How is type 2 diabetes treated?

The key thing to comprehend about medications for type 2 diabetes is that almost everybody has a similar extreme objective—decreasing your glucose. While there are numerous approaches to diminish glucose, a few techniques are more viable than others, and they all have diverse symptoms, dangers, and expenses. When thinking about what treatment is best for you, it’s imperative to ask yourself a couple of inquiries.

What degree of cost, risk, and side effects are you willing to take on? And can you stick with this treatment long-term?

It’s also important to recognize that not all diabetes treatments work the same—some methods only treat the symptoms of diabetes (high blood sugar), while others treat the root causes, insulin resistance and inflammation.

How does the standard of care treatment progress over the course of your life?

In early stages, many patients are recommended to start with lifestyle changes like exercising more and eating less. As the disease progresses, patients typically start taking medications. The first line of pharmaceutical therapy focuses on indirectly reducing blood sugar through pathways other than increasing insulin. If that fails, the second line of therapy is medications that increase insulin to reduce blood sugar (sulfonylureas like glipizide, and insulin). The next stage is to inject exogenous insulin (not made by your own body) using shots, a pump, or even a nasal inhaler.

Diabetes reversal vs. diabetes management

Reversal

Reversal techniques center around fixing the fundamental issues – the insulin obstruction and carb bigotry that are driving your side effect of high glucose. This methodology isn’t yet standard as not every single restorative expert trust that diabetes can be turned around. Notwithstanding what the accord is, there are peer-checked on, distributed examinations showing diabetes inversion. In spite of the fact that not in lifetime partners (the longest forthcoming examination is for 1 year), there are many case reports of individuals with earlier kind 2 diabetes keeping up ordinary blood glucose levels off prescriptions for quite a long time or decades. These don’t profess to be solutions for a reason – for the vast majority of these patients, on the off chance that they stray from the ordinary use of the treatment and come back to their past conduct, their diabetes regularly returns. Since there is no solution for sort 2 diabetes, when assessing your treatment choices, the most significant inquiry to pose to yourself is: would i be able to stay with this mediation for an incredible remainder? Since there is no remedy for sort 2 diabetes, when assessing your treatment alternatives, the most significant inquiry to pose to yourself is: would i be able to stay with this mediation for a mind-blowing remainder?

Management

The Management systems center around treating indications by implication diminishing glucose for the time being.

Keep in mind that glucose is a side effect of the fundamental issue of insulin obstruction and starch bigotry, so when you oversee diabetes by in a roundabout way diminishing glucose, you are just treating the side effects of your malady. While lessening glucose can shield you from the negatives impacts of constant high glucose, you need to remain over your administration techniques for them to be powerful or else your glucose will stay high.

Type 2 diabetes treatments

There are many treatment options for type 2 diabetes. Some focus on management and some focus on reversal, and they vary in terms of efficacy, long-term sustainability, risks and monetary costs.

Reversal Strategies

The Fit N Healthy Treatment

Medically supervised and individualized treatment that guides patients to nutritional ketosis through real-food based carbohydrate restriction, moderate protein intake and fat intake to achieve satiety. The  Fit N Healthy Treatment is delivered through an online clinic and includes individualized intensive nutrition and behavioral counseling, biomarker monitoring, online peer support and medical provider-guided medication management.

Examples

  •  Fit N Healthy

Efficacy at reducing A1c

56% reduced A1c below diabetes threshold in 10 weeks14

87% reduced or eliminated insulin in 10 weeks14

57% of patients who began on diabetes medications were able to reduce or eliminate at least 1 medication in 10 weeks14

Efficacy at reducing weight

14% total body weight loss at 6 months14

Cost

Moderate (free if covered by employer)

Long-term Risks

No serious adverse events and no symptomatic hypoglycemic events requiring medical intervention at 10 weeks.14

Medically supervised ketogenic diets have been used safely for decades

Common Side Effects

Can experience fatigue for 2+ weeks until the body adapts and experience the benefits.

Nutritional Ketosis

Low carb, high fat, moderate protein dietary plan without caloric monitoring

Examples

  • Ketogenic Diet
  • Banting

Efficacy at reducing A1c

.34% reduction in HbA1c15

Efficacy at reducing weight

Multiple meta-analyses and review articles have confirmed that truly low carb (<50g/day) and ketogenic interventions significantly reduce body weight and blood glucose (A1c, FBG)15,16,17,18,19 Cost Low Long-term Risks Common Side Effects Can experience fatigue for 2+ weeks until the body adapts and experience the benefits. [/av_toggle] [av_toggle title='Very Low Calorie Diet (VLCD) / Protein-Sparing Modified Fast (PSMF)' tags='' av_uid='av-czjrd'] Very low calorie diet: <800 kcal/d, <50% of energy intake from carbohydrates, adequate protein and minerals included in diet) Examples

  • Low Calorie, Low-fat Diet

Efficacy at reducing A1c

43% reduced their fasting blood glucose to under 126 mg/dL after 8 weeks of a very low calorie diet followed by several months of an isocaloric (normal calorie intake) diet.20

Efficacy at reducing weight

14.4kg (13%) lost in 6 weeks in obese persons without T2D21

Cost

Low

Long-term Risks

Inability to maintain long term weight loss.22

A VLCD must be a short term intervention because hypocaloric diets to this degree are not sustainable indefinitely and there’s a risk of gall stone formation if fat is too low for too long.23

Muscle loss is a risk if protein intake is inadequate

Common Side Effects

Can experience fatigue for 2+ weeks until the body adapts and experience the benefits.

Surgery

Bariatric Surgery

There are several types of bariatric surgery. They include:

  • Gastric sleeve: Most commonly performed bariatric surgery procedure. Surgical procedure (generally laparoscopic) removes a large portion of the stomach and reduces stomach to approximately 15% of prior size.
  • Gastric band: A small band is placed around the stomach laparoscopically, reducing the amount of food you can eat by reducing the effective size of the stomach.
  • Gastric bypass: Known as Roux-en-Y, gastric bypass divides the stomach into a small pouch that is divided from the stomach and attached to the small intestine. It functions both through restricting the seize of the stomach and by changing appetite hormones.
  • Duodenal switch: This procedure removes a portion of the stomach and divides a portion of the small intestine, the duodenum, from the stomach. It works both by restricting the amount of food that can be eaten as well as by reducing absorption.
  • Gastric balloon: 1-3 deflated ballons are introduced into the stomach through the esophagus and inflated, causing decreased food intake and increased satiety.
  • vBloc therapy: A device similar to a pacemaker is placed on the vagus nerve to block hunger signals to the brain and stomach.
  • AspireAssist: A suction device removes food directly from the stomach through a port or hole in the abdominal wall and stomach.

 

Examples

  • Orbera
  • Obalon
  • ReShape
  • Lap-band

Efficacy at reducing A1c

83% had remission or reversal at 12 months, as defined by HbA1c reduced to below diabetic threshold24

Remission 2 years post-op is 72.3% compared to usual care’s 16.4%25

At 15yrs, remission rates drop to 30.4%, compared to usual care’s 6.5%25

Efficacy at reducing weight

60 to 85% of excess weight lost at 1 to 1.5 years26

Cost

High

Long-term Risks

Ulcers, bowel obstruction, stenosis, cholelithiasis, dumping syndrome, bleeding, stenosis, leaks, reflux, port infection, esophagitis, hiatal hernia, band slippage, electrolyte imbalances, renal failure, cirrhosis, pancreatitis.

After bariatric surgery, long-term nutrition and micronutrient deficiency is frequent (eg, iron deficiency); the effect of surgery on the risk of hypoglycemia or bone fractures re-mains unclear 27

Mortality rate with metabolic surgery is 0.1% to 0.5%, the rate of major complications 2% to 6%, and minor complications up to 15%; the rate of reoperations or revisions ranges from 0.6% to 20% over 5 to 10 years28,29

Common Side Effects

nausea, vomiting, diarrhea

 

Management Strategies

Cardiovascular/Aerobic

Any sport or activity that works large groups of muscles, is continually maintained and performed rhythmically, is defined as an aerobic, or cardiovascular, exercise

Examples

  • Walking, jogging, cycling, and stair climbing, using the treadmill, stationary bike, elliptical machine, swimming, water aerobics, dance aerobics, hiking, volleyball, basketball and tennis

Cost

Low

Long-term Risks

None known

 

Resistance Training

A form of physical activity that is designed to improve muscular fitness by exercising a muscle or a muscle group against external resistance.

Examples

  • Crossfit, Bodybuilding, Weight Lifting

Cost

Low

Long-term Risks

None known

 

Diet

Low fat (high carb, moderate protein) diet

Examples

  • Low calorie, low fat diet
  • Ornish diet

Cost

Low

Long-term Risks

None known

High protein (moderate to low carb/fat) diet

30% or more of calories from protein, 50% or less energy from fat

Examples

  • Paleo Diet

Cost

Low

Long-term Risks

None known

Time-restricted feeding

  • Eating pattern that alternates between periods of eating and fasting (not eating for extended time periods). (eg, fasting overnight for 16h and eating within an 8h window)

    Examples

    • Some call this intermittent fasting

    Cost

    Low

    Long-term Risks

    Fasting affects medication requirements to manage diabetes, heart disease, or high blood pressure, and possible anti-coagulation (aka blood thinners) as well. For people with type 2 diabetes, medication requirements for adequate blood glucose control are dramatically reduced in just the first day or two of fasting or carbohydrate restriction, making close medical supervision mandatory.

    Risk of muscle loss if fasting for 24 hours of longer

  •  

Medications that do not increase insulin

Biguanides

Prevents the liver from making excess glucose.

Examples

  • Riomet (metformin HCl)
  • Glucophage (metformin HCl)
  • Glucophage XR (metformin HCl extended release)
  • Fortamet (metformin HCl)
  • Glumetza (metformin HCl)

Cost

Moderate to high*

Long-term Risks

Small increased risk of lactic acidosis with an elevation in creatinine.

Increased risk of vitamin B12 deficiency in some patients.

 

Thiazolidinediones (TZDs)

Oral medication that improves insulin sensitivity in muscle cells.

Examples

  • Actos (pioglitazone)
  • Avandia (rosiglitazone)

Cost

Moderate*

Long-term Risks

Increased risk of heart failure due to fluid retention

Potential for increased risk of bladder cancer (pioglitazone)

Decrease in bone mineral density can lead to a small increase in skeletal fracture

Weight gain

 

Alpha-Glucosidase Inhibitors

  • Oral medication that blocks absorption of starch in the gut.

    Examples

    • Precose (acarbose)
    • Glyset (miglitol)

    Cost

    Moderate*

    Long-term Risks

    None known

SGLT-2 Inhibitors

Oral medication that blocks the reabsorption of glucose in the kidney, excreting it in the urine.

Examples

  • Farxiga (dapagliflozin)
  • Jardiance (empagliflozin)
  • Invokana (canagliflozin)

Cost

Moderate*

Long-term Risks

None known

Medications that increase insulin

Sulfonylureas

Oral medication that signals the pancreas to produce more endogenous insulin.

Examples

  • Diabinese (chlorpropamide)
  • Tolinase (tolazamide)
  • Tol-Tab (tolbutamide)
  • Glynase (glyburide)
  • Micronase (glyburide)
  • Diamicron (gliclazide)
  • Glucotrol (glipizide)
  • Amaryl (glimepiride)
  • Orinase (tolbutamide)
  • DiaBeta (glyburide)

Cost

Moderate*

Long-term Risks

High risk of hypoglycemia

Insulin injections (rapid, short, intermediate)

Injectable medication that directly adds insulin to your blood. Starts lowering blood glucose between 5 mins-4 hours; peaks at 30 mins – 12 hours.

Examples

  • Novolog (aspart)
  • Novolin-R (regular/R)
  • Humalog (lispro)
  • Humulin-R (regular/R)
  • U-500 (regular/R)
  • Relion-R (regular/R)
  • Apidra (glulisine)

Cost

Moderate to high*

Long-term Risks

Increased risk of hypoglycemia

Weight gain

Insulin injections (long)

  • Injectable medication that directly adds insulin to your blood by injecting it. Starts lowering blood glucose between 1-4 hours; lasts 15-24 hours with minimal peak.

    Examples

    • Tresiba (degludec)
    • Lantus (glargine)
    • Levemir (detemir)
    • Toujeo (glargine)

    Cost

    Moderate to high*

    Long-term Risks

    Increased risk of hypoglycemia

    Weight gain

     

Insulin pumps

Devices that use rapid-acting insulin at adjustable basal rates + mealtime bolus to account for both basal and bolus insulin needs. Minimal peak; change pump location every 3 days.

Examples

  • Accu-check
  • Medtronic
  • Tandem
  • Sooli
  • Animas
  • Insulet
  • Asante

Cost

Moderate to high*

Long-term Risks

Increased risk of hypoglycemia

Weight gain

 

Inhaled insulin

Nasally inhaled medication that is rapid-acting, man-made insulin designed to be taken at mealtime only.

Examples

  • Afrezza

Cost

Moderate to high*

Long-term Risks

Increased risk of hypoglycemia

Weight gain

GLP-1 Analogs

  • Injectable medication that slows gastric emptying, inhibits glucagon secretion, enhances insulin secretion, and expands pancreatic beta cell mass. NOTE that GLP-1s increase insulin in a glucose-dependent manner, meaning that glucose must be elevated for GLP-1s to increase insulin secretion.

    Examples

    • Byetta (exenatide)
    • Bydureon (exenatide XR)
    • Victoza (liraglutide)
    • Trulicity (dulaglutide)
    • Tanzeum (albiglutide)

    Cost

    Moderate to high*

    Long-term Risks

    Reports of acute pancreatitis, but there is a lack of evidence to fully support

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DPP-4 Inhibitors

Injectable medication that extends the life of GLP-1 hormone by inhibiting its breakdown in the gut. GLP-1 hormone decreases blood sugar levels by enhancing the secretion of insulin when glucose is already elevated. DPP-4 causes GLP-1 to be broken down faster, so when you block DPP-4, you extend the life of GLP-1, thus increasing insulin secretion.

Examples

  • Nesina (alogliptin)
  • Onglyza (saxagliptin)
  • Januvia (sitagliptin)
  • Tradjenta (linagliptin)

Cost

Moderate to high*

Long-term Risks

Reports of acute pancreatitis, but there is a lack of evidence to fully support