Diabetes Treatments

While millions of Americans have diabetes, every individual has a unique treatment plan. Factors like age, lifestyle, other health conditions, and the type of diabetes you have all play a role in determining the best treatment plan.

The primary goal of any diabetes treatment is to keep blood sugar levels within a healthy range. This helps to alleviate symptoms and reduces the risk of developing complications associated with diabetes.

For people with type 1 diabetes , insulin is always part of the treatment plan. For type 2 diabetes , treatment typically consists of lifestyle changes, oral medicines, or injectable medications including insulin to maintain glucose control. In some cases, a combination of treatments may be recommended.

Insulin

How Does Insulin Work?

Insulin is a hormone that helps manage blood sugar levels in people with diabetes. Insulin acts like a key that allows glucose (sugar) in the bloodstream to enter cells in your body, where it can be used for energy. Without enough insulin, glucose builds up in the bloodstream.

People with type 1 diabetes need insulin because their bodies don't produce it, while people with type 2 diabetes can often also benefit from the addition of insulin either early in their course or later depending on how diabetes manifests in the individual.

Different Types of Insulin

There are several types of insulin for diabetes, including rapid-acting, intermediate-acting, long-acting, and ultra-long-acting. The type of insulin used depends on how quickly it needs to start working and how long it needs to last.

What is the Proper Way to Take Insulin?

Insulin is administered by injection, through an insulin pump, or inhaled. How it’s given is determined by a range of factors, including the type of diabetes being treated and the type of insulin prescribed, as well as the patient’s blood sugar levels, activity level, and meal patterns.

Injected Insulin

The most common method for delivering insulin, injection involves inserting a needle into the fatty layer of your skin, called subcutaneous tissue. This can be done using a syringe (needle) or more commonly an insulin pen.

Syringe

Using a syringe requires extracting a specific amount of insulin from a vial. You then pinch the skin where the insulin is to be injected and insert the needle at a 90-degree angle. Holding the needle still, you slowly push down on the plunger until all the insulin is injected. After a count of 10, the needle is removed and discarded.

Compared to insulin pens (described below), the self-measuring and -injecting syringe method is far more economical, a key consideration, especially for those requiring two types of insulin.

Insulin Pens

The biggest advantages of insulin pens are that they’re more convenient (no measuring required), offer greater dose accuracy, and, thanks to their compact design, allow for more discreet injections.

Insulin pens come with pre-measured amounts of specific types of insulin. Pens are available in disposable and reusable models. An increasingly popular reusable model is the smart or connected pen which connects to a smartphone app that calculates and tracks dosages. In addition to helping with dosage management, smart pens can track and highlight the relationship between insulin, food, and physical activity. This can lead to better diabetes management and optimized use of insulin.

Insulin Pumps

An insulin pump is a small, wearable device that delivers insulin directly into the bloodstream. Ideal for people with need for frequent insulin injections or variable insulin resistance levels throughout the day, a pump is programmed to release specific insulin doses based on blood sugar levels throughout the day. Pumps also integrate with CGM (continuous glucose monitoring) technology to automatically adjust insulin needs based on your current glucose levels. This is ideal for individuals with frequent low sugar episodes as the insulin pump can detect future low sugar episodes and pull back on insulin delivery to avoid a low sugar.

The downsides of a pump include the cost ($3000-$6000) and effort. To be successful with pump therapy, you must be attuned to your diabetes and frequently interact with the pump for optimal results. A pump requires regular cleaning and changing of parts. If your vision or fine motor skills are impaired, a pump may not be appropriate.

Inhalable Insulin

Inhalable insulin is a powdered form of rapid-acting insulin delivered through the lungs using an inhaler device. The insulin is quickly absorbed into the bloodstream, mimicking the body's natural insulin response more closely than injectable insulin.

Ideal for those who dislike needles or have difficulty self-administering injections, inhalable insulin is more convenient and discrete than subcutaneous injections. However, precise dosing can be more challenging compared to injectable forms, as the insulin comes in fixed-dose cartridges. In addition, the effects tend to come on and wear off faster than injected insulins, requiring careful timing and monitoring to prevent post-meal blood sugar spikes.

Medication for Type 2 Diabetes

For some people with type 2 diabetes, there’s a range of injectable and oral medications that can be taken in addition to insulin to lower blood glucose. They include:

Metformin

Commonly taken twice daily in pill form, metformin helps your body use insulin more effectively and reduces the amount of glucose your liver produces.

Dipeptidyl peptidase 4 (DPP-4) inhibitors

DPP-4s increase the insulin level in your body after meals, which helps to lower blood sugar. They are typically used in combination with diet and exercise to treat type 2 diabetes.

Currently available DPP-4s include:

• Alogliptin (Nesina)
• Linagliptin (Tradjenta)
• Saxagliptin (Onglyza)
• Sitagliptin (Januvia)

Glucagon-like peptide 1 (GLP-1) agonists

GLP-1 agonists are synthetic versions of the hormone GLP-1, a hormone produced in the small intestine and released after eating that helps regulate blood sugar levels and appetite. Taken in oral or injectable form, GLP-1 agonists also work to help you feel full by mimicking a natural compound called glucagon-like peptide-1 (GLP-1). In addition, GLP-1s slow digestion, which causes you to feel fuller longer and suppresses appetite.

Common GLP-1 options include:

• Dulaglutide (Trulicity)
• Exenatide (Byetta)
• Exenatide extended-release (Bydureon)
• Liraglutide (Victoza)
• Lixisenatide (Adlyxin)
• Injectable semaglutide (Ozempic)
• Oral semaglutide (Rybelsus)

Another GLP-1-based option is tirzepatide (Mounjaro). A combination of GLP-1 and GIP (glucose-dependent insulinotropic polypeptide) receptor agonists, Mounjaro is an injectable that decreases blood sugar levels by triggering the release of insulin when blood sugar levels are high, in addition to lowering the amount of sugar the liver makes and slowing food movement through the intestines. Studies have found the combination of GLP-1 and GIP to be more effective than GLP-1 receptor agonists at reducing hyperglycemia and promoting weight loss.

Meglitinides

Taken by mouth before meals, meglitinides stimulate the pancreas to release insulin, which helps control blood sugar.

Meglitinide options include:

• Nateglinide (Starlix)• Repaglinide (Prandin)

SGLT2 inhibitors

SGLT2 inhibitors are oral medications that block sugars from being reabsorbed by the kidneys, which lowers blood sugar levels.

Common SGLT2 inhibitors include:

• Bexagliflozin (Brenzavvy)
• Canagliflozin (Invokana)
• Dapagliflozin (Farxiga)
• Empagliflozin (Jardiance)
• Ertugliflozin (Steglatro)

Sulfonylureas

Taken by mouth, sulfonylureas stimulate the pancreas to release more insulin..

• Chlorpropamide (Diabinese)
• Glimepiride (Amaryl)
• Glipizide (Glucotrol)
• Glyburide (Diabeta, Glynase)

Thiazolidinediones

An oral medication, thiazolidinediones work by increasing insulin sensitivity, which helps the body use glucose more effectively.

• Pioglitazone (Actos)

Medication for Type 1 Diabetes

For years, the only treatment option for people with type 1 diabetes was insulin. But in November 2022, the FDA approved a monoclonal antibody treatment called Teplizumab-mzwv. Found to delay the onset of type 1 diabetes and approved for adults and children 8 years of age and older who have Stage 2 type 1 diabetes, Teplizumab-mzwv is injected once daily for 14 days. Marketed as TZIELD, the medication may extend the time patients can live without the need for insulin injections.

Lifestyle Changes to Manage Diabetes

Lifestyle changes encompassing diet, exercise, weight management, stress reduction, and adherence to medical regimens can significantly improve outcomes for individuals with both type 1 and type 2 diabetes.

Benefits of healthy habits include better glycemic control, reduced risk of associated complications, and an overall improved quality of life for those living with diabetes.

Diabetes-friendly lifestyle habits to discuss with your doctor include:

Diet

• Eat more vegetables: Eat a variety of non-starchy vegetables, especially cruciferous vegetables like broccoli and cauliflower.
• Limit sugary drinks: Avoid soda, juice, and sports drinks, which are high in calories and can cause blood sugar to spike.
• Eat fewer processed foods: Processed foods and saturated fats can contribute to high blood sugar levels.
• Eat balanced meals: Eat protein and vegetables first, then carbohydrates 30 minutes later.
• Practice carb counting: Because carbohydrates break down into glucose when digested, carb counting is a crucial part of diabetes management. Carb counting involves counting the number of grams of carbohydrates in a meal and matching that to your dose of insulin. There are several methods to count carbs. Speak with your doctor or nutritionist to determine the method that works best for you.
• Eat less: Eat only as much as your body needs.

Exercise

• Aim for at least 150 minutes of moderate-intensity exercise per week
• Consider exercising after meals to help manage post-meal blood sugar spikes

Weight Management

For individuals with type 2 diabetes who are overweight or obese, weight loss can significantly improve blood sugar control. In some cases, weight loss can prevent or delay the onset of diabetes or even lead to remission.

Even just losing a few pounds through healthy eating and exercise will reduce your risk of developing other related problems. Plus, you’ll start to feel better and have more energy.

Speak to your provider about setting specific weight loss goals and resources to help you achieve them.

Stress Reduction

Stress and inadequate sleep can negatively impact blood sugar levels. Incorporating stress-reduction techniques such as meditation, yoga, or regular physical activity can help manage diabetes more effectively. Additionally, maintaining good sleep habits, such as keeping a consistent sleep schedule and creating a conducive sleep environment, can improve diabetes management.

Stay Alert When Unwell

If you get an illness that prevents you from eating or drinking as much as usual, your blood sugar can be hard to manage. In addition to variations in diet and schedule, hormones your body releases to fight an illness can also raise your blood sugar levels.

For these reasons, it’s important to test your blood sugar levels more often when unwell and, if you take insulin, adjust levels accordingly.

For individuals with Type 1 diabetes or on SLGT2 inhibitors, ensuring your body has enough exposure to insulin is essential to avoid a serious, life-threatening condition called diabetic ketoacidosis (DKA). This can be challenging especially if you are not eating much or your sugars are sitting low. Be in contact with your doctor’s office during this time for advice.