If lifestyle changes aren’t enough, your doctor may recommend one of these medications.
The most important and impactful way to manage type 2 diabetes is by changing your lifestyle. “This includes a healthy diet with no drinkable carbohydrates, a good exercise regimen, a mindful practice, and keeping a healthy, normal weight,” says Ana Kausel, MD, endocrinologist in New York City.
For some people with diabetes, however, healthier habits may not be enough. If lifestyle changes have not succeeded in bringing A1C numbers down or if blood sugar numbers are dangerously high from the get-go, doctors may turn to medications. These medications may be insulin or non-insulin medications.
Understanding Insulin Medications
“When a type 2 diabetic stops making insulin, it’s because they’ve been struggling for years and years with insulin overproduction and insulin resistance. There’s a point where the pancreas shuts down and stops the insulin production,” says Dr. Kausel. “With the treatment of insulin we just want to give the pancreas a break, reset, and start the production again slowly.”
There are different types of insulin medications that do different jobs: long-acting insulin and short-acting insulin.
Long-acting insulin, also called basal insulin, is a single-dose daily insulin that helps keep blood sugar levels stable throughout the day.
Short-acting insulin is used before meals to control blood sugar. Short-acting insulin mimics the action of the pancreas, which is to increase the production of insulin with each meal, says Dr. Kausel.
Insulin may be offered as an injectable or inhaled medication. Traditionally, it came in a vial, and you would need to use a needle and syringe. Today, you have other options: “The most common presentation of insulin nowadays is insulin pens,” says Dr. Kausel.
Treatment plans for diabetes patients vary—not everyone is treated with insulin medications. “We usually start with non-insulin medications,” says Dr. Kausel.
Understanding Non-Insulin Medications
Non-insulin medications work differently than insulin, and they are divided by how they work in the body. Types of non-insulin medications:
- Metformin works with the liver to improve how it uses insulin. This is considered the first-line therapy for treating type 2 diabetes.
- DPP-4 inhibitors work with the pancreas to slow down digestion and reduce excessive release of glucagon.
- GLP-1 agonists block carbohydrate absorption in the intestines.
- SGLT2 inhibitors help the kidneys expel excess sugar through the urine.
- TZDs work to boost insulin sensitivity to help the body metabolize blood sugar.
“There are great new advancements for the management of diabetes with non-insulin medications,” says Dr. Kausel. Certain medications—specifically the GLP-1 agonists and SGLT2 inhibitors—have benefits beyond diabetes management, including heart and kidney protection.
“It is very important that you trust your diabetes team, trust your doctor, and discuss all the diabetes aspects so you can have a better quality of life,” says Dr. Kausel.
Dr. Kausel is an endocrinologist specializing in diabetes, obesity, and metabolic disorders in New York City.
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Type 2 diabetes can be treated, apart from
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lifestyle changes, with medications that can be insulin,
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or other non-insulin medications.
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When a type 2 diabetic stops making insulin,
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it's because they've been struggling for years and years
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with insulin overproduction and insulin resistance.
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There is a point where the pancreas shuts down
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and stops the insulin production, so with the treatment
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of insulin, we just want to give the pancreas a break,
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reset, and start again the production slowly.
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The long-term insulin, what we call basal insulin,
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we use as a one, single dose that will help
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maintaining basal or baseline levels
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of insulin in the body.
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And the short-acting insulin patients use
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whenever they're gonna eat, so it mimics the action
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of the pancreas, which is increasing the production
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of insulin with each meal.
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Sometimes a treatment with insulin can be temporary,
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sometimes it can last a few months to years,
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sometimes people need to stay on insulin forever,
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but not everybody has to be treated with insulin.
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We usually start with non-insulin medications.
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So non-insulin medications are different groups,
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and they divide themselves based on
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where they work in the body.
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We have medications that help
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the insulin enter the cells smoothly.
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We also have medications that help
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and optimize the production of insulin by the pancreas.
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And we have other medications that act
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at the kidney level, getting rid of the extra sugar in the body.
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There is great, new advancements
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for the management of diabetes with non-insulin medications.
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Specifically, two groups called the GLP-1 analogues,
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and the SGLT2 inhibitors.
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They have proven to have other non-diabetic
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great benefits for the patient, such as heart protection,
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and kidney protection.
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Despite all the treatments and advancements
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of diabetes, the most important factor in the
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management of diabetes type 2 is lifestyle changes.
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This includes a healthy diet, with no drinkable
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carbohydrates, good exercise regimen,
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a mindful practice, and keeping a healthy, normal weight.
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It is very important that you trust your diabetes team,
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trust your doctor, and discuss with them
02:36.567 --> 02:39.232
all the diabetes aspects so you can have
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a better quality of life.
02:41.367 --> 02:46.467
Overview of general medical care in nonpregnant adults with diabetes mellitus. UpToDate. (Accessed on March 16, 2020 at https://www.uptodate.com/contents/overview-of-general-medical-care-in-nonpregnant-adults-with-diabetes-mellitus)
Dipeptidyl peptidase 4 (DPP-4) inhibitors for the treatment of type 2 diabetes mellitus. UpToDate. (Accessed on March 16, 2020 at https://www.uptodate.com/contents/dipeptidyl-peptidase-4-dpp-4-inhibitors-for-the-treatment-of-type-2-diabetes-mellitus#H1205453)