Treatments and drugs

By Mayo Clinic Staff

Treatment for type 2 diabetes requires a lifelong commitment to:

  • Blood sugar monitoring
  • Healthy eating
  • Regular exercise
  • Possibly, diabetes medication or insulin therapy

These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.

Monitoring your blood sugar

Depending on your treatment plan, you may check and record your blood sugar level once a day or several times a week. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.

Even if you eat on a rigid schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to:

  • Food. What and how much you eat will affect your blood sugar level. Blood sugar is typically highest one to two hours after a meal.
  • Physical activity. Physical activity moves sugar from your blood into your cells. The more active you are, the lower your blood sugar level.
  • Medication. Any medications you take may affect your blood sugar level, sometimes requiring changes in your diabetes treatment plan.
  • Illness. During a cold or other illness, your body will produce hormones that raise your blood sugar level.
  • Alcohol. Alcohol and the substances you use to make mixed drinks can cause either high or low blood sugar, depending on how much you drink and whether you eat at the same time.
  • Stress. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly.
  • For women, fluctuations in hormone levels. As your hormone levels fluctuate during your menstrual cycle, so can your blood sugar level — particularly in the week before your period. Menopause may trigger fluctuations in your blood sugar level as well.

Healthy eating

Contrary to popular perception, there's no diabetes diet. However, it's important to center your diet on these high-fiber, low-fat foods:

  • Fruits
  • Vegetables
  • Whole grains

You'll also need to eat fewer animal products, refined carbohydrates and sweets.

A registered dietitian can help you put together a meal plan that fits your health goals, food preferences and lifestyle. Remember the importance of consistency. To keep your blood sugar on an even keel, try to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.

Low glycemic index foods also may be helpful. The glycemic index is a measure of how quickly a food causes a rise in your blood sugar. Foods with a high glycemic index raise your blood sugar quickly. Low glycemic foods may help you achieve a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber.

Physical activity

Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Get your doctor's OK before you start an exercise program. Then choose activities you enjoy, such as walking, swimming or biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes of aerobic exercise most days of the week. Stretching and strength training exercises are important, too. If you haven't been active for a while, start slowly and build up gradually.

Remember that physical activity lowers blood sugar. Check your blood sugar level before any activity. You might need to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar.

Diabetes medications and insulin therapy

Some people who have type 2 diabetes can manage their blood sugar with diet and exercise alone, but many need diabetes medications or insulin therapy. The decision about which medications are best depends on many factors, including your blood sugar level and any other health problems you have. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways.

  • Diabetes medications. Often, people who are newly diagnosed will be prescribed metformin (Glucophage, Glumetza, others), a diabetes medication that improves your body tissues' sensitivity to insulin and lowers glucose production in the liver. Your doctor will also recommend lifestyle changes, such as losing weight and becoming more active.

    When metformin is not enough to control your glucose level, other oral or injected medications can be added to treat type 2 diabetes. Medications lower glucose in different ways. Some diabetes medications stimulate your pancreas to produce and release more insulin. They include glipizide (Glucotrol), glyburide (Diabeta, Glynase) and glimepiride (Amaryl). Still others block the action of enzymes that break down carbohydrates in the intestine, such as acarbose (Precose), or make your tissues more sensitive to insulin, such as metformin (Glucophage) or pioglitazone (Actos).

If you can't take metformin, other oral drugs include:

  • Sitagliptin (Januvia)
  • Saxagliptin (Onglyza)
  • Repaglinide (Prandin)
  • Nateglinide (Starlix)

Recently approved drugs given by injection are:

  • Exenatide (Byetta)
  • Liraglutide (Victoza)

Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you considering many factors, including costs and other aspects of your health. Rosiglitazone (Avandia) has been linked to heart attacks, and its use has been restricted by the FDA.

In addition to diabetes medications, your doctor might prescribe low-dose aspirin therapy as well as blood pressure and cholesterol-lowering medications to help prevent heart and blood vessel disease.

  • Insulin therapy. Some people who have type 2 diabetes need insulin therapy as well. Because normal digestion interferes with insulin taken by mouth, insulin must be injected.

    Insulin injections involve using a fine needle and syringe or an insulin pen injector — a device that looks like an ink pen, except the cartridge is filled with insulin.

    Types of insulin are many and include rapid-acting insulin, long-acting insulin and intermediate options. Examples include:

  • Insulin lispro (Humalog)
  • Insulin aspart (Novolog)
  • Insulin glargine (Lantus)
  • Insulin detemir (Levemir)
  • Insulin isophane (Humulin N, Novolin N)

Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.

Bariatric surgery

If you have type 2 diabetes and your body mass index (BMI) is greater than 35, you may be a candidate for weight-loss surgery (bariatric surgery). Blood sugar levels return to normal in 55 to 95 percent of people with diabetes, depending on the procedure performed. Surgeries that bypass a portion of the small intestine have more of an effect on blood sugar levels than do other weight-loss surgeries. However, the surgery is expensive and there are risks involved, including a slight risk of death. Additionally, drastic lifestyle changes are required and long-term complications may include nutritional deficiencies and osteoporosis.

Pregnancy

Women with type 2 diabetes will likely need to alter their treatment during pregnancy. Although there's no evidence that metformin is harmful to a growing fetus, studies haven't been done to definitively establish its safety in pregnancy. So, during pregnancy, you'll likely be switched to insulin therapy. Also, many blood pressure and cholesterol-lowering medications can't be used during pregnancy. If you have signs of diabetic retinopathy, it may worsen during pregnancy. Visit your ophthalmologist during the first trimester of your pregnancy and at one year postpartum.

Signs of trouble

Because so many factors can affect your blood sugar, problems sometimes arise. These conditions require immediate care, because if left untreated, seizures and loss of consciousness (coma) can occur.

  • High blood sugar (hyperglycemia). Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough glucose-lowering medication. Check your blood sugar level often, and watch for signs and symptoms of high blood sugar — frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you'll need to adjust your meal plan, medications or both.
  • Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces toxic acids known as ketones. Watch for loss of appetite, weakness, vomiting, fever, stomach pain and fruity-smelling breath. You can check your urine for excess ketones with an over-the-counter ketones test kit. If you have excess ketones in your urine, consult your doctor right away or seek emergency care. This condition is more common in people with type 1 diabetes.
  • Hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Signs and symptoms of this life-threatening condition include a blood sugar reading higher than 600 mg/dL (33.3 mmol/L), dry mouth, extreme thirst, fever greater than 101 F (38 C), drowsiness, confusion, vision loss, hallucinations and dark urine. HHNS is caused by sky-high blood sugar that turns blood thick and syrupy. It tends to be more common in older people with type 2 diabetes, and it's often preceded by an illness or infection. HHNS usually develops over days or weeks. Call your doctor or seek immediate medical care if you have signs or symptoms of this condition.
  • Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it's known as low blood sugar. Your blood sugar level can drop for many reasons, including skipping a meal and getting more physical activity than normal. However, low blood sugar is most likely if you take glucose-lowering medications that promote the secretion of insulin or if you're taking insulin.

Check your blood sugar level regularly, and watch for signs and symptoms of low blood sugar — sweating, shakiness, weakness, hunger, dizziness, headache, blurred vision, heart palpitations, slurred speech, drowsiness, confusion and seizures.

If you develop hypoglycemia during the night, you might wake with sweat-soaked pajamas or a headache. Thanks to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning.

If you have signs or symptoms of low blood sugar, eat or drink something that will quickly raise your blood sugar level — fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Retest in 15 minutes to be sure your blood glucose levels are normal. If they're not, treat again and retest in another 15 minutes. If you lose consciousness, a family member or close contact may need to give you an emergency injection of glucagon, a hormone that stimulates the release of sugar into the blood.

Jan. 25, 2013

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