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Metformin is a popular prescription drug used as a first-line treatment for type 2 diabetes.
For the majority of users, metformin is effective and well tolerated. But if you experience severe or persistent side effects while taking this medication, or it simply doesn't work, you may wonder if you have any other options.
The answer is yes. This article investigates the best alternatives to metformin for patients with type 2 diabetes.
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Why not take metformin?
Metformin improves blood sugar control, fights insulin resistance (a condition in which the body does not use insulin efficiently), and even helps with weight loss. Most guidelines Recommended as first-line treatment for type 2 diabetes.
They are also very affordable and generally effective, although their effectiveness may come at the cost of side effects.
side effects
Metformin can cause a variety of potentially harmful side effects, including:
For people with demanding work or school schedules, some of these side effects may be impossible to tolerate.
Additionally, experiencing these side effects can affect other areas of your life as well. For example, dealing with chronic gastrointestinal issues may prevent you from eating properly or maintaining regular exercise habits.
See below for more information. Metformin side effects (common and serious) and Can metformin cause lactic acidosis?
contraindication
You may also avoid taking metformin because it is contraindicated (not recommended) with many other common prescription drugs. (The summary is as follows Some drugs that may interact with metformin. )
In some cases, you may not be able to stop taking another drug that interacts negatively with metformin, so you may need an alternative drug.
invalidity
For some people, metformin doesn't work at all. It won't help everyone better manage their blood sugar levels, lower their HbA1c levels (an indicator of blood sugar control over the past 2-3 months), or lose weight. In fact, some people gain weight when taking metformin.
For more information, see: Signs that metformin is working (or not).
Insurance and lifestyle considerations
Finally, some people choose not to take metformin because they don't have health insurance coverage or because they want to manage their diabetes without medications.
See below for more information. Everything you need to know about metformin.
What are the alternatives to metformin?
Here are some alternatives you can discuss with your doctor.
(Be sure to work with your health care provider before making any changes to your diabetes management.)
Sulfonylurea
Sulfonylureas are oral diabetes medications that are usually taken with or before meals. They work to lower blood sugar by increasing the production of insulin from the beta cells of the pancreas. These tablets are usually taken once a day before breakfast or twice a day before breakfast and dinner.
Sulfonylureas include:
- Glipizide (trade name Glucotrol)
- Glimepiride (Amaryl)
- Glyburide (diabetes, glinase)
Sulfonylurea side effects
Possible side effects include:
Thiazolidinedione (TZD)
TZDs are an oral class of type 2 diabetes medications that increase insulin sensitivity and help reduce glucose production by the liver.
These are easily available, affordable, and do not pose a high risk of causing hypoglycemia.
Thiazolidinediones include:
- Pioglitazone (Actos)
- Rosiglitazone (Avandia)
Thiazolidinedione side effects
Possible side effects include:
- weight gain
- Increased risk of heart disease
- Edema (swelling) of feet, legs, arms, and hands
- Increased risk of fractures
DPP-4 inhibitor
DPP-4 inhibitors lower blood sugar and HbA1c levels without causing hypoglycemia (unless used with other drugs that can cause hypoglycemia, such as insulin or sulfonylureas).
They work by interfering with the breakdown of GLP-1 and GIP, two hormones in the body that lower blood sugar levels.
These hormones are usually broken down very quickly. DPP-4 inhibitors slow this process, allowing the hormone to work longer and lowering blood sugar levels only if they rise.
These drugs are often taken orally in combination with metformin, but they can also be taken without metformin.
See below for more information. Metformin combination drug for type 2 diabetes.
DPP-4 inhibitors include:
- Sitagliptin (Januvia)
- Saxagliptin (Onglyza)
- Linagliptin (Tragenta)
- Alogliptin (Nesina)
Side effects of DPP-4 inhibitors
Possible side effects include:
- Hypoglycemia when taken with insulin or sulfonylureas
- Gastrointestinal problems such as an upset stomach
- Increased risk of pancreatitis (inflammation of the pancreas)
- Fever, body aches, and other flu-like symptoms
GLP-1 receptor agonist
GLP-1 receptor agonists can be taken orally or by injection (once a day or once a week), depending on the specific drug used. These function similarly to her GLP-1 and GIP hormones in the body, which reduce insulin levels, but are less easily broken down.
Some of these drugs not only lower blood sugar and HbA1c levels, but also protect against heart disease.
In particular, GLP-1 receptor agonists are not weight loss drugs, but they can help with weight loss. According to the Mayo ClinicResearch shows that all GLP-1 drugs can lead to a total weight loss of 10.5 to 15.8 pounds.
GLP-1 receptor agonists include:
Side effects of GLP-1 receptor agonists
Possible side effects include:
- nausea
- vomiting
- Low blood sugar levels (when used with insulin)
- If you are on insulin therapy, your need for insulin is reduced
- diarrhea
- Weight loss
SGLT-2 inhibitor
SGLT-2 inhibitors are a type of oral medication, usually taken daily, that are used to lower blood sugar and HbA1c levels by causing excess glucose to be released into the urine. It rarely causes hypoglycemia.
These drugs are can protect Prevent heart failure and improve outcomes for people with heart disease, kidney disease, or heart failure.
SGLT-2 inhibitors include:
Side effects of SGLT-2 inhibitors
Possible side effects include:
- Frequent urination
- Increased frequency of urinary tract infections (UTIs)
- Increased risk of kidney damage
- Increased risk of diabetic ketoacidosis (DKA)
- dehydration
- thirst
- Low blood pressure
- Increased risk of amputation, especially with Invokana
GIP/GLP-1 receptor agonist
The first drug in this class was Approved in 2022. This is an injectable drug taken once a week that works to lower blood sugar levels by mimicking the effects of both GLP-1 and GIP.
Research shows that this drug can improve average symptoms. Approximately 15% to 20% weight loss.
GIP/GLP-1 receptor agonists include:
Side effects of GIP/GLP-1 receptor agonists
Possible side effects include:
- gastrointestinal problems
- hypoglycemia, especially when used with other drugs that can cause hypoglycemia, such as sulfonylureas or insulin
- Weight loss
- pancreatitis
- Changes in cholesterol and triglyceride levels
- kidney problems
- fatigue and dizziness
insulin
Insulin has been the cornerstone of diabetes treatment. Discovered in 1921. It is often used in type 2 diabetes when other drugs do not provide adequate blood sugar control.
The goal of insulin treatment is to mimic the body's natural insulin production. It is administered by injection, infusion (from an insulin pump), or inhalation. Different types of insulin have different onset, peak, and duration of action.
Common insulins used in the United States include:
fast-acting insulin
- Insulin lispro (Humalog, Admelog)
- Insulin aspart (NovoLog, Fiasp)
- Insulin glulisine (Apidra)
short-acting insulin
- Normal human insulin (Humulin R, Novolin R)
intermediate-acting insulin
- NPH (Isophane) Insulin (Humulin N, Novolin N)
long-acting insulin
- Insulin glargine (Lantus, Basaglar, Tojo)
- Insulin detemir (Levemir)
- Insulin degludec (Tresiba)
Possible side effects
- Hypoglycemia, especially when insulin doses are not balanced by food intake and physical activity
- weight gain
- Changes in adipose tissue at the injection site
- Allergic reactions ranging from local reactions at the injection site to systemic reactions
- swelling of arms and legs
- Insulin resistance, especially at high doses over long periods of time
Less commonly used alternatives
α-glucosidase inhibitor
The starch you eat is broken down into sugar in your body. Alpha-glucosidase inhibitors help lower blood sugar levels by blocking the digestion of starch. They are taken with the first bite of each meal.
Alpha-glucosidase inhibitors include:
- Acarbose (generic only)
- Miglitol (Griset)
Side effects of α-glucosidase inhibitors
Common side effects include:
- Gastrointestinal problems such as gas and diarrhea
Meglitinide
Meglitinides are a type of oral drug that stimulate insulin-producing beta cells in the pancreas to release insulin. It is taken before each meal to lower blood sugar levels after meals.
Meglitinides include:
- Repaglinide (Prandin)
- Nateglinide (Starrix)
Meglitinide side effects
Common side effects include:
Lifestyle changes
Finally, making healthy lifestyle changes is always a good approach, regardless of whether you are taking medication or not. Regular physical activity and eating a balanced, nutritious diet can help manage blood sugar levels, lower HbA1c, and may even lead to weight loss.
This may be the cheapest option, but it can be difficult to maintain. There is also no guarantee that you will be able to stop taking the medication if you change your lifestyle.
Other factors, such as a genetic predisposition to diabetes, may cause you to need medication even if you feel well and are otherwise healthy.
Consult your doctor and a registered dietitian (RD) to create an exercise and eating plan that fits your lifestyle and health goals.
final thoughts
Metformin is a very popular, affordable, and readily available drug for type 2 diabetes management, but it is not suitable for everyone.
Some people experience debilitating side effects that make it impossible to take this drug long-term. Some people don't have insurance coverage for metformin, don't want to take additional medication, or metformin simply doesn't work for them.
Fortunately, other options are also available. Sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT-2 inhibitors, GIP/GLP-1 receptor agonists, and less common alternatives such as alpha-glucosidase inhibitors and meglitinides A drug class that includes drugs can be used to treat type 2 diabetes. .
Whether you are taking medication or not, adopting a healthy lifestyle approach such as increasing physical activity and eating a nutritious diet can also be helpful.
Find out what your health insurance will cover to ensure that changing your diabetes medication is financially sustainable in the long term.
If metformin is not working for you and you would like to switch to it, talk to your doctor about possible alternatives and discuss what will work best for you, your lifestyle, and your health goals.
