That’s because type 2 diabetes is a progressive condition, meaning it changes and usually becomes more complex to manage over time. As it progresses, your body may make less insulin or become more resistant to the insulin it does produce, so you may need to adjust your treatment. For example, if oral medication and lifestyle changes are no longer working to manage your diabetes, you may need to add a non-insulin or insulin injectable to your treatment plan. “Diabetes is very complex, and everybody’s diabetes is different,” notes Jeremy Beaulieu, a nurse practitioner and certified diabetes care and education specialist (CDCES) with the Diabetes Management Program at Brigham and Women’s Hospital in Boston. “There’s no one-size-fits-all approach to diabetes management.” Here are some questions to ask your doctor if you think you need to ramp up your treatment plan.
1. Why isn’t my type 2 diabetes treatment plan working as well as it used to?
“Many people with diabetes think they need to explore new treatments because what they’re currently doing isn’t working, and that’s true,” Beaulieu says. For example, you may notice that your blood sugar or A1C levels are rising, even though you eat a healthy diet, exercise frequently, and stick to your doctor-prescribed treatment. This could be because your type 2 diabetes is progressing, you’ve developed a complication, or another medication you’re taking is interfering with your diabetes treatment, among other potential causes. If you make additional diet modifications and exercise more but your A1C still continues to rise, it might be time to talk to your doctor about a change.
2. What types of injectable medications are available for type 2 diabetes?
Injectable medications for type 2 diabetes include both insulin and non-insulin drugs. Insulin medication is a synthetic form of the hormone produced by the pancreas that helps move glucose (blood sugar) into your cells, where it’s used for energy, the National Institute of Diabetes and Digestive and Kidney Diseases says. Injectable insulin helps control blood sugar levels in people whose bodies can’t produce enough insulin naturally. The drug lowers blood sugar levels by increasing the uptake of glucose in your muscle and fatty tissue and slowing the release of glucose from the liver, according to Cleveland Clinic. There are several prescription insulin products available, and each differs by how quickly it starts to work, when it peaks, and how long it remains effective. You typically inject insulin in your abdomen, legs, buttocks, or the back of your arms. Inhaled insulin and insulin pumps are also available. In addition, there are several non-insulin injectable diabetes drugs available, according to Cleveland Clinic. These are designed to keep food in your stomach longer and increase your body’s production of insulin when you eat while lowering the amount of glucose released by your liver. Your doctor should work with you to identify the right injectable medication for your diabetes.
3. Why might I need to include injectable medication in my treatment plan?
Many people with type 2 diabetes manage their symptoms by eating a healthy diet and being more physically active, according to the NIDDK. But some people also need medication. Whether you need medication usually depends on how well your blood sugar or A1C levels are being controlled, says M. James Lenhard, MD, an endocrinologist and the medical director of Christiana Care Health System’s Diabetes & Metabolic Diseases Center in Wilmington, Delaware. If diet and exercise alone can no longer help you maintain healthy blood sugar levels or hit your A1C target, your doctor may start you on an oral medication (pills). In time, you may need to change your medication, add medication, or take medicine you inject under your skin, such as an insulin or non-insulin injectable, to help control your blood sugar. Even if you don’t typically take insulin, you may need it at certain times, such as while you’re pregnant or if you’re in the hospital with another health problem, according to the NIDDK.
4. Having to take insulin or another injectable has left me feeling like I’ve failed at managing my type 2 diabetes. Why did my treatment need to change?
Needing to take insulin or another injectable medication to help manage diabetes does not mean you’ve failed. Although some people with type 2 diabetes could eat better or exercise more — or be more disciplined about taking their prescribed oral drug treatment — the condition is “a progressive genetic disorder, meaning that often, as you age, your pancreas makes less insulin,” Dr. Lenhard explains. “Maintaining a healthy weight and staying active only slow the process. They don’t stop it.” For many people with type 2 diabetes, moving to insulin or another injectable is a necessary response to a constantly evolving condition — not proof that you should give up on your healthy lifestyle habits.
5. I’m scared of needles. How can I make injections easier?
You aren’t the only person with a fear of needles. Luckily, certain type 2 diabetes medications can take some of this fear away. With some non-insulin injectables, for example, “You don’t even see the needle. You just place a pen-shaped device on your abdomen and push a button,” he explains. “The mechanism injects the drug, and then you take it off and throw it away. The whole process takes about a minute.” Other injectables use very small needles — about 2 to 3 millimeters long — that are designed to deliver the medication just beneath the skin, he adds. Talking to your doctor or a CDCES about your concerns can also help, according to Beaulieu. “I have found that teaching a person with type 2 diabetes how to administer an injectable in person and walking them through it reduces a lot of the anxiety associated with it,” he says. “Once someone has done it, sees that it doesn’t really hurt and is pretty easy to do, they generally don’t have any problems.”
6. Will I need to continue taking other diabetes medications, such as pills?
For most people with type 2 diabetes, metformin, which comes in pill form, is the oral drug they’ll take — at least to start. Metformin is designed to regulate the amount of blood sugar released by your liver, but it doesn’t help your body produce more insulin, according to the National Library of Medicine. That’s why your doctor may keep you on your oral medication as you transition to an injectable, Lenhard notes. This is called combination therapy. Eventually, you may stop the oral drugs and use only injectables, depending on how well your body produces insulin, according to the nonprofit Beyond Type 2.
7. How will I know if my new treatment is working?
You’ll know your new medication is working if your A1C numbers shift down toward the goal number set by you and your doctor — usually 7 percent for adults, according to Lenhard. Conversely, you’ll know it isn’t working if your A1C numbers remain high. An A1C test measures your average blood sugar levels over the past two to three months. You should see your doctor every three to six months to get your A1C levels checked, advises the ADA. Your doctor may also want to monitor your blood pressure, blood sugar, and cholesterol levels and, if needed, reevaluate your treatment plan, Lenhard says. It’s important to note that while your A1C tests your average blood sugar level over the course of several months, it can’t tell you what your levels are on a daily basis. So you’ll still need to regularly perform at-home blood sugar tests as prescribed by your doctor, he adds.
8. Do I need to adjust my diet and exercise plan, too?
Maybe, says Beaulieu. Chances are, if you’re eating a healthy diet for type 2 diabetes and exercising regularly but are no longer able to achieve your target blood sugar or A1C levels, no amount of diet changes or additional exercise will help; you’ll still need to start on drug treatment, he notes. But tweaks to your lifestyle can help your new treatment start working faster and more effectively overall, he adds. “A good diet and getting enough exercise will always form the basis of diabetes management, and it doesn’t hurt to reexamine what you’re doing if it doesn’t seem to be working.” Talk to your doctor or a CDCES about lifestyle changes that may help.
9. Will I need to change my treatment plan again in the future?
It’s possible. As we said, type 2 diabetes is progressive, meaning it worsens over time. That’s why you need to monitor your blood sugar and A1C regularly to make sure your treatment plan is working, Lenhard notes. If your doctor recommends a change, the first approach you try may not work, Beaulieu adds. “Some people will respond better to one class of medications than another due to underlying genetic variations, while some respond better to changes in their diet, and some respond better to exercise than others,” he says. “Plus, as people get older, we like their A1C to be a little bit higher, usually 8 percent or less, especially if they are on medications that can cause low blood sugar levels or insulin,” says Beaulieu. “The tighter control you have as someone gets older, the more they run the risk of having low blood sugar levels, which puts a strain on the body and, in an older adult, can be very dangerous and lead to falls, which can lead to fractures.”
