Treatment of Diabetes
The goal of treatment for diabetes is to maintain blood glucose levels as close to normal as possible. There are three basic treatments:
1. Diet: Changes in diet to be 30 percent fat (mostly monounsaturated fat and polyunsaturated fat), 40-55 percent carbohydrates (high fiber, low glycemic index) and 15 percent protein. The distribution of carbohydrates and calories throughout the day are important, as well as limiting total calories to achieve a near ideal body weight. These changes will lower blood glucose and lipid levels.
2. Exercise: Exercise burns calories and muscle glycogen, which lowers blood glucose. Exercise decreases insulin resistance, which allows insulin to normally manage glucose levels.
3. Medications:
– Oral medications reduce blood glucose levels by:
- improving insulin release from the pancreas
- reducing the available glucose
- decreasing insulin resistance
Oral medications are primarily effective for patients who have some insulin production, such as type 2 diabetes patients. The many available medications work on the intestines, liver, muscles, fat cells and pancreas. Your doctor will determine which mix of medications best treat your type 2 diabetes.
Injectable Medications:
Insulin
Insulin is injected to replace the insulin the body can no longer produce. Insulin reduces blood glucose. Different insulin has a variety of action times, from short acting to 24 hours. Your doctor will individualize your insulin type and amount to optimize your blood glucose control. Insulin is necessary for treating type 1 diabetes, and can be used with type 2 diabetes.
Supplements
Newer medications that supplement insulin production are now being offered. All but one of the following is useful in type 2 diabetes. See the individual medication’s website for full details:
- Saxagliptin (brand name Onglyza) is a DPP-4 inhibitor that enhances the effective of other oral medications — pill form.
- Sitagliptin (brand name Januvia) is a DPP-4 inhibitor that also enhances oral medication effectiveness — pill form.
- Exenatide (brand name Byetta) is an incretin mimetic that mimics a hormone that creates more insulin. Also acts as an appetite suppressant. This is an injectable medicine used with type 2 diabetes.
- Liraglutide (brand name Victoza) is an incretin mimetic that is also an injectable medicine for type 2 diabetes management.
- Pramlintide (brand name Symlin) is a synthetic form of a hormone amylin, which is limited in the person with diabetes. Amylin slows the emptying of the stomach and regulates the rate of blood glucose rise. This is an injectable medication for type 1 diabetes.
Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RAs)
GLP-1 RA drugs are used to control Type 2 diabetes and promote weight loss. GLP-1 RAs were originally developed to help patients with type 2 diabetes control their blood glucose (sugar) levels. However, GLP-1 RAs are now prescribed for weight loss for non-diabetic patients with obesity. GLP-1 RAs are available as injectables and in pill form. GLP-1 RAs include:
- Semaglutide (brand names Ozempic, Rybelsus, Wegovy)
- Dulaglutide (brand name Trulicity)
- Liraglutide (brand names Victoza, Saxenda)
- Tirzepatide (brand name Mounjaro, Zepbound)
Diet and exercise are the basis of treatment. Medication – oral medicine or injected insulin and other agents – is added if blood glucose goals are not achieved. Diabetes is a progressive disease and as time passes, you may need medication changes to achieve the best blood sugar outcomes.
