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Diabetes medications: an overview of the main types
Key takeaways
- Type 1 diabetes always requires insulin.
- For type 2, many options exist: metformin, GLP-1 and GIP/GLP-1 medicines, SGLT2 inhibitors, DPP-4 inhibitors, sulfonylureas, TZDs, and insulin.
- Some medicines also protect the heart and kidneys or help with weight; others carry a higher risk of low blood sugar.
- This is general education only — never start, stop, or change a medicine without your prescriber.
Diabetes medicines lower blood sugar in different ways. Your care team chooses based on your type of diabetes, A1C, weight, heart and kidney health, risk of low blood sugar, cost, and preferences.
Main classes at a glance
| Class | Examples (generic) | How it works | Things to know |
|---|---|---|---|
| Biguanide | Metformin | Lowers glucose output from the liver; improves insulin sensitivity | Often a first choice for type 2; stomach upset is common at first |
| GLP-1 receptor agonists | Semaglutide, dulaglutide, liraglutide | Boost insulin after meals, slow digestion, reduce appetite | Weekly or daily injections (one oral form); weight loss; some have heart benefits; nausea |
| Dual GIP/GLP-1 agonist | Tirzepatide | Acts on two gut hormone pathways | Weekly injection; marked A1C and weight reduction; GI side effects |
| SGLT2 inhibitors | Empagliflozin, dapagliflozin, canagliflozin | Kidneys remove extra glucose in urine | Heart-failure and kidney benefits; genital yeast infections; rare ketoacidosis |
| DPP-4 inhibitors | Sitagliptin, linagliptin | Raise the body's own GLP-1 levels | Pills; modest effect; low risk of lows |
| Sulfonylureas | Glipizide, glimepiride, glyburide | Make the pancreas release more insulin | Inexpensive; can cause low blood sugar and weight gain |
| Thiazolidinediones (TZDs) | Pioglitazone | Improve insulin sensitivity | Fluid retention, weight gain; not for heart failure |
| Insulin | Basal (long-acting), bolus (mealtime), premixed | Replaces or adds to the body's insulin | Essential in type 1; widely used in type 2 and pregnancy; low-blood-sugar risk |
Low blood sugar risk
Insulin and sulfonylureas can cause hypoglycemia — blood sugar below 70 mg/dL — with shakiness, sweating, a fast heartbeat, or confusion. Know the signs and your treatment plan, and call 911 if someone can't eat or drink safely or passes out.
Getting the most from your medicines
- Take them as prescribed and ask what to do if you miss a dose.
- Tell your team about side effects — there's often an alternative.
- Ask about cost-saving options and generics.
- Keep a log of glucose readings to show how treatment is working.
Medicines are one part of the plan
Eating patterns, activity, sleep, and stress all affect glucose. See diabetes management and the diabetes diet.
Cardivo can hold your glucose readings, notes about doses, heart rate, and blood pressure in one journal and turn them into a PDF for your next appointment.
This guide is general wellness education based on the public sources below. It is not medical advice, diagnosis, or treatment. Cardivo is not a medical device. If you think you are having a medical emergency, call 911.
Frequently asked questions
What is the most common medication for type 2 diabetes?
Metformin is one of the most commonly prescribed first medicines for type 2 diabetes, often alongside lifestyle changes. Your doctor may add or choose other classes based on your health.
What are GLP-1 medications?
GLP-1 receptor agonists such as semaglutide, dulaglutide and liraglutide help the body release insulin after meals, slow digestion and reduce appetite. Some also lower heart risk.
Which diabetes medications cause low blood sugar?
Insulin and sulfonylureas (such as glipizide and glimepiride) carry the highest risk of low blood sugar. Most other classes have a low risk when used alone.
Sources
- NIDDK — What is diabetes?
- American Diabetes Association — Diagnosis
- CDC — Low blood sugar (hypoglycemia)