Diabetes Type 2 Treatment, Drugs and Management Guidelines

Diabetes type 2 is caused due to the failure of the body cells to uptake glucose from the blood. Your pancreas produces adequate insulin, but the body cells do not utilize the glucose in the blood.

This is due to the failure of insulin, which normally makes the uptake of glucose by the body cells possible.

That is the reason the glucose in the blood stays unutilized or underutilized and its level in the blood rises above the normally permissible limit. Your doctor then pronounces you as a diabetic.

Diabetes type 2 treatment, therefore, involves increasing the sensitivity of the body cells so that they take up the glucose from the blood and utilize it for energy.

To make this possible rests in the hands of two people: one is your doctor and the other is you, yourself.

What can you do to treat and manage your diabetes type 2? There are two very important things you can do:

  • Exercise daily to burn the extra glucose in the blood and
  • Secondly have a healthy diabetes friendly diet.

What the doctor will do to treat you is give you advice on  your diabetes type 2 treatment and put you on the best line of medicines that suits you. Usually, the first line of treatment for type 2 diabetes is oral medications. Sometimes these diabetes pills may not control the diabetes and the doctor may then prescribe insulin injections.

Exercise is very important to treat and manage diabetes type 2

Exercise benefits on the health of the diabetic are as significant as sticking to the diabetes diet plan. Both these factors help in lowering the doses of your diabetes medicines. In fact, studies have shown these two factors can well reverse diabetes type 2 and help you stop your diabetes medication.

Exercise, especially aerobic exercises is necessary for a diabetic because it controls the weight and lowers the blood sugar level by making the blood glucose sensitive to insulin. It gives a sense of well-being and makes one feel overall better.

When you exercise, the body utilizes the glucose in the blood and converts it into energy required for the physical activity. The fall in the blood glucose levels relaxes the beta cells in the pancreas and they stop producing insulin.  Please note that exercise does not cause the blood sugar to fall below normal levels in a healthy person.

As you go on exercising, your body utilizes the fat cells in the fat depots of the body for energy. You thereby not only lower your blood glucose levels but also burn the fat, helping in weight loss.

Do read exercise guidelines for diabetes

Diabetes-friendly diet plan

In diabetes type 1 or type 2, eating the right foods and having the right diabetes-friendly diet plan is as important as the diabetes medication.

Otherwise, your treatment will just not be as effective.  Knowing what foods to eat and what foods not to eat in diabetes, therefore, is of paramount importance in the management of diabetes. Furthermore, the diabetes diet menu does not put too many restrictions and you should have no problems adhering to it.

It is a healthy eating plan for diabetes, which gives you the right amount of nutrients and stays low on fats and calories. It is a low-carb diet, which improves your blood sugar levels, helps in weight loss and is also good for heart health

Useful reading: The diabetes-friendly diet plan

Monitoring your blood sugar at home

The primary aim of diabetes treatment is to keep blood sugar levels within normal limits.

Measuring blood sugar level forms an important part of your diabetes care program. How else will you know if your treatment is working? You and more importantly your doctor can know this only if you keep checking your sugar levels and forwarding the reports to your doctor. Treating diabetes initially often requires a little trial and error method to figure out the best and the safest oral medication for you along with the optimum doses that keep your diabetes under control.

Testing for diabetes can be done at home using a glucometer.

How often should test your blood sugar levels in diabetes type 2?

This depends largely on the  type of medication you are taking. If you are on insulin injection, you will have to check at least twice a day. Testing is usually recommended before taking meals and at bedtime.

If you are managing your diabetes with other oral pills, exercise, and diet, you may not have to test daily, once it is known that your diabetes is stabilized.

What should be your blood sugar target range?

Your doctor will fix the target range of your blood sugar. It will depend on several factors:

  •  Your age Duration of diabetes
  • Duration of diabetes
  • Whether you have any diabetes complications
  • Whether you have any other associated health conditions such as high blood pressure, increased cholesterol and  heart disease
  • Whether you are pregnant or not

According to diabetes.co.uk, The National Institute for Health Care Excellence (NICE) guidelines recommend the levels for type 2 diabetes in adults as follows:

  • Before meals (fasting): 4 to 7 mmol/ or 72 mg/dl to 123 mg/dl
  • After meals (post prandial)  under 9 mmol/L or under 162 mg/dl

Diabetes type 2 prescription oral medications

Type 2 diabetes requires oral drugs for treatment unlike type 1 diabetes, which has to be treated with injectable insulin only. There are various oral prescription medications and each has its indications. However, it is seen in some cases that oral drugs do not succeed in controlling the blood sugar. In such cases, the doctor may put the patient on injectable insulin therapy also.

Below is the list of oral prescription medicines to treat diabetes type 2. I have also mentioned the generic and the brand names for easy identification.

1. Metformin

Brand names:  (Glucophage, Glumetza and others

Generic name: Metformin HCL

Metformin oral pills are the first line of medication prescribed in diabetes type 2 treatment. It lowers blood sugar by increasing the sensitivity of your body tissues to insulin. This helps the uptake of blood sugar by the body tissue cells, thereby lowering the increased blood sugar levels.

In a diabetic, who religiously follows the diabetic diet and performs regular physical activity, metformin also reduces the glucose production by the liver.

Dosage: Metformin is a biguanide that comes in tablet form of 500 mg and 850 mg strength. It is available as immediate release form or extended release form.

Immediate release metformin (eg Glucophage) is initially started in the dose of 500 mg twice a day or 850 mg once a day. Dose is increased by 500 mg every two weeks according to tolerance. Maintenance dose is 2000 mg per day in divided doses. If required, your doctor may increase this dose but not beyond 2500 mg per day.

Extended release metformin tablets (eg Glucophage XR) are initially started with a dose of 500 to 1000 mg once a day and gradually increased by 500 mg weekly to maintenance dose of 2000 mg per day. Maximum permissible dose is 2500 mg per day. If necessary, it can be given in divided doses.

Side effects include nausea, vomiting, stomach upset, diarrhea, weakness, or a metallic taste in the mouth may occur. That is why metformin is advised to be taken with meals.

Side effects disappear once you get used to this drug. However, if they persist or worsen, your doctor may reluctantly put you on another drug because metformin is the best and safest drug for diabetes type 2.

2. Sulphonylureas

Brand names: Diabenese, Glyburide, Glipizide, Glimepiride

Generic name: Chlorpropamide

There are several types of sulphonylureas medicines and they all act by stimulating the beta cells of the pancreas to secrete more insulin and lower blood sugar.

Diabenese is the first generation drugs still in use today. The second generation sulphonylureas used are glipizide (Glucotrol and Glucotrol XL), glyburide (Micronase, Glynase, and Diabeta), and Glimepiride (Amaryl).

The advantage of second generation sulphonylureas is that they are required to be taken in smaller doses.

These medicines are used as a replacement therapy when the patient cannot tolerate metformin and when you not overweight. They are also given with metformin, if metformin cannot control blood sugar on its own.

Sulphonylureas tablets are taken once or twice a day with meals.

Side effects include low blood glucose, skin rash, irritability, upset stomach and weight gain. Due to its side effect of lowering blood glucose, a diabetic patient on this drug should always carry some source of sugary food with him.

3. Meglitinides

Brand names: Starlix, Prandin

Generic names: 
Nateglinide, Repaglinide,
Meglitinides act in the same way as sulphonylureas by stimulating the pancreas to secrete more insulin. However, their mode of action is faster but shorter. Due to this mode of action of stimulating pancreas, they may cause hypoglycemia (low blood sugar level). Weight gain is another possible side effect. Their side effects do not last very long.

They are not commonly used but may be advised if your meal timing is irregular. They are advised three times a day before meals.

4. Thiazolidinediones

Brand names: Actos, Avandia

Generic names: pioglitazone, rosiglitazone

The mode of action of thiazolidinediones is similar to that of metformin. They increase the sensitivity of the body tissues to insulin thereby facilitating the uptake of glucose from the blood.

They also reduce production of glucose in the liver.

Side effects include weight gain, increased risk of heart failures, swelling of the ankles and fractures. People on these drugs are closely monitored for liver damage.

In some people, these drugs lower triglycerides and raise HDL levels.

They are commonly advised to be taken with metformin, sulphonylureas or with both. Tablets of such combinations are available.

Thiazolidinediones are used when other medications fail to lower the blood glucose within the target range.

5. Selective Dipeptidyl Peptidase-4 Inhibitors (DPP-4 inhibitors)

Brand Names:  Nesina,, Tradjenta, Onglyza, Januvia

Generic Names: alogliptin, linagliptin, saxagliptin, sitagliptin

These drugs have a most powerful effect of lowering blood sugar. They are available in combination with other oral diabetes medicines. They do not cause weight gain.

Mode of action: Incretin is a naturally occurring hormone in the body that stimulates the pancreas to release insulin after you eat. An enzyme called dipeptidyl peptidase-4 (DPP-4) removes it from your body. This is a normal process in healthy people.

Some people with diabetes type 2 do not produce adequate insulin. DPP-4 inhibitors inhibit the action of DPP-4. This helps incretin to stay in the body longer and stimulate a longer insulin production.

6. GLP-1 receptor agonists

This medication is not used alone by itself. It is used in combination with metformin plus sulphonylureas.

It is injected twice a day and lowers raised blood glucose level, without the risk of hypoglycemia.

It has the added advantage of causing weight loss and is therefore preferred in obese people.

7. SGLT2 inhibitors

Sodium-Glucose Transporter 2 (SGLT2) Inhibitors are the latest diabetes drugs in the market. They prevent the kidneys from absorbing sugar and instead they are excreted through the urine.

Side effects include yeast infection, urinary tract infection and penile foreskin infection in men.  These side effects are due to increased sugar in urine. It is not advised in elderly people with kidney disease and in people who are taking diuretics for fear of dehydration.

Examples are canagliflozin (Invokana) and dapagliflozin (Farxiga)..

Insulin therapy for diabetes type 2

Most diabetics have a fear of being put on insulin therapy. The very idea of taking insulin shots daily is not welcome. Oral insulin does not work because the digestive juices in the stomach break it down. Insulin injection or insulin pen or an insulin pump are used.

However, diabetes is a progressive disease and at times, it becomes necessary. According to everydayhealth.com, about half the people with diabetes type 2 in the United States need insulin due to high A1C.

If you are following your doctor’s prescription religiously, you do not exercise and stick to the diabetes meal every day, your A1C is bound to go high. Your doctor will then put on insulin treatment with the aim to bring your A1C to or below 7 percent.

At times this may be only for a short period to control your blood sugar level. Insulin may also be given along with other oral diabetes medicines such as metformin (Glucophage).

Insulin is recommended when the A1C is initially above 9 percent or when the oral diabetes medicines do not control your blood sugar.

Side effects include:

  • Pain due to insulin injections and blood glucose monitoring,
  • Weight gain due to the anabolic nature of insulin and
  • Hypoglycemia due to mismatch between food (carbohydrates) intake, exercise and alcohol consumption.
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