What is the treatment for type 2 diabetes?

While there is currently no cure for type 2 diabetes, the disease can be managed through lifestyle modifications and medication.

Type 2 diabetes can sometimes initially be managed through lifestyle modification including a healthy diet and regular exercise. However, as the disease progresses, people with type 2 diabetes are often prescribed tablets to control their blood glucose levels. These tablets are intended to be used in conjunction with healthy eating and regular physical activity, not as a substitute. Diabetes tablets are not an oral form of insulin and they require insulin to be present in the body to be effective.

Eventually it may be necessary to start taking insulin to control blood glucose levels, when your body is no longer producing enough insulin of its own. Sometimes tablets may be continued in addition to insulin.

The aim of diabetes management is to keep blood glucose levels as close to ‘normal' as possible, that is between 4 to 6 mmol/L (fasting), as this will help prevent both short-term and long-term complications.

Regular blood glucose monitoring is necessary to see if the treatment being followed is adequately controlling blood glucose levels.

In addition to the comprehensive answer above, if someone with type 2 diabetes is overweight, a slow, gradual weight loss is very effective in managing the condition.  

It can be very helpful to consult with your dietitian and diabetes educator to develop a plan that is going to work with your lifestyle.

Weight loss is an important aspect of type 2 diabetes management.

70-80% of people with recently-diagnosed type 2 diabetes and obesity are able to achieve normal blood glucose levels if they lose a significant amount of weight. Unfortunately weight loss is more difficult for people with type 2 diabetes, and is more difficult for those who have been diabetic for several years. Weight loss surgery has now been shown to be more a more effective treatment for diabetes than diet, exercise and medications (for people with recently-diagnosed type 2 diabetes who are also obese). 

Some academic articles going into the nitty-gritty details: 
An overview:
http://link.springer.com/article/10.1007/s00268-009-0062-y?LI=true#page-1
A randomised controlled trial showing remission of diabetes in 73% of patients treated with gastric banding surgery, compared to 13% treated with medications, diet and exercise: 
http://jama.jamanetwork.com/article.aspx?articleid=1149302

Weight loss is the closest thing we have to a cure for diabetes; “remission” is a better term, because the effects only last while the weight is kept off. 

Dean Spilias
http://www.uppergi.net

Diabetes is harder to control with time, and almost everybody will need medication eventually. There is, nowadays, a wide range of medications available and each of them have their own place. This is a rapidly changing & exciting field, and the last few years has seen a huge increase of options available - all great news for people with diabetes. Medicines vary in their side effect profile, efficiency with which they improve diabetes control, whether they cause weight gain, and whether they can cause low sugars (hypos). Also, some tablets are once daily. The large choice of medications can be confusing. Every medication has a chemical name and a brand name; chemical names are in “small print” on the box but will not vary over time (different manufacturers call them different names) and so are used here

The main tablets are: Metformin: Usually the first-line. Reduces insulin resistance & good long term record; abdominal side effects usually wear off after a few weeks of gradually increasing dose. Weight neutral, no hypo risk. Sulphonylureas (ending in “ide” eg. gliclazide) increases production of insulin. It's an actively glucose-lowering agent, so it's important to know how to test for and anticipate low blood glucose (uncommon). Acarbose: reduces digestion of carbohydrates and can be useful for high sugars after meals. Weight neutral, no hypo risk. Glitazones: reduce insulin resistance. Hypo risk low. Weight neutral, no hypo risk. Gliptins: enhances insulin secretion, reduce glucagon (works the opposite way to insulin) and reduce stomach emptying (and so can help reduce food intake). Weight neutral, no hypo risk (medicare PBS restrictions mean that metformin & a sulphonylureas need to be tried first)

The main injections are: Ending in “tide” eg. exenatide, liraglutide. These injections are taken daily and now a weekly version has come out. Insulin - last but not least! Most people don't want to go onto insulin because of fears over hypos and weight gain. However, it is important to start insulin when the time is right and most people do feel better as well as improving control of the diabetes.

Nutrtional therapy is also an option. You may find this recent post and video by Jason Fung of interest:) 

https://intensivedietarymanagement.com/reverse-type-2-diabetes-the-quick-start-guide/

https://intensivedietarymanagement.com/reverse-diabetes-naturally/

Type 2 Diabetes is associated with significant metabolic dysfunction, and the role of weight-loss surgery is often overlooked by many physicians, General Practitioners, Diabetic Educators for a variety of reasons.  Weight-loss surgery remains a procedure with a lot of social stigma, despite being proven to be the most effective treatment in bring remission of Type 2 Diabetes in patients with obesity.

The 2nd Diabetes Surgery Summit (DSS-II) guideline provides an algorithm for when patients with Type 2 Diabetes should be considered and referred for metabolic surgery.  Essentially patients with a BMI >40 with T2DM, and BMI 30-40 with poorly controlled diabetes despite medication and lifestyle intervention should be considered for bariatric surgery.

http://care.diabetesjournals.org/content/39/6/861