Diabetes Treatment

January 7, 2025

This page was reviewed under our medical and editorial policy by Ping H. Wang, M.D., professor and chair, Department of Diabetes, Endocrinology & Metabolism, City of Hope^® Cancer Center Duarte

After receiving a diagnosis of diabetes, it is important for patients to learn as much as possible about the disease and how it affects the body. Treatment varies depending on the individual and the type of diabetes diagnosed.

Key ways to manage diabetes include learning how to check and manage blood sugar levels, making certain lifestyle changes and taking doctor-recommended medications.

How to Manage Diabetes

To manage diabetes, patients need to make daily lifestyle changes in various areas, such as what they eat and drink to how they manage stress.

Diet: Healthy eating for people with diabetes means more than simply avoiding or adding certain foods. It means striking a balance to manage blood glucose (sugar). There are many diabetes friendly meal plans, and patients should consider following a regimen recommended by their doctor or nutritionist. A healthy eating plan should include foods and meals containing:

• Healthy fats (such as nuts, avocados, eggs and peanut butter)
• Nonstarchy vegetables (such as carrots, broccoli, asparagus or cauliflower)
• Lean protein or plant-based protein (such as beans, chicken, fish and eggs)
• Healthy carbohydrates such as low-fat milk and whole grains (oatmeal, brown rice) while being mindful of sugar content in fruits and starchy vegetables (such as corn, potatoes)
• Water and no-calorie beverages

People with diabetes should avoid foods and drinks that are overly processed and have added sugars, such as cookies, cakes, sodas, sports drinks and others.

As a starting point, a person with diabetes may consider the “plate method,” recommended by the American Diabetes Association and many other experts.

It starts with a 9-inch plate, such that:

• Half is filled with nonstarchy vegetables
• A quarter is filled with lean protein (such as chicken or fish)
• A quarter is filled with fruit, starchy vegetables, low-fat dairy or whole grains

Counting carbohydrates (carbs) is another key feature of meal planning. When people consume foods or drinks containing carbs, they are broken down into glucose (sugar), which provides energy for the body. It also boosts the level of glucose in a person’s blood. Regulating blood sugar is key to managing diabetes. Too much glucose in the blood is known as hyperglycemia; too little is hypoglycemia. A certified diabetes care and education expert or a nutritionist may be able to advise a patient on the appropriate amount of carbs to eat, what to pair them with and how to manage any needed dietary changes.

Exercise: Following a doctor-recommended exercise routine is another vital step in managing diabetes. Physical activity helps to lower blood glucose, blood pressure and cholesterol. The typical recommendation is for 150 minutes of exercise per week. Patients should aim for moderate activity, such as walking briskly, water aerobics, tennis or ballroom dancing. Chores such as gardening or house cleaning also count as exercise. For reference, a person engaging in moderate physical activity is able to talk, but not sing during the activity.

Stress management: Stress and lack of sleep may affect blood sugar levels. Adults should aim for seven to eight hours of sleep each night; children often need more. Quiet activities such as yoga or meditation may be helpful in managing stress.

Illness: A cold or the flu may cause a person’s blood sugar to rise. Having a plan in place ahead of time may make it easier to manage an illness. This includes knowing:

• What to eat and drink
• How frequently to check blood glucose
• How to check for ketones (what the body breaks fat into when there is not enough sugar present)
• How to adjust insulin or other medications
• When to call the doctor (vomiting, diarrhea or a fever of 101 degrees Fahrenheit or higher for 24 hours or longer)

Alcohol: Drinking alcohol along with certain diabetes medications or insulin may cause blood sugar to become too low. How a person with diabetes responds to alcohol depends on factors such as:

• Having a drink with a meal versus on an empty stomach
• How long a person has been drinking alcohol
• Medication use
• The number of carbs in the alcoholic drink

Patients are advised to consult their doctor about alcohol use and follow their advice when it comes to drinking.

Diabetes Medications

Different types of medications are used to treat people with diabetes, including drugs that are taken by mouth or injected under the skin. The treatment plan for each patient will vary, depending on the type of diabetes as well as any other health conditions. Treatment may include the following. Diabetes patients should consult their physicians to discuss which treatment is most appropriate for them.

Insulin: Normally, the pancreas makes insulin to regulate levels of glucose in the blood. With diabetes, it is unable to make enough insulin to do the job. Injecting insulin under the skin replaces what the body is missing. It is prescribed for type 1 diabetes and may be needed for type 2 diabetes. The type of insulin prescribed hinges on patients’ activity and schedule, their diet and how insulin works for them. The main difference between insulin types is how fast they start to work and how long the effects last. Most insulins have to be injected into the body using a syringe, a pen or a pump.

Alpha-glucosidase inhibitors: These drugs, prescribed for type 2 diabetes, lower blood sugar by blocking the breakdown of starchy foods in the intestines. This keeps blood sugar from rising too fast when a person eats foods like potatoes, bread and pasta. These drugs must be taken with the first bite of every meal. Examples of alpha-glucosidase inhibitors include acarbose and Glyset^® (miglitol).

Amylinomimetic injectables: Symlin^® (pramlintide acetate) is known as an amylinomimetic injectable and may be prescribed for type 1 or type 2 diabetes. When a person takes insulin with a meal and it is not working well enough, an amylinomimetic may help. This drug slows the passage of food from the stomach to the intestines, helping keep blood sugar levels under control and more steady. It may also suppress appetite.

Biguanides: Metformin is a biguanide, which lowers glucose production by the liver. People taking metformin may also respond better when they take insulin. Metformin is usually used to treat type 2 diabetes.

Dipeptidyl peptidase-4 (DPP-4) inhibitors: Dipeptidyl peptidase-4 (DPP-4) inhibitors help control blood sugar by preventing natural hormones known as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) from breaking down. When those hormones stay active, they control blood sugar when it is too high. DPP-4 inhibitors include Januvia^® (sitagliptin), Onglyza^® (saxagliptin), Nesina (alogliptin) and Tradjenta^® or Glyxambi^® (empagliflozin and linagliptin). This class of medications are for type 2 diabetes.

Dopamine-2 agonist: Cycloset^® (bromocriptine mesylate) is a dopamine-2 agonist approved for diabetes. It helps insulin work better in the body. This drug also helps to remove sugar from blood after meals. It is usually given in the morning for people with type 2 diabetes.

GLP-1 receptor agonists: GLP-1 receptor agonists are medicines that are usually injected under the skin. They help the pancreas create more insulin and improve the way insulin is supplied when blood sugar is high. They may also suppress appetite and help patients lose weight. These drugs are usually used to treat type 2 diabetes. GLP-1 receptor agonists include Bydureon^® (exenatide), Byetta^® (exenatide), Mounjaro^™ (tirzepatide), Ozempic^® or Rybelsus^® (semaglutide), Trulicity^® (dulaglutide), and Victoza^® or Saxenda^® (liraglutide). Rybelsus^® is a form of semaglutide that is taken by mouth.

GIP (glucose-dependent insulinotropic polypeptide): This is another hormone in the body that helps keep glucose levels steady. Mounjaro^™ is a combination GIP and GLP-1 receptor agonist used to treat type 2 diabetes.

Meglitinides: Meglitinides are prescribed for type 2 diabetes. These drugs help the pancreas supply more insulin. They are taken before eating to keep blood sugar low. Meglitinides include Prandin^® (repaglinide) and Starlix^® (nateglinide). They may cause blood sugar to get too low if not taken correctly.

Sodium-glucose transport protein 2 (SGLT2) inhibitors: SGLT2 inhibitors are approved for type 2 diabetes treatment. They lower blood sugar by working through the kidneys. These drugs help sugar leave the body in the urine. Drugs in this class include Brenzavvy^® (bexagliflozin), Farxiga^® (dapagliflozin), Invokana^® (canagliflozin), Jardiance^® (empagliflozin) and Steglatro^® (ertugliflozin).

Sulfonylureas: Used for type 2 diabetes, sulfonylureas help the pancreas make more insulin. While there are many sulfonylureas, ones commonly used include Amaryl^® (glimepiride), DiaBeta^® or Glynase^® (glyburide), and Glucotrol XL^® (glipizide). They are usually taken before meals, and may cause blood sugar to get too low.

Thiazolidinediones (TZDs): These medicines help insulin work better for people with type 2 diabetes. They also lower the amount of sugar that is made in the liver. Avandia^® (rosiglitazone) and Actos^® (pioglitazone) are the only TZDs. These drugs may cause or worsen congestive heart failure.

Learn more about:

Type 2 diabetes treatment

Type 1 diabetes treatment

Diabetes insipidus treatment