Treatment Options for Type 2 Diabetes

There are some health conditions that can be managed by simply taking a pill — but type 2 diabetes isn’t one of them. Diabetes is a complex condition that often requires lifestyle changes, and sometimes requires additional treatment.

For some people, making healthful lifestyle changes can be enough to gain control over blood sugar levels. For others, taking medication may also be necessary. There are many drug options available, and the initial approach might need to be tweaked as treatment progresses.

Treating Type 2 Diabetes With Lifestyle Changes

The first approach to managing diabetes usually means practicing healthier lifestyle habits. This is often centered on eating a better diet, getting exercise, and losing weight if necessary. If your doctor says you need to make these changes, it’s smart to tailor them to your personal preferences so that you'll be more likely to stick with them.

“First, I ask people about their exercise patterns and about what they like to eat, and try to get an idea about what might be improved,” says endocrinologist William Sivitz, MD, a professor of internal medicine at the University of Iowa Carver College of Medicine in Iowa City.

Dr. Sivitz emphasizes the importance of being active, eating a healthy diet, and having a good understanding of the role that carbohydrates play. He recommends eating healthy carbs, such as vegetables, fruits, legumes, whole grains, and dairy products. A certified diabetes educator or a registered dietitian can help personalize your diet and teach you strategies to control your blood sugar.

Also be sure to tailor exercise options to your likes so that you'll enjoy being active. Along with eating a healthy diet, being physically active helps with weight loss, lowers blood sugar, and improves your overall health.

Bariatric surgery is an option for some people with diabetes who are obese and can’t lose weight through diet changes, Sivitz says. According to a review of clinical trials published in the October 2014 issue of JAMA Surgery, people with diabetes who underwent bariatric surgery had greater weight loss than those who received non-surgical treatment, and the surgery was more effective in helping obese patients get diabetes under control. More information is needed on the long-term results. Bariatric surgery is usually considered as an option only after less invasive treatments haven’t helped, however.

“I try to give lifestyle strategies a chance to manage type 2 diabetes,” Sivitz says, adding that people with very high blood sugar levels may need to start medication and lifestyle changes at the same time.

Medications for Type 2 Diabetes Treatment

When lifestyle changes alone can't control blood sugar levels, your doctor may prescribe medicine. Metformin is generally the first drug used to treat type 2 diabetes. It works by lowering your liver’s blood glucose production and improving insulin sensitivity in your muscles.

Still, Sivitz says, "in some cases, metformin and lifestyle aren’t enough." Then, other oral medications may be added to drug therapy with metformin. They include:

Alpha-glucosidase inhibitors, which prevent the starches in foods like pasta and potatoes from being turned into blood sugar, controlling the rise in blood sugar after a meal. You take them when you eat food.
Bile acid sequestrants, which remove cholesterol from the body and also may lower blood sugar levels.
DPP-4 inhibitors, which stop the normal breakdown rate of a compound called GLP-1, which helps lower blood sugar levels.
Meglitinides, which trigger beta cells in the pancreas to release insulin. They're taken before each meal.
SGLT2 inhibitors, which slow the kidney’s reabsorption of glucose, allowing more blood sugar to leave your body via urine.
Sulfonylureas, which also trigger insulin-releasing beta cells in your pancreas. They are usually taken one to two times a day, before meals.
Thiazolidinediones, which improve the way your body uses insulin. They may also lower blood sugar production in the liver.
There are also non-insulin injectable medications for blood sugar control:

Exenatide and liraglutide are two injectables that ramp up insulin in response to high blood sugar, at the same time reducing the liver’s blood sugar release.
Pramlintide holds down the usual blood sugar rise after meals by slowing down the digestion of food.
Insulin in Type 2 Diabetes Treatment

Insulin is a naturally-occurring hormone in your pancreas that helps your body use blood sugar and keeps blood sugar within healthy ranges. But in the case of type 2 diabetes, a person’s body doesn’t use insulin properly. When your pancreas simply can't make enough insulin or use it well enough to control blood sugar, your doctor is likely to prescribe insulin injections.

“For people with diabetes who don’t respond to oral medications or non-insulin injectables, insulin can be started as a long-acting preparation once a day,” Sivitz says. Short-acting insulin may be added before meals if long-acting insulin alone isn’t effective enough.

Tips on Type 2 Diabetes Treatment

If treating your diabetes involves medication, make sure you understand the side effects of everything you take. Also talk to your doctor about whether your medication regimen could lead to low blood sugar — a risk that Sivitz notes might mean additional changes in your diet and exercise habits.

There are many options to help treat diabetes, and your treatment needs may change over time. If you have questions on your current treatment, talk to your doctor.