1. Could switching my type 2 diabetes medication have an impact on my day-to-day diet or exercise routine?

It’s possible for a new type 2 diabetes medication to impact your exercise routine or diet. It depends on the medication you switch to. Some medications have minimal or no risk of hypoglycemia (low blood sugar). This means they wouldn’t have any effect on your exercise plans. However, some medications increase the risk of low blood sugar during exercise. For example, medications such as sulfonylurea (Glipizide, Glimepiride, Glyburide) and meglitinide (Repaglinide, Nateglinide) have this risk. The dose of the new medication may need to be adjusted.

Insulin also increases the risk of low blood sugar. Talk to your doctor about insulin dose adjustment if you plan to start an exercise program.

When it comes to day-to-day diet, some medications can affect your appetite or cause nausea, or both. This may lead you to feel full for a longer period of time after a meal. Medications that have these effects belong to a class of drugs called glucagon-like peptide 1 (GLP-1) receptor agonists. People who take these medications frequently report reduced food cravings.

Some medications should be taken before meals, including short-acting or mealtime insulin, sulfonylurea medications, and meglitinide medications. You’ll need to coordinate the time you take your medication with your meals.

2. Could regular exercise reduce my need for type 2 diabetes medication?

Exercise increases glucose uptake by working the muscles and making the body more sensitive to insulin. Muscle blood glucose uptake remains elevated even after exercise. Insulin requirements usually decrease in people who take insulin treatments. Regular exercise may help with weight loss, your sense of well-being, and your quality of life.

Insulin and sulfonylurea increase the risk of low blood sugar during and after exercise, so it’s important to talk to your doctor about adjusting or reducing the doses of these medications. The dose reduction can be fairly significant in some people.

3. What are some of the more common treatments that are prescribed for type 2 diabetes?

Metformin is the preferred initial treatment for type 2 diabetes. It’s effective, safe, and inexpensive. It may reduce the risk of cardiovascular events and death. It also has beneficial effects on hemoglobin A1C reduction and weight.

If you aren’t able to take metformin, there are several other classes of diabetes medications available. These classes include:

  • Sulfonylureas. These are inexpensive, but can lead to low blood sugar and weight gain.
  • Insulin sensitizers. These are effective and have no risk of hypoglycemia, but can lead to weight gain.
  • Glucagon like-peptide 1 (GLP-1) receptor agonists. These are given by injection daily or weekly and can help with weight loss. The most common side effects include nausea and diarrhea.
  • DPP-4 inhibitors. These are an easy-to-use, once-a-day oral medication. They’re generally well tolerated, have a mild effect on glucose reduction, and mostly reduce post-meal blood sugars.
  • Alpha-glucosidase inhibitors. These are used more rarely. They can cause flatulence and decrease carbohydrate absorption.
  • Sodium glucose transporter 2 (SGLT-2) inhibitors. This is the newest class of diabetes medications. These lower glucose blood level by removing glucose from the body via urine.

Lifestyle management is also a fundamental aspect of diabetes care. It includes diabetes self-management education, medical nutrition therapy, physical activity, and psychological care. If you smoke, you may also need counseling to stop smoking.

4. What are factors to consider if I’m thinking of switching my type 2 diabetes medication?

Factors include degree of A1C reduction, effect on weight, cardiovascular safety and benefits, and risk of low blood sugar. You should also consider the drug’s safety profile, cost, side effects, and whether you prefer an oral or injectable medication.

5. After switching medications, how long should it take for me to notice a difference?

It depends on the medication used. For most medications, the effect on your blood sugar can be seen within one to two weeks. But it can take two to three months to see a change in hemoglobin A1C level.

6. What are some common side effects from type 2 diabetes medications?

Every medication class has its own side-effect profile.

For example, metformin and GLP-1 receptor agonists are associated with gastrointestinal (GI) side effects. These include nausea, abdominal discomfort, cramps, and diarrhea. Less common GI side effects include vomiting, severe abdominal pain, and constipation. There is also a potential risk of pancreatitis with GLP-1 receptor agonists, but it’s extremely rare.

Hypoglycemia is the most common side effect of sulfonylureas. This medication class is also associated with weight gain.

The most common side effects of SGLT-2 inhibitors are genital and urinary tract infections.

7. What are some common drug interactions to watch out for if I’m taking medication for type 2 diabetes?

The most common drug interaction when two or more diabetes medications are taken together is low blood sugar (hypoglycemia).

When sulfonylureas are added to other diabetes medications or other medications are added to sulfonylureas, there is an increased risk of hypoglycemia.

Metformin has a very low interaction potential, but caution is advised when used with other drugs that can impair renal function. Some may be at risk for lactic acidosis, but this is an extremely rare side effect.

People with diabetes may also be taking medication to control high cholesterol or blood pressure, or to thin the blood. It’s important to discuss all the risks and benefits of medication combinations with your healthcare provider.

8. Are there any changes I could make that might allow me to reduce or stop taking medication for type 2 diabetes?

Lifestyle modifications is one of the most important, if not the most important, part of comprehensive therapy for diabetes. Making dietary changes, getting regular exercise, and losing weight may allow you to reduce and even stop some medications.

9. What’s the best diet to follow for type 2 diabetes?

The best diet is the one that you can follow long term. It’s important to eat a balanced diet that includes complex carbohydrates and a reduced amount of simple carbohydrates.

You should also eat high-fiber foods such as fruits, vegetables, whole grains, nuts, beans, and legumes.

Reduce consumption of saturated fats to less than or equal to 7 percent of the total calories you consume. Instead, replace these fats with healthier oils and foods higher in unsaturated fats. Eat one or more good sources of omega-3 fats every day — fish, walnuts, canola or soybean oil, ground flax seeds, or flaxseed oil.

There is no one “diet” for diabetes. Many meal planning guidelines are available for people with diabetes. A meal plan shouldn’t be thought of as a diet, but more of an individualized guideline for healthier eating.

10. If I make a major change to my diet, are there any risks with type 2 diabetes?

If you’re making major changes in your diet and taking medications for diabetes, you may be at risk for low blood sugar. Also, if you choose a very low-carb diet and are taking GLP-1 receptor agonists or SGLT-2 inhibitors, you may be at risk for ketone/acid accumulation in the body that can lead to ketoacidosis. This is a dangerous condition requiring hospitalization. Talk to your healthcare provider about medication adjustments before making major dietary changes.

11. How much exercise do I need to get on a weekly basis?

It’s very important to exercise regularly. The Centers for Disease Control and Prevention recommends that every adult get at least two-and-a-half hours of moderate-intensity aerobic exercise every week. Try not to allow more than two days to go by between exercise sessions.

Physical activity is an essential part of blood glucose management and overall health in individuals with diabetes and prediabetes. Per American Diabetes Association guidelines, when sitting for long periods of time, add in light activity every 30 minutes. Adults with type 2 diabetes should ideally perform both aerobic and resistance exercises for optimal outcomes.

12. Does stress affect type 2 diabetes?

Both physical and emotional stress cause the body to produce a fight-or-flight response with the release of stress hormones. Their effect on the body is to make a lot of stored energy — glucose and fat — available to cells. But insulin produced by the body isn’t always able to make cells use this extra energy. It leads to extra glucose piling up in the blood.

As a result, stress causes high blood sugar levels. Also, people under stress may not take good care of themselves. They may eat more, exercise less, consume alcohol, or forget to take their medications. This can cause further elevation in blood sugar levels.

Coming up with a plan to cope with stress is important. If you need help, consult with your healthcare provider.

Dr. Marina Basina is an endocrinologist specializing in diabetes mellitus type 1 and 2, diabetes technology, thyroid nodules, and thyroid cancer. She graduated from Second Moscow Medical University in 1987 and completed her endocrinology fellowship at Stanford University in 2003. Dr. Basina is currently a clinical associate professor at Stanford University School of Medicine. She’s also on the medical advisory board of Carb DM and Beyond Type 1, and is a medical director of inpatient diabetes at Stanford Hospital. In her spare time, Dr. Basina enjoys hiking and reading.