes and obesity.