Metformin alternatives: safe options when metformin isn't right for you
Can’t tolerate metformin or been told it’s not safe for you? That happens. Metformin is often first choice for type 2 diabetes, but side effects, kidney limits, or other health issues mean some people need a different plan. Below are practical alternatives you can discuss with your clinician — what they do, who they help, and what to watch for.
Prescription medication alternatives
SGLT2 inhibitors (examples: empagliflozin, dapagliflozin) help lower blood sugar by making the kidneys remove glucose. They can help with weight and heart health in people who qualify. Watch for urinary infections and stay hydrated.
GLP-1 receptor agonists (examples: semaglutide, liraglutide) slow stomach emptying, lower appetite, and reduce blood sugar. Many patients lose weight on these drugs. They can cause nausea at first and need injections for most options.
DPP-4 inhibitors (example: sitagliptin) are oral pills that modestly lower blood sugar and rarely cause low blood sugar. They’re gentle but not as strong as GLP-1s or SGLT2s.
Sulfonylureas (examples: glipizide, gliclazide) work well to lower glucose but carry higher risk of low blood sugar and may cause weight gain. They’re often cheaper and may be useful short term.
Pioglitazone is another oral option that improves insulin sensitivity. It can cause fluid retention and isn’t ideal if you have heart failure.
Insulin is the most powerful way to lower blood sugar. It’s used when other drugs don’t control glucose or when pancreas function drops.
Which prescription is best depends on your kidney and liver function, heart history, weight goals, and cost. Your provider will weigh benefits and risks.
Non-drug options and supplements
Lifestyle changes can be as effective as some medicines. A lower-carb diet, losing 5–10% of body weight, and regular moderate activity can cut blood sugar a lot. Bariatric surgery is an option for people with severe obesity and can sometimes put diabetes into remission.
Some supplements get attention. Berberine has small trials showing glucose-lowering effects similar to metformin, but product quality varies and it can interact with meds. Cinnamon, alpha-lipoic acid, and chromium show mixed evidence. Don’t start supplements without checking with your doctor or pharmacist.
Other practical steps: monitor your blood sugar at home, check kidney function regularly, and report symptoms like severe nausea, muscle pain, or shortness of breath right away. If metformin causes stomach upset, ask about dose changes or extended-release versions before switching.
Every person’s diabetes is different. Talk openly with your clinician about goals, side effects you can’t tolerate, costs, and lifestyle. Together you can pick an alternative that fits your health and daily life.
