Treatment For Type 2 Diabetes

90%–95%¹ of the 37 million Americans living with diabetes have type 2 diabetes. This worrying statistic shows that it's vital to learn how to manage the condition.

Managing type 2 diabetes requires adopting a specific lifestyle and taking particular medications.

What is type 2 diabetes?

Type 2 diabetes is a medical condition that compromises your body's ability to regulate your blood glucose (sugar) levels.

Every cell in the human body needs energy to function efficiently. Typically, the body obtains this energy by extracting glucose (or sugar) from the energy-rich foods we consume, such as cereals (carbohydrates), or from stored fuel called glycogen, which is found in our liver and muscles.

The glucose is absorbed from the digestive tract, liver, or muscles into the bloodstream. To use this glucose for energy, the body needs a hormone called insulin to transport the glucose inside our cells, where it is metabolized to form energy.

Insulin (along with digestive enzymes) is made and stored in the pancreas, which is located in the upper abdomen behind the stomach.

In type 2 diabetes, genetic, environmental, and lifestyle factors can result in damage to the pancreas that, in turn, decreases insulin levels in the body. These same factors can also prevent insulin from transporting glucose easily into the cells for energy production.

This interference with insulin and glucose transport is known as insulin resistance. Both the decreased insulin production by the pancreas and the insulin resistance lead to less glucose being transported into cells for essential energy and higher levels of glucose circulating in the bloodstream.

If left untreated, high levels of blood glucose can cause dysfunction and tissue damage throughout the body. These effects are expressed as different signs and symptoms of type 2 diabetes.

Risk factors associated with diabetes 

Certain people are more at risk of developing type 2 diabetes. You may be more at risk if:

• You're genetically predisposed to develop diabetes due to your family history

• You're genetically predisposed to become obese or overweight due to your family history

• You are obese or overweight

• You're at least 45 years old

• You're of African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander descent

• You don't exercise regularly

• You have a particular pattern of fat distribution in your body, namely, a concentration of fatty tissue around the organs in the abdomen

• You have high blood pressure

• You have a low level of HDL cholesterol or a high level of triglycerides in your blood

• You have a history of diabetes in pregnancy (gestational diabetes) or have given birth to a baby weighing 9 pounds (4 kg) or more

• You have a condition called prediabetes

• You have polycystic ovary syndrome (PCOS)

Symptoms of type 2 diabetes

Type 2 diabetes has many signs and symptoms, most of which develop slowly. It can take several years for these to show up.

The main signs and symptoms of type 2 diabetes are:

• Increased thirst

• Frequent urination

• Increased hunger

• Unintended weight loss

• Fatigue/lack of energy

• Blurred vision

• Slow-healing sores

• Frequent infections

• Tingling, pain, and/or numbness in the hands or feet

• Darkened skin areas around the armpit and neck regions

Complications of type 2 diabetes 

People living with diabetes are at risk of developing health problems, also referred to as diabetes complications. If blood glucose levels stay too high for too long, type 2 diabetes complications can occur. These complications can affect many parts of the body, such as the blood vessels, nerves, eyes, kidneys, limbs, heart, and brain.

Complications can include:

• Eye problems, including diabetic retinopathy 

• Nerve damage or diabetic neuropathy

• Kidney disease

• Heart attacks

• Strokes 

• Skin conditions such as slow healing sores, fungal and bacterial infections

• Hearing problems

• Dementia

Why is it essential to treat type 2 diabetes?

Treating type 2 diabetes can help you avoid the complications associated with this condition. You will need to work with your primary healthcare provider to create an effective treatment plan. 

Please note that many people with type 2 diabetes can depend on their primary healthcare provider.

However, you may see more effective results if you're able to gain access to a multidisciplinary diabetes care team. This is a team of healthcare professionals who work with you to provide high-quality, coordinated care.

Your diabetes healthcare team may include the following people:

• Family physician (general practitioner)

• Endocrinologist or internal medicine physician

• Certified diabetes care and education specialist (CDCES)

• Dietitian

• Pharmacist

• Podiatrist

• Optometrist

• Psychologist

• Physiotherapist

• Other specialists such as a nephrologist (kidney specialist), ophthalmologist (eye specialist), cardiologist (heart specialist), neurologist (brain, spine, and nerve specialist)

How is type 2 diabetes diagnosed?

Type 2 diabetes is often diagnosed in labs or through a blood test during an annual checkup. However, if you're experiencing any symptoms of diabetes (as mentioned above), you should see your doctor or local healthcare provider as soon as possible for a comprehensive health assessment.

Tests for type 2 diabetes

Everyone over the age of 45 should consider routine screening for type 2 diabetes. Those with risk factors for type 2 diabetes (see "Risk factors associated with diabetes" above) should also be tested regularly regardless of age.

Commonly used tests for diagnosing type 2 diabetes include:

Fasting plasma glucose (FPG)

This test checks your blood glucose level at a single point in time after you've been fasting for at least eight hours. Most healthcare professionals recommend taking this test early in the morning after fasting through the night.

FPG results and their meaning are as follows:

• 99 mg/dl (5.5 mmol/L) or below: Normal glucose levels

• 100 mg/dl to 125 mg/dl (5.6 to 6.9 mmol/L): Indicates prediabetes

• 126 mg/dl (7.0 mmol/L) or higher: Indicates type 2 diabetes

Many healthcare professionals would consider taking this test two or three times on separate occasions to confirm your diagnosis.

Hemoglobin A1C test

This test provides a measure of your blood glucose levels over the two to three months before having the test.

Although the HbA1c is not the most reliable test for diagnosing type 2 diabetes, it can be convenient for some people because there is no need to fast beforehand.

Please note that some Southern Asian, Mediterranean, and African people can show falsely high or low results due to their genetic variation. Medical conditions that affect hemoglobin (Hb) in the blood can also make the HbA1c result unreliable.

Random plasma glucose test (RPG)

RPG tests check for blood glucose levels regardless of when you last ate and provide a snapshot of your blood sugar status. Healthcare providers consider this test when they want to determine your blood sugar levels without fasting.

A reading of 200 mg/dl (11.1 mmol/L) or above shows that you have diabetes.

Oral glucose tolerance test (OGTT)

The oral glucose tolerance test is a two-hour test that shows your doctor how your body processes glucose (sugar).

After you have fasted for eight to ten hours (you may be allowed water), your healthcare provider will take some blood to determine your fasting blood glucose level. They will then give you a drink containing a specific amount of glucose and you will have another one to two blood draws, with the second draw two hours after finishing the glucose drink.

OGTT results and their meaning:

• 139 mg/dl (7.7 mmol/L) or below: Normal glucose levels

• 140 mg/dl to 199 mg/dl (7.8 to 11.0 mmol/L): You have prediabetes

• 200 mg/dl (11.1 mmol/L) or higher: You have diabetes

What are the best treatments for type 2 diabetes?

Many people can improve their type 2 diabetes through changes to their diet along with other lifestyle changes, such as increasing the amount of daily exercise. Your doctor may also recommend taking oral medications with or without insulin therapy to help bring your blood glucose levels back to a healthy range.

Most healthcare providers now take a person-centered approach² to help people care for their diabetes. This approach encourages shared decision-making to address each person's individual needs and preferences when choosing diabetes treatment strategies.

Here are some of the best strategies and treatments for improving your type 2 diabetes:

Changes to your lifestyle

Lifestyle changes include:

• Adopting healthier eating habits

• Increasing exercise or activity levels

• Reducing stress or learning how to manage it better

• Decreasing alcohol intake

• Quitting smoking

Healthy eating

Food is crucial in helping to maintain healthy blood glucose levels. Experts in diabetes care recommend eating a high-quality diet based on whole, unprocessed foods.

Here are some tips for healthy eating when you have type 2 diabetes:

• Choose foods high in nutrients and low in empty calories

• Eat less sugar and fewer processed foods

• Choose complex carbohydrates

• Eat more fiber-rich plant foods and healthy fats

• Increase soluble fiber intake

• Choose healthy sources of protein

• Eat smaller portion sizes

• Read food labels to understand their nutritional value

Foods and beverages to avoid or limit

It's a good idea to avoid or limit certain food and drink if you have type 2 diabetes. These include:

• Foods high in trans fats or saturated fats (e.g., fatty meats, cream, shortening)

• Processed meats like salami, bacon, sausages, and hotdogs

• Refined foods such as cakes, pastries, white bread, and pasta made with white flour

• Processed or high-sugar snacks such as packaged cookies and candy

• Drinks or beverages that contain sugar or high fructose corn syrup, such as sweetened fruit juices and regular soda

It's good to speak to your doctor about your dietary restrictions, depending on your glucose levels. You might need to monitor your glucose levels more carefully and adopt a different nutritional plan than another person. However, not everyone is required to self-check their blood glucose levels, so follow your doctor's advice carefully.

Foods to include

A type 2 diabetes diagnosis doesn't mean that you should entirely do away with carbs. Healthy carbohydrates give you critical energy and fiber.

Some healthy food choices include:

• Vegetables. Both starchy and non-starchy vegetables are healthy carbs, although some people may be advised not to eat excessive amounts of starchy vegetables (e.g., white potatoes). Try to increase your intake of leafy greens like arugula, broccoli, kale, and spinach

• Beans/pulses, including kidney, pinto, navy, and black

• Whole fruits such as berries, apples, pears, and oranges 

• Wholegrain bread and cereals, e.g., foods made with 100% whole wheat, oats, brown rice, corn, and quinoa

• Fish high in omega-3 fatty acids: salmon, albacore tuna, halibut, herring, sardines, mackerel, and trout

• Milk and unsweetened or low-sugar yogurt

• Foods high in healthy monounsaturated fats such as avocados, nuts, seeds, and olive oil

It's a great idea to speak with your doctor about your personal nutritional goals. They might recommend that you see a dietitian who specializes in type 2 diabetes care.

Exercise

Exercise plays a crucial role in helping you to improve your health if you're diagnosed with type 2 diabetes. Exercise has the following benefits:

• Reduced blood glucose levels

• Less insulin resistance

• Weight loss and weight maintenance

• Lower blood pressure

• Fewer diabetes complications (such as heart attacks and strokes)

• More energy

• Better bone and muscle strength

• Improved mood

• Better quality sleep

Some physical activities you can adopt are as follows:

Aerobic exercise

Select aerobic exercises that you enjoy most such as running, biking, swimming, and walking. Engage in exercise for 30 minutes or more on most days of the week, or a minimum of 150 minutes every week. Children should engage in 60 minutes of brisk to vigorous aerobic exercise each day.

Resistance exercise

This anaerobic exercise improves your strength, balance, and ability to perform daily activities. It includes various activities such as yoga, calisthenics, and weightlifting. Adults are advised to engage in this type of exercise for two to three sessions a week.

Stay active

Break long bouts of inactivity like sitting at your computer by engaging in light activities such as walking around or standing every 30 minutes.

Blood glucose monitoring

Your doctor will advise you on whether or not you need to measure your blood glucose levels and how to go about this. You may need to check your blood glucose levels before or after meals, during exercise sessions, or even overnight. If you're on insulin therapy, you might need to monitor your blood glucose multiple times a day.

Glucose monitoring can be done via finger prick testing with a glucose meter at home. Keep a record of your measurements and share them with your healthcare team.

You can also use a continuous glucose monitoring (or CGM) device to record your glucose levels. This device has sensors placed under the skin to monitor your glucose every few minutes. The information is transmitted to a mobile device such as your phone and sends alerts when your glucose levels are too high or too low.

Based on your blood glucose readings, you can determine if you need to take action to keep your blood glucose levels within the healthy range set by your doctor. Your diabetes healthcare team will also be able to review your blood glucose levels over time to determine if you need to make changes to your treatment plan.

Medication

When lifestyle changes can't lower your blood glucose levels into the healthy range on their own, your healthcare provider may prescribe oral or injectable medication.

Medicines used to treat type 2 diabetes include:

Metformin

Many healthcare providers prescribe metformin as the first medication for type 2 diabetes. It lowers your glucose levels and improves the body's insulin sensitivity to ensure that it uses insulin more effectively.

Metformin has also been shown to increase lifespan, protect against heart attacks, decrease the risk of certain cancers, and assist with weight loss. Metformin is also prescribed for people with prediabetes and polycystic ovarian syndrome.

Common side effects are:

• Diarrhea

• Nausea

• Bloating

• Abdominal pain

• Headaches

• A metallic taste

• Rarely, lactic acidosis

Sulfonylureas

These drugs stimulate the pancreas to secrete more insulin. Some of the options to consider include:

• Glyburide

• Glipizide

• Glimepiride

• Gliclazide

You might experience side effects such as weight gain or low blood sugar.

Glinides

These drugs also stimulate the pancreas to produce more insulin. They offer faster results than sulfonylureas and have a shorter effect on the body. Examples include:

• Nateglinide

• Repaglinide

Thiazolidinediones

These drugs make the body's tissues more insulin-sensitive. Examples include:

• Pioglitazone

• Rosiglitazone

Potential side effects associated with these drugs include:

• Fluid retention

• Macular edema

• Weight gain

• Heart failure

• Risk of bone fracture

• Risk of bladder cancer

• High cholesterol

DPP-4 inhibitors

These drugs stimulate insulin production and modestly reduce your blood glucose levels. 

Examples include:

• Linagliptin

• Saxagliptin

• Sitagliptin

Please note that they might cause side effects such as joint pain and pancreatitis.

Glucagon-like peptide-1 (GLP-1) receptor agonists

These are injectable medications that:

• Stimulate insulin production

• Decrease blood glucose levels

• Reduce your appetite

• Slow your digestion

• Increase your metabolic rate

GLP-1 receptor agonists also decrease the risk of type 2 diabetes-related complications such as heart attacks, strokes, and kidney failure. Some GLP-1 receptor agonists can result in significant weight loss (and these are also used for people without diabetes who wish to lose weight).

Examples of GLP-1 receptor agonists include:

• Liraglutide

• Semaglutide

• Exenatide

Potential side effects³ include:

• Nausea/vomiting

• Diarrhea

• Indigestion

• Bloating

• Pancreatitis

• Gall stones/gall bladder disease

• Benign thyroid growths and, rarely, thyroid cancer

A combined GLP-1 and GIP receptor agonist injection called tirzepatide has also just been released.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors

These drugs affect your kidneys' blood-filtering function and inhibit glucose from being returned to your bloodstream. This results in more glucose being excreted in the urine.

SGLT2 inhibitors can decrease the risk of type 2 diabetes-related complications such as heart attacks, heart failure, and kidney failure. These drugs are also prescribed for people without diabetes to improve kidney or heart disease.

SGLT2 inhibitors can assist with modest weight loss and help to lower blood pressure. Examples include:

• Canagliflozin

• Dapagliflozin

• Empagliflozin

Potential side effects include:

• Increased urination

• Flu-like symptoms

• Low blood pressure

• Dehydration

• Urinary tract infections

• Genital yeast/candida infections

• Nausea and constipation

• Diabetic ketoacidosis

• A rare but serious genital infection called necrotizing fasciitis of the perineum — also known as Fournier's gangrene

Insulin therapy

Doctors prefer insulin therapy if lifestyle changes or other medications don't meet your glucose targets.

There are several types of insulin available. Some are short-acting, and others are intermediate or long-acting. Your doctor may prescribe a combination of different insulin types.

To determine which types of insulin and which doses you need, your doctor will consider factors such as your blood glucose levels over the course of the day, as well as your home and work commitments.

The current options for giving yourself insulin are:

• Insulin shots/injections or pens: Insulin can be injected into the fatty tissue just below your skin (the subcutaneous tissue) with a needle and syringe or a pen-like device.

• Insulin pump: An insulin pump delivers a steady dose of insulin into the subcutaneous tissue via a very thin tube inserted through the skin. There are several different types of insulin pumps available, and many now operate with a CGM (see "Blood Glucose Monitoring" above).

There is also an inhaled, rapid-acting insulin called Alfrezza available in some countries.

New insulin-delivery systems are currently in development, e.g., insulin patches and implanted devices. Advances in gene and stem-cell⁴ therapies will provide us with even more treatment options in the not-too-distant future.

When should I see a doctor? 

Specific signs and symptoms may suggest high glucose levels and the need to seek immediate care. These signs and symptoms include:

• Frequent urination and/or dark urine

• Excessive thirst, dry mouth

• Fatigue or lethargy

• Persistent headache

• Confusion or drowsiness

• Unconsciousness or seizures

• Fruity-smelling breath

• Persistent abdominal pain

• Persistent nausea or vomiting

The lowdown 

There's currently no cure for type 2 diabetes, but remission (or 'reversal') may be possible for some people.

By working closely with your doctor and other members of your diabetes healthcare team, you can help design a treatment plan that suits your individual needs.

Lifestyle changes, monitoring, and medication can all help to improve your type 2 diabetes and quality of life.