What Are the Treatments for Type 2 Diabetes?

David Levine

If you have Type 2 diabetes, you'll have to combine lifestyle changes with the use of medication to help control your blood sugar. It's not always easy, but the well-known Type 2 diabetes treatments, along with new treatments and some natural treatments for Type 2 diabetes, often help patients successfully manage the disease.

Natural Treatments for Type 2 Diabetes

A large component of this disease management involves natural treatments for Type 2 diabetes. These include 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 senior 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.

[See: 10 Myths About Diabetes.]

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.

Many people with diabetes also use dietary supplements. The American Diabetes Association says that people with diabetes are more likely to use supplements than people without diabetes. In fact, a National Health Interview Survey found that 22 percent of people with diabetes used some type of herbal therapy, and another study found that 31 percent used dietary supplements. By comparison, about 18 percent of all adults use supplements. However, the ADA says there is no research to prove that dietary or herbal supplements (including omega-3 supplements, cinnamon and other herbs) help to manage diabetes. It is best to get vitamins and minerals from the foods you eat, the ADA says.

Type 2 Diabetes Treatments

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.

[See: The 14 Best Diets to Prevent and Manage Diabetes.]

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 your blood sugar status every day.

Over time, exercise, healthy 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 also new treatments for Type 2 diabetes, including medications 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 different types, or classes, of these new Type 2 diabetes treatments include:

-- Alpha-glucosidase inhibitors.

-- Biguanides.

-- Bile Acid Sequestrants.

-- Dopamine-2 Agonists.

-- DPP-4 inhibitors.

-- Meglitinides.

-- SGLT2 inhibitors.

-- Sulfonylureas.

-- TZDs.

-- Oral combination therapy.

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 medications you may use. "There's not always one best next choice, and that leads to shared decision-making with the patient," Gabbay says.

Insulin and Other Injectable Treatments

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 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."

[See: Got Diabetes? Why You Must Protect Your Feet.]

Along with insulin, there are also new types injectable drugs to treat diabetes, including:

-- GLP-1 receptor agonists, such as albiglutide (Tanzeum), dulaglutide (Trulicity), exenatide (Byetta), exenatide extended release (Bydureon), and liraglutide (Victoza). -- Amylin analogue, such as pramlintide (Symlin)

Taking multiple pills or injectable drugs like 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 re-evaluate 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.

General Diabetes Management

Along with diet, exercise and medication, there are other important steps for successfully managing Type 2 diabetes.

-- Test A1c and blood glucose levels, as directed by your doctor.

-- Control blood pressure and cholesterol, again with your doctor's help.

-- Stop smoking.

-- Get your recommended vaccinations to prevent illness, which can affect blood glucose levels.

-- See a dentist, eye doctor and foot specialist regularly, as diabetes can damage your teeth and gums, eyes and lower extremities.

The National Institutes of Health recommends that you see your health care team at least twice a year, and more often if you are having problems or are having trouble reaching your blood glucose, blood pressure or cholesterol goals. At each visit, have your blood pressure, feet and weight checked. Talk with your health care team about your medicines and whether you need to adjust them.