Build a Treatment Plan for Type 2 Diabetes

A type 2 diabetes diagnosis can bring up a lot of questions and concerns, especially if this is all new to you. It may take some time to figure out what lifestyle adjustments and medications work best for your blood sugar (glucose) management, but with the right treatment plan, you can live a long, active, and healthy life with type 2 diabetes.

Understanding Type 2 Diabetes

Type 2 diabetes happens when your body can no longer use insulin the way it should to keep your blood sugar at healthy levels. Insulin is a hormone that helps move sugar from your bloodstream into your cells so your body can use it for energy. Your pancreas may make more insulin at first to try to help, but over time, it can't keep up with demand. Then sugar builds up in your bloodstream.

When blood sugar stays too high for too long, it can damage blood vessels and nerves. This increases the risk of heart disease, stroke, kidney disease, vision loss, and nerve pain.

These effects are highly preventable with good blood sugar management.

Here's how to create a diabetes treatment plan that works for you.

Getting Started on Your Plan

You create a diabetes treatment plan to manage your diabetes day to day. It includes:

What and how you eat
How much and how often you move your body
Whether you take medications and which ones
How often you check your blood sugar
How often you see your health care team

There is no one-size-fits-all plan. Your plan should fit your own budget, schedule, preferences, and health goals. A good plan is realistic and flexible, but not so strict that it becomes hard to follow.

Start with your diabetes care team. Together with your doctor, nurses, and diabetes educator, you can decide on your goals for blood sugar, weight, blood pressure, and cholesterol. Ask them questions like:

Do I need medication now or can I start with lifestyle changes and see how they affect my blood sugar?
What are my blood sugar goals?
What types of medication side effects should I watch for?
What is a healthy weight goal for me?
Which exercises are safe for me to try?
What kinds of foods should I be eating and avoiding?

Monitoring your blood sugar

Your doctor may ask you to check your blood sugar levels at home. This helps you (and them) understand how food, activity, stress, and medication affect your levels. Some people check blood sugar levels daily, others less often. Your doctor will guide you based on your treatment plan.

It's important to understand how to use tools that monitor your blood sugar. There are two options for tracking your daily blood sugar levels:

Blood glucose meter. This involves poking your finger to get a small drop of blood and then putting that blood on a disposable test strip. When you insert the strip into the blood glucose meter, the display tells you your blood glucose level.
Continuous glucose monitor. Unlike finger-stick tests, which show your blood sugar at just one moment, this device uses a tiny sensor placed under the skin to check glucose in the fluid between your cells and sends the information wirelessly to a smartphone or reader. Many devices also provide alerts when levels are too high or too low, helping you make safer decisions about insulin, meals, and physical activity.

In general, doctors recommend these daily blood sugar goals:

Before meals: about 80 to 130 mg/dL
One to two hours after meals: less than 180 mg/dL

These numbers are just general guides. Your doctor will help you understand what targets make sense for you.

Something commonly used to track diabetes control over time is the A1c test. It shows your average blood sugar over the past two to three months. Most adults with type 2 diabetes aim for an A1c below 7%. Your doctor may set a different goal based on your age, other health conditions, and risk of low blood sugar. Talk to your doctor to be sure you understand your A1c goals as you create your diabetes management plan.

Lifestyle Changes That Matter

Daily habits play a major role in controlling type 2 diabetes. Eating a balanced diet, staying physically active, and lowering your stress can all help keep your blood sugar levels in a safer range. These steps can also help you maintain a healthy weight. When you're overweight, losing even 5%-10% of your body weight can significantly improve blood sugar, blood pressure, and cholesterol.

Choosing diabetes-friendly foods

Food is one of the most powerful tools you have to manage diabetes. The key is to learn how different foods affect your blood sugar so you know what to focus on and what to eat in moderation.

A diabetes-friendly eating pattern usually includes:

Plenty of non-starchy vegetables (like peppers, zucchini, spinach, and broccoli)
Lean proteins (chicken, fish, eggs, and beans)
Healthy fats (olive oil, avocado, and nuts)
High-fiber carbohydrates (whole grains, beans, and lentils)

Be aware that carbohydrate-heavy foods such as breads, pastas, potatoes, rice, and certain fruits and vegetables raise your blood sugar more quickly than protein or fat. Pairing carbs with protein and fiber helps lessen blood sugar spikes.

Sugary drinks like sodas, sweet tea, and juices and high-sugar foods such as cake, candy, and ice cream can raise blood sugar very quickly. Cutting back on your sugar intake is one of the most effective steps you can take early on.

Instead of overhauling your whole menu, you may find it helpful to instead start with substitutes or alternative ingredients in your favorite recipes. Sometimes just focusing on portion size can also make a big difference.

For example:

Choose corn tortillas instead of flour tortillas.
Grill meats instead of frying them.
Go for brown rice instead of white.
Add vegetables to rice dishes to lower the blood sugar impact.

A dietitian is a helpful resource to tap into as you learn new diabetes-friendly eating patterns. Ask your diabetes team for a referral.

When in doubt, stick to the American Diabetes Association's guideline for a healthy plate:

Fill half your plate with non-starchy vegetables, such as spinach, carrots and tomatoes.
Fill a quarter of your plate with lean protein, such as tuna, lean pork, or chicken.
Fill the last quarter with a carbohydrate, such as brown rice or a starchy vegetable, such as green peas.

Creating an exercise routine

Exercise helps your body use insulin better, lowers blood sugar, supports weight loss, and improves mood and energy. You don't need a gym membership or expensive equipment to get physical activity. Any kind of regular, heart-pumping, muscle-using movement can make a difference.

If you haven't already been working out, start simple:

Take a walk after dinner.
Turn on music in your home and dance for 15 minutes.
Adopt a daily stretching routine.

Once you've started moving more, aim for:

At least 150 minutes of moderate (think a brisk walk) activity per week, split up however works best for your schedule
Muscle-strengthening activities two days per week using light weights or resistance bands

Most of all, find exercise you enjoy. You want to create a habit that improves not only your blood sugar, but your life overall. Make it a social event or find a workout buddy to help keep you motivated and committed.

Managing stress

You may not know that high stress levels can raise your blood sugar. Your body responds to stress by releasing cortisol and adrenalin. These are hormones that increase your blood sugar and blood pressure as part of the body's "fight or flight" response.

The more stressed you are, the more likely you are to use unhealthy habits to cope, which can derail your diabetes management, too. Putting stress relief habits into your daily routine can help ground and buoy you through the natural highs and lows of life.

Helpful strategies include:

Walking or stretching
Prayer or meditation
Talking with family or friends
Getting seven to nine hours of sleep when possible
Practicing gratitude and acceptance
Journaling
Relaxation techniques such as breathing exercises

Medications for Type 2 Diabetes

Many people with type 2 diabetes need medication. Taking medication does not mean you failed. It means your body needs extra help. One medication may control your blood sugar well, or you may need a combination of medications for best results.

Some medicines you take as a pill, while others you take as an injection. The most common options doctors prescribe are:

Biguanides

Biguanides are often the first class of medication doctors turn to for blood glucose management in diabetes. They work by lowering the amount of sugar your liver makes and helping your body use insulin better. Typically you take them twice a day with food.

Sulfonylureas

These are pills you take once or twice a day by mouth to help your pancreas release more insulin. They're good at lowering blood sugar, but some people have a problem with their blood sugar going too low and they also gain weight.

DPP-4 inhibitors

These medications help increase insulin release after meals and lower sugar production. You take them as a tablet by mouth once a day.

GLP-1 receptor agonists

These medications help lower blood sugar, slow digestion, and reduce your appetite so it's easier to control portions when you eat. Often GLP-1s lead to weight loss, which also improves blood sugar control. Some GLP-1s are injections and some are pills.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors

SGLT2 inhibitors are pills that help your kidneys filter glucose out of your blood so you pee more of it out and lower your blood glucose levels. Your doctor may choose this medication option if you have kidney or heart issues.

Thiazolidinediones (TZDs)

These drugs help insulin work better in your muscle and fat and lower the amount of glucose your liver makes. You take them once or twice a day by mouth.

Other less commonly prescribed diabetes medications include:

Alpha glucosidase inhibitors
Bile acid sequestrants
Dopamine-2 agonists
Meglitinides

Your doctor may prescribe these if other options aren't working well for you.

Insulin

Insulin therapy is a key treatment for people who live with type 1 diabetes (where your body can't make any or enough insulin). But about a third of people with type 2 diabetes also benefit from insulin injections to keep their blood sugar levels stable. You take it as a shot or with an injector pen. Some people use an insulin pump they wear throughout the day. There's also an inhaler you use to breathe in insulin through your mouth.

Looking to the Future

As your body changes, your diabetes management plan may change, too. You might need different medications, dosage adjustments, or new strategies for eating or exercise. This is normal. Metabolism changes with age and other medical conditions, and your life will change in all kinds of ways that may affect your blood sugar levels.

The key is to stay engaged with your diabetes care team. Check in if you find yourself having trouble keeping your blood sugar in a healthy range. And remember, you're not alone. More than 34 million people in the U.S. live with type 2 diabetes. As you navigate this lifelong journey, reach out to others who know what life with diabetes is like to build a community that can encourage and support you along the way.