Should You Manage Your Type 2 Diabetes with Medication?

Type 2 diabetes is all about managing blood sugar.

If you’ve been working with your primary care doctor to lower your blood glucose (sugar) and haven’t met your goals after three to six months, it’s time to see an endocrinologist – a doctor who specializes in diabetes and hormones in general – for a focused treatment plan that’s tailored to your specific health needs and lifestyle.

“It is important that patients understand how their diet and lifestyle impact the progression of this disease,” says Elkin A. Nunez, MD, director of endocrinology, diabetes, and metabolism at Atlantic Health System. “Over the long-term, diabetes places a great burden on the heart, brain, kidneys, and peripheral nerves. But once healthy patterns are established, diabetes medications are another option for most people to keep blood glucose between 80 and 180 mg/dl.”

Slowing Disease Progression

Effective diabetes care starts by working with a certified diabetes care and education specialist to establish a healthy diet, regular exercise, and medical monitoring – all part of diabetes self-management education. This must be in place before any medication is considered for your care plan, unless you’re at high risk for a cardiovascular event.

“Although not everyone with type 2 diabetes needs medication early in the disease process, many people will eventually benefit from it because diabetes is a progressive disease,” says Dr. Nunez. “If you’re symptomatic, your condition will improve when we incorporate insulin injections followed by non-insulin injectables and oral medicines. These not only help stabilize glucose levels, but some also lower cardiovascular risks and spur on weight loss – a critical part of reducing your cardiometabolic health risks.”

Understanding What Diabetes Medications Do

Diabetes medications can be administered via injection, pen, patches, or pumps. New classes of drugs not only normalize blood sugar but help reduce your risk for kidney disease, stroke, heart attack, and heart failure. Here’s how some of the medications work inside of the body:

1. Insulin therapy quickly regulates blood sugar by infusing glucose into the cells.
2. Metformin improves insulin sensitivity and reduces glucose production in the liver.
3. Sulfonylureas are a class of drugs that stimulate the pancreas to release insulin and lower blood sugar.
4. DPP-4 Inhibitors enhance the body's ability to maintain blood sugar levels by mildly increasing incretin hormones.
5. SGLT2 Inhibitors block glucose reabsorption in the kidneys so excess glucose is excreted in urine.
6. Glucagon-Like Peptide (GLP)-1 Receptor Agonists stimulates a glucose-dependent insulin release to reduce blood sugar, promote weight loss, and possibly improve cardiovascular health.
7. GLP 1 RA/GIP is the first in its class combination incretin hormone activator with multiple effects.
8. Amylin Analogs mimic the hormone amylin, which regulates post-meal blood sugar spikes.
9. Alpha-glucosidase Inhibitors slow down the digestion of carbohydrates for a slower rise in blood sugar after meals.
10. Thiazolidinediones increase insulin sensitivity.

Dr. Nunez cautions that no medication is free of potential adverse effects, so patients should know what to expect and when to seek further medical advice. He also encourages patients to take charge of their health and ask questions.

Asking The Right Questions

Patients who are undergoing diabetes management should have a thorough conversation with their doctor about medication options. To advocate for your health, here are a few questions to ask:

1. Would I benefit from the newer medications called glucose like peptide (GLP) 1 receptor agonist (GLP 1 RAs), and or sodium glucose cotransport 2 inhibitors (SGLT 2i)?
2. Are we reducing my cardiovascular risk to the best of our ability?
3. Are we minimizing my risk for long-term complications of blindness, end-stage kidney disease, amputation, heart failure, strokes, and heart attacks?
4. What can I do to avoid long-term diabetes complications?

“Become a student of your disease and keep making improvements every day,” says Dr. Nunez. “Medications will help you get control of your diabetes instead of letting your diabetes control you, but they work in conjunction with dedicated personal efforts to improve your health. You can change the course of this disease.”