Diabetes treatment may include:
MedicationNutrition therapyPhysical activityLifestyle measures to manage stress and other issuesSpecialist care to prevent and treat complicationsBariatric surgery
“The cornerstone of all diabetes treatment is a healthy lifestyle that includes diet and exercise,” says Kathleen Dungan, MD, an endocrinologist at the Ohio State University Wexner Medical Center in Columbus. “However, diabetes is a progressive disease, which means that even if you are doing well with a particular treatment, it usually fails over time.” The latest updates about care for type 2 diabetes can be found in the American Diabetes Association’s 2021 Standards of Medical Care, which lists updates related to diabetes, complications, new technology, and more. There are currently more than 10 classes of diabetes drugs, each of which lowers blood sugar in a different way. If your current drug regimen isn’t lowering your blood sugar enough, your doctor may elect to add a drug from a different class. Down the line, you may also need to add insulin to your treatment regimen. Side effects, such as stomach upset and diarrhea, are generally minimal, especially when you start with low doses and increase them slowly, Dungan says. She notes that metformin does not cause hypoglycemia (low blood sugar) or weight gain unlike some other treatments, has a long safety record, and is relatively affordable.
Sulfonylureas and Meglitinides
Sulfonylurea drugs have also been used for many years to help people with type 2 diabetes control their blood sugar. These drugs “cause the insulin-producing cells of the pancreas to produce insulin almost constantly, which means they [increase the] risk of low blood sugar and for weight gain,” says Daniel Einhorn, MD, an internist at Scripps Memorial Hospital in La Jolla, California. “But, they are inexpensive and they are effective, and have been used for a long time,” he adds.
Glimepiride (Amaryl)Glipizide (Glucotrol)Glyburide (DiaBeta)
Repaglinide (Prandin)Nateglinide (Starlix)
Alpha-Glucosidase Inhibitors
Thiazolidinediones (TZDs)
DPP-4 Inhibitors
Another group of drugs are known as DPP-4 inhibitors.
GLP-1 Receptor Agonists and GIP Agonists
Glucagon-like peptide 1 (GLP-1) agonists are a class of drugs that mimic the action of a hormone called glucagon-like peptide 1, according to the Mayo Clinic. When blood sugar levels start to rise after you eat, these drugs stimulate your body to secrete more insulin, which in turn helps lower your blood sugar levels and manage type 2 diabetes. Plus, GLP-1 agonists appear to help suppress appetite and may also lead to weight loss.
Another drug, semaglutide (Rybelsus), is taken orally once daily, per the Mayo Clinic. Common side effects of GLP-1 agonists include nausea, vomiting, and diarrhea. More serious risks include low blood sugar levels (hypoglycemia), but this usually only happens if you’re taking another medication to lower blood sugar at the same time, such as sulfonylureas or insulin. Along with GLP-1, glucose-dependent insulinotropic polypeptide (GIP) is also secreted after meal ingestion. GLP-1 and GIP receptor agonists work together to promote post-meal insulin secretion and blood sugar control, according to a review published in September 2019 in the International Journal of Molecular Sciences. In May 2022, the U.S. Food and Drug Administration (FDA) approved the tirzepatide (Mounjaro) injection to improve blood sugar control in adults with type 2 diabetes, in addition to diet and exercise. Tirzepatide is a first-in-class drug that activates both the GLP-1 and GIP receptors, which leads to improved blood sugar control. The drug is injected under the skin once a week. Clinical studies found tirzepatide was more effective than other diabetes therapies. Possible side effects include nausea, vomiting, diarrhea, decreased appetite, constipation, upper-abdominal discomfort, and abdominal pain.
Combination Therapy
Many of the above drugs for type 2 diabetes are also available in combination form, including glyburide and metformin (Glucovance), as well as sitagliptin and metformin (Janumet). “There are numerous combination therapies that incorporate most classes of glucose-lowering medication,” Dungan says. Combination therapy, or two drugs in a single pill, can help reduce the pill burden for people with diabetes, she says. Combination medication can be highly effective and may make it easier to stick to your diabetes treatment plan. But Dungan notes that one drawback of combination therapy is that the dose of the individual medication in each cannot be individually adjusted. In addition, if you experience side effects, it can be tougher to figure out which medication is to blame. “Most patients with type 2 diabetes who require insulin start with a single injection of long-acting (basal) insulin given once daily,” Dungan says. Short-acting insulin may be added later on to get glucose levels further under control. That short-acting insulin, Dungan explains, is generally started with the largest meal of the day, and coverage of additional meals is added as needed. There’s no one-size-fits-all eating plan for people with diabetes, so it is often helpful to work with a registered dietitian or diabetes educator to design a diabetes meal plan that meets your diabetes goals and accommodates your food likes and dislikes, daily schedule, and access to food. She notes that working with a registered dietitian to develop a meal plan to fit your lifestyle can be helpful, “since the best diet is the one that a person can stick with for the long haul.” To that end, Dungan notes that keeping a food log can help you understand how many calories, carbs, and nutrients you’re consuming. In addition, most people with diabetes should limit carbohydrates, especially simple carbohydrates, like white bread, white pasta, white potatoes, white rice, cereal, and juice, Dungan says. They should instead opt for more fresh vegetables and fruit, or high-fiber, whole-grain options, she says, noting that the Mediterranean diet is rich in vegetables, lean meats and fish, and monounsaturated fats, and low in saturated fats and simple carbohydrates. She adds that you can monitor your glucose levels one to two hours after meals to determine how the food you’ve eaten affects your blood sugar. Be sure to check with your doctor before starting any glucose monitoring so you can figure out the best mode and frequency for your individual health.
Brisk walkingClimbing stairsPlaying tennisDancingBicycling or indoor spinningRowingJogging or runningHikingSkating
Lifting weightsTaking group fitness classes that involve using weightsUsing weight machines at the gymHeavy gardening or other activities that can help you build and maintain muscle
Overhead arm stretchesTorso twistsLeg lifts or extensions
Before you start a formal exercise program or increase your level of physical activity, it’s important to get your doctor’s okay and to find out which activities you can do safely. If you have uncontrolled high blood pressure, severe neuropathy, foot ulcers, or diabetic retinopathy, you may need to take certain precautions, according to Kaiser Permanente. In general, though, exercise can provide a lot of benefits. “Exercise is critical for patients with diabetes to maintain heart health and maintain glucose control,” Dungan says. She notes that it’s best to consult your doctor about the type and frequency of activity that is best for you, and find out whether you need additional testing to make sure that exercise is safe. Still, Dungan says, brisk walking nearly every day for at least 30 minutes is safe and beneficial for most people. It’s important to understand that there are several types of bariatric surgery — including gastric bypass and gastric sleeve — and that they can vary in invasiveness and effectiveness for treating type 2 diabetes, Dungan says. The diabetes-reversing effects of bariatric surgery can last for many years, but it’s still important for people who once had type 2 diabetes to be monitored for its recurrence and potential complications. As for other healthcare professionals, Dungan notes that many diabetes clinics have dietitians, pharmacists, social workers, and mental health specialists on staff, all of whom can contribute to your diabetes management program. “Each patient’s needs will differ slightly,” Dungan says. For instance, if you can’t control your blood sugar with standard treatments or if you have frequent or severe hypoglycemia, you should consider seeing an endocrinologist, she says. If you develop complications, like heart disease, kidney disease, or foot ulcers, you may need to see specialists who can help with those conditions. Each year, everyone with diabetes should see an eye care professional who has experience treating patients with diabetes, Dungan says. For example, poorly managed stress or mental health disorders may contribute to diabetes burnout and a general lack of motivation to stay on top of healthy diet and lifestyle habits. Your doctor or diabetes educator can help improve your emotional well-being, Dungan says. Even if you do not have a diagnosed mental health disorder, you can and should talk to these professionals about diabetes-related distress or stressors, and learn about key resources or relaxation techniques to help you manage the disease. Check your blood sugar regularly. If your doctor recommends it, good blood sugar management can prevent complications down the line. Examine your feet. Foot issues like swelling, sores, blisters, and calluses may be a sign of nerve damage caused by diabetes. Be sure to talk with your doctor about what you can do each day to improve your disease management.
