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What Is The Best Treatment For Type 2 Diabetes

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  • What Should I Know About Side Effects Of Diabetes Medicines

    Side effects are problems that result from a medicine. Some diabetes medicines can cause hypoglycemia, also called low blood glucose, if you dont balance your medicines with food and activity.

    Ask your doctor whether your diabetes medicine can cause hypoglycemia or other side effects, such as upset stomach and weight gain. Take your diabetes medicines as your health care professional has instructed you, to help prevent side effects and diabetes problems.

    Safety And Side Effects

    All the diabetes medicines can cause side effects. These vary from drug class to drug class and medicine to medicine.

    Understandably, side effects can keep people from taking their diabetes treatments. On average, 10 to 20 percent of people with diabetes stop taking their pills due to side effects. It’s important to discuss any side effects you experience with your doctor.

    Since many people with diabetes are trying to lose weight, the weight gain that can occur with some diabetes medicines can be especially frustrating.

    The box below gives an overview of side effects associated with various diabetes drugs. The potential side effects of each drug are discussed at length in the next section.

    Side Effects of Oral Diabetes Drugs

    Most of the side effects listed here ease over time or stop when the medication is discontinued. However, a few can be permanent in certain people

    Common

    • Gastrointestinal side effects
    • Edema

    Uncommon

    • Hypoglycemia or low blood sugar Congestive heart failure
    • Anemia
    • Allergic reactions
    • Lactic acidosis
    • Macular edema
    • Pancreatitis
    • Cancer

    Most notably, some diabetes drugs can cause low blood sugar, or hypoglycemia. This is a dangerous side effect and one that leads some doctors to prescribe one diabetes drug over another.

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    What Other Injectable Medicines Treat Type 2 Diabetes

    Besides insulin, other types of injected medicines are available. These medicines help keep your blood glucose level from going too high after you eat. They may make you feel less hungry and help you lose some weight. Other injectable medicines are not substitutes for insulin. Learn more about noninsulin injectable medicines.

    Breaking Down Diabetes: Drugs For Diabetes Starting With The Best Metformin

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    Editors’ note: We are revising two posts in the Breaking Down Diabetes series to reflect current findings on the most effective medications. The best place to begin the series is with the first post, On the road to diabetes: A look at what’s happening inside the body.

    A huge assortment of 100 medications are available to treat high blood sugar in Type 2 diabetes, including two historical breakthrough drugs, insulin and metformin. The pharmaceutical industry has successfully added a few new, innovative drugs, but the most effective drugs remain the older, less expensive medications.

    Let’s make some sense out of this mess of medications.

    Most are given by mouth , but injected insulin, which I’ll address in a future blog post, remains a key medication. In addition, oral drugs have limited impact, so they are often used in combinations . Patients frequently try multiple oral drugs before starting insulin.

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    Available As A Generic

    Brands: Amaryl, Diabeta, Glynase, Glucotrol, Glucotrol XL

    Generics: Glimepiride, Glipizide, Glyburide

    Brands: Januvia, Onglyza, Tradjenta, Nesina

    Generics: Sitagliptin, Saxagliptin, Linagliptin, Alogliptin

    Yes

    Brands: Byetta, Bydureon, Victoza, Trulicity

    Generics: Exenatide, Exenatide Long-Acting, Liraglutide, Dulaglutide

    Yes Combinations of Sulfonylureas Plus Metformin

    Brands: Glucovance

    Generics: Glyburide and Metformin combination

    Yes Other Combinations Brands: Actoplus Met, Avandamet, Janumet, Kombiglyze XR, Kazano, Jentadueto, Jentadueto XR*, Xigduo XR*, Invokamet, Invokamet XR*, Synjardy No

    No

    *XR=extended release, XL=long-acting

    Our evaluation of diabetes drugs is based largely on a comprehensive, independent review of the scientific research that examined 219 carefully selected studies. The 2016 review was conducted by a team of physician researchers at the Johns Hopkins University Evidence-based Practice Center. This team conducted the review as part of the Effective Health Care Program sponsored by the Agency for Healthcare Research and Quality, a federal agency.

    The full report is available at www.effectivehealthcare.ahrq.gov/reports/final.cfm. The Johns Hopkins University Evidence-based Practice Center and the Agency for Healthcare Research and Quality are not responsible for the advice and recommendations in our report.

    Combination Medications For Type 2 Diabetes

    Glyburide/metformin , rosiglitazone/metformin , glipizide/metformin , pioglitazone/metformin , and metformin/sitagliptin are five examples of combination pills on the market to treat type 2 diabetes. There are many, many more combination pills available.

    These combination drugs carry the benefit of taking fewer pills, which hopefully improves compliance. While they work well, most health-care professionals initiate individual medications to optimize dosing, before switching to a combination pill once the patient has been stable on individual medications for a while.

    Read Also: How To Treat Diabetes Without Insulin

    Can Type 2 Diabetes Be Cured

    Type 2 diabetes cannot be cured, but people with the condition may be able to manage their type 2 diabetes through lifestyle changes and, if needed, diabetes medications to control blood sugar levels.

    Its also emerging that some people who are overweight or obese can put their type 2 diabetes into remission by losing a substantial amount of weight, especially early in their diagnosis. Their blood sugar measurements return to healthy levels below the diabetes range. Its not a permanent solution, and diabetes could come back, so it needs to be maintained. However, many people were still in remission 2 years later. This should only be tried under the supervision of your doctor.

    Effects On The Inflammatory Pathway

    What is the Best Treatment for Type 2 Diabetes?

    The benefits of metformin on macrovascular complications of diabetes, separate from its conventional hypoglycemic effects, may be partially explained by actions beyond glycemic control, particularly by actions associated with inflammatory and atherothrombotic processes . Metformin can act as an inhibitor of pro-inflammatory responses through direct inhibition of NF-kB by blocking the PI3KAkt pathway. This effect may partially explain the apparent clinical reduction of cardiovascular events not fully attributable to metformins anti-hyperglycemic action .

    Some studies also point to a modest effect on inflammatory markers in subjects with IGT in T2DM while others have found no effect at all .

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    Why Physical Activity Is A Key Tool For Diabetes Treatment

    That includes 150 minutes per week of moderate-intensity aerobic activity, such as:

    • Brisk walking
    • Taking group fitness classes that involve using weights
    • Using weight machines at the gym
    • Heavy gardening or other activities that can help you build and maintain muscle

    Diabetes Care

    • Overhead arm stretches
    • Torso twists
    • Leg lifts or extensions

    Before you start a formal exercise program or increase your level of physical activity, it’s important to get your doctor’s okay and to find out which activities you can do safely.

    In general, though, exercise can provide people with diabetes with a lot of benefits. Exercise is critical for patients with diabetes to maintain heart health and maintain glucose control, Dungan says. She notes that its best to consult your doctor about the type and frequency of activity that is best for you, and find out whether you need additional testing to make sure that exercise is safe. Still, Dungan says, brisk walking nearly every day for at least 30 minutes is safe and beneficial for most people.

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    Management Of Coronary Heart Disease

    There is contradictory epidemiologic evidence as to whether diabetes is in fact a CHD risk equivalent. For the present, however, that is the position adopted by most groups, such as the National Cholesterol Education Program and the ADA.

    Although the risk for CHD is 2-4 times greater in patients with diabetes than it is in individuals without diabetes, control of conventional risk factors is probably more important in event reduction than is glycemic control. Control of hypertension, aspirin therapy, and lowering of LDL cholesterol levels are vitally important in reducing CHD risk.

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    How Is Type 2 Diabetes Managed

    Theres no cure for Type 2 diabetes. But you can manage the condition by maintaining a healthy lifestyle and taking medication if needed. Work with your healthcare provider to manage your:

    • Blood sugar: A blood glucose meter or continuous glucose monitoring can help you meet your blood sugar target. Your healthcare provider may also recommend regular A1c tests, oral medications , insulin therapy or injectable non-insulin diabetes medications.
    • Blood pressure: Lower your blood pressure by not smoking, exercising regularly and eating a healthy diet. Your healthcare provider may recommend blood pressure medication such as beta blockers or ACE inhibitors.
    • Cholesterol: Follow a meal plan low in saturated fats, trans fat, salt and sugar. Your healthcare provider may recommend statins, which are a type of drug to lower cholesterol.

    Kidney Failure And Dehydration

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    The GLP-1 RAs and SGLT-2 inhibitors can lead to dehydration, and in rare cases, kidney failure. Be sure to tell your doctor if you become dehydrated and/or feel weak and dizzy. And drink plenty of fluids when you are taking them.

    The SGLT-2 inhibitors also can increase urination. Sometimes this can cause people to feel dizzy or weak and become dehydrated.

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    How Well Is Your Type 2 Diabetes Treatment Plan Working

    Living with type 2 diabetes requires ongoing management: being mindful of what you eat, regularly exercising, monitoring your blood sugar, and, for most, taking medication as directed. But even when youre doing everything right, diabetes can change over time.

    Type 2 diabetes is a chronic, lifelong condition. Diabetes is caused by two core defects: the pancreas not making an appropriate amount of insulin and the bodys cells not taking in glucose as they should. That tends to get worse over time, says Laurie Kane, MD, an endocrinologist at Providence Saint John’s Health Center in Santa Monica, California. Due to these changes, your diabetes treatment plan may require adjustments through the years to help keep things under control.

    Knowing when and if you need to make changes to your treatment plan can be tricky. While some symptoms losing weight despite eating more, blurry vision may be more noticeable, others fatigue, dry eyes are harder to recognize as a sign that you may benefit from a treatment change. Diabetes can be a silent disease, explains Dr. Kane. Thats why its important to work with your primary care provider or endocrinologist to monitor it closely. We really want your numbers at the levels that have been proven in research studies to prevent complications, she adds.

    Is your type 2 diabetes treatment working as well as it should to keep these measurements within healthy ranges? Take the assessment to find out.

    Why Do Some People With Type 2 Diabetes Need To Take Insulin While Others Dont

    Type 2 diabetes occurs due to a combination of two issues. The first is insulin resistance. This means the body cant use insulin as effectively as it once did. The second is the bodys inability to produce enough insulin to compensate for the degree of insulin resistance that an individual is experiencing. We call this relative insulin deficiency.

    There are different degrees of insulin deficiency. Insulin may be introduced early in the course of a persons treatment if they have symptoms of high blood sugar, along with weight loss, A1C levels over 10 percent, or a random blood sugar test over 300 milligrams per deciliter .

    People whose blood sugar levels arent that high can usually achieve target glucose control with non-insulin medications. That means they dont need insulin therapy at this point in their treatment.

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    Which Diabetes Drug Is Best

    Study calls it a draw, with a slight edge for metformin

    HealthDay Reporter

    TUESDAY, July 19, 2016 — No single drug to treat type 2 diabetes stands out from the pack when it comes to reducing the risks of heart disease, stroke or premature death, a new research review finds.

    The analysis of hundreds of clinical trials found no evidence that any one diabetes drug, or drug combination, beats out the others.

    Researchers said the results bolster current recommendations to first try an older, cheaper drug — metformin — for most patients with type 2 diabetes.

    “There are very few things experts agree on, but this is one of them,” said Dr. Kevin Pantalone, a diabetes specialist at the Cleveland Clinic and a member of the Endocrine Society.

    “Metformin, in the absence of contraindications or intolerability, should be the first-line agent to treat patients with type 2 diabetes,” he said.

    Metformin can cause upset stomach and diarrhea, so some patients are unable to stick with it day to day, explained Pantalone, who wasn’t involved in the study. And people with kidney disease generally shouldn’t take it, he said.

    More than 29 million Americans have diabetes — mostly type 2, according to the U.S. Centers for Disease Control and Prevention.

    The disease, which is often linked to obesity, causes blood sugar levels to be chronically high. Over time, that can lead to complications, such as heart disease, stroke, kidney failure and nerve damage, the CDC says.

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    Type 2 Diabetes In Children And Teens

    The Natural Cure for Type 2 Diabetes

    Childhood obesity rates are rising, and so are the rates of type 2 diabetes in youth. More than 75% of children with type 2 diabetes have a close relative who has it, too. But its not always because family members are related it can also be because they share certain habits that can increase their risk. Parents can help prevent or delay type 2 diabetes by developing a plan for the whole family:

    • Drinking more water and fewer sugary drinks
    • Eating more fruits and vegetables
    • Making favorite foods healthier
    • Making physical activity more fun

    Healthy changes become habits more easily when everyone makes them together. Find out how to take charge family style with these healthy tips.

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    Management Of Intercurrent Medical Illness

    Patients with intercurrent illness become more insulin resistant because of the effects of increased counterregulatory hormones. Therefore, despite decreased nutritional intake, glycemia may worsen.

    Patients on oral agents may need transient therapy with insulin to achieve adequate glycemic control. In patients who require insulin, scheduled doses of insulin, as opposed to sliding scale insulin, are far more effective in achieving glycemic control.

    Metformin is a special case. If patients taking metformin have any illness that leads to dehydration or hypoperfusion, the drug should be temporarily discontinued because of a possible increased risk of lactic acidosis.

    Why Building A Diabetes Care Team Is Critical For Effective Treatment

    Your first resource for managing your type 2 diabetes should be your primary care provider. Dungan notes that most patients with type 2 diabetes can rely on their primary care provider alone for treatment. But its important for people with type 2 diabetes to also stay up-to-date on diet and treatment recommendations by coordinating with a certified diabetes care and education specialist , a dietitian, a nurse, or a pharmacist, Dungan says. That education should occur at the time of diagnosis and periodically over time, such as after the start of insulin therapy, Dungan explains.

    As for other healthcare professionals, Dungan notes that many diabetes clinics have dietitians, pharmacists, social workers, and mental health specialists on staff, all of whom can contribute to your diabetes management program.

    Each patients needs will differ slightly, Dungan says. For instance, if you cant control your blood sugar with standard treatments or if you have frequent or severe hypoglycemia, you should consider seeing an endocrinologist, she says. If you develop complications, like heart disease, kidney disease, or foot ulcers, you may need to see specialists who can help with those conditions.

    Each year, everyone with diabetes should see an eye care professional who has experience treating patients with diabetes, Dungan says.

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    Medication To Reduce The Blood Glucose Level

    Most of the medicines for type 2 diabetes are given in tablet form. However, some people with type 2 diabetes need insulin injections to help control blood sugar levels. Some people gain a great deal of benefit from insulin injections and these are sometimes used fairly soon after the diagnosis of type 2 diabetes has been made. Insulin injections can be used in combination with other medicines to further improve glucose control.

    Medication is used in addition to, and not instead of, the above lifestyle measures.

    Metformin And Lactic Acidosis

    Herbal Remedies For Type 2 Diabetes

    Metformin has been associated with rare occurrences of lactic acidosisa build-up of lactic acid in the blood that can be fatal. This extremely rare risk appears to exist mostly for people with diabetes who also have moderate to severe kidney disease. Based on years of data suggesting that metformin appears safe in persons with mild to moderate kidney disease, the FDA recently loosened its restrictions on metformin. The agency now says that metformin can be safely used in patients with moderate kidney failure, but shouldnt be used with more advanced levels of kidney failure.

    Metformin also lower vitamin B12 levels and some doctors may recommend you take a B12 supplement if you take this medicine.

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