Your type 2 diabetes treatment is not only unique to you, but it's also likely to change over time as your needs change. It might be a tweak to help you achieve better blood sugar control, or it could be a reduction in medication if your lifestyle changes have had a positive effect on your health, according to U.S. Department of Health and Human Services national diabetes management guidelines.
To create and refine a treatment plan to suit your individual needs, your doctor reviews and monitors your health information — such as your weight, A1C levels, and other lab data — with the most recent diabetes treatment guidelines.
Your type 2 diabetes treatment plan might need to be adjusted if:
  • You aren’t achieving optimal blood sugar control.
  • You’re achieving control and no longer require certain medications.
  • You’re experiencing unpleasant side effects from a medication.
  • Your health insurance won’t cover the recommended medications.
  • New medications are available that may be better for you.
Blood Sugar Testing for Type 2 Diabetes
A primary indicator of how well your type 2 diabetes treatment is working — and whether it needs adjusting — is your blood sugar level. Fasting blood sugar levels are the traditional way to track diabetes, but the A1C test is the gold standard. This blood test shows your doctor how well your blood sugar has been controlled on average over the past three months, according to the American Diabetes Association (ADA).
“Nearly everyone should have an A1C that’s less than 8 percent, but how much less than that depends on the person,” explains endocrinologist Elizabeth Seaquist, MD, a professor of medicine and the Pennock Family chair in diabetes research at the University of Minnesota Medical School in Minneapolis. Although most people find that their target A1C is about 7 percent, some may have higher or lower goals depending on their overall health and other factors.
Your doctor may recommend A1C testing every three or six months. At the same time, you should be doing your own blood sugar testing at home to help keep track of how your body responds to diet, exercise, and other aspects of your daily life.
However, because diabetes is a progressive disease, most people will likely require changes in their treatment plan, including different medications, over time. “Once you achieve your target with one class of medicines, your A1C will tend to go up over the years,” Dr. Seaquist says.
Between A1C tests, she says, if you notice that your levels are consistently higher than they should be when testing your blood sugar at home, call your doctor to discuss the situation. Most people can’t “feel” high blood sugar (hyperglycemia) as it's happening, but the ADA states that you could experience some hyperglycemia symptoms, such as insatiable thirst and urinating a lot, as the body tries to get rid of excess blood sugar — other important signals that your doctor might need to adjust your treatment plan. Never stop or alter aspects of your treatment plan on your own. Be sure to consult your doctor first.
Adjusting Your Type 2 Diabetes Treatment
The primary reason for a change in treatment is that your blood sugar levels remain high despite your best efforts to carefully follow your type 2 diabetes treatment plan. Adjustments to your plan might include:
  • Reviewing lifestyle modifications to make sure you’re eating and exercising correctly.
  • Trying a new medication or adding a medication to your current regimen.
  • Replacing a medication that has numerous side effects with one that has fewer side effects.
  • Adding insulin to your type 2 diabetes treatment if non-insulin approaches aren’t enough.
  • Taking insulin temporarily to bring down dangerously high blood sugar levels.
If your original plan was to manage diabetes with diet and exercise alone but you don’t see results in three to six months, your doctor might adjust your plan by starting you on a medication, such as metformin. From there, your doctor will work with you to further evaluate and determine just the right medication to suit your preferences and lifestyle.
Managing Side Effects From a Change in Treatment
Depending on the changes your doctor prescribes, you may experience side effects with an adjustment to your type 2 diabetes treatment plan. Among the most common side effects listed in national diabetes management guidelines are:
  • Low blood sugar
  • Nausea
  • Weight gain
  • Fluid retention
To best adapt to any adjustments, make sure you understand the changes being made to your treatment plan and that you’re aware of all possible side effects of any medications you’re taking, Seaquist says. On a positive note, many side effects are temporary and will likely go away as your body adjusts to these changes and gets used to new or different drugs, she adds.
The most recent diabetes treatment guidelines emphasize that diabetes treatment should be tailored to the individual. This means that you and your doctor have a lot of flexibility in crafting a plan that works best for you, which includes being able to make changes to your treatment plan when necessary.