Can’t take metformin because of side effects or kidney limits? Or has it stopped doing its job? There are clear alternatives—both drugs and lifestyle steps—that can help you control blood sugar. This page walks you through the common options, what they do, and what to ask your doctor.
SGLT2 inhibitors (examples: empagliflozin, dapagliflozin). These pills lower blood sugar by making the kidneys remove more glucose in urine. They often help with weight loss and can protect the heart and kidneys in some people. Main downsides: higher risk of urinary tract infections and, rarely, dehydration. Not ideal if you have recurrent genital infections.
GLP-1 receptor agonists (examples: semaglutide, liraglutide). These are injectable (some weekly, some daily) and lower blood sugar while often causing weight loss and reduced appetite. They can work well when weight loss is a goal. Side effects usually include nausea at first, and they’re more expensive than many pills.
DPP-4 inhibitors (example: sitagliptin). These are oral drugs that gently lower blood sugar and have few side effects. They’re weight neutral and carry low risk of low blood sugar, but their glucose-lowering effect is modest compared with GLP-1s or SGLT2s.
Sulfonylureas (examples: glipizide, gliclazide). These older pills boost insulin release from the pancreas and can be effective and inexpensive. Downsides: higher risk of hypoglycemia (low blood sugar) and weight gain.
Thiazolidinediones (example: pioglitazone). These improve insulin sensitivity. They can lower blood sugar well but may cause weight gain, fluid retention, and a small increased risk of fractures in some people.
Insulin. When pills aren’t enough, a low-dose basal insulin at night can safely bring down fasting glucose. Modern basal insulins have lower risk of severe lows, but injections and the chance of hypoglycemia matter.
Diet and weight loss often change the game. A consistent drop of 5–10% body weight commonly improves blood sugar. Low-carb approaches can lower fasting and post-meal glucose quickly; pick a plan you can stick with. Aim for 150 minutes a week of moderate exercise—walking, cycling, or swimming—to improve insulin sensitivity.
Check kidney function before switching drugs. If metformin was stopped due to low eGFR, SGLT2s may still be an option at certain levels, but dosing and safety differ. Always discuss heart and kidney history—some drugs help the heart, others don’t.
When you talk to your clinician, bring a list: current meds, A1C or recent glucose numbers, kidney function, weight goals, and cost/coverage concerns. Ask about hypoglycemia risk, likely weight effects, and whether injections are needed.
These choices work best when tailored to you. If metformin isn’t right, there are solid alternatives—so plan a focused chat with your care team and get a step-by-step plan you can follow.
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