How is Type 2 Diabetes Treated?

March 20, 2019

Maintaining normal blood sugar levels is a critical component to health and wellness. Under normal conditions, sugar in the blood, also known as blood glucose, is used by the body for energy. This function is absolutely necessary. If the body’s ability to properly utilize blood glucose becomes impaired, blood glucose levels will rise and remain elevated - when blood glucose levels rise beyond a certain threshold, diabetes ensues. 

There are two fundamental types of diabetes: type 1 and type 2. Type 1 diabetes is characterized by the inability of the pancreas to produce insulin, a hormone necessary for maintaining normal blood sugar levels. Individuals affected by type 1 diabetes are dependent on insulin injections. Most cases of type 1 diabetes are not preventable or reversible.

In contrast, with type 2 diabetes, the pancreas still makes insulin but the production is impaired and/or ability of the body to utilize insulin properly is impaired. Type 2 diabetes is the most common form of diabetes and is likely preventable through lifestyle modifications. When we talk about diabetes, this is usually the type we are referring to.
Most cases of type 2 diabetes start out as pre-diabetes. Pre-diabetes is characterized by blood sugar levels that are elevated but not high enough to be classified as diabetes: also known as “borderline diabetes.” The usual course of treatment for pre-diabetes consist of a reduction in caloric intake and an increase in physical activity.  If left untreated, pre-diabetes usually leads to diabetes. 

According to the Centers for Disease Control, over 80 million people are living with pre-diabetes. Alarmingly, nearly 90 percent of people with pre-diabetes are unaware of their condition until they are diagnosed with diabetes. Even more alarming is that the number of diagnosed cases of diabetes has tripled over the past 20 years, and is expected to triple again within the next 20-30 years. If the trend continues, the net result would be one in three Americans having diabetes!
Since so many people are affected by diabetes, it is important to have an understanding of how diabetes is treated. Every component to diabetes treatment is implemented with the objective of controlling blood glucose, and with the ultimate goal of preventing or delaying long term complications.  

Although diabetes medications are considered a cornerstone of diabetes treatment, lifestyle modifications are by far the most important and most modifiable treatment component for both new onset and ongoing cases of diabetes. At minimum, lifestyle modifications should involve the implementation of a meal plan that places a particular focus on the amounts and sources of carbohydrates consumed. At Penn Highlands Healthcare, educational programs by certified diabetes educators are available in DuBois, St. Marys, Brookville, Clearfield, Punxsutawney and Philipsburg through the Diabetes and Nutritional Wellness Centers of Penn Highlands DuBois and Penn Highlands Elk. They are both recognized by the American Diabetes Association as meeting the high quality standards for diabetes education. (This recognition also allows for reimbursement for attending by Medicare and other insurances.)

Sometimes this strategy of diet and exercise is so effective that some patients find that healthy blood glucose levels can be maintained without the aid of medication. Conversely, poor diet and little exercise can result in poor blood glucose control even when in conjunction with medications. 

There are now a multitude of new diabetes medications, with novel mechanisms, that are effective in achieving treatment objectives. However, the wide and growing variety of available treatment options often lends itself to confusion as to which medications should be used.

But there is one that both the American Diabetes Association and the American Association of Clinical Endocrinologists have historically and uniformly recommended. It is metformin. In conjunction with lifestyle modification, this is the first-line for the treatment of type 2 diabetes in most patients. 

Even with the emergence of novel treatment options, this recommendation remains mostly unchanged. Metformin is recommended not only because of its well established effectiveness, but also because of its safety and cost effectiveness. Severe side effects with metformin are very rare, it usually does not cause hypoglycemia, or low blood sugars, and its low average retail price makes it affordable for most even without prescription drug coverage. 

The most common side effects of metformin are stomach upset and diarrhea, especially upon initiation of treatment. 

Metformin is available in immediate and extended release formulations. Prescribing trends favor the use of the immediate release formulation, with only occasional prescribing of the extended release formulation. 

However, many people find at least some, usually significant, level of relief from the after having a conversation with their doctor about switching from the immediate release formulation to an equivalent dose of the extended release formula. Equivalent doses of the extended release metformin usually yield the same level of blood glucose control. Also, the extended release formula does not have to be taken as frequently throughout the day versus the immediate release and the retail cost is usually comparable.

Beyond metformin, drug therapy can become costly and complex and may consist of multiple medications. Most other medications can be used in conjunction with metformin or may be used in place of metformin for those that cannot take it.

Regardless of the medication regimen, it is extremely important to understand, that any and all diabetes medications must be used in conjunction with dietary and lifestyle modifications. Otherwise, medications only have very limited value in achieving diabetes treatment goals and objectives.

If you have questions about your diabetes medications, feel free to schedule a free, 20-minutes counseling session. Make an appointment with me at the Penn Highlands Community Pharmacy by calling 814-375-6165. We may also be able to help patients acquire a free glucose meter and discounted or free tests strips. 

Also, you can also visit with me at the next Diabetes Support Group session at PH DuBois at 6:30 p.m. on Tuesday, April 16, in room 207 of the Central Resource Center, 204 Hospital Ave., DuBois. It is free to attend.