Type 2 Diabetes

Treatment Options for Type 2 Diabetes

Type 2 diabetes is on the rise, with the worldwide prevalence increasing from 4.7% in 1980 to 8.5% in 2014, according to the World Health Organization. 

With this rise comes to an increase in the different ways to treat diabetes. 

The ultimate goal of any diabetes treatment is to improve blood sugar levels and insulin resistance. 

This, in turn, helps improve blood glucose levels. Having good glycemic control greatly improves the outcomes for those with type 2 diabetes.

Reducing the risk of complications, such as a heart attack, high blood pressure, cardiovascular disease, and other diabetes complications

If a person’s diabetes is diagnosed early, healthy lifestyle changes may be recommended. Making healthy changes to diet and exercise can help naturally improve blood sugar levels. 

In this article, we will be discussing the treatment options available for type 2 diabetes. 

Treatment options for type 2 diabetes 

Metformin 

One of the most popular diabetes medications is Glucophage, commonly referred to as metformin. 

Many people are started on metformin because it isn’t known to cause low blood sugar, and is in a convenient pill form. 

Metformin is also less likely to cause weight gain compared to other types of diabetes medications. However, it is important to bear in mind that it isn’t a weight loss medication. 

Sulfonylureas 

Another common class of oral diabetes medications is called sulfonylureas. These include the more commonly-used drugs glyburide, glipizide, and glimepiride. Sulfonylureas act to increase insulin production in the pancreas, helping to improve blood glucose levels. 

Injectable insulin 

Injectable insulin is one of the oldest diabetes treatments. It is often used when other types of diabetes medication haven’t effectively controlled blood sugar. There are several different types of insulin, all with varying effects on blood sugar. 

Long-acting insulin lasts 12-24 hours and is usually taken once or twice a day. Intermediate-acting insulin lasts about 12 hours and is often taken twice a day. 

Short-acting insulin lasts around 6-8 hours and is usually taken about 30 minutes before meals. 

Finally, rapid-acting insulin starts to work very quickly and is often taken right at the start of meals. It lasts around 4-6 hours, and the risk of low blood sugar is highest with rapid-acting insulin because it works so quickly. 

Newer non-insulin injectables 

Newer non-insulin injectables include DPP-4 inhibitors and GLP-1 receptor agonists. DPP-4 inhibitors help to promote the hormones that encourage insulin production while also helping to reduce the amount of sugar released from the liver. 

GLP-1 receptor agonists 

GLP-1 receptor agonists work to increase insulin production as well as slowing down glucose absorption. [6] GLP-1 receptor agonists can cause weight loss, which in some cases can help control blood sugar. 

What are the advantages of the different types of type 2 diabetes treatments? 

The significant advantage of lifestyle changes to help with type 2 diabetes is the avoidance of medication side effects and cost. 

However, in some cases, lifestyle changes might not be enough to treat your diabetes. For example, if your pancreas isn’t making enough insulin or you’ve had diabetes for a long time. 

Oral medications are preferred by people who don’t want to take injections. Metformin is generally affordable, which is another benefit and a reason why it’s so often prescribed. 

The advantages of injectable medications are that they may help further reduce blood sugar while not causing weight gain. This can often be the case when using insulin (due to improved blood sugar levels.) 

Insulin’s primary benefit is that it tends to be very effective at reducing blood glucose levels. 

Safety and effectiveness of type 2 diabetes treatments 

With all the different options available today, a common concern is about the safety and effectiveness of type 2 diabetes treatments. 

As with any medication, there are certain risks and potential side effects. 

Metformin 

Metformin is notorious for its potential side effect of gastrointestinal upset. This can result in nausea, diarrhea, as well as bloating.

As a result, many healthcare professionals will suggest to their patients to start with a small dose. This will gradually increase to the target dose over a few weeks to avoid severe stomach upset. 

A rare complication of metformin is called lactic acidosis. This usually occurs in the presence of another health problem, such as kidney failure or heart attack. 

Sulfonylureas 

Sulfonylureas can cause low blood sugar, which can be life-threatening. 

As with any blood glucose-lowering medication, users should exercise caution and check their blood sugar. It is also important to avoid low blood sugar by eating consistently and taking the medication as prescribed. 

GLP-1 receptor agonists 

GLP-1 receptor agonists don’t cause low blood sugar and may help patients with weight loss, which can be favorable for blood glucose levels. However, caution should be exercised in patients with a history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2. 

DPP-4 inhibitors 

Certain DPP-4 inhibitors may be contraindicated in those with a history of pancreatitis, and patients with kidney insufficiency should also be monitored if prescribed DPP-4 inhibitors to assess kidney function. 

Insulin 

Insulin can cause low blood sugar, which is why healthcare providers often encourage self-monitoring of blood glucose if diabetic patients are taking insulin at home.

Basal insulin and short-acting insulin can also cause low blood sugar if too much is taken, or not enough food is eaten around the time of the dose. Working closely with your healthcare provider and/or diabetes educator is crucial for staying safe while taking insulin. 

How do you know if a type 2 diabetes treatment is effective? 

Having your blood sugar levels tested regularly is a great way to know how effective a diabetes treatment is. A hemoglobin A1c is recommended every 3-6 months, 

Because A1c tests are sometimes only done twice per year, another great way to assess effectiveness is to check blood sugar levels at home with a glucometer machine. 

Many healthcare professionals suggest a blood sugar target of 80-130 mg/dL before eating a meal and less than 180 mg/dL 2 hours after starting a meal. 

What makes a good type 2 diabetes treatment? 

A good type 2 diabetes treatment is one that fits with the patient’s lifestyle. The patient should show improvement in blood sugar while minimizing harmful side effects. 

Some patients end up needing to start injectable insulin after years of taking oral medication. Others may only ever need to take oral medications to keep their blood sugar at their target. 

There isn’t a “best” treatment option, only what’s best for the individual and their circumstances. 

What’s new in treatment for type 2 diabetes 

A newer class of diabetes medication called the FDA first approved SGLT-2 inhibitors in 2013. SGLT-2 inhibitors decrease the amount of glucose absorbed by the kidneys, which increases the glucose content excreted in the urine. 

Because of this, a potential side effect is increased urinary tract infections from the sugar in the urinary tract. 

Newer ultra-long-acting insulins, such as insulin degludec and insulin glargine U300, are more concentrated than regular basal insulin. As a result, they are gaining popularity for those whose basal insulin doesn’t last the whole day, or for those who need more flexible dosing. 

Natural treatments for type 2 diabetes 

What role does exercise play in treating type 2 diabetes naturally? 

Exercise plays a vital role in helping to treat type 2 diabetes. 

During exercise, the body becomes more insulin sensitive, helping to lower blood sugar levels. Muscles use glucose for energy during exercise and keep taking up sugar even after a person is done exercising. 

Exercise also helps to increase the synthesis of glycogen. Glycogen is sugar stored in the liver. It is essential for maintaining blood sugar in the absence of food, such as fasting. 

If sugar is being used to create glycogen, less of it is circulating in the bloodstream in the form of high blood sugar. 

It’s recommended that adults aim for 150 minutes of moderate-intensity physical activity per week, or 30 minutes 5 days per week. 

Research shows that strength or resistance training also helps to reduce blood sugar. This is as exercising increases the muscles’ uptake of sugar. 

People suffering from diabetic neuropathy should also strive to be physically active. Research suggests that exercise may improve neuropathy symptoms while improving muscle strength. 

What kinds of diets can treat type 2 diabetes? 

Countless diets claim to promote weight loss and improve health conditions, including diabetes. 

Many of these diets can be very restrictive, and some may be costly as well. 

While some of them may result in weight loss (and even improved blood sugar numbers), the problem lies in their sustainability. Most people who follow diets end up re-gaining the weight they lost. Also, dieting can lead to body image problems and eating disorders. 

A diet high in fiber and low in simple sugars is a healthy way to promote balanced blood sugars. Foods rich in fiber include whole grains, quinoa, legumes, nuts, seeds, fruit, and vegetables. 

Limiting added sugars is also very beneficial. Many foods and drinks contain much more sugar than is healthy, not just those with diabetes. Some examples include sugary beverages, sweetened cereal, snack bars, and desserts. 

A healthy diet to help treat type 2 diabetes should be balanced and non-restrictive. Making small, positive changes to eating habits can make a big difference when it comes to blood sugar improvement. 

Best supplements for treating type 2 diabetes 

Certain herbs and spices are known for their potential to improve blood sugar. 

Cinnamon, prickly pear, bitter melon, fenugreek, garlic, and aloe vera are some of the more popular botanicals that may have anti-diabetic effects, according to some studies. 

If you’re already taking diabetes medications, you mustn’t stop taking them to try a natural remedy instead.

Before starting any new supplements, it’s important to talk with your doctor. Certain herbs may interact dangerously with some medications. 

As the Food and Drug Administration doesn’t regulate supplements, it’s essential to choose a reputable brand, which uses high-quality ingredients in clinically significant dosages. 

What are the best supplements for treating type 2 diabetes? 

Some studies have linked alpha-lipoic acid (APA) to decreased insulin resistance, therefore improving blood glucose levels. 

Another study notes that APA may be useful for reducing diabetic neuropathy symptoms. However, further research needs to be done to confirm how effective they are. 

Chromium is a mineral that helps improve insulin resistance. It also plays a role in the metabolism of carbohydrates, fats, and proteins. Insulin resistance plays a role in metabolic syndrome, which increases the risk of heart disease. 

Interestingly, levels of chromium tend to be lower in people with type 2 diabetes, which is why supplementation may be beneficial for those individuals. 

One of the more popular supplements for diabetes is cinnamon. While the suggested dose and duration isn’t clear according to research, the use of cinnamon has been associated with several benefits. 

These benefits include: 

  •  a reduction in blood glucose levels 

  •  a reduction in triglycerides, LDL “bad” cholesterol 

  •  an increase in HDL “good” cholesterol. 

Though there are limited studies so far, the research also suggests the potential for aloe vera to be effective at reducing blood sugar levels and blood lipid levels. 

The studies done on aloe vera have been short-term at 6-12 weeks. Therefore, more long-term studies would need to be done to validate its use for people with both prediabetes and type 2 diabetes

There has been promising research on garlic for its anti-diabetic and lipid-lowering properties. In one study, garlic was found to significantly reduce Hemoglobin A1c levels compared to control at both 12 and 24 weeks. 

What makes a supplement a good choice for treating type 2 diabetes? 

With all the supplements geared towards the treatment of type 2 diabetes, you may be wondering which one is the best choice. Just like there isn’t a one-size-fits-all medication regimen for diabetes, there isn’t one for supplements, either. 

A good fit would be a supplement that doesn’t interact with your medications, is free of side effects, and shows an improvement in your blood sugar levels. 

Conclusion

Diabetes mellitus can be a challenging disease to live with on a day to day basis. But by implementing good diabetes self-management and glucose control, you can enjoy a healthy lifestyle. 

Talking with your doctor about the different alternatives for supplementation, as well as reviewing the potential side effects is the best way to come up with a plan. 

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About Our Author Diana Gariglio-Clelland

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Diana Gariglio-Clelland obtained her B.S. in Nutrition from the University of Idaho and is a Registered Dietitian with experience in the hospital, community and primary care health settings.

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