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Type 2 Diabetes: Sequencing Therapies

If you have type 2 diabetes, chances are your doctor has recommended lifestyle changes to improve your blood glucose control. But what happens when diet and exercise aren’t enough? When diabetes medications are needed, doctors generally take the following steps.

Step 1: Know your goals!

Your doctor can help you set personalized goals. For most people, the goal A1c level is lower than 7 percent. Elderly individuals with multiple health problems might have a goal closer to 8 percent. As you work towards your goal, be sure to tell your doctor if you experience any episodes of low blood glucose.

Keeping a log or diary, particularly of extreme drops or rises in blood glucose, can help your doctor choose treatments that will work best for your specific needs and avoid drugs that lower your blood glucose too much.

Step 2: Keep up the hard work!

Continue to eat a balanced diet and exercise regularly. Healthy lifestyle changes are key in people with type 2 diabetes. Be sure to follow your doctor’s instructions closely as you work toward your goals.

Sticking to your treatment plan wins the race when it comes to type 2 diabetes. Work with your doctor to ensure that every few months you are further along the path to your ideal A1c level than when you first began your treatment plan.

Step 3: When lifestyle changes aren't enough, metformin can help.

The diabetes drug metformin is often the first medication a doctor will prescribe for a person with type 2 diabetes. People often start on a low dose and work their way up to a dose that controls their blood glucose.

Step 4: When metformin isn't enough, other medications are available.

People with long-standing or uncontrolled diabetes often require a second or third type of oral pill in addition to metformin. If you have longstanding or uncontrolled diabetes, your doctor will choose among several available options to find the best treatment based on your medical history.

Step 5: Insulin injections are always an option.

If you’ve tried two or three types of oral pills with limited success, your doctor will likely suggest a single daily injection of insulin in addition to your other medicines. Those who take insulin must continue to monitor their blood glucose levels closely to avoid low blood glucose levels. Pills for diabetes may need to be continued, reduced or stopped completely once insulin is started.

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