Just a heads up: this post is over 10 years old now and diabetic technologies have changed A LOT since then. Leaps & bounds. Itās a whole new world of management now. And itās all for the better. Itās never been a better time to be diabetic.
Letās have a little update for 2026.
So my partner is (pretty badly) T2 diabetic and has been for about a decade now. Iāve gotten to watch the changes over the years. I was just diagnosed mildly T2 diabetic a few months ago. His momās also diabetic. So Iāve been around this for a while now, with different paths for all of us.
Also note that this is the path I took and he took over the years. What you do when may be a different in 2026; theyāre coming out with new drugs and different techniques (when you try what drugs) literally all the time for this.
1) At first theyāre just gonna start you on a pill like Jardiance, an SGLT2 inhibitor. 1 pill a day, thatās it, real easy. The only side effect is that I have an increased risk of a UTI, so Iām supposed to drink lots of water. (I do seem to be more thirsty on it.) (Thatās all Iām on. Hopefully itāll work to lower my A1C & then thatāll be it for me!)
2) If that doesnāt work, they may start you on Metformin as well. I forget the type of med it is, but itās incredibly common for diabetes treatment. Gives some people diarrhea and/or nausea while they get used to it, but that usually goes away anywhere from a few days to 2 weeks. My partner takes 2 pills of it, 2x a day for 4 pills total.
3) They may throw a GLP-1 agonist in there, possibly after all that, but possibly first. Yes, I know we all know them as weight loss drugs, but they started as diabetic drugs, and they are REALLY GOOD at controlling blood sugar. Really, REALLY good when youāre finally on the right one for you. You may end up trying a number of them to get the one thatās just right for you. Donāt despair; not everyone loses weight on them. My partner not only hasnāt lost any weight on any of the ones heās been on, heās GAINED weight on one of them! Most GLP-1 agonists are one shot a week; some are pills, and I think thereās one out there thatās 1 shot a day. The needles, you canāt even feel them unless you get unlucky and you happen to hit a nerve.
4) If all that doesnāt work, I think thereās a couple of other pills they can try (sulfonylureas?)
5) If THAT doesnāt work, THEN they try insulin.
First you try a long acting insulin that you take 2x a day. Itās probably gonna be the Lantus Solostar (if youāre in the USA. I havenāt seen any other brands.) itās the shape and size of a marker. itās a simple injector; you put a pen needle cap on the end, dial up the amount youāre supposed to take, stick it in you, push the button, wait 5 seconds, then take it out & discard the needle. Simple. No messing around with measuring doses from vials or large needles.
6) If that doesnāt work, at that point they switch you to a short acting insulin. In this day and age, itās rare to be doing it by hand anymore (that is, starting out doing it by hand; folks who are long well managed doing it by hand may continue doing that.) You will be getting a CGM/pump combo with an infusion set.
The CGM, Continuous Glucose Monitor, is a little sensor that sticks on your body 24/7 and constantly reads the glucose in your fluids (NOT actually in your blood.) It usually goes on the back of your upper arm. Thereās a number of brands and they last different amounts of times. My partnerās used to last a week but they literally just came out with a new model that lasts for 2 weeks. (Theyāre still working the kinks out of that model.) CGMs keep you from having to stick yourself up to 6 times daily to manually take your blood sugars.
Your insulin pump uses short acting insulin to deliver both a basal & a bolus. A basal is the 24/7 background drip of insulin your body needs all the time. A bolus is an extra bonus amount insulin you give yourself before you eat to make up for the carbohydrates in your food. You enter into the pump the amount of carbs youāre eating & it figures out how much insulin to give you and boluses accordingly. Your insulin pump also is the monitor that shows you what your sugar levels are according to your CGM. They also have graphs so you can see how youāre doing over time, etc. Modern CGMs work with pumps to constantly change what your basal is according to your sugar readings. (This was not the case in the mid 2010s in the USA. It hadnāt been approved yet.) The interface is quite simple and quite idiotproof, very much on purpose. They are also the most bug-free devices Iāve ever seen. Some pumps even let you give them firmware upgrades for better functionality. My partnerās went from having to test his sugars manually 1-2 times daily to only having to do it 1x when you first put your CGM in to calibrate the new sensor. The CGM talks to the pump via Bluetooth. And yes, it can talk to his phone if he wants it to.
The infusion set goes from your pump to your body. Itās a reservoir that goes into the pump, a little tube, and a part that sticks to your skin and goes into your body to deliver the insulin. My partnerās infusion set used to last 3 days before he had to change it out, but they just came out with a new model that lasts a week. He has to put a new reservoir with more insulin in roughly daily (YMMV on that.) It takes about 5 mins to fill a reservoir from the vial of insulin and then put it in the pump.
There are models that have pump, reservoir and infusion set in one unit. (It may even include the CGM?) Iāve only seen T1 and children use this, though. I donāt think it works well for T2s, esp not folks who use a lot of insulin.
Honestly, the biggest problem with diabetes, once you figure out the combo that works for you, is dealing with pharmacies & insurance. 2nd worse is your CGM or infusion set coming out of your body early (which might happen less with someone less sweaty. Also, they make all sorts of sticky tapes, adhesives, etc. for this. Including one specifically for very active diabetics called GrifGrips. Comes in like a hundred different colors, shapes, and designs.)
You really DO have to stay on top of it though and take it seriously. Itās not just hands and feet that can be damaged; my partner has internal organ damage thatās irreversible because he didnāt take it seriously enough at first and let it go too long. (And an organ that you donāt realize has nerve endings. Youād be surprised where in your body thereās nerves.)
But if you accept it right off the bat and do what needs to be done, itās absolutely no longer a death sentence; most diabetics live long & healthy lives now with well managed blood sugars and a minimum of hassle. And most people donāt get to the point of needing a pump; itās usually just a pill or a few a day for most diabetics.