Type 2 Diabetes Treatment Overview

When to see a healthcare provider

Always see a healthcare provider if you have symptoms of type 2 diabetes, like frequent urination or thirst, or if a blood test shows that you have high blood sugar levels. You will work with your provider to create a treatment plan, which includes diet and exercise, and often medications to bring down your blood sugar levels.

You should also contact a provider if your blood sugars remain above your goal after 3 months of lifestyle changes. The provider will review your treatment plan and may add or change a medication to help get your blood sugar levels under control.

You may also be referred to a podiatrist (foot doctor) if you have complications related to your feet. You may also need to see an ophthalmologist or optometrist for regular screening of your retina.

How to diagnose type 2 diabetes

There are several tests used to diagnose diabetes:

• Random blood sugar testing. The blood test can be done immediately—no fasting required—and may be used if you’re experiencing symptoms of diabetes.
• Fasting plasma glucose test. This blood test measures your blood glucose (sugar) levels at the time of the test. It’s taken after fasting for 8 hours.
• Glycated hemoglobin (A1C) test. This blood test provides an average glucose level based on the past 2 to 3 months. It doesn’t require fasting.
• Oral glucose tolerance test. This involves drinking a sugary drink and then checking blood glucose 2 hours later.

They may also order lab tests for kidney function, liver function, and cholesterol, and check a urine sample to screen for kidney damage.

What to expect from your visit

Your healthcare provider will do testing to confirm your diagnosis and see how severe your diabetes is and whether you have any complications from diabetes, like kidney damage. They will also do a physical examination, including a foot exam to check for damage to blood vessels, nerves, skin, and nails.

They will discuss whether you need to lose weight and how to control your blood sugar levels through diet and exercise. You will also be taught how to monitor your blood sugar levels at home.

They will tell you about the different medication options for you, which depends on how severe your diabetes is. Some medications can increase your body’s production of insulin, a hormone that helps move blood sugars out of your blood and into your cells. Others increase your body’s sensitivity to insulin. You may need oral medications or ones that you inject, depending on how high your blood sugar is.

Prescription medications for type 2 diabetes

Oral medications help control blood sugars

• Metformin: Increases your body’s sensitivity to insulin and decreases sugar production from the liver.
• Sulfonylureas and glinides: Increase the production of insulin.
• Thiazolidinediones: Increase sensitivity to insulin.
• Di-peptidyl peptidase-4 inhibitors: Reduce the breakdown of insulin.
• Alpha-glucosidase inhibitors and sodium-glucose co-transporter-2 inhibitors: Eliminate sugar through the gut or urine.

Injectable hormones

• Glucagon-like peptide 1 agonists: Increase production of insulin, improve insulin sensitivity, and help with weight loss by slowing down the emptying of the stomach. These are for high-risk people, including those with heart or kidney disease and those who need to lose weight.

Insulin

• Long-acting (basal) insulin: glargine (Lantus, Basaglar), degludec (Tresiba), detemir (Levemir)
• Rapid acting insulin: lispro (Humalog), aspart (Novolog)

Types of providers

• A primary care provider can diagnose diabetes and treat mild to moderate symptoms.
• An endocrinologist (hormone specialist) can create treatment plans for more severe symptoms.
• An eye care provider (ophthalmologist or optometrist) does annual exams to check for retina damage caused by diabetes.
• A podiatrist is a foot doctor who can check for nerve or blood vessel damage from diabetes, tell you about preventive care, and treat more complicated conditions like wounds and ulcers.

How to manage type 2 diabetes at home

Type 2 diabetes can often be helped by eating a healthy diet, losing weight if you’re overweight, and exercising regularly. But many people may also need to take medications.

You can make changes to your diet yourself or follow a plan that has been shown to help, like the Mediterranean diet and the DASH diet. Exercise can help control blood sugars, support weight loss, and improve quality of life.

If you’re overweight, try to lose weight. Even small amounts of weight loss, as little as 5%, can significantly improve your blood sugars. Consider working with a dietician or using weight loss programs like Weight Watchers, calorie counting apps like myfitnesspal, or psychology-based programs like Noom.

An important part of controlling your blood sugar is to check your levels regularly. Your doctor may recommend that you test your blood sugar at various times of the day, like in the morning or after eating a meal. How often you do this depends on what medications you’re taking and the severity of your diabetes.

If you’re taking insulin, you’ll check it more frequently (up to 6–8 times daily). Other medications may only require blood sugar checks 1–2 times daily.

Types of blood sugar monitoring include:

• Finger stick testing with a home blood glucose monitor (glucometer). Use a lancet (a needle-like device) to make a small puncture on the fingertip. Place a drop of blood on a testing strip to be read by the glucose monitor.
• Continuous glucose monitoring. A wearable device beneath the skin that measures sugar levels.

Diet and exercise changes that help diabetes

• Reduce the amount of carbohydrates (starches and sugars) to help prevent spikes in blood sugar.
• Eat whole grains (whole wheat or multigrain bread, brown rice) instead of white flour or white rice.
• Avoid concentrated sugars like juice or soda.
• Increase your non-starchy vegetables, like green beans, carrots, and broccoli.
• Use the plate method for portioning foods—whole grain carbohydrates make up one quarter of your plate, lean protein another quarter, and fruits and vegetables make up the remaining half.
• Aim for about 150 minutes of moderate intensity aerobic exercise (brisk walking, cycling, jogging) weekly. This adds up to about 30 minutes, 5 days a week.
• Do resistance exercise at least twice weekly (squats, push-ups, crunches, resistance bands).
• Avoid being sedentary for long periods of time. Aim to stand and do some light activity multiple times throughout the day.
• If you have underlying medical conditions that limit your ability to exercise, make sure to discuss these with a healthcare provider before beginning an exercise program.

Wellness and prevention

• Quit smoking.
• See your primary care provider for regular visits and screening for diabetes if you have family members with diabetes, you are overweight, or you have gestational diabetes or other conditions that increase your risk for diabetes.
• Keep a healthy body weight through your diet and regular exercise.