Diabetes Medications: Metformin and Others - How They Work and What to Avoid

You're sitting in the doctor's office. Fresh test results in front of you. The doctor says calmly: "Type 2 diabetes. We need to start treatment." And suddenly a thousand questions are racing through your mind. What does this mean? What medications? For how long? Does this mean life is over?

No, life is not over. Quite the opposite - a new chapter is beginning. And you know what? You actually have a huge influence on how it will look. Diabetes is not a sentence, it's a challenge. And the medications we're about to discuss honestly are one of the most important tools in your hands.

I won't lie to you - diabetes requires effort. But with the right knowledge and support, you can live a long, healthy and active life. Let's start from the beginning.

How does diabetes actually work? A quick explanation

Imagine that your cells are houses and glucose (blood sugar) is a parcel that needs to be delivered inside. Insulin is the courier - it opens the door and brings the parcel in. The problem with type 2 diabetes? Either there aren't enough couriers (the pancreas doesn't produce enough insulin), or the doors are broken (cells are resistant to insulin). The result? Parcels pile up outside the house - glucose circulates in the blood, unable to enter the cells.

And this is where medications step in. Their job is either to help the courier (increase insulin production), fix the doors (improve insulin sensitivity), or simply reduce the number of parcels (lower blood glucose levels).

Metformin: the first-line medication - why?

If you've just been diagnosed with type 2 diabetes, there's a good chance your doctor will prescribe metformin. It's an absolute classic - the number one medication for treating diabetes for over 60 years. And that's no coincidence.

How does metformin work?

Metformin works on several fronts at once:

• Reduces glucose production in the liver - the liver has a habit of producing "reserve" sugar at night. Metformin says: stop, we don't need it.
• Improves cell sensitivity to insulin - fixes those "broken doors" I mentioned.
• Slows glucose absorption from the gut - sugar after a meal reaches the blood more slowly.

The result? Lower blood sugar, both fasting and after meals.

Advantages of metformin

• Doesn't cause hypoglycaemia (dangerously low blood sugar) - safe as monotherapy
• Often helps with slight weight loss (unlike some other diabetes medications)
• Beneficial effects on the cardiovascular system
• Relatively affordable and widely available
• Proven for decades - we know exactly what to expect

Side effects - let's be honest

Metformin is an excellent medication, but it's not perfect. The most common issues are:

Gastrointestinal problems: Nausea, diarrhoea, bloating, abdominal discomfort. These are the most common side effects, especially at the start. Good news? For most people, they pass within 1-2 weeks.

How to minimise them?

• Start with small doses and increase gradually (your doctor will set the schedule)
• Take metformin during or right after a meal - never on an empty stomach
• Consider extended-release (XR) formulations - gentler on the gut
• Limit fatty, hard-to-digest meals at the start of treatment

Vitamin B12 deficiency: Long-term metformin use can lower vitamin B12 levels. Worth checking once a year and supplementing if needed.

When to avoid metformin?

• Severe kidney disease (renal failure)
• Heart failure
• Severe liver disease
• Alcohol abuse
• Acute infections, dehydration

Before procedures involving contrast dye, metformin sometimes needs to be temporarily stopped - your doctor will inform you about this.

Other diabetes medications - what else is in the medicine cabinet?

Metformin doesn't always suffice. Or it can't be used. Or diabetes progresses. That's when doctors reach for other treatments.

1. Sulphonylureas (glibenclamide, gliclazide)

How do they work? They stimulate the pancreas to produce more insulin.

Pros: Effective, rapid blood sugar reduction, affordable.

Cons:

• Risk of hypoglycaemia (dangerously low sugar) - especially if you skip a meal
• Can cause weight gain
• Effectiveness may decline over time (pancreatic exhaustion)

When to use? Often in combination with metformin, when metformin alone isn't enough.

Important: Always carry something sweet (sweets, juice) in case of hypoglycaemia. Symptoms: trembling hands, sweating, feeling of hunger, nervousness, palpitations.

2. DPP-4 inhibitors (sitagliptin, vildagliptin)

How do they work? They increase incretin levels - hormones that stimulate insulin secretion in response to a meal.

Pros:

• Low risk of hypoglycaemia
• Weight neutral (you don't gain weight)
• Well tolerated - few side effects
• Convenient (often one tablet daily)

Cons: More expensive than metformin and sulphonylureas.

3. GLP-1 receptor agonists (liraglutide, dulaglutide, semaglutide)

This is a newer class of medication - and currently very popular.

How do they work? They mimic the action of the natural hormone GLP-1:

• Stimulate insulin secretion (when blood sugar is elevated)
• Inhibit glucagon secretion (a hormone that raises blood sugar)
• Slow stomach emptying - you feel full for longer
• Act on the satiety centre in the brain - you have less appetite

Pros:

• Effective blood sugar lowering
• Help with weight loss (often significantly - 5-10 kg)
• Beneficial effect on heart and blood vessels
• Low risk of hypoglycaemia

Cons:

• Administered by injection (once daily or once weekly)
• Side effects: nausea, vomiting (especially at the start)
• Expensive - reimbursement often requires meeting certain conditions

Fun fact: Semaglutide (Ozempic, Wegovy) became famous as a "celebrity weight loss drug". But remember - it's a diabetes medication, not a cosmetic. Only use it under medical supervision.

4. SGLT2 inhibitors (dapagliflozin, empagliflozin)

How do they work? They block glucose reabsorption in the kidneys - sugar is excreted in the urine.

Pros:

• Lower blood sugar independently of insulin
• Help with weight loss (you lose calories through urine)
• Lower blood pressure
• Protect the heart and kidneys - great for people with heart disease

Cons:

• Increased risk of urinary tract infections and genital thrush (due to sugar in the urine)
• Risk of ketoacidosis (rare but serious)
• Expensive

Tip: Maintain good intimate hygiene, drink plenty of water, react quickly to signs of infection.

5. Insulin - when it's needed, it's needed

Many patients fear insulin. "It's the end", "It means things are bad", "It's addictive". Wrong thinking.

The truth is: Insulin is a natural hormone your body produces. If the pancreas can't produce enough of it, you need to provide it externally. Just as people with an underactive thyroid take thyroid hormones - there's nothing wrong with that.

When is insulin used for type 2 diabetes?

• When other medications don't control blood sugar well enough
• When HbA1c is very high (above 10%)
• During pregnancy (many oral medications are contraindicated)
• During acute illnesses, infections, surgical procedures

Types of insulin:

• Long-acting (basal) - one or two injections daily, provides a steady level of insulin
• Short-acting (bolus) - before meals, covers the sugar rise after eating
• Mixtures - combine both types

Side effects: Mainly hypoglycaemia (if the dose is too high) and weight gain. But with proper dose adjustment and regular meals, these can be avoided.

Medication isn't everything - lifestyle matters

Now for the most important part. I could prescribe you the best medications in the world, but if you keep eating as before, don't get off the sofa and keep smoking - they won't work miracles.

The research is unforgiving: lifestyle changes are as effective as medications. And sometimes even more effective.

Diet - your first line of defence

What to eat?

• Non-starchy vegetables (broccoli, spinach, peppers) - as much as you want, practically unlimited
• Whole grain products (wholemeal bread, grains, brown rice) - in moderate amounts
• Lean protein (fish, poultry, eggs, legumes)
• Healthy fats (olive oil, nuts, avocado)
• Fruit - yes, but in moderation (berries, apples are better than bananas, grapes)

What to avoid?

• Sugar and sweets (cake, biscuits, milk chocolate)
• Sugary drinks (cola, juices, energy drinks)
• White bread, white rice, chips
• Fast food, processed meat
• Trans fats

The plate rule: Half your plate - vegetables. Quarter - protein. Quarter - whole grain carbohydrates. A spoonful of healthy fat.

Exercise - a prescription-free medicine

You don't have to run a marathon. Just 150 minutes of moderate activity per week is enough - that's 30 minutes a day, 5 days a week. A brisk walk, cycling, swimming, gardening - whatever you enjoy.

Why does it work? Exercise makes your muscles use glucose - blood sugar drops. Plus it improves cell sensitivity to insulin. It's like a natural medication.

Weight - every kilogram matters

If you're overweight or obese, losing even 5-10% of your body weight can dramatically improve diabetes control. Some people after losing weight can stop taking medications entirely. I'm not joking.

Stress and sleep

Chronic stress raises cortisol - and cortisol raises blood sugar. Lack of sleep has a similar effect. Aim for 7-9 hours of sleep, find ways to relax (meditation, hobbies, time with family).

Monitoring - knowledge is power

If you don't measure, you don't know. And if you don't know, you can't react.

Home blood glucose monitoring

A glucometer is your friend. Especially if you take insulin or sulphonylureas.

When to measure?

• Fasting (in the morning before breakfast)
• 2 hours after a meal (to see how your body handles food)
• Before bed (if you use insulin)
• When you feel strange (could it be hypoglycaemia?)

What results are OK?

• Fasting: 80-130 mg/dl
• 2 hours after a meal: below 180 mg/dl

Your doctor may set different targets - it's an individual matter.

HbA1c - the gold standard

This is a blood test that shows your average blood sugar over the past 2-3 months. It's done every 3-6 months at a laboratory.

Targets:

• For most people with diabetes: below 7%
• For older adults, those with heart disease: below 8% (less strict)
• For younger people, without complications: below 6.5%

Most common questions (and honest answers)

Will I have to take medications for the rest of my life?

Not necessarily. If you lose weight, change your diet and start exercising - diabetes can go into remission. Some people stop taking medications entirely. But it requires consistency. And always under medical supervision.

What if I forget to take a tablet?

It depends on the medication. General rule: if you remembered within a few hours - take the dose. If most of the day has passed - skip the dose, don't double the next one. Check the leaflet or ask your pharmacist.

Can I drink alcohol?

Moderate drinking (1 drink daily for women, 2 for men) is probably OK - but be careful. Alcohol can cause hypoglycaemia, especially if you take insulin or sulphonylureas. Always eat something with alcohol. And ideally monitor your blood sugar.

Where can I buy medications more affordably?

Diabetes medication prices can vary between pharmacies - even by 20-30%. Check CheaperForDrug before buying. Especially if you take medications without full reimbursement - you could save hundreds of euros over a year.

Can supplements help?

Some have certain effects (chromium, magnesium, alpha-lipoic acid), but they never replace medications prescribed by your doctor. Treat them as an addition, not the foundation of treatment. And always consult your doctor - they can interact with medications.

When to see a doctor immediately?

Call or go to the emergency department if:

• Blood sugar above 300 mg/dl and not dropping despite treatment
• Symptoms of ketoacidosis: abdominal pain, nausea, vomiting, acetone breath, rapid breathing
• Severe hypoglycaemia: loss of consciousness, seizures, inability to swallow
• Acute infections, fever above 38.5 degrees C
• Wounds that won't heal

Summary - what to remember?

Metformin is the first-line medication - effective, safe, proven. Start with small doses, take with food.

There are many groups of medications - if one doesn't work, there are other options. Don't give up.

Insulin is not a death sentence - it's simply a hormone your body needs. Don't be afraid of it.

Medication is only half the battle - diet, exercise and weight loss make a huge difference. Sometimes more than tablets.

Monitor your blood sugar regularly - at home with a glucometer, every few months with HbA1c. Knowledge is power.

Talk to your doctor and pharmacist - have doubts? Ask. It's your health, you have the right to know.

Compare medication prices - CheaperForDrug will help you find the best deals.

Disclaimer

This information is educational and does not replace a medical consultation. Every patient is different - dosing, medication choice and treatment plans must be established individually by a diabetologist or internist. Never change your dosing or stop medications without consulting your doctor. If you have questions about your treatment - talk to your doctor or pharmacist.

And remember: Diabetes is not the end of the world. It's a challenge that you can take on and win. Thousands of people live with diabetes and live life to the fullest - they travel, exercise, raise children, build careers. You can too. It requires work, consistency and support - but it is possible.

Your health is in your hands. And savings on medications? At CheaperForDrug. Take care of yourself wisely - and affordably.