Type 2 Diabetes medications & treatments

Medically reviewed by  Jamie Winn, PharmD

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Type 2 diabetes mellitus is characterized by insulin resistance, meaning that the body’s cells do not respond properly to insulin and cannot easily absorb sugar from the bloodstream. When people with Type 2 diabetes eat or drink, their bodies do not use insulin properly. As a result, blood glucose levels remain at persistently high levels, a condition called hyperglycemia.

Right now, one in ten Americans is living with Type 2 diabetes. According to the Centers for Disease Control and Prevention (CDC), that number is only going to rise—in 2050, as many as one in three adults could have the disease.

The statistics can be frightening, but it is possible to successfully manage the condition. A total commitment to lifestyle changes is the first and the only step required for some. For others, medications can keep blood sugar under control. There is no question, however, that a diagnosis of Type 2 diabetes is truly a life-changing event.

What is Type 2 Diabetes?

Type 2 diabetes is not the only type of diabetes, but it is by far the most common. It affects about 95% of all people with diabetes.

There are several different types of diabetes:

• Type 1 diabetes (T1D)
• Type 2 diabetes (T2D)
• Prediabetes
• Gestational diabetes (diagnosed in pregnancy)
• Other rare forms of diabetes (for example, diabetes-related to medications, or problems with the pancreas)

Some of them are temporary or reversible, like prediabetes or gestational diabetes. Other types are long-term and permanent, like type 1 and type 2 diabetes.

The different types of diabetes are more like a spectrum, rather than distinct categories. Also, people can have more than one type of diabetes.

The two major types of diabetes are Type 1 and Type 2. In Type 1 diabetes, the body loses the ability to make insulin. Less common than Type 2 diabetes, Type 1 diabetes is typically diagnosed in childhood.

Type 2 diabetes is more often diagnosed in older adults, although the epidemic of childhood obesity is increasing Type 2 diabetes among children, teens, and young adults. Type 2 diabetes is the more common form and affects approximately 31-32.5 million of the 34.2 million people living with diabetes in the United States.

Type 2 diabetes is caused by two problems: either the body doesn’t make enough insulin, or it doesn’t respond normally to insulin (referred to as insulin resistance). When our body can’t produce or respond to insulin properly, our blood sugar levels rise.

Type 2 diabetes also has a genetic link, and is more common in those with a family history of diabetes. But other risk factors play an important role as well:

• Weight (obesity is the most common cause of type 2 diabetes)
• Lack of physical activity
• Smoking
• Poor sleep
• Metabolic syndrome is a cluster of conditions that increase your risk of developing diabetes, as well as heart disease and stroke

High blood sugar can raise blood pressure and damage the linings of blood vessels, leading to plaque buildup (atherosclerosis). Most affected are the capillaries, which are the smallest blood vessels that supply needed oxygen to the body’s tissues. Over time, this plaque build-up leads to potentially severe or even life-threatening complications of diabetes such as:

• Cardiovascular disease
• Stroke
• Kidney disease
• Peripheral nerve damage (neuropathy)
• Retinal damage (diabetic retinopathy)
• Vision loss
• Skin problems
• Slow wound healing

Diabetes is one of the leading causes of cardiovascular disease, kidney disease, blindness, and lower limb amputation.

How is Type 2 Diabetes diagnosed?

Type 2 diabetes is usually diagnosed using the glycated hemoglobin A1C test. This blood test indicates your average blood sugar level for the past two to three months. Results are interpreted as follows:

•  Below 5.7% is normal.
• 5.7% to 6.4% are diagnosed with prediabetes.
• 6.5% or higher on two separate tests indicates diabetes.

If the A1C test isn’t available, or if you are unable to use an A1C test due to certain conditions that might interfere with it, your doctor may use the following tests to diagnose diabetes:

Random blood sugar test. Blood sugar values are typically measured in milligrams of sugar per deciliter (mg/dL). Regardless of the time passed since you last ate, a level of 200 mg/dL or higher suggests diabetes, especially if you also have signs and symptoms of diabetes, such as frequent urination and extreme thirst.

Fasting blood sugar test. A blood sample is taken after an overnight fast. Results are interpreted as follows:

• Less than 100 mg/dL is normal.
• 100 to 125 mg/dL is diagnosed as prediabetes.
• 126 mg/dL or higher on two separate tests is diagnosed as diabetes.

Oral glucose tolerance test. This test is less commonly used than the others, except during pregnancy. You’ll need to fast overnight and then drink a sugary liquid at the doctor’s office. Blood glucose levels are tested periodically for the next two hours. Results are interpreted as follows:

• Less than 140 mg/dL is normal.
• 140 to 199 mg/dL is diagnosed as prediabetes.
• 200 mg/dL or higher after two hours suggests diabetes.

Screening. The American Diabetes Association recommends routine screening with diagnostic tests for type 2 diabetes in all adults age 45 or older and the following groups:

• People younger than 45 who are overweight or obese and have one or more factors associated with an increased risk of diabetes
• Women who have had gestational diabetes
• People who have been diagnosed with prediabetes
• Children who are overweight or obese and who have a family history of type 2 diabetes or other risk factors
• Excess weight
• Certain ethnicities (Native American, African American, Hispanic/Latino, Asian American, Pacific Islander)
• High blood pressure
• History of cardiovascular disease
• Low HDL cholesterol
• Immediate relatives with Type 2 diabetes
• Sedentary or inactive lifestyle
• Dark skin pigmentation under the armpits and skin folds
• Women with polycystic ovary syndrome

If you’re diagnosed with diabetes, your doctor or health care provider may do other tests to distinguish between type 1 and type 2 diabetes — since the two conditions often require different treatment plans.

Symptoms of Type 2 diabetes

Signs and symptoms of type 2 diabetes often develop slowly. You can be living for years with type 2 diabetes and not know it. As it progresses, the symptoms of diabetes might include:

• Increased urination
• Increased thirst
• Increased appetite
• Fatigue
• Weight loss without trying
• Headaches
• Slow healing of skin sores and cuts
• Blurry vision
• Darkened skin under the armpits and body folds.

If you’re diagnosed with diabetes, your doctor or health care provider may do other tests to distinguish between type 1 and type 2 diabetes — since the two conditions often require different treatment plans.

Symptoms of Type 2 diabetes

Signs and symptoms of type 2 diabetes often develop slowly. You can be living for years with type 2 diabetes and not know it. As it progresses, the symptoms of diabetes might include:

• Increased urination
• Increased thirst
• Increased appetite
• Fatigue
• Weight loss without trying
• Headaches
• Slow healing of skin sores and cuts
• Blurred vision
• Darkened skin under the armpits and body folds.

Type 2 Diabetes treatment options

There is no one way to treat type 2 diabetes, as the condition can vary greatly from person to person. That being said, treatment typically falls into one of two categories: lifestyle changes or medication.

Lifestyle changes, such as a healthy diet, smoking cessation, stress reduction, and exercise, are often the first line of defense against type 2 diabetes. Making small tweaks to your daily routine can have a big impact on your blood sugar levels.

Several medications can be used to treat type 2 diabetes. Some of these drugs are taken orally (by mouth), while others are injected. The most common FDA-approved oral medications include:

• Sulfonylureas such as Glucotrol (glipizide), Amaryl (glimepiride), and Glynase (glyburide) help the pancreas make more insulin.
• Meglitinides such as Prandin (repaglinide) and Starlix (nateglinide) work like sulfonylureas, but they act faster and don’t last as long.
• Thiazolidinediones (TZDs) such as Actos (pioglitozone) and Avandia (rosiglitazone) help insulin work better in muscle and fat cells.
• Biguanides such as metformin lower blood sugar by making the liver less likely to release glucose into the blood.
• Alpha-glucosidase inhibitors such as Precose (acarbose) and Glyset (miglitol) slow the breakdown of carbohydrates in the intestine, so they are absorbed more slowly into the blood.
• DPP-4 inhibitors such as Januvia (sitagliptin), Onglyza (saxagliptin), Nesina (alogliptin), and Tradjenta (linagliptin) prevent the breakdown of a hormone called GLP-1, which helps control blood sugar levels.
• SGLT2 inhibitors such as Invokana (canagliflozin), Farxiga (dapagliflozin), and Jardiance (empagliflozin) reduce renal glucose reabsorption which produces a reduction in blood glucose without stimulating insulin release.

If lifestyle changes and oral medications don’t control blood sugar levels, people with Type 2 diabetes may need to take an injectable medication. Injectable medications include GLP-1 receptor agonists and insulin.

GLP-1 receptor agonists such as Ozempic (semaglutide) are a class of drugs that mimic the effects of the hormone GLP-1. GLP-1 is a hormone that helps control blood sugar levels by stimulating the release of insulin from the pancreas. GLP-1 receptor agonists can be injected under the skin with a syringe or an insulin pen.

Insulin is a hormone that helps the body’s cells take in glucose from the bloodstream. Insulin can be injected with a syringe or an insulin pen. There are a few different types of insulin, including:

• Rapid-acting insulin (Humalog)
• Short-acting insulin (Humulin-R)
• Intermediate-acting insulin (Humulin NPH)
• Long-acting insulin (Levemir, Lantus, Toujeo)
• Ultra-long acting insulin (Tresiba)

Rapid-acting insulins work very quickly and last 1 to 2 hours. They are typically used before meals. Short-acting insulins work more slowly than rapid-acting insulins, but they still start working within 30 minutes and last 2 to 4 hours. Intermediate-acting insulins take a little longer to start working, but they provide a steady supply of insulin for 6 to 14 hours. Long-acting insulins provide a slow and steady supply of insulin for up to 24 hours. Ultra-long-acting insulins such as Tresiba last more than 40 hours with very little fluctuation in the blood levels of the drug.

People with Type 2 diabetes can also use a pump to deliver insulin. Insulin pumps are small, computerized devices that deliver insulin 24 hours a day through a small catheter placed under the skin.

Regardless of how intensive your diabetes treatment is, blood glucose monitoring is extremely important in how successful your blood glucose control will be. Typically, blood will be extracted through a finger prick and placed on a test strip, which is then inserted into a blood glucose monitoring device. Some blood glucose meters allow you to use a blood sample from an alternate site such as your palm, forearm, or upper arm. The frequency of how often your blood sugar level is recorded throughout the day depends on several factors and is determined by your doctor.

A continuous blood sugar monitor may be required for some individuals. A sensor is placed beneath the skin on specific areas of the body, including the abdomen or arms. It regularly measures glucose levels in the fluid between skin cells and transmits the information to a receiver. Continuous blood glucose monitors can be linked to an insulin pump to automate insulin injections.

What is the best medication for Type 2 Diabetes management?

The best medication for Type 2 Diabetes will depend on the individual’s specific health problems, medical conditions, medications that the individual is already taking that may potentially interact with Type 2 diabetes medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a medication list of some of the most prescribed Type 2 Diabetes medicines as well as common starting dosages and side effects.

Best medications for type 2 diabetes

Your healthcare provider will determine the dosage which is right for you based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist and this is not a complete list.

What are the common side effects of Type 2 diabetes medications?

Different classes of medications have different side effects. However, this is not a complete list, and you should consult with a healthcare provider for possible side effects and drug interactions based on your specific situation.

The most common and serious side effect of antidiabetic medications is low blood sugar (hypoglycemia). Symptoms of hypoglycemia include:

• Shakiness
• Dizziness
• Sweating
• Hunger
• Headache
• Anxiety
• A heartbeat that is fast or irregular
• Confusion or feeling “foggy-headed”
• Weakness

Other common side effects based on include:

• Nausea
• Upset stomach or indigestion
• Diarrhea
• Flatulence
• Low blood sugar
• Weight gain
• Upper respiratory infection
• Back pain
• Bloating
• TZDs specifically have been linked to serious side effects such as the development of, or exacerbation of pre-existing, congestive heart failure, heart attack, bladder cancer, and bone fractures. Less severe side effects include swelling and higher LDL cholesterol levels.

What are some home remedies for Type 2 Diabetes?

Many patients can manage their diabetes without the need for medications. The most effective home remedy treatments include:

• Exercise more. Regular aerobic or resistance training is the best way to increase insulin sensitivity.
• Get more sleep. Several studies have linked poor sleep to reduced insulin sensitivity.
• Reduce stress. Stress affects your body’s ability to regulate blood sugar. It encourages the body to go into “fight-or-flight” mode, which stimulates the production of stress hormones like cortisol and glucagon. These hormones break down glycogen, a form of stored sugar, into glucose, which enters your bloodstream for your body to use as a quick source of energy. Studies have shown that increased levels of these hormones reduce insulin sensitivity.
• Lose weight. Excess weight, especially in the belly area, reduces insulin sensitivity and increases the risk of type 2 diabetes.
• Cut down on carbs. Reducing your carb intake, or spreading it out evenly throughout the day could help increase insulin sensitivity. That’s because high-carb diets tend to lead to spikes in blood sugar, which put more pressure on the pancreas to remove sugar from the blood.
• Reduce your intake of added sugars. These added sugars are found in more highly processed foods. The two main types of sugar added during the production process are high-fructose corn syrup and table sugar, also known as sucrose. Both contain approximately 50% fructose. Many studies have found that higher intakes of fructose can increase insulin resistance among people with diabetes.
• Add some spice to your life. Try adding garlic, turmeric, ginger, fenugreek, or cinnamon to your diet. Also, green tea and apple cider vinegar. Though more research is needed, they have shown positive results in animal studies.
• Try a supplement. Chromium, berberine, and magnesium supplements are linked to increased insulin sensitivity. Resveratrol appears to increase insulin sensitivity, particularly among people with type 2 diabetes.

Frequently asked questions about Type 2 diabetes

What is the best treatment for Type 2 diabetes?

Each person is different, so there is no single treatment plan that’s best for everyone with diabetes. For most people, the most effective treatment is a healthy diet low in carbohydrates and saturated fats, regular exercise, and achieving and maintaining healthy body weight.

Can you be cured of Type 2 diabetes?

Type 2 diabetes is a chronic, lifelong condition. Some patients, however, can maintain normal blood sugar levels through diet, exercise, and weight loss.

Can you live a long life with Type 2 diabetes?

Although Type 2 diabetes does lower life expectancy, how much will depend on the severity of the condition, the age of onset, and the patient’s commitment to healthy eating, regular exercise, and maintaining a healthy weight.

What are the newest drugs for Type 2 diabetes?

Type 2 diabetes drugs are constantly in development. The newest drugs either increase hormones that stimulate insulin production (GLP-1 receptor agonists such as Victoza or Ozempic) or prevent the kidneys from reabsorbing sugar from the urine (SGLT-2 inhibitors such as Invokana and Farxiga). Unfortunately, neither of these types of drugs are first-line therapies but are only used when other medicines have failed.

Related resources for Type 2 Diabetes

• Diabetes diagnosis. American Diabetes Association
• Early Signs and Symptoms of Type 2 Diabetes. WebMD
• Type 2 Diabetes. MayoClinic
• Insulin, Medicines, and Other Diabetes Treatment. National Institute of Diabetes and Digestive and Kidney Diseases
• Oral Diabetes Medications. Cleveland Clinic
• Blood Sugar Testing and Control. American Diabetes Association
• An Update on SGLT2 Inhibitors for the Treatment of Diabetes Mellitus. National Library of Medicine
• Diabetes Overview. National Institute of Diabetes and Digestive and Kidney Diseases