How is type 2 diabetes treated?

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The way that diabetes is treated, depends on what type you have. There is also no one single treatment method! Blood glucose monitoring, insulin, and oral medications all play a role in treating diabetes. A healthy diet, maintaining a healthy weight, and enjoying regular physical activity, are all part of managing diabetes too. If you have type 2 diabetes and know someone with type 1 diabetes, you will likely be undergoing different treatment methods.

What is Type 2 Diabetes?

Type 2 diabetes explained simply

Type 2 diabetes is an elevation in blood sugars that occurs when a sugar called glucose can’t get into your fat and muscles where it is needed. Elevated blood glucose damages the lining of blood vessels leading to a range of complications in various organs of the body.

Type 2 diabetes explained in detail

What are the risk factors for developing type 2 diabetes mellitus?

There are a number of risk factors which increase your chance of developing type 2 diabetes and increase a persons risks. There are some risk factors that mean you are more likely to develop diabetes. These include:

• Have a family history of diabetes
• Being overweight or obese, particularly extra weight around the waist
• Being physically inactive
• Eating a poor diet (one that is high in fat, salt, and sugar)
• High blood pressure
• Having signs associated with diabetes like skin tags and dark colouration around the neck and arm pits called acanthosis nigricans
• Being older (over 55 years of age) – the risk increases as we age
• Over 45 years of age and being overweight
• Over 45 years of age and being overweight
• Ethnic background, including Aboriginal and Torres Strait Islanders, Pacific Islanders, Asian and South East Asian, African Americans, Native Hawaiians, and Hispanics/ Latinos

How is type 2 diabetes diagnosed?

Diagnosing type 2 diabetes is done through a number of tests including random blood glucose test, fasting blood glucose test, and oral glucose tolerance test. The following values are used to diagnose diabetes.

Random blood glucose test

Random blood glucose test results to indicate diabetes

	mmol/L	mg/dL
Random blood glucose test	over 11.1 mmol/L	over 200 mg/dL

Fasting blood glucose test

Fasting blood glucose test results to indicate diabetes

	mmol/L	mg/dL
Normal	5.6 mmol/L or less	100 mg/dL or less
Type 2 diabetes	7 mmol/L or more	126 mg/dL or more

Oral glucose tolerance test

Oral glucose tolerance test results to indicate diabetes

	mmol/L	mg/dL
Normal after 2 hours	under 7.8 mmol/L	under 140 mg/dL
Type 2 diabetes after 2 hrs	11.1 mmol/L or more	200 mg/dL or more

Treating type 2 diabetes

Treatment in type 2 diabetes primarily involves making lifestyle changes, monitoring blood glucose levels, and also taking diabetes medication, using insulin or both. Maintaining a healthy weight through a healthy diet and regular physical activity, is not only important in your diabetes treatment, but it is important for your overall health and well-being.

Healthy diet

You maybe have heard of a ‘diabetes diet’ but there is no specific diabetes diet! There are however, certain foods that you should prioritise over others. A healthy diet focuses on a wide variety of fruits and vegetables, wholegrains, lean proteins (i.e. red meat and fish), and low-fat dairy. These are foods that are packed with essential vitamins and minerals, and lower in fat and energy. Limiting the amount of saturated fats, refined carbohydrates (white bread and pasta), and sugary foods is also important. On the note of sugary foods, it is ok to have them sometimes, but they should be limited and treated as an occasional food item.

Understanding what food you can eat and in what quantities, can be difficult. It can take some time adjusting to a change in diet, even if they’re only small changes. Carbohydrate counting is a good option for people with diabetes, because it can help them to space their carbohydrate intake out across the day.

Physical activity

Regular exercise has great benefits for everyone, including people with diabetes! Exercise has the ability to lower your blood glucose levels by moving glucose into your cells where it’s used for energy. Exercising can also increase your sensitivity to insulin, meaning that your body needs less insulin to move glucose from the blood and into the cells.

Before you start exercising, you should talk to your doctor as they will be able to advise what level of intensity is best for you. If it’s been a little while since you’ve been to the gym, generally speaking, starting off with a morning or afternoon walk is a great way to slowly introduce yourself into exercising again. You can start my walking around the block and increase the distance of your walk little by little every day.

If you choose activities that you enjoy, or used to enjoy, it makes exercising far more exciting. Maybe you have a bike in the shed that is gathering a bit of dust, but you miss the feel of the wind blowing through your hair. Maybe you miss swimming when it’s really hot. Or maybe you’ve always wanted to take up salsa dancing. Whatever it is, finding an activity you like that can fit into your daily routine, will mean that you’re more likely to stick with it for the long haul.

When exercising, you should aim for at least 30 minutes or more of aerobic exercise on most days of the week. You could even break it up into three lots of 10 minutes and spread it across the day! Remember, it it’s been awhile since you were last active, start slowly and build gradually.

For some ideas on how to incorporated exercise into your daily life, read 4 easy diet and exercise steps!

Monitoring blood glucose levels

Monitoring your diabetes is important part of your diabetes management. You may be checking and monitoring your blood glucose levels around four times per day, or even more if you’re using insulin. Careful and regular daily monitoring is the only way to ensure that your blood glucose levels remain within their target range. If you have type 2 diabetes and you aren’t using insulin, you will likely check your blood glucose levels less frequently throughout the day.

If you use insulin, there are a number of ways that you can monitor your blood glucose levels, for example with Continous glucose monitoring (CGMS) and Flash glucose monitoring with Abbott's freestyle Libre. Continuous glucose monitoring is able to provide information on patterns and trends in blood glucose levels, as well as reduce the number of fingerstick tests.

Although you might be managing your blood glucose levels well, they can still sometimes change unexpectedly for a number of reasons. They may change in response to food, physical activity, medications, illness, alcohol, and stress. If you’re a woman, changes in your hormone levels may also impact your blood glucose levels!

In addition to daily monitoring, you should be having a blood test every three months to check your HbA1c. HbA1c is a measure of your average blood glucose level over three months. HbA1c test is a good indicator for how well your diabetes treatment plans have been going overall. Your target levels may differ from someone else due to your age or what medications you may be taking to help with your diabetes management.

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Insulin

Insulin has such an important role! You may remember that insulin is a hormone produced by your pancreas and helps get glucose from the blood and into the cells. If you have type 1 diabetes, you already know that insulin is essential for your diabetes management. You need insulin to survive! Some people with type 2 diabetes or gestational diabetes use insulin too and for these people, insulin is necessary.

There are many different types of insulin products available. This includes rapid-acting insulin, long-acting insulin, and intermediate insulin which is a mix of rapid and long-acting. The type of insulin you use depends on your treatment plan. Your doctor may have prescribed you with a combination of insulin types to use throughout the day and night.

Have you ever wondered why you can’t take insulin orally, as a tablet? It’s because your stomach enzymes would interfere with insulin and break it down before it could reach the blood stream. If insulin is broken down, it won’t be of much use at all! This is why insulin is often injected, for example with an insulin pen. Insulin pens look like big markers we used for drawing as kids.

There are also insulin pumps available. The pump is a small device, worn 24 hours a day, and is approximately the size of a small mobile phone. It’s worn outside of your body, with a tube connecting the reservoir of insulin to a fine needle that’s inserted just below the skin of your abdomen. These needles are replaced every 2-3 days.

There is new technological development known as continuous glucose monitoring. Continuous glucose monitoring (CGM) used with an insulin pump, can alert the wearer to fluctuations in blood glucose levels with alarms and visual displays on the pump itself. What a nifty invention!

Oral or other medications

Sometimes oral medications are given to people with diabetes too. Some of these medications can stimulate your pancreas to produce and release more insulin. While others inhibit the production and release of glucose from your liver, which means that you need less insulin. One of the most common medications is Metformin (which is covered in detail in the following article Starting on metformin. What you need to know). This is typically the first medication prescribed to people with type 2 diabetes.

A new group of oral medications that are being used increasingly more commonly are called SGLT2 inhibitors. This class of drug works by blocking the reabsorption of glucose from the urine resulting in lots of glucose being lost from the body. This lowers blood sugar values and reduces the amount of insulin the body needs to produce to control a person's blood sugar. All good things. There are many variations of this drug including:

• canagliflozin (Invokana)
• dapagliflozin (Farxiga, Forxiga)
• empagliflozin (Jardiance)
• sotagliflozin (Zynquista)
• ertugliflozin (Steglatro)

These medications are covered in greater detail in the following article SGLT2 Inhibitors: What's the story?

But I have borderline diabetes. How is prediabetes treated?

Treating prediabetes is similar to type 2 diabetes. A healthy lifestyle consisting of a nutrient-rich diet and regular physical activity, is essential. This is especially so if you have been diagnosed with prediabetes. Making simple changes to your diet, can really make a difference to lowering your blood glucose levels, bringing them back within the healthy target range. By exercising for 150 minutes a week (that’s only 30 minutes a day for five days!) and losing approximately 7% of your body weight, can make such a big difference to prevent or delay a diagnosis of type 2 diabetes.

You can learn more about how prediabetes is treated by reading our article How is prediabetes treated?.

What are the recommended Hb A1c target ranges for patients with diabetes?

The Hb A1c test, or the glycated haemoglobin A1c test, is a blood test that can be taken at any time. It gives an indication as to what your average blood glucose levels have been over the previous three months, by measuring the percentage of a certain type of haemoglobin, called HbA1 that has been altered by a glucose molecule has attached to it.

For some patients, their doctor may provide them with their own personalised Hb A1c target range. There are general target ranges, as well as target ranges depending on other factors like age (child vs adult) or pregnancy.

Recommended Hb A1c target ranges for patients with type 2 diabetes

Type 2 diabetes Hb A1c target ranges

	Hb A1c Target
General	< 53 mmol/mol, < 7.0%
Pregnancy or planning pregnancy	< 42 mmol/mol, < 6.0%
Children and adolescents	< 53 mmol/mol, < 7.0%

To learn more about Hb A1c you, read our articles about what the test is and why it shouldn't be used for diagnosing diabetes.

• What is the Hb A1c test?
• The Hb A1c test to diagnose diabetes
• Hb A1c and the risk of developing complications in type 2 diabetes

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What should I do next?

If you experience any symptoms of type 2 diabetes or you have type 2 diabetes risk factors, it is important to get tested for as soon as possible. Some people are at higher risk and need regular testing. If you are 45 years or older or have other risk factors for diabetes, you will require more frequent testing. By diagnosing and treating the type 2 diabetes early, it means you can decrease the risk of developing diabetes or delay type 2 diabetes complications, for example nerve damage, blindness, and heart disease. It is important to know that diagnosing type 2 diabetes should not rely solely on using a Hb A1c test.

Once you learn what your type 2 diabetes status is, or if you already have type 2 diabetes, the next most important step is to become educated. You can join the 12-week Type 2 Diabetes Program to help you learn how to prevent or delay type 2 diabetes. The program is personalised and tailored, giving you more of the content that you want. The program also helps you to stay motivated and teaches you what changes you need to make. The first week is free and full of helpful and crucial information.

If you would like to be a part of a supportive program, with easy to understand video content covering all aspects of diabetes, join our personalised 12-week Type 2 Diabetes Program today! Don't forget, when you sign up, you receive the first week free!