What you take for diabetes depends on which type you have and how well your blood sugar is currently controlled. Most people with type 2 diabetes start with a pill called metformin, while people with type 1 diabetes need insulin from the day they’re diagnosed. Beyond those starting points, the range of options has expanded significantly, from injectable medications that also protect the heart and kidneys to wearable devices that track blood sugar around the clock.
Type 1 Diabetes Requires Insulin
In type 1 diabetes, the body’s immune system destroys the cells that produce insulin, so replacing that insulin is the only treatment. There is no pill alternative. Insulin comes in several forms that differ mainly in how fast they start working and how long they last.
Rapid-acting insulin kicks in within about 15 minutes, peaks around one hour, and wears off in two to four hours. You typically take it right before a meal to cover the carbohydrates you’re about to eat. Long-acting insulin, by contrast, takes roughly two hours to start working but lasts up to 24 hours and has no sharp peak. It provides a steady background level of insulin throughout the day. Most people with type 1 use both: a long-acting dose once or twice daily plus rapid-acting doses at meals.
Insulin can be delivered through a traditional syringe, a pen device, or an insulin pump that attaches to the body and delivers tiny doses continuously. Pumps paired with continuous glucose monitors can even adjust insulin delivery automatically, sometimes called a “closed-loop” or “artificial pancreas” system.
Metformin: The Usual Starting Point for Type 2
For type 2 diabetes, the first medication most people are prescribed is metformin. It works in three ways: it reduces the amount of sugar your liver releases into the blood, slows sugar absorption from food, and helps your cells respond better to the insulin your body still makes. The typical starting dose is 1,000 mg once daily with food, and doctors may increase it up to 2,000 mg per day based on how your blood sugar responds.
Metformin is popular because it’s effective, inexpensive, and doesn’t cause weight gain. The most common side effects are digestive: nausea, bloating, or diarrhea, especially in the first few weeks. Taking it with a meal and increasing the dose gradually helps minimize those issues. For many people with early or mild type 2 diabetes, metformin combined with lifestyle changes is enough to keep blood sugar in a healthy range.
When Metformin Isn’t Enough
If metformin alone doesn’t bring your blood sugar to target, your doctor will add a second medication. Two older options illustrate the tradeoffs involved.
Sulfonylureas stimulate your pancreas to release more insulin. They’re cheap and effective, but they carry a real risk of low blood sugar (hypoglycemia) and tend to cause weight gain. In studies comparing them head-to-head with another class of drugs called DPP-4 inhibitors, about 24% of people on sulfonylureas experienced low blood sugar episodes at one year, compared to only 3% on DPP-4 inhibitors. DPP-4 inhibitors also promoted modest weight loss instead of weight gain. The tradeoff is cost: sulfonylureas are significantly less expensive.
GLP-1 Medications and Their Added Benefits
A newer class of injectable medications has become a major part of type 2 diabetes treatment. These drugs mimic a gut hormone that triggers insulin release after meals, slows digestion, and reduces appetite. You may have heard of some by their brand names: Ozempic and Rybelsus (semaglutide), Trulicity (dulaglutide), Mounjaro (tirzepatide), and Victoza (liraglutide).
Most are given as a once-weekly injection, though one form of semaglutide (Rybelsus) is a daily pill. Doses start low and increase over several weeks to reduce nausea, the most common side effect. For example, semaglutide injections start at 0.25 mg weekly for four weeks before increasing, and tirzepatide starts at 2.5 mg weekly.
What sets these medications apart is their benefits beyond blood sugar control. Semaglutide has been shown to reduce the risk of major cardiovascular events like heart attack and stroke in people with existing heart disease. It also slows kidney disease progression in people with type 2 diabetes and chronic kidney problems. Most people lose a meaningful amount of weight on these medications, which itself improves blood sugar, blood pressure, and cholesterol. For people with type 2 diabetes who also have heart disease, kidney disease, or obesity, these drugs often become a preferred second medication after metformin.
SGLT2 Inhibitors
Another newer class works by causing the kidneys to flush excess sugar out through urine. These pills lower blood sugar, promote modest weight loss, and slightly reduce blood pressure. Like GLP-1 medications, they have proven benefits for heart failure and kidney disease that go beyond blood sugar control. Common side effects include urinary tract infections and yeast infections, because the extra sugar in the urine creates a hospitable environment for bacteria and yeast.
Insulin for Type 2 Diabetes
Some people with type 2 diabetes eventually need insulin too, especially after many years when the pancreas produces less and less on its own. This doesn’t mean treatment has “failed.” It reflects the progressive nature of the disease. The transition often starts with a single daily injection of long-acting insulin added to oral medications, and it may later expand to include mealtime doses. The same insulin types used in type 1 diabetes apply here.
Gestational Diabetes
Diabetes that develops during pregnancy is usually managed first with meal planning and exercise. If those changes don’t bring blood sugar into range, insulin is the preferred medication because it doesn’t cross the placenta and is considered safest for the baby. Some oral medications have been studied during pregnancy, but the evidence on their safety is limited, and insulin remains the standard choice when medication is needed.
Diet and Exercise Are Treatments Too
Medication is only part of the picture. For type 2 diabetes in particular, what you eat and how much you move have a direct, measurable effect on blood sugar. General dietary guidelines for people at high risk or living with diabetes suggest getting roughly 45% to 65% of calories from carbohydrates, 10% to 35% from protein, and 20% to 35% from fat, but the specific balance should be tailored to you. What matters most in practice is choosing carbohydrates that digest slowly (whole grains, legumes, vegetables) rather than refined sugars, and keeping portions consistent so blood sugar doesn’t swing wildly between meals.
Regular physical activity improves your cells’ sensitivity to insulin, sometimes enough to reduce the amount of medication you need. Both aerobic exercise (walking, cycling, swimming) and resistance training (weights, bodyweight exercises) help independently, and combining them works best.
Monitoring Your Blood Sugar
Knowing your blood sugar in real time helps you and your doctor adjust treatment. The traditional method is a fingerstick glucose meter, which gives a single reading at the moment you test. Continuous glucose monitors (CGMs) are small sensors worn on the skin that check sugar levels every few minutes and show trends over time, making it much easier to spot patterns.
CGMs were once reserved mainly for people on insulin, but the 2025 standards of care from the American Diabetes Association now recommend considering them for anyone with type 2 diabetes, even those not on insulin, to help reach blood sugar goals. The recommendation also encourages introducing CGMs as early as possible after diagnosis rather than waiting until complications arise.
Handling Low Blood Sugar
If you take insulin or sulfonylureas, low blood sugar is a risk worth preparing for. The standard approach is called the 15/15 rule: eat 15 grams of fast-acting carbohydrate, wait 15 minutes, then check your blood sugar again. If it’s still low, repeat. Practical sources of 15 grams include three glucose tablets, half a cup of juice or regular soda, six to seven hard candies, or one tablespoon of sugar. Keeping one of these options within reach, especially in your car, gym bag, or nightstand, is a simple precaution that can prevent a dangerous situation.