If you have Type 2 diabetes, you’ll have to combine lifestyle changes with the use of medication to help control your blood sugar.
A large component of Type 2 diabetes treatment is healthier eating and more physical activity. “I believe the lifestyle modifications are more important than medicines,” says Dr. Maria Subang, an endocrinologist with Kaiser Permanente in Colorado Springs, Colorado. “It’s not a pleasant doctor’s visit if we have to always say, ‘Eat less and move more,’ but American society in general needs to make healthier choices.”
“We find that the most successful changes are made when we can negotiate the changes patients can make,” says Dr. Robert Gabbay, chief medical officer and vice president at the Joslin Diabetes Center, which is part of Harvard Medical School in Boston. That means finding where you can fit healthier eating or physical activity into your lifestyle. For example, if you like to go to the mall, you could squeeze in more time walking while you’re there to help you stay physically active.
It can be difficult to make permanent healthier changes on your own, so Subang refers patients to the National Diabetes Prevention Program, designed by the Centers for Disease Control and Prevention. This program, available throughout the U.S., provides accurate information about diabetes management and offers support to those who have the condition. Ultimately, the behavioral changes recommended by the program, including weight loss and more physical activity, help you control your blood sugar. If it’s under better control, you’re less likely to have complications from diabetes.
“Healthy food choices and physical activity aren’t easy, but they’re important,” Subang says.
In addition to lifestyle changes, patients who are newly diagnosed with Type 2 diabetes are often prescribed an oral drug called metformin. “Metformin has been around a long time,” Gabbay says. “We tend to choose it because it lowers morbidity, helps control blood sugar and helps a little with weight loss.” Morbidity refers to health complications.
Your doctor will likely start you on a lower dose of metformin because it can upset your digestive system and cause bloating, gas or diarrhea. You’ll probably start to see changes in your blood sugar level after a couple of weeks, although it could take longer.
Your metformin dose will depend on how much the drug does (or doesn’t) affect your digestion and how well-controlled your diabetes is. If you’re doing well with lifestyle changes, the only drug you may need for your Type 2 diabetes is metformin, Subang says.
Your doctor will work with you on a target blood sugar level for your Type 2 diabetes while you use metformin. If you have other health complications related to diabetes and a hard time controlling your blood sugar, you may need to take other diabetes medicines as well.
In addition, the use of at-home blood sugar testing kits will help you monitor how your blood sugar is doing every day.
Over time, exercise, healthier eating and the use of metformin alone may not be enough to control your blood sugar. “The good news is that there are more treatments available now to improve your health,” says Dr. Loren Wissner Greene, a clinical professor of endocrinology at NYU Langone Medical Center in New York.
There are other types of medications used when you have Type 2 diabetes that can help your body produce more insulin (leading to better blood sugar control) or improve your body’s sensitivity to the insulin it already makes. Some of these new drugs change the way blood sugar is released in your body. Other drugs help control blood sugar, lower the risk for heart disease and promote weight loss. The side effects will vary based on the drug, but they can include digestive problems, an increased risk for heart failure or urinary tract infections.
The decision of whether to add other drugs to your Type 2 diabetes treatment beyond metformin comes down to several factors, including cost, whether the drugs promote weight loss or gain and if the drugs interact with other medication you may use. “There’s not always one best next choice, and that leads to shared decision-making with the patient,” Gabbay says.
Sometimes the oral medications for Type 2 diabetes aren’t enough to keep blood sugar under control. In that case, your doctor may add insulin to your treatment. Insulin is what people with Type 1 diabetes use to control their blood sugar. Although the actual rate of insulin use among patients can vary, Greene estimates that about one-third of those with Type 2 diabetes use it.
There are different types of insulin your doctor may prescribe. Some insulin is shorter-acting versus long-acting. Other insulin types are injected before you eat. Your doctor will help you find the right type of insulin for you. In many cases, it’s easier to use insulin nowadays because the needles are tinier than they once were and easier to inject, Greene says.
If you have Type 2 diabetes and need to take insulin, don’t feel bad about it. “Taking insulin is not a personal failure. That can become a big barrier to starting it,” Gabbay says. “It’s a part of the natural course of the disease.”
Taking multiple pills or insulin for diabetes is hard, especially if you also have to use medication for other conditions. “I know when people are at work, this can be a big challenge, and they’ll say they have no time to take medicine,” Subang says. Still, it’s important to take medication regularly. If you miss doses, you’ll have a harder time controlling your blood sugar, and that can lead to a variety of health problems.
“The patient has to be in control because the doctor can’t be there 24/7,” Greene says.
If you’re on medication for Type 2 diabetes and your blood sugar is higher than your target range with no explanation, let your doctor know. It may be time to reevaluate your medications. Your doctor may also change your treatment if your hemoblogbin A1C level – used to track your blood sugar average over three months – is trending higher than usual.