Diabetes is a chronic disorder in which the body does not produce or use insulin effectively. Treatments include medication, lifestyle adjustments, and management of any complications.
The main aim of diabetes treatment is to return blood glucose, also known as blood sugar, to a safe threshold and reduce the risk of complications.
Therefore, it is essential for people to attend all diabetes appointments to ensure they receive the most suitable treatments and for a healthcare professional to check for any signs of complications.
There are various types of diabetes. This article discusses the treatments for type 1 and type 2 diabetes, which include insulin, other medications, and lifestyle adjustments.
Some people can manage type 2 diabetes with lifestyle adjustments alone, so we also examine the steps a person can take in the early stages of the condition to slow its progression.
Learn about type 2 diabetes remission.
The main medication for managing type 1 diabetes is the hormone insulin. Some people with type 2 diabetes may also need to take it.
People with type 1 diabetes must take insulin as their pancreas does not produce it. Supplementary insulin helps the cells in the body to absorb glucose and use energy.
A person with type 1 diabetes will need to receive insulin at several points throughout the day. Some doses of insulin will occur before or after a meal.
With type 2 diabetes, insulin is
Self-monitoring blood sugar levels can help an individual decide when to take insulin.
Insulin has several different delivery methods. The most common methods
- Insulin pump: This delivers small, continuous doses of insulin throughout the day.
- Needle and syringe: An individual draws insulin fluid from a bottle and injects a shot. The most effective location is on the stomach, but a person can also administer a shot into the upper arm, the buttocks, or the thigh. Some people need several shots to return blood sugar to an ideal level. Others might only require one shot.
- Insulin pen: Some insulin pens are disposable, while others offer space for a replaceable insulin cartridge. They are costlier than needles but easier to use and resemble a pen with a needle instead of a nib.
Less commonly, people might use the
- Inhaler: People can inhale some types of insulin as a powder from an inhaler device. Inhaled insulin can reach the blood faster than other types. However, it is only suitable for adults who have type 1 or type 2 diabetes.
- Jet injector: This method delivers a fine, high-pressure spray into the skin instead of a needle injection.
- Injection port: This contains a short tube that the person who needs insulin shots just beneath the skin. They would then inject insulin into the port with a pen or needle and syringe and fit a replacement every few days. An injection port is an alternative to puncturing the skin every day.
A person with type 1 diabetes will
However, alongside lifestyle measures, such as a nutrient-dense diet and regular exercise, a person with type 2 diabetes might need to manage their blood sugar levels in other ways.
Metformin is a type of biguanide and a key medication for type 2 diabetes that people take in pill form or as a liquid. It reduces glucose production in the liver and makes muscle tissue more sensitive to insulin to improve glucose absorption. It can also assist with weight loss, which can also reduce the effects of diabetes.
RECALL OF METFORMIN EXTENDED RELEASE
In May 2020, the
Food and Drug Administration (FDA)recommended that some makers of metformin extended release remove some of their tablets from the U.S. market. This is because an unacceptable level of a probable carcinogen (cancer-causing agent) was found in some extended-release metformin tablets. If you currently take this drug, call your healthcare provider. They will advise whether you should continue to take your medication or if you need a new prescription.
Other medications can also help reduce blood sugar in people with type 2 diabetes, such as:
- Alpha-glucosidase inhibitors: Acarbose and miglitol slow the breakdown of starches into glucose after a meal and slow down the increase in blood sugar levels.
- Bile acid sequestrants (BASs): These reduce cholesterol and blood sugar and are safe for people who also have liver issues, as they do not enter the bloodstream.
- DPP-4 inhibitors: Alogliptin, linagliptin (Tradjenta), and saxagliptin help improve the binding of glucose to the blood without causing low blood sugar levels.
- Meglitinides: Nateglinide and repaglinide stimulate the release of insulin but might cause low blood sugar.
- SGLT2 inhibitors: Canagliflozin and dapagliflozin (Farxiga) help block the reabsorption of glucose in the kidneys, resulting in sugars leaving the body through the urine.
- Sulfonylureas: Glimepiride, glipizide, and chlorpropamide stimulate the release of insulin in the pancreas.
- Thiazolidinediones, or TZDs: Pioglitazone (Actos) improves the function of insulin in the fat and muscle and slows glucose production in the liver.
- GLP-1 agonists: Dulaglutide (Trulicity), exenatide (Byetta), liraglutide (Victoza), lixisenatide, and semaglutide (Ozempic) can help with weight loss, and some types decrease cardiovascular events.
Some medications reduce blood sugar too much and cause low blood sugar — hypoglycemia — if a person takes them outside of mealtimes. People should speak with a doctor and assess the risk of this and other side effects when receiving a prescription.
A doctor may prescribe people a combination of these medications if only taking one type at a time is not having the desired effect on blood sugar levels. Not all of these drugs interact with each other, as they impact different functions in the body.
Certain medications require an injection, such as GLP-1 receptor agonists, which reduce the glucose output of the liver and increase insulin production.
A person must also inject amylin analogs, such as pramlintide (Symlin), which a doctor would prescribe for use alongside meals to slow the movement of food through the gut and manage blood sugar levels after eating.
Some newer and more experimental treatments have demonstrated a positive effect on blood sugar levels and diabetes.
Also known as weight loss surgery, this may help people with obesity and type 2 diabetes regain target blood sugar levels.
An artificial pancreas, known as the hybrid closed-loop system, replaces glucose monitoring and insulin injections, measuring blood sugar levels every 5 minutes and automatically administering appropriate doses of insulin and glucagon.
Remote monitoring by medical professionals or parents and caregivers is also possible to ensure that the system stays working.
Mealtimes still require a manual adjustment to the amount of insulin but can allow people with diabetes to sleep through the night without waking to test blood sugar or reduce levels using medication.
Pancreatic islet transplantation
Islets are clusters of cells that produce insulin. The immune system of a person with type 1 diabetes attacks these cells.
Transplantation takes islets from a donated, functional pancreas and replaces destroyed islets in a person with type 1 diabetes.
This is an experimental treatment that is only available through enrolling in research studies.
Many insurance plans do not cover weight loss treatment or experimental methods. Therefore, people should speak to their providers before undergoing these procedures. Results vary and often depend on whether the person with diabetes takes insulin, how long they have had diabetes, and the extent of weight loss.
Physical activity is vital for using up spare glucose in the body and making the muscles more sensitive to insulin.
The American Diabetes Association (ADA) recommends all people with diabetes get 30 minutes of moderate-to-vigorous exercise at least 5 days per week. This can help people improve blood sugar and blood pressure and also reduce the risk of heart disease.
Aerobic exercise can support weight management, reduce blood sugar, and improve insulin use in the body.
- brisk walks or long hikes
- cycling, whether outdoor or using a machine
- water aerobics or low impact aerobics classes
- racquet sports
- climbing the stairs
Strength training is also important, as improving muscle buildup increases how much glucose the body burns while resting.
Activities that can improve muscle strength include:
- lifting weights, either using machines, free weights, or household objects
- resistance bands
- calisthenics, such as squats, pushups, or lunges
- activities that involve high exertion, such as gardening
If a healthcare professional finds ketones in the urine, this means the body is burning fat instead of glucose. Excess ketones can be extremely dangerous, as the body cannot handle high levels of this waste product.
People should not exercise if ketones become apparent in the urine.
Individuals should also check with a healthcare professional before starting an exercise plan or changing their routine.
A person with diabetes can still eat the foods that they enjoy, just less frequently or in smaller portions.
Individuals should follow the advice of a healthcare professional or dietitian, eat a varied meal plan that includes foods from all groups, and adhere to the recommended amounts.
Some people with diabetes should eat at the same time each day, while others have a little more flexibility with the timings of meals. Portion size is also very important in people with diabetes. A person should speak to a dietitian about the best way to manage this.
The following are
Starchy and nonstarchy vegetables are generally suitable for people to consume, including:
People with diabetes should be mindful of high sugar fruits, such as watermelon, but moderate amounts of the following have great nutritional benefits:
Wholegrains should make up at least half of all grains in the diet of a person with diabetes, including:
Wholemeal produce can also include bread, pasta, and cereal.
Low fat and lean proteins can help build muscle mass without increasing fat and blood sugar levels, such as:
- lean beef or pork
- skinless chicken or turkey
- peanuts and nuts
- dried beans
- peas, such as chickpeas or split peas
- meat alternatives, such as tofu
People with diabetes should consider low fat, nondairy, or nonfat cheese, milk, and yogurt.
Foods with heart-healthy fats
Not all fat contributes to diabetes, and some types of fat help protect against its effects on the heart, including:
- seeds and nuts
- salmon, tuna, and mackerel
- oils that take a liquid form at room temperature, such as olive oil
Foods to avoid
A diabetes diet should exclude:
- fried foods
- salty foods, such as potato chips
- sugary foods, including candy, ice cream, and cakes
- drinks that contain added sugar, such as soda and energy drinks
Water should replace sweetened beverages. Swap the sugar in any coffee or tea for artificial sweeteners, such as stevia.
Females should drink no more than one alcoholic beverage on any day, and males should limit alcohol intake to a maximum of two drinks.
Alcohol can reduce blood sugar levels too far for people taking insulin, increasing the risk of hypoglycemia. Eating food when drinking alcohol can reduce the risk.
Diabetes is a condition in which the body does not produce or use insulin effectively. Treatments can include medication and lifestyle adjustments.
All people with type 1 diabetes and some with type 2 diabetes will need to take insulin, which individuals usually inject using a needle and syringe or pen. Other medications for managing blood sugar levels and improving insulin absorption and production are also available.
A person with type 2 diabetes in its early stages can manage high blood sugar using regular, moderate-to-intense exercise, weight loss if necessary, and a nutrient-dense diet.
Surgeries are also available, such as bariatric surgery and an artificial pancreas. However, these are not as common and are often not included in insurance coverage.
Will I always need to take insulin if I have type 1 diabetes?
People with type 1 diabetes will always need to take insulin. However, receiving pancreatic islet transplantation may be an option for some individuals.Suzanne Falck, MD, FACPAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.