Treatments for Type 2 Diabetes

Type 2 diabetes cannot be cured, but there are effective treatments that have been proven in clinical studies to help control blood glucose levels, slowing the progression of the disease and preventing serious complications from developing. In some cases, early-stage diabetes can be reversed — put into remission — with treatment. Guidelines for type 2 diabetes treatments and medications are based on how high your blood glucose is, how well it is controlled, your age and overall health, and any other health conditions you have or medications you take.

Studies have found that a large proportion of people with type 2 diabetes do not take their medications regularly or as directed, and at least 45 percent of those with type 2 diabetes fail to achieve blood glucose control. Stopping or underusing a medication allows blood sugar to rise, causing progressive damage that leads to worsening symptoms, complications such as blindness, kidney failure, and foot amputation, and a high risk for stroke and heart disease. For this reason, it is important to continue taking all medications as prescribed even if you feel better. If side effects bother you, talk to your doctor about switching medications or timing them differently. Set reminders and ask for help from family if you have trouble remembering to take your type 2 diabetes treatments.

Types of Treatments for Type 2 Diabetes

Lifestyle changes, including losing weight, eating healthier, and getting more exercise, are considered first-line therapy for type 2 diabetes. These changes can have a significant impact on how fast insulin resistance progresses. Medications can help control blood sugar levels. Type 2 diabetes is a progressive disease, and at some point, you will likely need to begin using insulin to control your blood glucose levels.

Many people with type 2 diabetes are prescribed multiple medications that work together to better control blood glucose levels. For more details about specific diabetes treatments, visit Treatments A-Z.

Monitoring

Testing and tracking your blood glucose is a vital part of managing your type 2 diabetes. Regularly monitoring your blood sugar at home helps you better control your glucose levels and gives your doctor a clear picture of how well your medication is working. If you are taking your medications as directed, and your blood glucose is not under control, your doctor will be able to change the timing or dosage of medicine to be more effective.

Lifestyle Changes

Improving diet and increasing exercise are fundamental to the successful treatment of type 2 diabetes. Some people with type 2 diabetes can get their blood glucose under control with significant weight loss, changing eating habits, and increasing physical activity, without adding medications. Weight loss can lower levels of inflammation in the body that are believed to contribute to insulin resistance. Exercise raises the body’s sensitivity to insulin, lowering blood glucose levels, and also contributes to weight loss. Eating a lower-calorie diet results in weight loss. Changing the amount and type of carbohydrates you eat can help you maintain healthy blood glucose levels and eating fewer saturated fats can help control cholesterol and triglyceride levels.

Medications

There are 11 classes of medications approved for treating type 2 diabetes. Most are taken orally, while others are injected. Some diabetes medications need to be taken at a certain time of day, before or after meals, to be effective. Some diabetes medications can cause upset stomach and hypoglycemia, or low blood sugar, as common side effects. Other side effects are specific to each drug or drug class. The most common classes of drugs prescribed for type 2 diabetes are highlighted below.

Metformin is the second-line treatment for high blood glucose in people with type 2 diabetes, after diet and exercise. Metformin is in a class called biguanides, which are believed to work by decreasing the amount of glucose produced by the liver and making the muscle tissue more sensitive to insulin. Metformin is sold under brand names including Fortamet, Glumetza, Glucophage, and Riomet. If your blood glucose is not controlled with lifestyle changes and metformin, guidelines indicate adding another medication or insulin. If this combination does not work to control blood glucose, the doctor will likely prescribe additional medications.

Sulfonylureas are believed to work by increasing the amount of insulin released by the pancreas. Sulfonylureas include glyburide, sold under the brand names DiaBeta and Micronase, and Amaryl (glimepiride).

Thiazolidinediones, also known as TZDs and glitazones, are believed to work by decreasing the amount of glucose released by the liver and making insulin more effective in muscle and fat tissues. Glitazones include Actos (pioglitazone) and Avandia (rosiglitazone).

Exenatide, sold as Byetta and Bydureon, is a glucagon-like peptide-1 (GLP-1) receptor agonist and an incretin mimic. Exenatide mimics the effects of incretin, which signals the pancreas to make more insulin and prevents the liver from releasing glucose. Exenatide is believed to work by improving the ability of the pancreas to secrete insulin in response to meals, thus normalizing blood glucose levels. Exenatide also causes weight loss.

Dipeptidyl peptidase 4 (DPP-4) inhibitors such as Januvia (sitagliptin) and Onglyza (saxagliptin) work by increasing the activity of the GLP-1 that the body makes.

Drugs in the sodium-glucose transporter 2 (SGLT2) inhibitor class work by causing excess glucose to be eliminated in the urine. Farxiga (dapagliflozin), Invokana (canagliflozin), and Jardiance (empagliflozin) are SLGT2 inhibitor medications.

Combination Medications

Some people with a complex treatment regimen for type 2 diabetes may prefer to take a combination drug containing medications from more than one class. Taking one medication instead of several may prove more convenient and easier to remember. Examples of combination drugs include Actoplus Met (pioglitazone/metformin), Glucovance (glyburide/metformin), and Janumet (sitagliptin/metformin).

Insulin

If medication plus improvements in diet and exercise fail to keep blood glucose levels in check, your doctor will likely suggest that you begin using insulin. Type 2 diabetes is a progressive disease, and the longer you have it, the more likely you are to need insulin, even if you do everything right. Insulin is just another way to control blood glucose.

When your doctor prescribes insulin, they will help you calculate the dosage and explain how to schedule your insulin doses. After you have used insulin for a while, your doctor will help you adjust the dosage for maximum effectiveness.

There are several types of insulin:

• Rapid-acting — Taken before a meal and effective in about 15 minutes
• Regular or short-acting — Taken before a meal and effective in about 30 minutes
• Intermediate-acting — Taken twice a day and effective for 10 to 16 hours
• Long-acting — Taken once a day and effective for 20 to 24 hours
• Pre-mixed — Combines a shorter-acting insulin with a longer-acting insulin

Insulin is sold under many different brand names.

Insulin must be injected subcutaneously (into the skin); it is not effective if it is swallowed. Insulin injection areas include fleshy parts of the abdomen, thighs, buttocks, and the backs of the arms.

Insulin is absorbed most quickly when injected into the abdomen. Deeper injections provide more rapid effectiveness.

There are several different delivery methods for insulin.

Syringes

There are many different types of syringe. Your doctor can help guide you in choosing the brand that is right for you. The barrel (the part that holds the liquid) must be large enough to hold a dose. The markings on the barrel must be legible for you. Needle gauge is another factor. The higher the number of the needle gauge, the smaller the needle will be. Some people find that smaller needles cause less pain.

Pens

Insulin pens are small, lightweight devices that resemble large ink pens. Most insulin pens have removable needles that should be replaced for each use. Insulin pens may be disposable or durable (refillable). Disposable pens come prefilled with insulin, while durable pens must be filled with insulin cartridges. Insulin pens may be easier to use while traveling because they can be kept at room temperature for several days.

Pump

Some people with type 2 diabetes have difficulty controlling their blood glucose levels even when taking insulin multiple times per day. An insulin pump may help some people in this situation maintain better blood glucose control. An insulin pump consists of a small computerized device (the pump) approximately the size of a cell phone, a flexible plastic tube, and a small needle. The needle is inserted into the skin of the abdomen and taped down. The tube connects the needle with the pump, which is worn on the belt or in a pocket. The pump is programmed to release insulin in two ways. Basal insulin is released slowly throughout the day, while bolus insulin is released at mealtimes.

Other Treatments for Type 2 Diabetes

Dialysis

High blood glucose levels in type 2 diabetes damage the kidneys, sometimes to the point where they can no longer function well enough to keep you healthy. People with severe kidney damage require kidney replacement therapy such as dialysis. Types of dialysis include hemodialysis and peritoneal dialysis.

Hemodialysis is a process of filtering waste products from the blood using a machine as an artificial kidney, known as a dialyzer. Hemodialysis can be done at a dialysis center, in a hospital, or at home. If you receive hemodialysis at a dialysis center, you will likely need to go three times each week. Hemodialysis will take three to five hours each time you go. If you do hemodialysis at home, you may choose more frequent treatments (four to seven times each week) for shorter periods of time.

In peritoneal dialysis, the peritoneum, or tissue lining your abdomen, is used to filter waste products from the blood. One advantage of peritoneal dialysis is that your body does not build up as much fluid and waste as it does with hemodialysis. Stress on your heart and arteries is reduced. It is also easier to maintain a normal work schedule with peritoneal dialysis since you do not need to spend hours at a dialysis center each week.

Surgeries

Some people with obesity and type 2 diabetes undergo bariatric surgery, such as gastric bypass surgery (Roux-en-Y), adjustable gastric band (also known as the lap-band or LABG), or sleeve gastrectomy, to lose weight. To be eligible for bariatric surgery, it is usually necessary to have a body mass index (BMI) over 35, or a lower BMI with medical complications such as poorly controlled diabetes. One study involving 20,000 people with type 2 diabetes who had received a gastric bypass surgery found that 84 percent of participants completely reversed their diabetes after surgery; they became able to maintain normal blood glucose levels without medication.

Amputation is sometimes a result of diabetic neuropathy (nerve damage), poor circulation, and infections in people with type 2 diabetes and poorly controlled blood glucose. Approximately 67 percent of amputations in the U.S. can be attributed to diabetes or a complication of diabetes. People with type 2 diabetes receive amputations 28 percent more often than people without diabetes. Most amputations involve lower extremities. The most common types of amputation are toe, foot, below the knee, and above the knee.

In people with end-stage kidney failure for whom dialysis is not a good option, a kidney transplant may be considered. A kidney transplant is a surgery to replace one diseased kidney with a healthy kidney from a living or deceased donor. After receiving a kidney transplant, you will need to take immunosuppressive medication for the rest of your life to prevent your body from rejecting the new organ.

Vaccinations

People with type 2 diabetes are recommended to receive pneumonia vaccines as welll as the annual flu vaccine.

Complementary, Alternative, and Natural Treatments

Some people with type 2 diabetes incorporate natural or holistic treatments and report relief from certain symptoms when they use complementary or alternative treatments such as acupuncture or herbal or nutritional supplements. Complementary treatments such as cinnamon, turmeric, vitamin D, or fish oil supplements are a few that have shown potential for reducing inflammation in people with type 2 diabetes. It is important to notify your doctor of any natural treatments you use, since some can interact with medications in dangerous ways, or make them less effective. Complementary therapies should not replace prescribed medications, which have been proven effective in clinical studies.

Condition Guide

• Type 2 Diabetes — An Overview
• Diabetes — The Path to Diagnosis
• Symptoms of Type 2 Diabetes
• Types of Diabetes
• What Causes Type 2 Diabetes?

References

1. Diabetes Myths — American Diabetes Association
2. A Brief History of the Development of Diabetes Medications — American Diabetes Association
3. Type 2 Diabetes — Mayo Clinic
4. Type 2 Diabetes and Complementary Therapies — Cleveland Clinic
5. Recommendations for Antihyperglycemic Therapy in Type 2 Diabetes — American Diabetes Association
6. Type 2 Diabetes and Insulin — EndocrineWeb
7. Poor Medication Adherence in Type 2 Diabetes: Recognizing the Scope of the Problem and Its Key Contributors — Patient Preference and Adherence
8. Prescription Assistance — American Diabetes Association
9. Financial Help for Diabetes Care — National Institute of Diabetes and Digestive and Kidney Diseases
10. Bariatric Surgery May Cure Type 2 Diabetes in Some Patients — Cleveland Clinic
11. Diabetes and Amputation: Everything You Need To Know To Avoid Amputation — TheDiabetesCouncil.com
12. Diabetes Medication Side Effects — Diabetes.co.uk
13. How To Beat Needle Phobia — Diabetic Living