What Is the Best Treatment for Diabetes?

Reviewed on 4/21/2021

There are three main types of diabetes and the best treatment depends on the type. Type 1 diabetes treatment involves insulin, diet, and exercise; type 2 diabetes treatment involves diet, exercise, and weight management; and gestational diabetes treatment involves diet and insulin.
There are three main types of diabetes and the best treatment depends on the type. Type 1 diabetes treatment involves insulin, diet, and exercise; type 2 diabetes treatment involves diet, exercise, and weight management; and gestational diabetes treatment involves diet and insulin.

Diabetes mellitus is a metabolic disorder that occurs when the body either produces insufficient or no insulin or doesn’t use insulin properly, causing blood sugar (glucose) levels to rise (hyperglycemia).

Glucose is the body’s main source of energy, and the pancreas produces a hormone called insulin that helps convert glucose from the food you eat into energy the body uses.

There are three main types of diabetes and the best treatment depends on the type of diabetes that is present: 

  • Type 1 diabetes (previously called insulin-dependent or juvenile diabetes)
    • Little to no insulin is produced by the pancreas
    • It is an autoimmune condition, which means it is chronic, does not go away on its own, and will need to be managed for the rest of your life
    • The best treatment for type 1 diabetes is use of insulin combined with diet and exercise
    • Type 1 diabetes may also be treated with a combination of insulin and metformin, or a combination of insulin and pramlintide (Symlin)
  • Type 2 diabetes
    • The body doesn’t use insulin properly causing blood sugar levels to rise
    • The most common form of diabetes 
    • May be reversed in some cases with proper diet, exercise, maintaining a healthy weight, and lifestyle changes
    • The American Diabetes Association and the European Association for the Study of Diabetes recommend metformin as the best treatment for type 2 diabetes, combined with diet and exercise
      • Once treatment with metformin has started, a second diabetes drug such as an SGLT2 (sodium-glucose transporter 2) inhibitor or a GLP-1 (glucagonlike peptide-1) receptor agonist may be added
  • Gestational diabetes 
    • Disrupts the way the body uses sugar (glucose) during pregnancy
    • Occurs because pregnancy increases the body's need for insulin, but the body cannot always make enough
    • The best treatment for gestational diabetes includes specialized meal plans and scheduled physical activity, and it may also include daily blood glucose testing and insulin injections
      • The goal is to keep blood glucose levels equal to those of pregnant women who don't have gestational diabetes
    • After delivery, gestational diabetes usually goes away and a woman’s blood sugar levels will return to normal

Lifestyle changes to manage diabetes include:

  • Manage A1C (average blood glucose level over the past 3 months)
  • Check blood glucose levels daily
  • Keep blood pressure in check
  • Maintain healthy cholesterol levels
  • Don’t smoke
  • Follow a diabetes meal plan as recommended by your doctor or nutritionist
  • Eat a plant-based/vegan/vegetarian diet with plenty of fruits and vegetables, whole grains, beans. If you choose to eat meat and dairy, choose lean poultry and fish, and low-fat dairy.
  • Drink plenty of water
  • Chose foods that are low-calorie, low-fat, low-sugar, and low-salt
  • Exercise regularly 
  • Get adequate sleep
  • Manage stress/practice relaxation techniques 
  • Take prescribed diabetes medications 

Medications used to treat diabetes include: 

  • Insulin 
  • Meglitinides 
  • Alpha-glucosidase inhibitors 
  • Thiazolidinediones 
  • DPP- 4 Inhibitors 
  • Sulfonylureas 
  • Biguanides 
  • Dopamine receptor agonists 
  • Bile acid sequestrants 
  • SGLT2 inhibitors 
  • GLP-1 receptor agonists 
  • Amylin analog 
  • Combination medicines, which may be made up of more than one medication in the above classes
  • Women with gestational diabetes may need insulin or metformin 

If lifestyle changes and medications are insufficient, other treatments for diabetes may include: 

  • Weight-loss surgery (bariatric surgery) for some patients who are obese
  • Artificial pancreas 

What Are Symptoms of Diabetes?

Symptoms of diabetes include:

  • Increased urination
  • Increased thirst 
  • Increased hunger, even though people are eating
  • Blurred vision
  • Fatigue
  • Sores/cuts/bruises that do not heal
  • Frequent infections
  • Darkened skin, often in the armpits and neck
  • Numbness, tingling, or pain in the feet or hands (more common in type 2)
  • Unexplained weight loss (more common in type 1)

What Causes Diabetes?

Type 1 diabetes is believed to be caused by an autoimmune reaction in which the body attacks itself and destroys beta cells in the pancreas that make insulin. 

Risk factors for developing type 1 diabetes include: 

  • Genetics/family history
  • Ethnicity: Caucasians are more likely to develop type 1 diabetes than African Americans and Hispanic/Latino Americans
  • Age: more likely to occur in children, teens, and young adults, though it can develop at any age
  • Triggers, such as viruses

Type 1 diabetes is not caused by diet or lifestyle factors.

Type 2 diabetes is caused by several factors, including: 

  • Genetics
  • Family history
  • Occurs more often in certain ethnic groups: African Americans, Alaskan Natives, American Indians, Asian Americans, Hispanic/Latinos, Native Hawaiians, or Pacific Islanders
  • Lifestyle factors 
  • Overweight or obesity
  • Physical inactivity

Factors that can increase the risk of developing type 2 diabetes include:

Risk factors for developing gestational diabetes include:

  • Age over 25 years
  • Overweight/obesity
  • Ethnicity: Hispanic-Americans, African-Americans, Native Americans, South or East Asians, or Pacific Islanders
  • Family history of diabetes 
  • Prior gestational diabetes during pregnancy 

How Is Diabetes Diagnosed?

Diabetes is diagnosed with the following tests: 

  • Fasting plasma glucose (FPG) test 
  • A1C test 
  • Glucose challenge test
  • Random plasma glucose (RPG) test 
  • Oral glucose tolerance test (OGTT)

SLIDESHOW

Diabetes: What Raises and Lowers Your Blood Sugar Level? See Slideshow

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Reviewed on 4/21/2021
References
https://www.niddk.nih.gov/health-information/diabetes

https://www.fda.gov/media/119148/download

https://www.cdc.gov/diabetes/basics/type1.html

https://www.uptodate.com/contents/gestational-diabetes-beyond-the-basics?search=Gestational%20Diabetes%5C&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2

https://www.medscape.com/viewarticle/939114 https://www.jdrf.org/t1d-resources/about/treatment/ https://www.diabetes.org/diabetes/gestational-diabetes/how-to-treat-gestational-diabetes