Insulin usually isn’t the first line of defense for type 2 diabetes treatment. Find out about lifestyle changes and other medication options you can try to help control type 2 diabetes.
If you’re newly diagnosed with type 2 diabetes, your first worry might be that you’ll need to begin insulin injections immediately to get your blood sugar under control. But unless your blood sugar levels are dangerously high, chances are that insulin won’t be the first step in your type 2 diabetes treatment plan.
The most recent type 2 diabetes treatment guidelines, published in the January 2015 issue of the journal Diabetes Care, suggest that the best place to begin may be with a personalized, diabetes-friendly diet and increasing physical activity, along with using the common oral type 2 diabetes medication metformin (or an alternative, if there’s a reason you can’t take metformin). People who are very motivated to address type 2 diabetes through lifestyle changes may try diet and exercise alone for three to six months after diagnosis.
The current type 2 diabetes treatment recommendations are:
- Weight loss. Losing at least 5 percent of body weight can improve type 2 diabetes control significantly, according to the guidelines.
- Dietary changes. Work with your doctor to create a diet that has a healthy balance of protein, carbohydrates, fats, and fruits and vegetables, according to the American Diabetes Association. Limiting the simple carbohydrates in your diet, such as crackers and bread, is a cornerstone of diabetes control.
- Physical activity. About 150 minutes of exercise a week, or 30 minutes five or more days a week, is recommended for type 2 diabetes control. In addition, resistance training at least two days a week is also recommended to significantly improve blood sugar control.
Although it’s possible for type 2 diabetes to go into remission with these lifestyle changes, many doctors prescribe metformin from the start.
Type 2 Diabetes Treatment: Next Steps
If lifestyle changes and metformin don’t help you meet your type 2 diabetes treatment goals, your doctor might recommend an additional drug, often from one of these different classes of diabetes medications:
- Sulfonylureas. This class of oral medication triggers beta cells to release more insulin.
- Meglitinides. This class of oral medications also triggers beta cells to release more insulin.
- Biguanides. Metformin is in this class of oral drugs, which reduces the amount of blood sugar (blood glucose) made by the liver and helps increase the muscles’ sensitivity to insulin.
- Thiazolidinediones. These oral drugs help muscle and fat tissue use insulin more effectively and also may reduce the blood sugar released by the liver.
- Alpha-glucosidase inhibitors. These oral drugs slow the rise in blood sugar after meals by stopping the breakdown of starches and some types of sugar in the digestive process.
- DPP-4 inhibitors. These oral drugs help your body use its own compound that reduces blood sugar.
- SGLT2 inhibitors. These drugs cause excess glucose to be removed from your body in the urine.
- Pramlintide. This is an injectable form of the hormone amylin, which is made in the pancreas along with insulin. This medication helps keep A1C low. A healthy level of A1C is considered to be 7 percent or lower.
- Exenatide. This is an injectable synthetic hormone that helps lower blood sugar levels when they’re high. When combined with weight loss, exenatide may lead to better glycemic control, according to research published in the February 2015 issue of Cardiovascular Diabetology.
Determining which of these drugs or combination of drugs to try is based on a variety of factors, including any other health conditions you have, the side effects you can tolerate (such as nausea or weight gain), and your insurance coverage. You also may need other medication, such as a statin, to help reduce heart disease risk, which is higher in people with type 2 diabetes.
Research is ongoing to find new types of medications as well as to determine which combinations of the existing medications are most effective over time for people with type 2 diabetes.
When You Need to Start Insulin
Although insulin is effective, many people with type 2 diabetes want to avoid it as long as possible, sometimes because they worry about giving themselves injections, or because the idea of it brings home the severity of the disease. However, diabetes is a progressive disease that makes it harder and harder for your body to make the insulin needed to manage blood sugar levels as time goes on. If you can’t meet your goals (such as sticking at or below 7 percent A1C) using non-insulin methods, your doctor will recommend insulin. A significant number of people with diabetes do take insulin, sometimes only for a brief period, to help achieve control of blood sugar levels.
“As many as half of people with type 2 diabetes need insulin because the current A1C of those with diabetes in the United States is pretty high,” says researcher and endocrinologist Kenneth Cusi, MD, chief of the division of endocrinology, diabetes, and metabolism at the University of Florida in Gainesville.
Insulin can help you control your blood sugar levels over a long period. In a study involving 1,262 adults with diabetes, adding insulin to other diabetes medications enabled about 40 percent of them to reach the A1C goal of 7 percent, according to the study, published in 2013 in the journal Vascular Health Risk Management.
“There are a lot of misconceptions about diabetes treatment,” Dr. Cusi says. ”Some people may fear that when you step up to insulin, you’re going to die or go blind.” But Cusi points out that dire outcomes such as these could, in fact, be more likely to occur because insulin was started too late in the course of the disease, and that people who follow their diabetes treatment plan are far less likely to experience complications.
The most important takeaway about a successful type 2 diabetes treatment plan is to find and stick with the regimen that works best for you. If you need medication for type 2 diabetes, work closely with your doctor to determine the kind that’s best for you.