Managing Type 2 diabetes for 20 years is a significant milestone, and it is very common for treatment plans to evolve over time. As the body's natural insulin production decreases over the years, a combination of therapies is often needed. Standard options include metformin to improve insulin sensitivity, SGLT2 inhibitors or GLP-1 receptor agonists to protect your heart and kidneys, or insulin therapy to maintain stable blood sugars. Along with a balanced diet and regular exercise, monitoring is key. Because treatment must be highly personalized, please consult your physician to safely tailor the best medication combination for your current health needs.