4 of the best ways to treat diabetes and lower blood sugar

From insider.com

To treat diabetes, you may need to take insulin, use medication like metformin, get regular exercise, and maintain a healthy diet. 

The best treatment for your diabetes depends on whether you have type 1 or type 2, but regardless, you will need to follow similar recommendations to effectively lower blood sugar. 

This article was reviewed by Jason R. McKnight, MD, MS, a family medicine physician and clinical assistant professor at Texas A&M College of Medicine

No matter what type of diabetes you have, the goal of diabetes treatment is to control blood sugars and keep them within the healthy range.

Type 1 diabetes must be treated with insulin, since the pancreas does not produce insulin naturally. People with type 2 or gestational diabetes don't always need insulin treatment, and will often focus on lifestyle changes and oral medications that encourage insulin production or decrease insulin resistance.

With proper access to healthcare, diabetes is highly treatable, says Katherine Araque, MD, an endocrinologist and director of endocrinology of the Pacific Neuroscience Institute at Providence Saint John's Health Centre in Santa Monica, California.

Here are the four main ways you can treat and manage your diabetes.

1. Take insulin

Insulin is a hormone produced in the pancreas in healthy individuals. It helps facilitate the process of converting blood sugar into fuel, so that glucose doesn't build up in the blood.
In people with type 1 diabetes, the pancreas cannot produce insulin, so they need synthetic insulin. This can happen in two ways:

• Daily insulin injections. Most people with type 1 diabetes need to take insulin at least three times a day, though this can vary. Your doctor will give you guidance and explain how and when to do injections. Injections are done at home by the patient. 
• An insulin pump. Insulin pump therapy delivers insulin through a catheter, which is a thin tube that is placed in the body semi-permanently and delivers insulin right into the tissue. The medication is the same as injections, but you won't need to give yourself daily shots.  

People with type 2 diabetes are treated with insulin when they are unable to control their blood glucose levels with lifestyle changes and medication. Overall, roughly 24% of people with diabetes are treated with insulin, according to a 2018 study published in Diabetes Care.

If you need insulin, your doctor will provide specific guidance on how much you need and when you should take it.

2. Use medication 

Although people with type 1 diabetes will need insulin, they may also be prescribed medication if they have some remaining pancreas function. The medication can encourage insulin production in the body.

People with type 2 diabetes are prescribed medication when they can't control their blood sugars through diet and exercise. Oftentimes, people with type 2 diabetes use more than one medication to control their condition.

However, medications are usually not recommended for pregnant people with gestational diabetes.

Common medications used to treat diabetes include:

Metformin 

Metformin is the most common medication used to treat type 2 diabetes. It's sometimes used to treat type 1 diabetes in people who still have some insulin production, along with insulin.
Metformin helps control blood sugar by making it easier for the body to absorb glucose. It's usually taken twice a day, with meals. Even when used alone, metformin can reduce A1C levels by 1.5% on average, which is enough to drop blood sugar levels from diabetes to prediabetes.

Sulfonylureas

Sulfonylureas are a class of drugs that encourage the pancreas to release more insulin. They're used to treat type 2 diabetes. They are often taken once or twice a day before meals.

Sulfonylureas have a similar efficacy to metformin, and can be used alongside it.

Thiazolidinediones (TZDs)

TZDs make it easier for the body to use insulin; they reduce insulin resistance. They can be used to treat type 2 diabetes. They are taken 1 to 2 times per day.
After a year of taking TZDs, people with type 2 diabetes reduced their A1C levels by 1.4%, according to a 2019 study published in Vascular Health Risk Management.

3. Get regular exercise

Exercise is important for people with all types of diabetes. "Exercise helps at multiple levels: it increases base metabolic rate, fights insulin resistance, and helps with weight loss," says Araque.

Exercise helps muscles burn glucose and reduces insulin resistance. When you exercise, your muscles burn more glucose, removing it from the bloodstream and helping to lower blood sugar levels.
For example, a 2017 study published in Biomedical Research followed 120 obese teens, who did two hours of aerobic exercise twice a day for six days a week. After five weeks, their average fasting blood sugar was reduced by 0.84 nanomoles per liter (nmol/L) for males and 1.04 nmol/L for females. The researchers described this as "an extremely significant difference."

The Centre for Disease Control and Prevention (CDC) recommends that people with diabetes get the normally recommended amount of exercise: 150 minutes of exercise each week, including two days of strength workouts that incorporate major muscle groups. The American Diabetes Association recommends starting with small changes, like walking daily. 

Any exercise will help, but some may be especially beneficial. For example, a 2019 study published in Diabetologia found that afternoon exercise decreased blood sugars more than morning exercise.

Overall, you should work with your doctor to identify an exercise program that will benefit you, Araque says.

4. Maintain a healthy diet 

Healthy eating is critical for people with diabetes. As food breaks down, it releases glucose into your blood. Some foods, including processed sugars and carbohydrates, raise blood sugars more than other foods, like proteins or leafy vegetables.
In particular, people with diabetes need to be aware of how many carbs they eat per day. They should also create an eating plan that includes the following:

• Eating lean proteins, whole grains, fruits, and vegetables
• Avoiding sugary drinks
• Limiting refined carbohydrates, like chips or cookies 

For example, the DASH diet and Mediterranean diet — which both emphasize healthy fats, lean protein, protein and vegetables — have been proven to help people with type 1 and type 2 diabetes control blood sugar.
Read more about the best ways to eat if you have diabetes:

• Best diet for diabetics
• Best snacks for diabetics  
• Can diabetics eat fruit? 
• Foods to lower blood sugar 

Takeaways 

Diabetes is a chronic but manageable condition, Araque says. People with diabetes should work with their doctor, nutritionist, and an exercise professional to design a program that meets their needs.

"The most important message is if they follow these recommendations they can get this under control and decrease risk for complications," Araque says. "Patients should have hope."

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