Type 2 diabetes doesn’t stand still. Symptoms can change over time. So can the way your body responds to diabetes medicine. That means controlling type 2 diabetes is like trying to hit a moving target – you have to make adjustments.

The foundations of good diabetes control don’t change, though: every type 2 patient should control carbohydrate intake by watching what he or she eats, and should get plenty of exercise, lose excess weight, and quit smoking. These important lifestyle changes may be enough to keep your blood sugar under control. They are not only good for managing diabetes; they benefit your overall health. And they come without the expense and possible side effects of medicine.

When pills may be needed

If your blood sugar levels are still too high, a prescription pill is usually the next step. Oral medications only help people with type 2 diabetes; type 1 patients rely on insulin injections. (Some type 2 patients need to inject insulin too.) Pills are taken in addition to the healthy lifestyle measures mentioned above; they don’t replace them.

Many doctors’ first choice in oral diabetes drugs is metformin, a well-proven and inexpensive drug. It helps your liver to send less sugar (glucose) into your blood stream, and also helps your body make better use of its insulin to lower your blood sugar.

Pills work best in the early years of type 2 diabetes. They may lose effectiveness over time. It’s not clear why, but doctors usually don’t think this means that your diabetes is getting worse. It simply means that it’s time for a change.

Drugs work differently

There are several different classes of diabetes drugs. Each kind works in different ways to help control blood sugar. It may take a little trial-and-error for your doctor to find the right diabetes medication for you to start with. Then if your first drug stops working as well as it used to, or if it never did enough even with an increased dose, adding one or more other drugs that attack the problem differently may be just the thing to get your blood sugar back where it belongs – and keep it there.

This multi-drug approach, called “combination therapy,” has proven remarkably effective in many cases of persistent high blood sugar. Why, then, doesn’t your doctor just give you two or more oral diabetes medicines to begin with? Because like all prescription medicines, each of these pills comes with its own possible risks and side effects, and its own expense. Your doctor knows that it’s best to seek the fewest drugs and smallest doses that will give you the blood-sugar control you need. So it’s a good idea to start with one pill and see what happens before making adjustments.

How you can help

Being a good patient will help you to get the best care from your doctor. Follow instructions, take all your medicines as directed, bring records of your blood sugar levels to your appointments, ask questions, and always let the doc know about any changes in your symptoms.

To learn more about oral diabetes medications:
Can Diabetes Pills Help Me?
How to Avoid the 6 Most Common Medication Mistakes: Part 1
How to Avoid the 6 Most Common Medication Mistakes: Part 2