Managing your Type 2 diabetes

Diabetes is a metabolic disorder in which cells are not able to take up sugar from the bloodstream properly. If not managed, diabetes causes high levels of sugar to build up in the bloodstream, which can eventually cause damage to organs and tissues in the body.

There are two main types of diabetes, Type 1 and Type 2. People with Type 1 diabetes have a damaged pancreas. The pancreas is a small organ in the body that produces a hormone called insulin. Insulin is required for body cells to be able to take up sugar from the bloodstream. In Type 1 diabetes, the damaged pancreas makes very little insulin or none at all.

In second type of diabetes, called Type 2, the pancreas makes insulin normally, but the body’s cells are not able to properly absorb and use the insulin. Therefore, their ability to take up sugar from the bloodstream is impaired.

According to the Centers for Disease Control and Prevention, about 29.1 million people in the United States are living with diabetes. That’s over 9% of the entire US population! The vast majority (90-95%) of these individuals have Type 2 diabetes.

Why Manage Type 2 Diabetes?

If not managed, high blood sugar levels can be very dangerous for people with Type 2 diabetes. In the short-term, high blood sugar levels can cause nausea, dizziness, confusion, or coma.

Blood sugar levels that are not well managed can also cause long-term complications that develop over years. A person with diabetes may not notice these symptoms until they become very bothersome. Some of the long-term complications of untreated or poorly managed diabetes include:

  • Increased risk of heart attack and/or stroke
  • Peripheral artery disease (poor circulation) in the legs and feet
  • Poor wound healing, ulcers, or gangrene in the legs and feet
  • Nerve damage
  • Kidney damage
  • Damage to the retina in the eye leading to poor vision or loss of vision

Avoiding these long-term complications is a key goal in the management of Type 2 diabetes. There are different management options, including lifestyle changes, medication, and bariatric surgery (for patients who also have obesity).

Lifestyle Changes

Lifestyle changes can make a big impact upon the health of people with Type 2 diabetes, and are recommended regardless of choices about medication or surgery. In fact, sometimes blood sugar can be adequately controlled with lifestyle changes alone. Lifestyle changes for people with Type 2 diabetes include:

  • Exercise: Aim for 30 minutes per day, 5 days per week. Try to do both aerobic exercise (walking, jogging, dancing, cycling, swimming, etc.) and resistance training (weight lifting, yoga, abdominal crunches, pushups, etc.). Start slowly and increase the intensity or length of the exercise as you feel comfortable. An exercise class for people who are beginning a new exercise program can be very helpful.
  • Diet: Aim for a diet rich in whole grains, fruits, and vegetables. Reduce the amount of sugar, processed food, desserts, and fast food in the diet.
  • Weight loss: Even a small amount of weight loss – such as 10 to 15 pounds – can make management of blood sugar levels easier.

Medication Options for Type 2 Diabetes

When lifestyle changes alone are not enough to manage Type 2 diabetes, your doctor may suggest adding medication to get blood sugar levels under control. There are a number of different types of diabetes medications, including:

  • Metformin: Improves the sensitivity of body cells to insulin so that they can use insulin more effectively. This is often the first medication that is used for Type 2 diabetes.
  • Sulfonylureas (glyburide, glipizide, glimepiride): These medications help the pancreas make more insulin.
  • Meglitinides (repaglinide, nateglinide): Another group of medications that help the pancreas make more insulin.
  • Thiazolidinediones (rosiglitazone, pioglitazone): Like metformin, these medications make body cells more sensitive to insulin. These medications have more side effects than metformin, however.
  • DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin): These medications can lower blood sugar levels by a small or moderate amount.
  • GLP-1 receptor agonists (exenatide, liraglutide): These medications slow digestion and help lower blood sugar levels. They are often used along with another medication.
  • SGLT2 inhibitors (canagliflozin, dapagliflozin): Newer medications that prompt the kidneys to excrete more blood sugar in the urine.
  • Insulin: Although in the past insulin therapy was mainly given to people with Type 1 diabetes, it is sometimes prescribed for Type 2 diabetes. Insulin must be injected with a needle. There are many types of insulin, some which work over a short time, and some which work over many hours.

Bariatric Surgery

People with Type 2 diabetes who also have obesity with a BMI of over 35.0 may benefit from bariatric surgery to lose weight. Studies show that between 55% and 95% of these patients will have normal blood sugar levels after losing weight through bariatric surgery. Different types of surgery have different success rates, so this is important to discuss with your doctor.

Taking Responsibility for Your Type 2 Diabetes

For all people with Type 2 diabetes, it is essential to take an active role in maintaining your health. It is important to:

  • Regularly monitor blood sugar levels as instructed by your doctor. It is very important to make sure that your blood sugar level does not get too low or too high.
  • Go to regular checkups with your doctor or other healthcare professionals. People with diabetes need to take special care of the health of their heart, legs and feet, kidneys, eyes, and mouth/teeth/gums.

By changing their lifestyle, carefully managing blood sugar levels, and watching for warning signs of complications, people with Type 2 diabetes can take control of their condition. Finding a support group or education program can also be helpful. The more knowledgeable about the disease that you are, the more likely you are to lead a healthy, active life!

Further Reading

American Diabetes Association. Taking Care of Your Diabetes.

Centers for Disease Control and Prevention. Managing Diabetes.

Mayo Clinic. Type 2 Diabetes Treatment.