You should see your doctor every three to four months for an A1C test and, if necessary, a reevaluation of your treatment plan.
Even if you’re taking steps to manage your type 2 diabetes, you may find that your treatment plan isn’t as effective as it once was.
This is because type 2 diabetes is a progressive disease, which means it evolves and becomes more difficult to manage with time. As the condition worsens, your body may generate less insulin or become more resistant to the insulin it does produce, necessitating medication adjustments. If oral medication and lifestyle changes aren’t enough to control your diabetes, you may need to add a non-insulin injectable or insulin to your treatment regimen.
“Diabetes is a complicated disease, and everyone’s diabetes is different,” says Jeremy Beaulieu, a nurse practitioner, and certified diabetes care and education specialist (CDCES) at Boston’s Joslin Diabetes Center. “Diabetes management is not a one-size-fits-all solution.”
If you believe you need to increase your treatment plan, here are some questions to ask your doctor.
1. Why isn’t my type 2 diabetes treatment plan as effective as it once was?
“Many patients with diabetes believe they need to look into new medicines because what they’re doing now isn’t working,” adds Beaulieu. Even if you eat a balanced diet, exercise regularly, and follow your doctor’s treatment plan, you may notice that your blood sugar (glucose) or A1C levels are rising. This could be due to a variety of factors, including the progression of your type 2 diabetes, the development of a health condition related to your diabetes, or another drug you’re taking interfering with your diabetes therapy, to name a few. If your A1C continues to climb after making additional dietary changes and exercising more than ever, it’s time to talk to your doctor about a change.
2. Why would injectable medicine be necessary in my treatment plan?
According to the National Institute of Diabetes and Digestive and Kidney Diseases, many persons with type 2 diabetes can control their symptoms by consuming a nutritious diet and increasing their physical activity (NIDDK). However, some persons with the illness require medicine as well. M. James Lenhard, MD, an endocrinologist and the medical director of Christiana Care Health System’s Diabetes and Metabolic Diseases Center in Wilmington, Delaware, says it depends on how well your blood sugar or A1C levels are controlled. If diet and exercise are no longer enough to keep your blood sugar levels in check or meet your A1C goal, your doctor may prescribe an oral prescription (pills). To help control your blood sugar, you may need to adjust your medication, add medication, or take medicine that you inject under your skin, such as insulin or non-insulin injectables. Even if you don’t typically take insulin, you may need it at times, such as while pregnant or if you’re in the hospital for another reason, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
3. What types of injectable diabetic medicines are available?
Non-insulin medicines and insulin, a synthetic form of the hormone generated by the pancreas that aids in the movement of glucose into your cells, where it is used for energy, are among the injectable therapies for type 2 diabetes, according to the NIDDK. Injectable insulin is used to help patients whose bodies don’t create enough insulin to naturally control their blood sugar levels. According to the Cleveland Clinic, the medication reduces glucose levels by enhancing glucose absorption in muscle and adipose tissue and decreasing glucose release from the liver. According to the Cleveland Clinic, there are numerous varieties of prescription insulin products available, and each varies in terms of how quickly it begins to act when it peaks, and how long it remains effective. Insulin can be injected into the abdomen, legs, backs of arms, or buttocks. Insulin pumps and inhaled insulin are also available.
According to the Cleveland Clinic, there are various non-insulin injectable diabetes medicines available. These are intended to retain food in your stomach for longer and enhance insulin production as you eat while limiting the amount of blood sugar (or glucose) produced by your liver. According to the Cleveland Clinic, your doctor should work with you to determine the best insulin or non-insulin injectable medication for your diabetes.
4. Does it mean I’ve failed to manage my type 2 diabetes if I need to take insulin or another injectable?
It’s not a sign that you’ve failed if you need to take insulin or another injectable medication to assist manage your diabetes. Dr. Lenhard notes that while some patients with type 2 diabetes may eat better, exercise more, or be more disciplined about taking their prescribed oral medicine treatment, the disease is “a progressive genetic problem,” meaning that the pancreas often produces less insulin as they age. “Staying active and maintaining a healthy weight will only slow the process down.” They don’t put a stop to it.” Many persons with type 2 diabetes find that switching to insulin or another injectable is a necessary response to their condition’s ever-changing nature. However, this does not imply that you should abandon your healthy lifestyle choices.
5. Needles terrify me. How can I make injections go more smoothly?
Many people are afraid of needles, thus some type 2 diabetes drugs were created with this in mind, according to Beaulieu. “You don’t even see the needle” with some non-insulin injectables, for example. He explains, “All you have to do is lay a pen-shaped gadget on your abdomen and press a button.” “The mechanism injects the medicine, and you then remove it and discard it.” It takes around a minute to complete the operation.” Other injectables, he adds, employ extremely small needles — around 2 to 3 millimeters long — to deliver the medicine just beneath the skin. According to Beaulieu, talking to your doctor or a CDCES about your concerns can also help. “I’ve found that educating a person with type 2 diabetes how to administer an injection in person and guiding them through it helps to alleviate a lot of the worry,” he says. “Once someone has done it and seen that it doesn’t hurt and is quite simple to do, they usually have no problems.”
6. Will I need to take any more diabetes medications, such as tablets, in the future?
Metformin, which comes in pill form, is the oral treatment of choice for most people with type 2 diabetes, at least at first. According to Kaiser Permanente, metformin is designed to control the amount of blood sugar released by your liver, but it does not assist your body make more insulin. As a result, your doctor may decide to maintain you on your oral medication as you transition to an injectable, according to Lenhard. This is referred to as “combination therapy.” Depending on how successfully your body produces insulin, you may eventually quit taking the oral medicines and exclusively use injectables, according to Kaiser Permanente.
7. How will I know whether or not my new treatment is effective?
If your A1C values drop below the goal number set by you and your doctor — usually 7% for most adults, according to Lenhard — you’ll know your new medicine is working. In contrast, if your A1C levels remain high, you’ll know it’s not working. An A1C test tracks your blood sugar levels over the course of two to three months. Your A1C, blood pressure, blood sugar, and cholesterol levels should be examined every three to four months, and your treatment plan should be reevaluated if necessary, according to Lenhard. It’s crucial to remember that A1C tests give you an average level over several weeks or months, which is why you should do at-home blood sugar tests as directed by your doctor to evaluate how your medications are affecting your levels on a daily basis, he says.
8. Do I also need to make changes to my diet and exercise routine?
Perhaps, says Beaulieu. If you’re eating a balanced diet for type 2 diabetes and exercising frequently but still can’t reach your goal blood sugar or A1C levels, there’s a good chance that no amount of dietary adjustments or additional exercise will help; you’ll need to start taking medication, he says. “A good diet and getting adequate exercise will always form the backbone of diabetes control, and it doesn’t hurt to reconsider what you’re doing if it doesn’t seem to be working,” he says, “and it doesn’t harm to reexamine what you’re doing if it doesn’t seem to be working.” Discuss lifestyle modifications with your doctor or a trained diabetes educator to see whether they can help your treatment be more effective.
9. Will I have to make any changes to my treatment plan in the future?
It’s conceivable. As previously stated, type 2 diabetes is a progressive disease that develops with time. That’s why, according to Lenhard, you should check your blood sugar and A1C levels on a frequent basis to ensure your treatment strategy is functioning. If your doctor suggests a change, the first strategy you attempt might not work, according to Beaulieu. “Some people will respond better to one class of drugs than another due to underlying genetic variance,” he explains, “while others may respond better to dietary changes and others will respond better to exercise.”
“Plus, as patients become older, we desire their A1C to be a little bit higher, usually 8% or less,” says Beaulieu, “especially if they’re on drugs that can induce low blood sugar or insulin.” ‘As someone gets older, the tighter control they have, the more they risk having low blood sugar levels, which puts a burden on the body and, in an older adult, may be quite dangerous and lead to falls, which can lead to fractures.’