Life with Diabetes

How Type 2 Diabetes Progresses

Why you may need more medication over time

After your initial diagnoses of type 2 diabetes, you may notice that it’s harder to reach your diabetes treatment targets even though your medication, exercise routine, diet, or other things you do to manage your diabetes hasn’t changed—and that’s normal. Every so often, your routine to manage your diabetes will likely need to be adjusted. You might start managing your diabetes with diet and exercise alone, but, over time, will have to progress to medication, and further down the line you might need to take a combination of medications, including insulin. 

Switching from taking an medications other than insulin, like metformin, to insulin can make you feel like you haven’t been doing enough to manage your diabetes. But this isn’t true. Your body changes as it ages and diabetes is a progressive disease, so your need for different medications and treatments also changes. 

While you may have to adjust your treatment plan and medications as your body changes and your diabetes progresses, it to helps prevent complications and helps you stay as healthy as possible.

How diabetes progresses

Diabetes is considered a progressive condition, which is why the first step you take to manage your diabetes will not stay effective long-term. 

Scientists understand the basics of type 2 well, including how the body makes and uses insulin. When beta cells in the pancreas can’t produce enough insulin to keep your blood sugar (blood glucose) from raising too high, the result is diabetes.

First, your body stops making enough insulin or using insulin it does make properly. When your body doesn’t use insulin properly, it’s called insulin resistance.  

Your beta cells increase the amount of insulin they produce to make up for the insulin resistance. Over time, the body works even harder to make more insulin and eventually it can’t keep up.

Unlike people with type 1 diabetes, people with type 2 still have functioning beta cells. They usually have no idea there is a problem until a doctor tests their blood sugar levels. Because symptoms can be minimal and go unnoticed, many people can have type 2 diabetes for a long time before it’s diagnosed. 

Sometimes, type 2 diabetes can be managed with an eating plan and physical activity. Exercise and weight loss have been shown to improve how your body uses insulin. In addition to these lifestyle changes, medications can be prescribed. Many times, the first medication prescribed is metformin, which decreases amount of glucose produced by the liver.

However, medications like metformin may not be enough to manage your diabetes as time goes on. You may need more and more diabetes medications to reach your blood sugar targets.

The progression of type 2 diabetes is why it may feel like a race you can’t win. 

Chain reaction 

  • The body becomes resistant to its own insulin
  • Beta cells pump out more insulin to make up for insulin resistance
  • Beta cells can’t keep up with insulin needs and blood sugar levels rise to levels high enough to diagnose diabetes
  • Lifestyle changes (diet and exercise) and medications (oral or injectable) are used to manage blood sugar
  • Your body can’t keep up with the amount of insulin needed to manage your blood sugar and more medications are needed over time

Understanding why it changes

Despite decades of research, we still don't know why some people need to do more to manage their diabetes than others. 

Genetics plays a role. Researchers have connected more than 70 different genes to type 2 diabetes, but it’s still hard to tell what the interaction between them is.

The the progression of type 2 diabetes varies from person to person. 

Slowing the progression

Research continues to explore how to slow or even stop type 2 progression. There’s a lot of evidence that it may be reversible. But studies have shown that this usually isn’t permanent. Many times, after blood sugar is managed without lifestyle or medication, blood glucose elevates again. 

Until researchers unravel the mystery of diabetes progression, doctors recommend the proven approach of exercise, an eating plan, and weight loss (if needed). This manages blood sugar levels and may help delay progression of type 2 diabetes. 

Learn more about types of insulin and other diabetes medications

If you or a loved one needs help paying for insulin, we have the resources to help