Once diagnosed, the immediate goal for patients is to stabilize their glucose (blood sugar) levels. Their physician will recommend a target glucose range. The patient will aim to keep glucose levels within the physician-recommended range with a combination of diet and exercise, usually along with antidiabetic agents and sometimes insulin.

Usually, the first treatment for type 2 diabetes is meal planning, weight loss and exercise. Nutrition counseling and meal planning often involve cutting calories, replacing a few large meals a day with several small meals, replacing sugars and starches with nutritious high-fiber complex carbohydrates, and trading saturated fats and trans fats for lean protein and monounsaturated and polyunsaturated fats.

Losing weight and increasing activity levels can help lower the body’s resistance to insulin. Exercise also reduces glucose levels by taking glucose from the blood and using it for energy. For those with various medical conditions outlined below, exercise programs need to be carefully monitored by a physician.

When these steps are not enough to bring glucose levels down near the normal range, the physician may recommend medication.

Type 2 diabetes may be treated with glucose-lowering medications, and if these agents fail to control blood sugar, the physician may prescribe insulin.

Antidiabetic agents used to treat type 2 diabetes include:

• Alpha-glucosidase inhibitors. Block the breakdown of complex carbohydrates in the intestine, as well as some simple carbohydrates.
  
  
• Biguanides. Decrease the amount of glucose produced by the liver. They may also lower insulin resistance in the muscles.
  
  
• Meglitinides. Stimulate the beta cells of the pancreas to release more insulin in response to a meal.
  
  
• Sulfonylureas. Stimulate the beta cells to produce and release more insulin.
  
  
• Thiazolidinediones. Lower insulin resistance. This helps insulin work better in muscles and fat cells and reduces glucose production in the liver.
  
  
• DPP-4 inhibitors. Affect the pancreatic alpha cells and beta cells to reduce release of glucose from the liver and increase production of insulin.
  
  
• Incretin mimetics. Injected medications that promote insulin production by the beta cells and perhaps restore the beta cells themselves. They may also make the body more sensitive to insulin and promote weight loss.
  
  
• Synthetic amylin. Injected drug that may be prescribed to people who have unstable diabetes despite the use of insulin.
  
  
• Combination antidiabetic agents. A combination of medications can be used to treat type 2 diabetes.

The physician may also prescribe other medications including diet pills to reduce obesity, antihypertensives to lower blood pressure and cholesterol drugs to improve levels of blood fats.

A physician may also recommend insulin therapy. According to the American Diabetes Association, 30 to 40 percent of patients diagnosed with type 2 diabetes use insulin therapy to control their diabetes. Patients may need to take insulin on its own or in addition to antidiabetic agents. Forms of insulin administration include syringe injections, insulin pens, insulin pumps, jet injectors and inhaled insulin.

Daily glucose testing may be necessary. Glucose monitoring can alert patients when their glucose levels are above or below their target range. If readings are frequently out of range, a physician may recommend a change in the patient’s diabetes management plan.

Type 2 diabetes increases a person’s risk of developing many serious complications such as nerve, eye, kidney and blood vessel damage. Patients can delay or prevent the onset of these complications by controlling their glucose, cholesterol and blood pressure. However, many diabetic individuals do not meet their recommended goals.

Patients will require regular medical checkups to screen for developing problems. According to recommendations of national healthcare organizations, at each visit with their healthcare provider, patients should have the following checked:

• Blood pressure
• Weight
• Feet
• Eyes

At least twice a year, patients should have:

• Glycohemoglobin tests
• Dental exams and teeth cleanings (every three months for many patients)
• Visit with their endocrinologist

Once a year, the ADA recommends that diabetic individuals have:

• A cholesterol test. (Some people may need to be tested more often.)
  
  
• A dilated eye exam by an ophthalmologist.
  
  
• A complete foot exam, including inspection and sensation checks. (Patients with neuropathy or deformities such as hammertoes or bunions may need to have more frequent foot exams.)
  
  
• Urine tests for proteinuria
  
  
• A flu shot

In addition to these guidelines, patients with type 2 diabetes should also have a pneumonia vaccination at least once in their lifetime. Patients who are 65 and those suffering from chronic illness or a weakened immune system may require an additional pneumonia shot five to 10 years after their first one.

A physician can create a sick-day plan in advance to help patients cope with infections and other health problems.

Patients may need to see various specialists to screen for or treat complications ranging from heart conditions to sexual dysfunction. Recent research suggests suggests that screening procedures such as a stress test can find coronary artery disease in many people with type 2 diabetes, even those with no cardiac symptoms or risk factors. Patients may wish to ask their physician if such screening methods are recommended for them.