Type 2 Diabetes Treatment Options
You have lots of options to manage type 2 diabetes (also called type 2 diabetes mellitus). Food, exercise, and medication work together to bring your blood sugar (blood glucose) under control.
Over your lifetime, you'll probably handle the disease in different ways. How your body responds to treatment can change. And researchers are always looking for new diabetes medicines.
Here's what you need to know about the type 2 diabetes treatments available now.
Type 2 Diabetes Medications
Your doctor will help you figure out if you need to take medicine, which kind is right for you, and how often you should take it. Medications you take in pill form are often the first option for people with type 2 diabetes when diet and exercise alone aren't enough to keep their blood sugar in a healthy range. There are many such medications, and they work in different ways. You can take these alone or in combination with others, including insulin.
Metformin
This is one of the most commonly used medications to treat type 2 diabetes. It's a type of drug called a biguanide, and it's the only available medication in its class. Metformin (Fortamet, Glumetza) tells your liver to make less glucose, and it helps your cells take in glucose so you have less in your bloodstream.
You take it as a pill, usually twice a day. The most common side effects are diarrhea and other digestive issues, but you can lessen these by taking it with food.
Sulfonylureas
Some of the drugs in this class are glimepiride (Amaryl), glipizide (Glucotrol), and glyburide (Diabeta, Glycron, Glynase, Micronase). They tell your pancreas to make more insulin, the hormone that allows your cells to absorb glucose for fuel.
You take these drugs once or twice a day before meals. They can cause weight gain and low blood sugar.
Meglitinides
These medicines also tell your pancreas to make more insulin. Drugs in this class include nateglinide (Starlix)and repaglinide (Prandin). You take them before a meal. They can also cause your blood glucose to dip too low.
DPP-4 inhibitors
These keep your body from breaking down hormones that give your pancreas the "go" signal for insulin. This means those hormones work longer, and only lower your blood sugar when it's too high. Examples include alogliptin (Nesina), linagliptin (Tradjenta), saxagliptin (Onglyza), and sitagliptin (Januvia, Zituvio).
Most people take them once a day. The side effects are different for each of these medications, but they're generally mild.
Thiazolidinediones (TZDs)
These medicines help insulin work better. They lower insulin resistance from your cells so your pancreas doesn't have to work as hard.
Pioglitazone (Actos) and rosiglitazone (Avandia) are drugs in this class. You take them once or twice a day. They may cause you to gain weight and retain fluid, which can lead to swelling in your legs and feet. They can also put you at risk for heart failure, so you shouldn't take them if you have heart issues.
SGLT2 inhibitors
This type of drug works in your kidneys, where extra sugar gets filtered out of your blood. It blocks the action of a protein that puts glucose back in circulation, so you pee out more of it.
Canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance), and ertugliflozin (Steglatro) are FDA-approved to treat type 2 diabetes. They can also help you lose weight and lower your blood pressure. Most people take one pill every morning. The most common side effects are vaginal yeast infections and urinary tract infections.
Alpha-glucosidase inhibitors
You take these pills with the first bite of every meal. They slow the digestion of starchy foods such as bread, pasta, rice, potatoes, and corn. This keeps your blood glucose from shooting up after you eat.
Examples are acarbose (Precose) and miglitol (Glyset). The most common side effects are digestive problems such as gas and diarrhea.
Bile acid sequestrants
The drug colesevelam (Welchol) lowers your cholesterol and can also help lower your blood glucose. Doctors aren't exactly sure why it works on blood sugar, but people with type 2 diabetes often have problems with cholesterol too. You take several pills either once or twice a day with a meal. It can cause gas and constipation.
Dopamine receptor agonists
This kind of drug works directly on your brain to help it process the hormone dopamine. It helps control blood glucose levels, although it's unclear exactly how. The FDA has approved bromocriptine (Cycloset) for treating type 2 diabetes. You take one pill every morning. It can cause nausea.
Nonsteroidal mineralocorticoid receptor antagonists (nsMRAs)
If you have both type 2 diabetes and chronic kidney disease, you might be given finerenone. This type of drug protects your kidneys and can lower your heart disease risk. You may also get it if you can't safely take an SGLT2 inhibitor. Possible side effects include high blood potassium and low blood pressure.
Combination medicines
For some people, type 2 diabetes medications work better when you take two or more different types at the same time. Some of the most common combinations are put together into a single pill.
You can get a prescription for these common combinations:
- Metformin combined with a sulfonylurea, a TZD, a DPP-4 inhibitor, or an SGLT2 inhibitor
- A sulfonylurea added to either a DDP-4 inhibitor or a TZD
- A DDP-4 inhibitor combined with a TZD
Injectable Medications for Type 2 Diabetes Treatment
Some type 2 diabetes treatments come in the form of a shot. There are several different types of these medications, some you take one or more times a day, while others are taken once a week.
In general, these drugs are prescribed if other treatments haven't worked well enough to bring down your blood glucose levels. Some of them also benefit your heart health and can help you lose weight.
GLP-1 receptor agonists
Glucagon-like peptide-1 (GLP-1) is a hormone that signals your pancreas to make insulin when your blood sugar rises. These drugs do the same job. And because your body doesn't break them down as quickly as it does the natural hormone, their effect lasts longer. They also slow down how quickly food leaves your stomach, making you feel full.
The GLP-1 receptor agonists that are approved to treat type 2 diabetes are:
Trulicity, Bydureon, and Ozempic are injections you give yourself once a week. Victoza is a once-daily injection, and Byetta is a twice-daily injection. Rybelsus is a pill you take once a day.
GIP and GLP-1 receptor agonist
This kind of medication mimics the action of both GLP-1 and glucose-dependent insulinotropic polypeptide (GIP), another digestive hormone. One drug, tirzepatide (Mounjaro), is approved to treat type 2 diabetes. It's an injection you give yourself once a week.
Insulin for type 2 diabetes
Some people with type 2 diabetes take insulin because other medicines aren't enough to control their blood sugar. Insulin therapy can also be a short-term fix for a situation when your blood glucose is harder to control, like when you've been sick or under a lot of stress.
Types of insulin are grouped by how fast they start to work and how long their effects last. You might have to use more than one kind of insulin. Some insulins come premixed. You can take insulin in one of several ways:
Injections with a needle and syringe. You fill the syringes from a bottle of insulin and give yourself a shot. You pick a spot and rotate between belly, thigh, butt, and upper arm.
Insulin pump. It connects to a tiny needle under your skin to provide a steady stream of insulin throughout the day.
Insulin pen. It looks like a pen but has a needle on the end. Some are prefilled with insulin, while others have a container you replace.
Inhaler. You breathe in powdered insulin.
Injection port. This tube goes under your skin and lets you use a needle, syringe, or pen without having to stick yourself in a different spot every time. You keep the port in place for a week and then replace it with a new one in a new spot.
Jet injector. This sends a fine spray of insulin into your skin at high pressure instead of using a needle.
Pramlintide (Symlin)
This drug acts like a hormone, amylin, that your pancreas sends out with insulin. It helps keep your blood sugar from rising after you eat and slows down how quickly food leaves your stomach.
You only take pramlintide if you're also using insulin, and that drug hasn't done enough to control your blood glucose. You take both at the same time before meals.
Diabetes Management
Whether you take medication or not, lifestyle changes are an important part of type 2 diabetes treatment.
Weight loss. Losing 5%-10% of your body weight (that’s about 10-20 pounds if you weigh 180 pounds) can lower your A1c level and your risk for cardiovascular disease. (A1c is a test doctors use to check your average blood glucose levels over 3 months.) It may help you cut back on medications to treat diabetes, high blood pressure, and high cholesterol. Weight loss can also ease symptoms of depression and help with sleep apnea.
Healthy diet. There's no one-size-fits-all diabetes diet. You'll need to pay attention to carbs, fiber, fat, and salt to manage your blood sugar and avoid complications of diabetes. How much and when you eat are important, too. Talk to your diabetes team or a registered dietitian to help you plan your meals and snacks.
Physical activity. From working out to doing chores, activity lowers your blood sugar. It helps your cells use insulin. It also helps your muscles use glucose. Make sure you check your blood sugar before and after exercise.
Better sleep. Not getting enough sleep can raise your odds of getting type 2 diabetes in the first place. The length of time you sleep and the quality of sleep can raise A1c levels. That means improving your sleep can lead to lower blood glucose readings.
Weight Loss Surgery for Type 2 Diabetes Treatment
For some people, weight loss surgery can be a helpful type 2 diabetes treatment option.
Diet, exercise, and even medications don't always lead to enough weight loss to make a meaningful difference in diabetes control. Research has found surgical weight loss can help people lower their A1c levels.
Doctors usually recommend surgery for people who have a body mass index (BMI) of 35 or more. Experts say it should also be considered for people with a BMI of 30 or higher who haven't been able to control their type 2 diabetes with other treatments.
Type 2 Diabetes Monitoring
Your doctor will want to see you often to do certain tests to see how well your diabetes is under control. These include:
Blood glucose monitoring. You’ll use a blood glucose meter to check your blood sugar when your doctor tells you to. Or you can get a gadget that continuously monitors your levels. Your blood glucose number tells you how well your treatment is working.
Regular checkups. The doctor will check your A1c and cholesterol levels, along with doing tests to make sure your thyroid, liver, and kidneys are all working as they should.
Regular eye exams. The doctor will check for signs of retinopathy, which is nerve damage to your eye caused by diabetes.
Regular foot exams. The doctor will check for foot problems and nerve damage to your feet.
Which Is the Right Type 2 Diabetes Treatment for You?
Your doctor can help you decide which of the type 2 diabetes treatment options is right for you. Many things go into the decision, including:
Your goals. The target range for your blood glucose may be higher or lower than someone else's. The level you're trying to get to or stay at, plus how quickly you're trying to get there, will help make the treatment choice.
Your A1c level. If your A1c isn't too far from your goal when you're diagnosed, you may start with conservative treatment such as diet and exercise changes alone or in combination with metformin. If it's very high, your doctor may recommend a medication such as insulin to bring it down fast.
Your overall health. A GLP-1 inhibitor or SGLT2 inhibitor might be your best choice if you have heart disease or kidney disease, or if you're trying to lose a large amount of weight. If low blood sugar episodes are particularly risky for you, you probably won't get drugs such as insulin or sulfonylureas, as they could push your level too low. You also need to consider how well you can handle a certain drug's possible side effects, and whether you have other health problems that make a particular drug dangerous for you.
How long you've had diabetes. The longer your blood glucose stays too high, the greater the chances you'll have complications. If one drug doesn't bring your levels under control quickly, your doctor may recommend adding another type of medication. A drug can also become less effective if you've been on it for a long time, in which case you may need to add another.
Cost. For most people who have it, type 2 diabetes is a lifelong condition, so the affordability of your treatment is something to consider. The price of medications varies widely and depends on your insurance coverage. Metformin may only cost you $10 a month, while semaglutide can cost around $1,000.
Personal preference. If you don't like needles, insulin or a GLP-1 inhibitor may not be right for you. If you have trouble remembering to take pills, something you take once a week may work best.
It's easy to get discouraged by a high number on a glucose meter. If you aren't meeting your goals, talk to your doctor about whether it may be time to change your treatment strategy.
Takeaways
You have a broad range of type 2 diabetes treatment options. The cornerstone is a combination of weight loss, physical activity, and dietary changes. You may also get medication to help bring your blood sugar under control. Your doctor can help you decide what's the best treatment for you.
Type 2 Diabetes Treatments FAQs
How serious is type 2 diabetes?
Type 2 diabetes is very serious. Blood glucose that's too high for a long time can cause many other health problems, including heart disease, stroke, kidney disease, vision loss, and nerve damage that can lead to amputations and sexual dysfunction.
Can I live a normal life with type 2 diabetes?
Yes. The lifestyle changes that help you manage type 2 diabetes are the same things recommended for everyone — eat food that's good for you, stay physically active, and get to a healthy weight. A diabetes educator can work with you on an eating plan that lets you still enjoy your favorite foods. It will take some getting used to, but medication and blood sugar monitoring don't have to hold you back from any activities you want to do, and they will help you stay healthier longer.
Is type 2 diabetes curable?
It's possible to improve your body's blood glucose control to the point where your levels stay below the diabetic range and you can stop taking medication. Doctors call that remission. But it can come back unless you keep up with your lifestyle changes.
