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See below for descriptions of how different kinds of diabetes pills work.
Biguanides
This category of diabetes pills slows the liver from releasing glucose (sugar) and improves a person's response to the body's own insulin. If biguanides are used alone, they rarely cause blood sugar to drop too low.
Medication: metformin (Glucophage, Glucophage XR)
- Initial dose:
- Week 1: 250 mg with evening meal
- Week 2: 250 mg with breakfast and dinner
- Week 3 and 4: 500 mg with breakfast and dinner
- Max dose: 2000 mg daily
- Adverse effects: Cramping, gas, diarrhea. Lactic acidosis is rare but possible in people with serious heart, kidney, lung, or liver disease
- Special considerations: Metformin is the first choice for type 2 diabetes treatment if lifestyle changes don't bring blood sugar levels to safe levels. When used alone, it rarely causes low blood sugar.
- Precautions: Patients should have a kidney function test before starting metformin. Patients should stop taking metformin if they are running a high fever accompanied by continuous vomiting, diarrhea, or both. Daily alcohol use while taking metformin can cause a buildup of lactic acid which can cause damage to the kidneys, lung, and heart.
Sulfonylureas
This category of diabetes pills causes the pancreas to make more insulin. Sulfonylureas can only be used by people whose bodies already make some insulin. These drugs can cause blood sugar to drop too low. These drugs shouldn't be used by anyone with an allergy to sulfa drugs.
Medication: glimepiride (Amaryl)
- Initial dose: 1 to 2 mg once a day at breakfast or first main meal
- Max dose: 8 mg daily
- Side effects: Low blood sugar
Medication: glipizide (Glipizide XL, Glucotrol, Glucotrol XL)
- Initial dose: 2.5 mg to 5 mg before breakfast or before breakfast and dinner
- Max dose: 20 mg daily for Glipizide XL and Glucotrol XL and 40 mg daily for Glucotrol IR
- Side effects: Low blood sugar
- Special considerations: Recommended for patients aged 65 and older if at risk for long periods of low blood sugar levels. Patient aged 65 and older should not exceed 20 mg daily.
Sodium-Glucose Co-Transporter 2 (SGLT-2) Inhibitors
This category of diabetes pills causes the kidneys to get rid of glucose in the urine.
Medication: empagliflozin (Jardiance)
- Initial dose: 12.5 mg once a day
- Max dose: 25 mg daily
- Side effects: Light-headedness, urinary or genital infections, ketoacidosis, dehydration
- Special considerations: May be used for heart or kidney protection
- Precautions: Patients should call their health care team right away if any sores in the genitals develop. SGLT2 medications should be stopped during any illness with high fever, vomiting or diarrhea.