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Alternatives to Insulin for Type 2 Diabetes

The medications, lifestyle measures, and other treatments that can prevent or delay the need for insulin.

Over 37 million people in the United States have a form of diabetes; 90% to 95% of these people have type 2 diabetes. People older than 45 are more commonly diagnosed with type 2 diabetes. But it’s becoming more common among young adults, teens, and children.

How does a person develop type 2 diabetes? Your pancreas makes a hormone called insulin that moves sugar from your bloodstream and into your cells. Then, the cells use sugar (glucose) to create energy. Certain situations can make it harder for your cells to use sugar.

There are a couple of ways an individual can develop type 2 diabetes. This type of diabetes can result from:

  • A decrease in insulin secretion (the amount of insulin your pancreas makes)
  • A decrease in insulin sensitivity (your cells’ response to insulin). This is also known as insulin resistance.

Because of this, the amount of sugar in your blood builds up, causing hyperglycemia, or high blood glucose. If left untreated, hyperglycemia puts you at greater risk for:

  • Heart disease, including heart attack
  • Kidney disease
  • Amputations
  • Stroke
  • Vision loss

Why Are Non-Insulin Treatments Used for Type 2 Diabetes?

At the time of diagnosis, your health care provider might recommend certain pharmacological and non-pharmacological treatments for your type 2 diabetes. The main goal of treatment is to prevent or delay diabetes complications. Type 2 diabetes is a progressive condition, meaning that it can get worse over time. Early on in the condition, insulin resistance occurs, causing your cells to have a decreased response to insulin. Because of this, your cells have trouble taking sugar from your blood. But your pancreas is still making enough insulin to overcome this resistance.

As time goes on, your pancreas won’t be able to make enough insulin to overcome insulin resistance. Because of this, you eventually may need insulin therapy to manage blood glucose levels. The goal of non-insulin treatments is to keep you from getting to the point that you need to take insulin. These treatments help your cells use insulin better or increase insulin secretion. This, in turn, helps you achieve normal blood sugar levels.

Pharmacological Treatments for Managing Type 2 Diabetes

Type 2 diabetes treatment regimens differ from person to person, and over time you may need more than one medication to keep your blood sugar levels under control. Treatment is individualized based on these factors:

  • Your hemoglobin A1c (HbA1c or A1C) treatment target
  • Medication costs
  • Medication side effects
  • Other medical conditions you may have such as heart disease, high blood pressure, or kidney disease

Pharmacological treatments for type 2 diabetes include oral medications and injectable medications.

Oral Medications

There are six classes of oral medications that are commonly used to treat type 2 diabetes, listed below. Since some of the medications are prescribed together, they are sometimes available in combination tablets. These combination tablets tend to be expensive. But as more of the medications become generic, affordability should improve.

Biguanides

  • Medications: metformin (Glucophage)
  • Side effects: vitamin B-12 deficiency, increased risk of lactic acidosis

Dipeptidyl peptidase-1 (DPP-4) inhibitors

  • Medications: alogliptin (Nesina), linagliptin (Tradjenta), saxagliptin (Onglyza), sitagliptin (Januvia)
  • Side effects: angioedema, joint pain, and pancreatitis (inflammation of the pancreas)

Glucagon-like peptide -1 receptor agonist (GLP-1 RA)

  • Medication: semaglutide (Rybelsus)
  • Side effects: nausea and vomiting, pancreatitis, increased risk of thyroid cancer

Sodium-glucose cotransporter-2 (SGLT-2) inhibitors

  • Medications: canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance), ertugliflozin (Steglatro)
  • Side effects: urinary tract infections, increased risk of diabetic ketoacidosis, increased risk of amputations (canagliflozin, ertugliflozin)

Sulfonylureas

  • Medications: glimepiride (Amaryl), glipizide (Glucotrol), glyburide (Micronase)
  • Side effects: hypoglycemia, increase risk of death from heart disease, weight gain

Thiazolidinediones

  • Medications: pioglitazone (Actos) and rosiglitazone (Avandia)
  • Side effects: congestive heart failure, peripheral edema, bone fractures (especially in females), weight gain

Other classes of drugs that are less widely used but still have a role in treating type 2 diabetes include alpha-glucosidase inhibitors, amylinomimetics (Symlin), bile acid sequestrants, dopamine agonists, and meglitinides.

Injectable Medications

Your doctor may also recommend an injectable medication to help manage blood sugar. Besides insulin (the seventh most commonly used medication in the U.S.), several medications in the GLP-1 receptor agonist class (see previous section) are available as an injection. They are listed in the chart below along with how frequently they are injected. Side effects of the drugs include pancreatitis and increased risk of thyroid cancer.

Non-Pharmacological Treatments for Type 2 Diabetes

Non-pharmacological treatments are just as important as pharmacologic treatments for managing diabetes. Non-pharmacologic therapies include:

  • Diabetes self-management education and support (DSMES)
  • Weight management
  • Medical nutrition therapy
  • Mental health and well-being support
  • Physical activity
  • Smoking cessation

Here is more detail on some of these categories.

Dietary and Lifestyle Changes

Weight management plays an important role in preventing the progression of type 2 diabetes. Among other things, the benefits of weight loss include:

  • Better glycemic control
  • Lower blood pressure
  • Improved cholesterol levels

For most people, achieving and maintaining a weight loss of 5% or more is recommended. An energy deficit of around 500 to 750 calories per day can help you achieve this. This means your body uses 500 to 750 more calories than it takes in. A combination of nutrition therapy and physical activity can help you achieve this goal.

Medical Nutrition Therapy

Medical nutrition therapy involves meeting with a registered dietician who specializes in the dietary needs of people with diabetes. Research has shown that people who meet with a dietician have a greater decrease in their A1C levels than those who don’t. A lower A1C means your diabetes is better controlled.

Working with a dietician can help determine the best nutritional strategies for you. While everyone’s nutrition goals, tastes, and culture are different, some common types of diets that provide a benefit to those with diabetes include:

  • DASH (Dietary Approaches to Stop Hypertension)
  • Low carbohydrate
  • Low fat
  • Mediterranean
  • Vegan and vegetarian

Physical Activity

Physical activity is movement that increases your energy use. This can include playing soccer, taking a brisk walk, swimming, doing housework, or gardening. Exercise is a structured form of physical activity that often improves:

  • Blood glucose control
  • Heart health
  • Overall well-being
  • Physical fitness
  • Weight loss

Most people should aim for 150 minutes or more of moderate-to-vigorous aerobic exercise per week. You should also do resistance, strength, and flexibility training two to three days a week. Make sure to check with your health care provider before starting any physical activity program.

While this may seem like a lot of exercise, it’s okay to start slow. Try small stretches of aerobic activity for 10 minutes and work your way up to 30 minutes or more each day. Over time, you can increase your exercise intensity as your fitness levels improve.

Fitting exercise into your daily schedule can be a challenge. Look for opportunities to add leisure-time activities to your day. Try moving every 30 minutes to help break up sedentary behaviors, like watching TV or working on the computer. Something as simple as standing or performing light physical activities helps improve glycemic control.WEIGHT LOSS SURGERY

Can Weight Loss Surgery Help?

Weight loss surgery, also called metabolic or bariatric surgery, can aid in significant and long-lasting weight loss. In turn, this can help to improve blood sugar for people living with type 2 diabetes.

Up until recently, weight loss surgery was for people with a high body mass index (BMI). But given the degree and rapid improvement of glycemic control, weight loss surgery is sometimes an option for those without obesity.

There are a couple of different weight loss procedures available. Both involve making your stomach smaller. While these procedures are great for weight loss and glycemic control, they aren’t without risks. Talk with your health care provider to see if weight loss surgery is an option for you. They can help you understand all the associated risks and benefits.ALTERNATIVE TREATMENTS

Can Alternative and Complementary Treatments Help?

Herbs and Supplements

Many dietary supplements claim to either help prevent or to treat type 2 diabetes. The problem is that there is very little evidence to support these claims. Research has linked the following supplements to possibly helping to prevent and/or treat diabetes:

  • Alpha-lipoic acid: may improve symptoms of nerve damage related to diabetes (diabetic neuropathy), but evidence is limited
  • Chromium: might improve glycemic control, but evidence is limited
  • Cinnamon: studies show mixed results on the benefits of using it for diabetes
  • Magnesium: helpful in correcting low magnesium levels, but the benefit for type 2 diabetes is unclear
  • Omega-3 fatty acids: may impact glucose levels, but studies show mixed results
  • Resveratrol: weak evidence supports its role in controlling glucose levels

Dietary supplements can be harmful if taken in the wrong doses. For instance, large doses of certain types of magnesium can cause diarrhea or abdominal pain, while chromium can damage your kidneys. This is a concern for people with diabetes, as diabetes itself can lead to kidney damage.

Supplements can also interact with prescription medications and cause unwanted side effects. So be sure to talk to your health care provider or pharmacist before starting any supplements.

Mind and Body Techniques

Mind-body practices combine gentle movement with mind-based practices like meditation. They’re becoming popular for improving symptoms caused by metabolic syndrome, a cluster of conditions that increase your risk of developing type 2 diabetes. These conditions include:

  • High blood sugar
  • High blood pressure
  • High cholesterol
  • Insulin resistance

Yoga, meditation, and tai chi are a few techniques that have some evidence supporting their use. A review of available studies showed that yoga may benefit people with diabetes by improving:

  • A1C
  • Blood glucose levels
  • Doses of type 2 diabetes medications needed
  • Insulin sensitivity
  • Weight reduction

Qigong is another mind-body technique. It makes use of different exercises to optimize energy within your body, spirit, and mind. Qigong may improve blood glucose levels by reducing insulin resistance and glucose intolerance. However, research into its efficacy is limited.

Mind-body techniques can be helpful for several reasons. Besides having benefits for people living with diabetes, mind-body techniques can make you feel more relaxed and improve your mood and sleep quality. However, more research is needed to fully understand their role in managing metabolic syndrome.AFFORDING INSULIN

What If I Am Prescribed Insulin and Can’t Afford It?

Insulin costs have increased over the years, making it hard for many to afford this critical medicine. If, after trying non-insulin treatments for type 2 diabetes, your doctor determines that you need to take insulin, resources may be available to you to help with the cost. Both the American Association of Clinical Endocrinology and the American Diabetes Association have dedicated pages to assist those needing insulin. Additionally, some types of insulin can be purchased affordably for $25 per vial at Walmart.CONCLUSION

Bottom Line

Type 2 diabetes is a chronic medical condition that results in hyperglycemia. Treatment with medication and lifestyle changes helps to achieve glycemic control and prevent complications of diabetes. This can delay or prevent the need for insulin therapy.

While some studies suggest that dietary supplements may provide benefits for those living with diabetes, more research is needed. Mind-body techniques are becoming increasingly popular. However, their role in managing type 2 diabetes is not fully understood at this time.


https://www.endocrineweb.com/conditions/type-2-diabetes/insulin-alternatives

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