Your diabetes treatment guide

In order for food to become energy, your body breaks down whatever you eat — a bowl of oatmeal, PB&J, fish tacos — into glucose, or blood sugar. That glucose is used to fuel all the systems in your body. But you need insulin (a hormone produced by your pancreas) for that glucose to get from the bloodstream into your cells.

It’s a delicate system — one that doesn’t work efficiently if you have diabetes. Your body either doesn’t produce insulin at all (type 1 diabetes) or doesn’t use its insulin correctly (type 2 diabetes). The result: Blood sugar levels rise, potentially leading to some serious complications like chronic kidney disease, vision loss, and heart disease.

Avoiding those complications is the main goal of diabetes treatments. By helping you manage your blood sugar, they minimize the impact the condition has on your body. Here are the different medications, devices, and lifestyle changes that work together to do just that.

Glucose monitoring

Seeing how your blood sugar behaves throughout the day helps you and your doctors know how well your treatment plan is working and make any necessary adjustments. That’s why it’s important to check your glucose level at regular intervals (your healthcare team will tell you how often you need to do it).

Called home glucose monitoring, it can be done with a finger prick/glucose meter (you poke your finger and put a drop of blood on a test strip) or with a continuous glucose monitor (a wearable device attached to your skin that measures glucose in real time and transmits the results to your phone).

Insulin

Insulin therapy — when additional insulin is injected into your body via a needle, pen, or pump delivery system — can be a crucial piece of the treatment puzzle for all types of diabetes. But it’s particularly important for people with type 1, since their bodies aren’t producing any insulin on their own.

Insulin is so important because it’s needed for the body to absorb and produce glucose efficiently. “It’s similar to a lock and key, where insulin is the key that unlocks glucose and allows it to enter the cells and be used by the body,” says Nicole Lynch, a clinical nurse at the University of Utah Diabetes and Endocrinology Center.

There are different types of insulin, which vary according to how fast they work and how long they last.

• Rapid-acting insulin begins to work about 15 minutes after injection and is effective for about 2 to 4 hours
• Regular or short-acting insulin begins to work about 30 minutes after injection and is effective for about 3 to 6 hours
• Intermediate-acting insulin begins to work about 2 to 4 hours after injection and is effective for about 12 to 18 hours
• Long-acting insulin begins to work several hours after injection and is effective for about 24 hours
• Ultra long-acting begins to work about 6 hours after injection and is effective for about 36 hours or longer.

In 2015, the FDA approved an inhalable insulin that works even faster than injected insulin since it goes directly into the blood system. That said, it leaves the blood system quickly as well, so the effects don’t last as long as traditional injected insulin.

Oral medications

Oral diabetes meds can be another helpful tool in managing blood sugar levels. Here are some of the ones your doctor may prescribe:

• Sulfonylureas help the pancreas release more insulin, which lowers blood sugar.
• Biguanides reduce the amount of blood sugar produced by the liver, improve how insulin works in the body, and slow the process of converting carbs to sugar.
• Thiazolidinediones increase how much glucose goes into muscles, fat, and the liver, which makes insulin work more efficiently,
• Alpha-glucosidase inhibitors delay the body’s breakdown of carbs, lowering blood sugar.
• Meglitinides enable the pancreas to release more insulin, lowering blood sugar.
• DPP-4 inhibitors help your pancreas release more insulin after meals and lower the amount of blood sugar released by the liver.
• SGLT2 inhibitors act on the kidneys to remove extra sugar from the body.
• Bile acid sequestrants lower cholesterol and blood sugar levels.
• Dopamine agonists lower the amount of glucose the liver produces.

Injectable medications

Some of the newest treatments for diabetes are injectable drugs like dulaglutide (Trulicity), liraglutide (Victoza), semaglutide (Ozempic), and tirzepatide (Mounjaro). These medications mimic naturally occurring hormones: Semaglutide, liraglutide, and dulaglutide mimic a hormone called glucagon-like peptide-1 (GLP-1) while tirzepatide mimics both GLP-1 and glucose-dependent insulinotropic polypeptide (GIP). Known collectively as GLP-1 agonists, these medications trigger your pancreas to produce more insulin and delay gastric emptying, which can help lower blood sugar. They also reduce appetite, often resulting in weight loss.

Can losing weight help manage diabetes?

Yes, losing weight can improve blood sugar levels — and the more you lose, the bigger an impact it will have. In fact, research even suggests that losing enough weight can result in diabetes remission for those with type 2 diabetes, which is defined as A1C levels — a measure of how well you’re controlling your blood sugar — staying below 6.5% for at least three months without glucose-lowering medication. In a study of younger adults recently diagnosed with type 2 diabetes, 61% of people who lost an average of 11.9% of their weight had their diabetes go into remission.

That’s where a program like the WeightWatchers Diabetes Program comes in. People with type 2 diabetes who followed the plan for six months lost 5.7% of their weight and reduced their A1C levels by 0.75 percentage points.*

How are the different types of diabetes treated?

There are some ways treatments vary depending on if you have type 1, type 2, or gestational diabetes.

Type 1 diabetes

With type 1 diabetes, your body doesn’t produce insulin at all. That’s why everyone with type 1 has to have insulin therapy, usually a combination of shorter-acting insulin before you eat and a longer-acting formulation at night. The amount of insulin depends on your weight, with higher amounts needed during certain events like puberty, pregnancy, and illness.

Beyond following a healthy diet, those with type 1 diabetes can benefit from eating at the same time every day and consuming similar amounts of carbs during those meals. They are more likely to be on a schedule with their insulin — taking specific amounts at the same time — so a consistent eating pattern can help control blood sugar.

Gestational diabetes

Treating gestational diabetes, a form of high blood sugar that happens during pregnancy, can be tricky. “Part of the difficulty in treating gestational diabetes is that blood glucose targets are even lower than normal,” Lynch says. “That said, a large majority of women who have gestational diabetes are able to manage it by monitoring carbohydrate intake and increasing exercise to reduce insulin resistance.” Certain brands of insulin (like NPH, novolog, or Humalog) are safe to use in pregnancy, but others haven’t been studied yet in pregnancy, she says. Your care team will take all of that into account when they come up with your treatment plan.

Type 2 diabetes

Because people with type 2 diabetes are still making insulin, doctors often prescribe oral medications to help the body use its insulin better, according to Lynch. This allows them to improve blood sugars without going on insulin (something that would be impossible for someone with type 1 diabetes). A drug known as Metformin, which is a biguanide, is often used as the go-to oral treatment for type 2 diabetes before any other medications are considered, since it tends to work well with few side effects.

If blood sugar is still difficult to control with lifestyle changes and oral medications, insulin may be added to the mix. A sign you need insulin is if your A1C levels are greater than 9%. It’s common to start with intermediate-acting or long-acting forms, which are taken either in the morning or at bedtime, but some people may need a more complex insulin approach.

Can diabetes be cured?

It depends which kind you’re talking about. While there’s no cure for type 1 diabetes, gestational diabetes tends to go away after delivery and type 2 diabetes can go into remission — that means you won’t show any signs of the condition or need any medication. Studies have shown that losing weight and keeping it off is significantly associated with diabetes remission. The greater the weight loss, the higher your chances of having the disease go into remission.

How do you know if your diabetes treatment is working?

Ideally, your treatment plan would do exactly what it’s supposed to do — keep your blood sugar in the ideal range. That’s why it’s important to keep an eye on key numbers. “Monitoring your blood glucose and having hemoglobin A1C checked every 3 to 6 months as recommended by your provider can help you know if your diabetes treatment is working for you,” says Dr. Sudipa Sarker, M.D., associate professor of medicine at the Johns Hopkins University School of Medicine, and the director of the Johns Hopkins Inpatient Diabetes Management Service. Your provider will likely aim for A1C less than 7%. If yours is above that level, your doctor may recommend changing your treatment plan to see if a different medication works better.

The bottom line

There are different medications used to treat diabetes, including oral medications, insulin, and injectable medications. The diabetes treatment that’s right for you largely depends on the type of diabetes you have, how severe it is, and what your doctor recommends based on your unique health history. Regardless of the chosen medication, lifestyle changes like increasing your physical activity and eating well can also help improve blood sugar. Lastly, keep up with your regular check-ins so your healthcare team can make sure your treatment plan is working as well as it should.