The right treatment course depends on your personal factors.
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.”
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When I first diagnose
someone with Type 2 diabetes,
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we talk about what it means
to have high blood sugar.
00:00:06,710 --> 00:00:08,900
We talk about the blood sugar effects.
00:00:08,900 --> 00:00:10,499
And then we shift to treatment.
00:00:10,499 --> 00:00:13,365
00:00:13,365 --> 00:00:16,156
A well managed Type
2 diabetic is eating
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healthfully a consistent number of
carbohydrates on a daily basis.
00:00:20,930 --> 00:00:22,930
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They're taking measures to
lose weight if they need to.
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If they're taking medicines that may
increase the risk of low blood sugar,
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they're checking their finger
sticks on a regular basis.
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I was given my glucometer.
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I was shown how to use it.
00:00:36,530 --> 00:00:38,980
I was told how many times a day to use it.
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I went to a dietician and
that made a big difference.
00:00:43,050 --> 00:00:45,750
We look at diet,
we look at exercise patterns and
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we try to optimize those things and
give someone a three month chance, or
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so, at lowering their A1C on their own.
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your blood sugar is really high,
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your A1C is really high,
I will perscribe medications initially.
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People with Type 2 diabetes can take
any one of a whole host of medications.
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The easiest way to think
about medications for
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Type 2 diabetes are either to
think about pills or injections.
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In terms of pills, there are medications
that act at the pancreas level,
00:01:12,930 --> 00:01:17,300
there are medications that help your liver
and muscle to use insulin better, there
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are medications that block carbohydrate
absorption from the intestines.
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There are medicines that
can help the kidneys
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eliminate sugar through the urine so that
the body doesn't hold on to that sugar.
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And in terms of injections
there are two things.
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There's insulin and then there
are injections that are not insulin
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that they make a different
hormone in the body.
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And that particular
hormone is called GLP-1.
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Deciding on the right course
of medication therapy for
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a patient with type 2
diabetes is pretty complex.
00:01:46,420 --> 00:01:48,830
It requires taking a good history,
00:01:48,830 --> 00:01:53,690
understanding someone's own preferences
and approach to diet and exercise, and
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you must take into account whether
they're overweight or obese.
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The main goal besides lowering blood sugar
in the treatment of type 2 diabetes,
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is to control weight.
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And so initially if someone
just needs one medication,
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many times I like to
start out with metformin.
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That's still considered by the American
Diabetes Association to be first-line
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therapy for type 2 diabetes.
00:02:13,400 --> 00:02:16,220
Usually I'll try to max out
the metformin, I'll try to get to
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the effective therapeutic dose as
long as the patient is tolerating it.
00:02:19,820 --> 00:02:24,120
And if that point with max dose metformin
and diet and lifestyle changes,
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the patient is still not meeting glucose
targets, I'll add a second agent.
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We like to start first
with non-insulin medications,
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especially if the situation calls for
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But after two, three, maybe even
four drug classes are being used and
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we're not hitting our targets
in terms of blood sugar or
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A1C, then we need to talk about insulin.
00:02:44,940 --> 00:02:47,750
But I don't want patients to
view it as a personal failure,
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it's just the progressive
nature of the disease.
00:02:49,990 --> 00:02:53,350
When we think about the treatment of
Type 2 diabetes a generation from now,
00:02:53,350 --> 00:02:56,820
we'll be talking about drugs that
have nothing to do with blood sugar.
00:02:56,820 --> 00:02:59,990
We may be talking about drugs
that influence inflammation.
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Drugs for weight loss.
00:03:01,720 --> 00:03:05,110
We may be even talking about a vaccine for
type II diabetes, and
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hopefully even type I.
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I think it'll be a very different
conversation, but we also have to,
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in the mean time, use what's in our
disposal for the treatment of type 2.
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Allemann S, Houriet C, Diem P, Stettler C. Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis. Curr Med Res Opin. 2009 Dec;25(12):2903-13.
Dipeptidyl peptidase-4 (DPP-4) inhibitors for the treatment of type 2 diabetes mellitus. Waltham, MA: UpToDate, 2018. (Accessed on February 28, 2018 at https://www.uptodate.com/contents/dipeptidyl-peptidase-4-dpp-4-inhibitors-for-the-treatment-of-type-2-diabetes-mellitus#H1205453.)
Fitness: what we recommend. Arlington, VA: American Diabetes Association, 2015. (Accessed on February 28, 2018 at http://www.diabetes.org/food-and-fitness/fitness/types-of-activity/what-we-recommend.html.)
Look AHEAD Research Group, Pi-Sunyer X, Blackburn G, Brancati FL, Bray GA, Bright R, Clark JM, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care. 2007 Jun;30(6):1374-83.Weight loss. Arlington, VA: American Diabetes Association. (Accessed on February 28, 2018 at http://www.diabetes.org/food-and-fitness/weight-loss/.)