Management of type 2 diabetes

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In type 2 diabetes, the body does not produce enough insulin, or it cannot properly use what it produces. Learn how type 2 diabetes is managed.

Key points

  • In children and teens with diabetes, blood sugar levels are higher than normal and must be brought down to a target level.
  • Children and teens must check and record blood sugar levels in order to properly manage their diabetes.
  • Maintaining a healthy diet and exercising regularly are key to managing type 2 diabetes.
  • Some children and teens will require medication or insulin to manage their diabetes.

Type 2​ diabetes is a disease that usually runs in families. Other family members may already have diabetes or may be at risk for developing it. For this reason, it is important that everyone in the family learn about diabetes, learn how to help monitor blood glucose (sugar) levels, and start adopting a healthy lifestyle.​​

Blood sugar monitoring

Blood sugar levels, also called blood glucose levels, help determine whether enough insulin is being produced by the pancreas or whether it is working effectively.

Everyone has a bit of sugar in their blood. Before eating, it is normal to have a blood sugar level of 3.3 to 6.0 mmol/L. After eating, blood sugar levels will rise immediately; however, after two hours, they should be less than 7.8 mmol/L.

These sugar levels account for the food you have eaten that day, and remain in the bloodstream to be used for ongoing body processes (such as your heartbeat) and for immediate activity needs (such as walking around). The rest of the sugar from food is stored, with the help of insulin, in tissues (such as liver and muscle) to be released as needed for future use.

What does insulin normally do?

In children and teens with diabetes, blood sugar levels are higher than normal. Therefore, one of the first goals of management is to reach "target blood sugar levels" — reducing the amount of sugar in the blood until it is in the target range.

Target blood sugar levels

Target blood sugar levels for patients with type 2 diabetes are as follow:

  • Fasting blood sugars and blood sugars before meals (when you have not eaten for two hours before the meal) should be between 4 mmol/L to 7 mmol/L.
  • Two hours after eating, blood sugar levels should be between 5 mmol/L to 10 mmol/L.

To manage blood sugar levels, it is important to know what they are. In children and teens with type 2 diabetes, this means checking blood sugar levels often and writing down the results. Your diabetes team will tell you how many times a day to check your blood sugar level.

Blood sugar levels can be checked at home using a finger-pricking device, a lancet, a test strip, and a glucose meter. Patients must prick their fingers, squeeze a drop of blood on a test strip, and place it in the meter which will test the blood and provide results.

Keeping track of these numbers in a journal or a log will help recognize patterns so that your child or and teenager can keep their blood sugars in the target range. Blood sugars are affected by a combination of food, physical activity, stress, and illness.

Lifestyle changes

Proper nutrition and exercise are very important in diabetes control. Being active helps lower the sugar that is in the blood and reduces insulin requirements. One way to become more active is to reduce screen time.

Eating a well-balanced diet also reduces the demand for insulin from the pancreas and is very important in the diabetes control. Healthy eating and regular exercise can also help your child or teen feel better, stay healthy longer, and reduce the risk of complications.

Illustration of factors affecting blood sugar levels
Blood glucose (sugar) levels can be affected by food, activity, stress, and illness.

Maintaining a proper diet

If you have a dietitian as part of your health-care team, they can help you design a personalized meal plan that suits your family’s lifestyle. It may include foods from your culture and some of your child or teen’s favourite foods. The dietitian can also help you figure out how much your child should eat and how often.

Here are some healthy eating tips for everyone:

  • Eat three regular meals a day with some snacks. Eating regularly helps the body maintain consistent blood sugar levels.
  • Eat a variety of foods at each meal: vegetables and fruit, meat or alternatives, and whole-grain breads and cereals.
  • Choose whole fruit instead of fruit juice.
  • Sugary foods and sweets (such as pop, chocolate, pastries, and even syrup and jam) will quickly raise your blood sugar level, and should be consumed sparingly.
  • Eat fewer high-fat foods such as chips and fast food. This will keep your weight down (and your heart healthy).
  • Avoid eating too much salt or too many salty foods.
  • Eat foods that are high in fibre; they can help you feel fuller for longer.
  • Avoid drinking your calories; drink water when you are thirsty and avoid pop and juice, which can raise blood sugar levels and cause unwanted weight gain.

Maintaining a healthy lifestyle is the most important part of managing diabetes. Staying at a healthy body weight will help lower blood sugar levels.

When trying to maintain a healthy weight, avoid fad diets. Most are inefficient in the long run, and some are even dangerous. Your diabetes health-care team can help you and your child work out a meal and exercise plan for a healthy lifestyle, and will provide you with support.


One of the best things your child can do to stay healthy is stay active. Exercise is an important part of managing type 2 diabetes. Your child or teen should choose activities they like to do, such as swimming, playing a sport, or riding a bicycle. Picking activities that involve friends of other family members can help make exercise fun.

Physical activity will:

  • help your child feel better
  • make the heart, lungs, and muscles stronger
  • lower blood sugar levels
  • lower blood pressure levels
  • help your child maintain a healthy weight
  • help manage stress and reduce anxiety.

If your child is taking insulin or other medications, talk to the diabetes team about balancing exercise with these medications to avoid low blood sugar (hypoglycemia). Children with type 2 diabetes should always have some form of sugar and extra food on hand when they exercise, in case they begin to show signs of hypoglycemia (i.e., feeling light-headed, shaky, irritable, hungry, or weak).


Sometimes eating well and exercising are not enough to keep blood sugar levels in the target range. If this happens, the doctor may prescribe medication to help control blood sugar levels. For some people, this means taking pills by mouth every day. Others will need insulin injections alone or in combination with pills.

Your diabetes team will teach you and your child about how to take the medication, and show you how to adjust your dosage if eating habits or physical activity levels change.

In order to work, the medication needs to be taken properly. This means carefully following the doctor’s instructions about how to take it, and taking the right amount at the right time. When your child gets a new prescription, make sure you both understand how to take it.

Pills (oral anti-hyperglycemic agents)

Metformin (Glucophage) is the most commonly used oral medication for type 2 diabetes in children and teenagers.

There are several classes of diabetes pills approved for use to treat type 2 diabetes in adults. Some of the other drugs for adults have not yet been studied in detail in the younger population and are therefore not often prescribed. However, in the future, some of these drugs may be used more in children to treat type 2 diabetes.


Generic name (Canadian trade names)

  • Metformin (Glucophage)


  • reduces the amount of glucose produced by the liver
  • makes liver and muscle cells more sensitive to insulin

Insulin secretagogues, sulfonylureas

Generic name (Canadian trade names)

  • Gliclazide (Diamicron, Diamicron MR)
  • Glimepiride (Amaryl)
  • Glyburide (Diabeta, Euglucon)


  • stimulate the beta cells in the pancreas to make more insulin
  • may also make body cells more sensitive to insulin

Insulin secretagogues, non-sulfonylureas

Generic name (Canadian trade names)

  • Repaglinide (GlucoNorm)
  • Nateglinide (Starlix)


  • stimulates the beta cells in the pancreas to make more insulin
  • duration of action is shorter than sulfonylureas’
  • has no effect on insulin sensitivity

Sodium-glucose-transporter 2 inhibitors

Generic name (Canadian trade names)

  • Canagliflozin (Invokana)


  • increases glucose (sugar) loss in the urine, leading to lower blood sugar levels


Generic name (Canadian trade names)

  • Sitaglitpin (Januvia)
  • Saxagliptin (Onglyza)
  • Linagliptin (Trajenta)


  • increases insulin release when blood sugar levels are increased

Alpha-glucosidase inhibitors

Generic name (Canadian trade names)

  • Acarbose (Glucobay)


  • slows down the conversion of carbohydrates to sugar in the intestines

Insulin sensitizers (thiazolidinediones)

Generic name (Canadian trade names)

  • Rosiglitazone (Avandia)
  • Pioglitazone (Actos)


  • makes cells more sensitive to insulin
  • improves cells’ ability to use sugar


Not all children or teenagers with type 2 diabetes will require insulin injections. Taking insulin may be needed for a period of time to help lower blood sugar levels and negate high blood sugar symptoms. Insulin might also be a permanent option to control your child’s type 2 diabetes. Your diabetes care team will help you and your child learn how to administer insulin, including calculating the correct dose and checking blood sugar levels.

Insulin comes in vials, prefilled disposable dosing devices, and cartridges, and can be administered with syringes, pens, or pumps.

Last updated: October 17th 2016