Diabetes: Practical medication tips and what to try when metformin isn’t enough
Worried your blood sugar won’t budge even after trying diet, exercise, and metformin? You’re not alone. Type 2 diabetes often needs a second drug, and the right choice depends on your goals—lower A1c, weight loss, heart protection, or avoiding low blood sugar. This page gives clear, usable pointers to help you and your prescriber pick the best next step.
When metformin stops working
If your A1c stays above target after a few months on metformin, it’s time to consider adding or switching therapy. First, check basic things: are you taking metformin regularly, is the dose optimized, and are lifestyle steps in place? Ask for an A1c test and kidney function check (eGFR). Kidney function affects which drugs are safe. If you haven’t already, read our piece "Best Second-Line Diabetes Medications When Metformin Isn't Enough" for a detailed look at current options.
Think about what matters to you. Want weight loss? GLP-1 receptor agonists often help. Need heart or kidney protection? SGLT2 inhibitors have strong evidence. Want an easy oral option? DPP-4 inhibitors or sulfonylureas might fit. Cost and delivery method (pill vs injection) also matter—don’t ignore them.
Choosing the right second drug
Here’s a simple checklist to discuss with your clinician:
- Goal: lower A1c vs weight vs cardiovascular benefits. Different drugs do different things.
- Kidney status: many meds require a minimum eGFR.
- Hypoglycemia risk: avoid sulfonylureas or insulin if low blood sugar is a big concern.
- Side effects: SGLT2s can raise UTI risk; GLP-1s can cause nausea; sulfonylureas can cause weight gain.
- Cost and access: insurance coverage matters—ask about copay cards or cheaper alternatives.
If you want practical comparisons, check our article "Exploring 10 Effective Alternatives to Metformin for Diabetes Management". It lists mechanisms, pros/cons, and who benefits most from each class.
For people close to target, small changes can work: improve sleep, add resistance training, and cut sugary drinks. For higher A1c, combination therapy is common—two drugs often work better than one. If you’re offered insulin, don’t panic. Modern basal insulin is safe and effective for many, especially when oral meds aren’t enough.
Finally, stay engaged. Track your A1c, know your target, and note symptoms of low blood sugar. If cost or supply is an issue, our site also covers safe online pharmacy options and tips to find affordable medications. Always ask your prescriber why they chose a drug and what side effects to watch for.
Want a deeper dive? Read the full guides on specific drug classes and real-world tips linked on this tag page—these pieces break down choices into plain language so you can feel confident in your next step.
Jan, 23 2025