When your doctor says you have type 2 diabetes, you may worry about getting shots of insulin to control the disease. But that’s seldom the first step, and some people don’t need insulin for years — or ever.
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When you have type 2 diabetes, your body doesn’t make enough insulin, as the body is unable to use it properly. Without insulin, blood glucose (sugar) levels rise. High blood glucose levels can damage your organs, including blood vessels, nerves, kidneys and eyes.
But with lifestyle changes and medications, many people are staying healthier longer with type 2 diabetes. Endocrinologist Richard Shewbridge, MD, says there is lot you can do to live well with diabetes.
What’s behind type 2 diabetes?
Type 2 diabetes develops because the body becomes resistant to insulin. Insulin is a hormone made by the pancreas to turn blood sugar into energy. “Type 2 diabetes means the process to turn food into energy isn’t working as well,” says Dr. Shewbridge.
Poor choices in diet and lack of exercise work to worsen insulin resistance, he says. And genetics can play a role, too. Additionally, people with type 2 diabetes tend to make less and less insulin over time and that causes a rise in blood sugar after meals.
The role of eating right and exercising
Many people with type 2 diabetes aren’t put on medication right away. Your doctor will likely suggest changes in your eating and exercise habits first.
“Once someone is put on medication, they may need it for the rest of their life. But, they also can treat diabetes with a healthy lifestyle and exercise,” says Dr. Shewbridge.
Healthier eating habits are a good place to start. “Cut out simple sugars. Eat less starchy bread, pasta, noodles and cereal. These foods don’t necessarily taste sweet, but they break down quickly,” he says.
If someone is overweight, trimming down also helps improve blood sugar control. Dr. Shewbridge says that losing as little as 5 percent of one’s total body weight can improve the body’s ability to convert blood sugar into energy.
Another benefit of a healthy diet and regular exercise is that you may need less medication. And taking less medication means you’ll likely see fewer side effects, he says.
When medications are necessary
If diet and exercise don’t stabilize your blood glucose levels, there are several prescription medication options. There are many types of oral medications to help boost insulin production, reduce glucose or help your body use insulin more effectively.
Dr. Shewbridge explains that most people will need medication eventually. Some “might do fine for years and years” without medication, while others need it sooner, he says.
If that time comes, there are many medication options:
- A biguanide (metformin) is a first-line treatment for type 2 diabetes. “Its primary job is to make insulin work better in the body,” says Dr. Shewbridge. It is effective in lowering blood sugar without causing hypoglycemia, and does not cause weight gain as a side effect. Also, the drug is relatively safe and available in generic form, he says.
- Sulfonylureas (e.g., glipizeide or glimepiride) help the pancreas produce more insulin to lower blood glucose. Dr. Shewbridge says doctors prescribe these drugs alone or with other diabetes medications. Possible side effects include hypoglycemia and weight gain.
- Meglitinides (such as Prandin® or Starlix®) help the pancreas produce insulin specifically with meals, as they act faster than sulfonylureas.
- Insulin is prescribed in type 1 diabetes but sometimes also for people who have type 2 diabetes. This drug is not usually a first-line treatment, Dr. Shewbridge says. Insulin can cause hypoglycemia and requires an injection, which is inconvenient and may cause hypoglycemia if not dosed carefully.
And that brings us back to the subject of shots and insulin.
If your doctor says you have type 2 diabetes, don’t worry about insulin shots. Instead, take control of your condition by learning more about it and making a plan for a healthy diet and regular exercise — and you’ll likely need fewer medications in the long run.