Diabetes treatment: what actually works and when to act
High blood sugar doesn’t have to control your life. You can lower A1c and feel better with the right mix of medicine and daily habits. This page gives clear, practical steps so you know the common drugs, what they do, and how to choose next steps if metformin alone isn’t enough.
Core medicines and what they do
Most people start with metformin. It’s cheap, usually well tolerated, and helps lower A1c by about 1%. If metformin isn’t enough, doctors commonly add one of these classes:
- SGLT2 inhibitors (empagliflozin, canagliflozin, dapagliflozin): lower blood sugar and cut heart and kidney risks in many patients. Watch for genital infections and check kidney function before starting.
- GLP-1 receptor agonists (liraglutide, semaglutide): great for weight loss and strong A1c drops. Expect nausea at first; dosing and injection schedules vary by drug.
- DPP-4 inhibitors (sitagliptin, linagliptin): modest A1c effect, low risk of hypoglycemia, and easy to add if you want a gentle option.
- Sulfonylureas (glipizide, glyburide): effective and inexpensive but can cause low blood sugar and weight gain.
- Insulin: the most powerful way to lower glucose. It’s used when A1c is very high or oral drugs aren’t enough. Modern basal insulins are easier to manage than older forms.
Practical steps you can start today
1) Move more: aim for 150 minutes weekly of moderate activity (walking, cycling). Exercise lowers glucose and improves insulin sensitivity right away.
2) Cut portion sizes and favor whole foods: vegetables, beans, whole grains, and lean proteins. Carb control matters more than cutting all carbs.
3) Track: bring a 2–4 week glucose log and a current meds list to your provider. That helps pick the best next drug and avoid interactions.
4) Know side effects: SGLT2 can cause dehydration and infections, GLP-1 can cause nausea, sulfonylureas risk hypoglycemia. Always ask your clinician how to spot and manage these.
5) Check labs: A1c every 3 months when changing therapy, kidney tests (eGFR) before some drugs, and yearly eye and foot checks.
If metformin isn’t enough, see our guide “Best Second-Line Diabetes Medications When Metformin Isn't Enough” for a clear comparison of options and how to choose based on weight, heart disease, and kidney status.
Red flags to act on now: very high A1c (>10%), sudden weight loss, severe thirst, repeated low sugars, or symptoms of infection. Those need prompt medical attention.
Want a simple checklist to bring to your next visit? Pack your recent glucose readings, current meds, questions about side effects, and your goals (weight loss, fewer lows, heart protection). That makes the visit focused and useful.
Diabetes treatment is personal. With clear goals, the right meds, and daily habits, most people get better control and fewer complications. Talk with your clinician and use these practical steps to move forward.
Jan, 5 2025