Treatment for Type 2 Diabetes: How to Get Blood Sugar Levels on Track

The right treatment course depends on your personal factors.

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A diagnosis of type 2 diabetes requires you to think about your body differently. Once-foreign phrases like “insulin resistance” and “glucose control” may suddenly start to make up a huge part of your daily thought process.

“When I first diagnose someone with type 2 diabetes, we talk about what it means to have high blood sugar,” says Minisha Sood, MD, an endocrinologist in New York City. “We talk about the blood sugar effects. And then we shift to treatment.”

Lifestyle Tweaks to Treat Type 2 Diabetes

Your everyday habits may significantly affect how well you can manage blood glucose levels. A study from Diabetes Care found that a one-year program consisting of nutrition education and increased physical activity had huge benefits. Participants with type 2 diabetes lost an average of 8.6 percent of the body weight, lowered their A1C levels, and improved their blood pressure and lowered their cholesterol numbers.

So what’s the secret? These habits influence how well you can manage type 2 diabetes, according to Sonal Chaudhry, MD, an endocrinologist at NYU Langone Health in New York City.

  • Eating healthfully. Along with other guidelines for a healthy diabetic diet, this includes trying to consume a consistent number of carbohydrates from day to day.

  • Exercising regularly. The American Diabetes Association recommends about 150 minutes of moderate-to-vigorous exercise per week. Here are tips for exercising with diabetes.

  • Losing weight, if necessary. Excess weight can increase your risk of complications and reduces your glucose control. Find more information on losing weight for diabetes here.

  • Self-monitoring blood sugar levels. A study of 3,270 patients with type 2 diabetes found that those who regularly monitored blood sugars had lower A1C levels and improved glycaemic control.

“We look at diet, we look at exercise patterns, and we try and optimize those things and give someone a three-month chance or so at lowering their A1C on their own,” says Dr. Sood.

Medications to Treat Type 2 Diabetes

Doctors turn to medications if lifestyle changes have not succeeding in bringing A1C numbers down to a healthy level, or if blood sugar numbers are dangerously high from the get-go. Most medications for type 2 diabetes fit in one of two categories: pills and injections.

Here are commonly used pills to help treat type 2 diabetes, according to Dr. Sood.

  • Metformin works with the liver to improve how it use insulin better. This is considered the first-line therapy for treating type 2 diabetes. “Usually I’ll try to max out the metformin; I’ll try to get to the effective therapeutic dose as long as the patient is tolerating it,” says Dr. Chaudhry. “[If] the patient is still not meeting glucose targets, I’ll add a second agent.”

  • 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.

Two types of injection medications are available for patients with type 2 diabetes: insulin and GLP-1 injections.

“Deciding on the right course of medication therapy for a patient with type 2 diabetes is pretty complex,” says Dr. Sood. “It requires taking a good history, understanding someone’s own preferences and approach to diet and exercise, and [considering] whether they are overweight or obese.”

Insulin therapy is required for treating type 1 diabetes, but it is typically prescribed for type 2 diabetes when other drugs have not been successful at helping patients meet blood sugar targets. (Here’s more info about the difference between type 1 and type 2 diabetes.) That’s not a reason to feel defeated, however: “I don’t want patients to view [needing insulin] as a personal failure,” says Dr. Sood. “It’s just the progressive nature of the disease.”

Future type 2 diabetes treatment options may address type 2 diabetes in new and unexpected ways, far beyond just blood sugar management. “We may be talking about drugs that influence inflammation, drugs for weight loss, we may be even talking about a vaccine,” says Dr. Sood. “I think it will be a very different conversation, but we also have to in the meantime use what’s in our disposal for the treatment of type 2.”