Dr. Angela Ryan Lee is board certified in cardiology and internal medicine. Her professional interests include preventive cardiology, medical journalism, and health policy.
Jason DelCollo, DO, is board-certified in family medicine and on the faculty of Philadelphia College of Osteopathic Medicine.
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.
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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:
Eating high glycemic index foods can be especially harmful if you have diabetes and blood sugar dysregulation.
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:
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).
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:
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.
The choice of oral medication is an individualized decision. Your healthcare provider will consider factors like a medication’s effectiveness and tolerability, as well as any other medical conditions you have.
Metformin is commonly prescribed to start because it is well-tolerated and inexpensive. It also has the possible benefit of reducing heart disease. SGLT2 inhibitors and GLP-1 agonists are beneficial for people with heart disease.
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 (hemoglobin A1c >10% or blood glucose >300 mg/dL) or when three months of triple oral combination therapy has not resulted in blood sugar control.
There are several different types of insulin. Each type takes a different amount of time to reach peak effect. How long the effect last also differs by type.
The types of insulin range from rapid-acting (acts within 15 minutes and wears off after 2-4 hours) to ultra-long acting (acts within 6 hours and wears off after 36 hours).
A typical insulin regimen includes longer-acting insulin delivered once or twice a day and rapid-acting insulin dosed before meals.
Insulin can be delivered by injection from a needle, pen, or pump. There is also a form of rapid-acting insulin that can be inhaled.
In addition to oral medications and insulin, there are several injectable medications to help control blood sugar. These include:
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.
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, up to 33%—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:
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.
Your options for treating diabetes can seem overwhelming, but remember that your healthcare team is there to guide you in choosing the best plan for your needs. Let your provider know if you have any concerns about changing your diet and exercise routine, as these are essential parts of any diabetes treatment plan.
If you have any side effects from the medications you're prescribed, tell your team. Your provider can adjust your medication regimen or try alternatives to help you reach your blood sugar goals.
Metformin is a commonly prescribed diabetes medication because it is affordable and has a tolerable side effect profile, but there are other medications that can be prescribed for diabetes.
Alpha-glucosidase inhibitors, DPP-4 inhibitors, GLP-1 agonists, SGLT-2 inhibitors, sulfonylureas, and thiazolidinediones are a few other classes of medications that can help lower blood sugar.
Depending on the class, diabetes medications can have side effects like weight change, gastrointestinal symptoms, fluid retention, and infections of the upper respiratory tract and urinary tract.
Low blood sugar (hypoglycemia) is a potentially serious side effect of some diabetes medications, including insulin, sulfonylureas, and meglitinides.
While type 1 diabetes requires insulin replacement, some people with type 2 diabetes can be treated without medications. Making dietary changes, getting regular physical activity, and achieving a healthy weight can go a long way to getting your blood sugar levels under control.
Some people are able to put their type 2 diabetes into remission with these lifestyle adjustments and do not require medication.
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Angela Ryan Lee, MD, is board-certified in cardiovascular diseases and internal medicine. She is a fellow of the American College of Cardiology and holds board certifications from the American Society of Nuclear Cardiology and the National Board of Echocardiography. She completed undergraduate studies at the University of Virginia with a B.S. in Biology, medical school at Jefferson Medical College, and internal medicine residency and cardiovascular diseases fellowship at the George Washington University Hospital. Her professional interests include preventive cardiology, medical journalism, and health policy.
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