Type 2 Diabetes Treatment

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Type 2 diabetes is the most common chronic condition in the UK and affects the way your body processes and stores sugar (glucose). Although there is no cure, the condition can be managed with prescription medication like metformin. It is estimated that by 2025, 5 million people in the UK will have been diagnosed with type 2 diabetes.

Type 2 diabetes causes symptoms like excessive thirst, needing to pee more than usual, and tiredness, although some people may not have any symptoms. If it is not well managed, it can affect your sight, heart, nerves, and feet, but it can be managed well with healthy lifestyle choices and medication.

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Metformin 500mg

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About Type 2 Diabetes

: Type 2 diabetes is a chronic metabolic condition that causes high blood sugar levels, also known as hyperglycaemia. It happens when the pancreas doesn’t produce enough insulin, a hormone that helps regulate blood sugar, or when the body doesn’t use it effectively and becomes resistant (insulin resistant). As a result, glucose builds up in the bloodstream.
Over time, type 2 diabetes can harm the kidneys, heart, eyes, and nerves, so it is important to get a prompt diagnosis, monitor your health, and attend regular checkups.
Type 2 diabetes can be caused by several factors including genetics, as it can run in families, and lifestyle choices like poor diet or physical inactivity, with an increased risk in people over 40 and certain ethnic groups. Symptoms include:
frequent urination
excessive thirst
extreme tiredness or fatigue
slow healing wounds
weight loss
blurred vision
genital itching or recurrent thrush
Type 2 diabetes is the most common chronic disease in the UK. More than 3.9 million people have been diagnosed with diabetes and 90% of diagnosed adults have the type 2 form. It’s also estimated that around 1 million people are currently undiagnosed and by 2025 more than 5 million people will be diagnosed with diabetes.
: There are several different type 2 diabetes treatments available, including tablets and injections.
: Metformin
Metformin is usually the first-line treatment that’s prescribed for type 2 diabetes. It is available as a tablet and is advised when diet and exercise changes alone haven’t been enough to reduce blood sugar levels.
Studies show that metformin reduces the risk of diabetes-related complications and death significantly compared to diet alone.
Metformin belongs to a group of medications called biguanides and works by:
lowering the amount of sugar your liver releases into your blood
helping the insulin your body makes to work better
reducing how much sugar is absorbed from the gut
Because of the way it works, metformin improves insulin resistance to stop your blood glucose levels rising too high.
Metformin usually starts working within the first week of starting treatment, but it can take up to 12 weeks for you to see the full benefit. Clinical trials show that metformin reduces the risk of diabetes-related:
complications from 12.7 events/1,000 patient-years with diet alone to 7.5 events/1,000 patients-years
death from 20.6 events/1,000 patient-years with diet alone to 13.5 events/1,000 patient-years
Metformin is available as slow-release or standard-release tablets:
Slow-release tablets release metformin slowly, so you’ll usually only need to take it once per day.
Standard-release tablets release the medication work more quickly and you may need to take them more often during the day.
Your doctor will advise which dose and which type of metformin tablets will be most suitable for you. You can request a treatment on ZAVA by filling out a short online questionnaire. If metformin alone is not enough to manage your diabetes or you cannot take it, you may be prescribed other oral medications.
Sulphonylureas
Sulphonylureas stimulate the pancreas to produce more insulin and they are usually taken once or twice a day with or just before a meal. Sulphonylureas can lower blood sugar levels by around 20% and HbA1c results by 1 to 2% but they can increase the risk of hypoglycaemia (low blood glucose) and weight gain.
In the UK, there are 5 sulphonylureas available. They are:
Glibenclamide
Gliclazide
Glimepiride
Glipizide
Tolbutamide
Prandial glucose regulators (repaglinide and nateglinide)
Prandial glucose regulators are similar to sulphonylureas because they stimulate the pancreas to make more insulin. They work faster than sulphonylureas but their effects only last for a short time. They are available as tablets and should be taken up to 30 minutes before each meal. Prandial glucose regulators include Prandin and Starlix.
Thiazolidinediones (glitazones)
Glitazones improve your body’s sensitivity to insulin and reduce insulin resistance. They may also protect your pancreatic cells to help them work more effectively. The only glitazone available in the UK is Pioglitazone. It is available in tablet form and research shows that after 2 years Pioglitazone sustained blood sugar control in 69% of patients compared to 50% of patients treated with gliclazide. It is available in 15mg, 30mg or 45mg doses and is taken once per day.
Alpha glucosidase inhibitor (Acarbose)
Acarbose slows down the digestion of carbohydrates, lowering the rise in blood sugar after eating. It is available as a tablet and the usual starting dose is 50mg, increased to 3 times a day.
DPP-4 inhibitors (gliptins)
Gliptins enhance the body’s natural production of insulin and lower the production of glucose in the liver by increasing the levels of hormones like GIP and GLP-1. They work in a way that depends on glucose, minimising the risk of hypoglycaemia. They are available as tablets, and a common example is sitagliptin. Research shows that sitagliptin can reduce HbA1c (Hemoglobin A1c) levels by 0.5% at a dose of 100mg daily over 18 weeks. You’ll need to take it every day and it usually starts to work within a few hours of taking it.
SGLT2 inhibitors
These tablets work by lowering the amount of glucose that’s absorbed by your kidneys and passing the excess out in your urine. You’ll usually take them once a day with or without food. Some SGLT2 inhibitors, like dapagliflozin, can get to work in as little as 2 hours, but it can take up to a week for the full effects to happen. They can reduce HbA1c levels by 7 to 10 mmol/mol compared to a placebo.
Common examples of SGLT2 inhibitors include:
Canagliflozin
Dapagliflozin
Empagliflozin
Ertuglifozin
: Insulin
Some people with type 2 diabetes may need to inject insulin to manage their condition. You’ll usually take insulin if the insulin your pancreas makes isn’t working properly (insulin resistance) or your pancreas doesn’t produce enough.
There are different types of insulin available, such as:
long-acting or intermediate-acting insulin taken once or twice a day
long-acting or intermediate-acting insulin taken once or twice a day and a separate rapid-acting or short-acting insulin taken before a meal
mixed or biphasic insulin that contains an intermediate and rapid-acting or short-acting insulin that’s taken 1 to 3 times a day before meals
insulin pumps, usually inserted via a cannula and delivered throughout the day
Each type of insulin and what is prescribed will vary from person to person, according to which type of diabetes is needed to be treated. A healthcare professional will decide which treatment is most suited to you.
Note: You inject insulin yourself using an insulin pen which helps to ensure you inject your medication safely and at the right dose. It’s usually painless and you only inject a small amount under your skin.
GLP-1 agonists
Also known as incretin mimetics, GLP-1 agonists, like Ozempic and Mounjaro, are injectable medications that lower blood glucose levels, increase the amount of insulin when it’s needed, and can stimulate weight loss in type 2 diabetes patients. They are usually self-injected once weekly and are effective medications.
Semaglutide (Ozempic) has been shown to lower 2-hour postprandial glucose levels by 37%.
Tirzepatide (Mounjaro) is also a glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist. For this reason, research shows that tirzepatide causes a greater reduction in blood sugar levels than semaglutide.
: All treatments for type 2 diabetes (injections and tablets) work in different ways, and the administration for them by a healthcare professional varies depending on patient condition, needs and requirements.
Generally, type 2 diabetes medications work alongside lifestyle changes to help control blood sugar levels and prevent diabetes-related health problems from occurring.
Type 2 diabetes medications work in ways including but not limited to:
lowering blood sugar levels
reducing glucose absorption (from the intestine)
decreasing insulin metabolism in the liver
decreasing glucagon secretion
increasing insulin sensitivity
Here is further information on type 2 diabetes medications and how they specifically work:
Tablets
Oral medications are often the first-line treatment for type 2 diabetes and work in different ways to lower blood sugar levels.
Metformin:
the most common medication prescribed to manage type 2 diabetes.
works by lowering the amount of sugar released by the liver
improves the effectiveness of insulin by reducing glucose absorption from the intestines.
noticeable improvements in their blood sugar levels within a few days but it can take several weeks for the full effects to become apparent.
Sulphonylureas
work to stimulate your pancreas to produce more insulin to lower your blood sugar levels
decreases insulin metabolism in the live
decreases glucagon secretion
increases insulin sensitivity
they work quickly, with some working in as little as 30 minutes to reduce your blood glucose levels.
Sodium-glucose co-transporter-2 (SGLT2) inhibitors
work by blocking the SGLT2 protein in the kidneys which reabsorbs glucose in the urine back into the bloodstream
encourages more sugar to leave the body in your pee, lowering blood sugar levels
Injections
GLP-1 agonists
As well as tablets, several injections can lower your blood sugar levels while also helping you to lose weight, including:
tirzepatide (Mounjaro)
semaglutide (Ozempic)
dulaglutide (Trulicity)
These injections start to work after the first dose and mimic the hormone glucagon-like peptide-1 (GLP-1), which signals to the pancreas to release insulin after eating, lowering blood sugar levels. They can also:
reduce the amount of sugar your liver makes
slow down digestion
lower your appetite
Insulin injections
Insulin is another type of injectable type 2 diabetes treatment that’s usually prescribed if other treatment options haven’t worked. Unlike the other type 2 diabetes injections, insulin is a hormone that works by moving glucose from your bloodstream into the body’s cells, where it is used for energy.
How long insulin injections take to work varies depending on the type you are prescribed. For example, most insulins start working within 15 minutes, some take 2 to 4 hours. Intermediate and longer-acting insulin can continue to lower glucose levels for up to 36 hours.
What’s the best treatment for type 2 diabetes?
The best treatment for type 2 diabetes will depend on several factors including your current health, preferences and any other medications you may be taking.
Metformin is the most common type of medication prescribed for type 2 diabetes, which can help to keep your blood sugar levels within a healthy range.
You should take metformin, and all other diabetes medications, alongside healthy lifestyle changes, such as eating a healthy diet and getting plenty of exercise. Generally, healthcare professionals consider it to be the best early approach to managing type 2 diabetes.
: As with all medications, there is a risk your diabetes medication will cause side effects, but not everyone will experience them.
Depending on the type of medication you are taking, some, particularly gliclazide, insulin, and GLP-1 agonists, can cause hypoglycaemia (low blood sugar) when combined with other medications. You must always tell your doctor about the medication you are currently taking or thinking about taking so that they can assess which diabetes treatment is most safe and suitable for you.
Metformin, the most common type of type 2 diabetes medication may cause the following side effects.
Very common side effects (may affect more than 1 in 10 people) include:
feeling sick (nausea)
being sick (vomiting)
problems with digestion
diarrhoea
abdominal pain
Common side effects (may affect up to 1 in 10 people) include:
low B12 blood levels, signs of this may include red tongue, extreme tiredness, pins and needles, and taste changes
Very rare side effects (may affect up to 1 in 10,000 people) are:
abnormal liver function test results
skin reactions
lactic acidosis
How long do these side effects last?
Most mild side effects of type 2 diabetes medication should go away on their own within a few weeks to months of starting treatment or when your body has adjusted to it.
What to do if you get side effects
If you experience any side effects when you start taking type 2 diabetes medication, speak to your doctor about how to manage them or discuss finding an alternative treatment, if necessary.
: Most people should be able to take type 2 diabetes medications like metformin, but it depends on any other medical conditions you have or medication you’re taking.
You should let your doctor know if you have any medical conditions, but especially if you:
have liver or kidney problems
have a severe infection
have recently had a heart attack or have heart failure
have severe circulation problems
drink alcohol excessively
It is important to tell your doctor about your lifestyle and any current or previous medical history, including any medications you take. This will help them assess which type 2 diabetes medication is most appropriate and safe for you to take.
: It is important to get an early diagnosis. You may be at a higher risk of developing type 2 diabetes if you:
have a close relative with the condition
are over 40 years old or over 25 if you’re from an Asian, Black African or Black Caribbean background
are overweight or obese
The symptoms of type 2 diabetes include:
feeling thirsty all the time
frequent need to pee
feeling very tired
skin darkening and itching around the genitals
slow healing cuts and wounds
unexplained weight loss
blurred vision
If you are experiencing any type 2 diabetes symptoms or you think you may be at risk, you should make an appointment to see your doctor for a diagnosis.
Type 2 diabetes is diagnosed by a blood test to check your blood sugar levels. If your results show your blood sugar levels are raised, your doctor will discuss what you need to do next, including any lifestyle changes you should make or any medications you may need to take.
: Managing type 2 diabetes isn’t just about medication – lifestyle changes and alternative approaches can have a real impact in controlling your blood sugar levels and improving your overall health.
Exercise
Regular physical activity is good for diabetes because it improves your body’s sensitivity to insulin, helping to lower blood sugar levels. It also promotes weight loss, reduces stress, and supports heart health.
Activities like brisk walking, cycling, jogging, swimming, dancing, strength training, and team sports can be really beneficial. The NHS recommends completing at least 150 minutes of moderate-intensity exercise per week.
Healthy eating
Although there is no special diet to follow when you have type 2 diabetes, you should focus on eating a healthy balanced diet. Some things you should consider if you have type 2 diabetes are:
eating a range of different foods, focusing on nutrient-dense foods like fruit, vegetables, wholegrains, legumes, lean meats and proteins
reducing your sugar, fat, and salt intake
avoiding skipping meals
Weight management
If you are overweight, losing even a small amount of weight can improve your insulin sensitivity and reduce your blood sugar levels. It can also lower your risk of cardiometabolic complications which are also associated with type 2 diabetes. In some cases, weight loss (bariatric) surgery may be recommended to help you lose weight.
➤ Our weight loss service can support you to lose weight. Some weight loss injections can be used to treat type 2 diabetes and support weight loss.
Support groups
Diabetes can have an emotional as well as a physical impact on you. So, connecting with other people who have the same condition can provide vital support, lifestyle tips, and encouragement. Look for type 2 diabetes support groups in your local area or speak to your doctor for more information.
: No, there is no cure for type 2 diabetes. However, it can be managed and put into remission for some people through healthy lifestyle changes and weight management.
Remission occurs when your blood sugar levels are below the diabetes range and you no longer need to take your medication for at least 3 months. Losing weight by improving your diet and increasing your weekly exercise, or using weight loss medications like Mounjaro or Wegovy (semaglutide medication developed for weight loss), if you are eligible, may help.
It’s also important to reduce the amount of carbohydrates and calories you eat to help keep your blood sugar levels within a normal range. However, you should not ‘crash diet’ or follow any extreme fads as these may have serious, negative health consequences.
Although it may be possible to put type 2 diabetes into remission, there is currently no long-term evidence to suggest it can be cured.

Medically reviewed by:
Dr Zoe Miller Medical Editor
Accreditations: MBChB, BSc

After completing her first degree, she went on to study graduate-entry medicine at Warwick University. After graduating as a doctor, she worked within the West Midlands in Urology, Respiratory Medicine, Infectious Disease, and Psychiatry before transitioning into a full-time medical communications role.

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Last reviewed: 22 Feb 2025

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