Treating diabetes starts with the development of a personalized strategy to lower your blood sugar levels and keep them stable. That’s because high blood sugar levels can lead to a number of complications over time, such as an increased risk for heart disease, stroke, blindness, numbness or pain in the feet and legs, known as diabetic peripheral neuropathy, and amputation, according to the American Diabetes Association (ADA).
“When you are newly diagnosed, the sooner you can get blood sugar under control, the fewer complications you will see down the line,” explains Dr. Lakshmi Goudar, an endocrinologist with Sentara Endocrinology Specialists in Norfolk, Virginia.
If you’ve just been diagnosed, your doctor is likely to recommend metformin—usually as a generic but also available under such brand names as Fortamet, Glucophage, Goumetza and Riomet—along with a healthy diet, regular exercise and weight loss, according to the latest care guidelines issued by the ADA. Your doctor will work with you to set blood sugar targets, or goals, that you should aim for.
First approved by the Food and Drug Administration in 1995 for treating diabetes, “metformin is still the first-line treatment,” Goudar says. That's because it's effective and safe for most people, and also is less costly than many other treatment options. The drug, an oral medication, works by increasing your body’s ability to use the insulin your pancreas naturally makes. Insulin helps your body use blood sugar so that it doesn’t run high. Metformin also reduces the amount of blood sugar your liver makes.
If your blood sugar levels were very high when you were first diagnosed with diabetes, you might also be prescribed insulin to stabilize your blood sugar and help your pancreas, which has been working hard to try to manage your blood sugar levels.
“The only way your pancreas can rest is to give insulin,” Goudar says.
Diabetes Treatment Plan
While you and your doctor work on your treatment plan, it’s also important to devise a plan for diabetes-friendly meals, regular exercise and weight loss. To control your diabetes, you should be moderately physically active at least 150 minutes a week, as well as doing two or three strength-training workouts weekly.
“Exercise increases insulin sensitivity,” says Goudar, which means that your body can use insulin more effectively, helping to make all your other treatment strategies more successful. Exercise also helps with weight loss. Losing at least 5 percent of your body weight can improve diabetes control. Consider working with a certified diabetes educator to plan a diet, exercise and weight-loss program that will help control your blood sugar levels.
To find out how your treatment plan is going, your doctor will periodically check your fasting blood sugar levels, and you'll also have an A1c test, which measures your average blood sugar level for the past three months, explains Goudar. You'll also need to learn how to check your blood sugar at home so you can control your levels throughout the day.
If your blood sugar levels are not responding, or you cannot take metformin for some reason, your doctor might recommend a new medication or combination of diabetes medications from seven different drug classes, as well as insulin.
“I want you to think of all the meds I can put you on as part of an arsenal to fight diabetes,” Goudar says.
For your part, she says, it's important to remember that diabetes treatment is personalized. Share any and all concerns with your doctor, whether you’re worried about cost, the time it takes to manage diabetes, what you can eat or side effects of treatment.
With all the available options, changes to your treatment plan are almost inevitable—but they don't mean you haven't managed your diabetes. Rather, tweaking your treatment plan is how you and your doctor can work together to find the right treatments for you.