The Best Alternatives to Metformin for Type 2 Diabetes Management

Metformin is a well-liked prescription drug that’s used as a first-line remedy for sort 2 diabetes. 

For almost all of customers, metformin is efficient and well-tolerated. However in case you are experiencing extreme or persistent uncomfortable side effects when taking this drugs, or if it merely isn’t working, it’s possible you’ll marvel if there are every other choices.

The reply is sure. This text will examine the most effective alternate options to metformin for folks with sort 2 diabetes. 

Key Factors:

• Whereas an efficient remedy for a lot of, metformin could cause important uncomfortable side effects reminiscent of gastrointestinal points, and it could have detrimental interactions with different frequent medicines. 
• In some instances, metformin will not be efficient in managing blood glucose ranges or will not be suggested due to well being circumstances or insurance coverage protection limitations.
• A number of courses of diabetes medicines supply totally different mechanisms of motion and advantages for managing sort 2 diabetes. These alternate options could also be extra appropriate for individuals who can’t tolerate metformin or discover it ineffective.
• Every different class of treatment comes with its personal set of potential uncomfortable side effects, starting from gastrointestinal points to dangers of hypoglycemia and weight achieve. Understanding these results is significant for choosing probably the most acceptable remedy possibility.
• Together with treatment, life-style modifications reminiscent of elevated bodily exercise and dietary adjustments could be efficient in managing sort 2 diabetes. Though troublesome to take care of, these measures can considerably enhance blood sugar administration and general well being. 

Why would you not take metformin?

Metformin helps higher handle blood sugar ranges, struggle insulin resistance (a situation wherein the physique doesn’t use insulin effectively), and might even assist with weight reduction. Most tips advocate it because the first-line remedy for sort 2 diabetes. 

It is usually very reasonably priced and customarily efficient, however that effectiveness can include a price: uncomfortable side effects. 

Negative effects

Metformin could cause a wide range of probably detrimental uncomfortable side effects, together with:

For some individuals who have strict work or faculty schedules, enduring a few of these uncomfortable side effects will not be doable. 

Moreover, experiencing these uncomfortable side effects may influence different areas of your life. Coping with continual gastrointestinal points, for instance, can turn out to be an impediment to consuming nicely or forestall you from sustaining an everyday train behavior. 

Contraindications

In different instances, folks might keep away from taking metformin as a result of it’s contraindicated (not suggested) to take with many different frequent pharmaceuticals. (Right here is an summary of the medication which will work together with metformin.) 

Generally it’s inconceivable to cease taking one other drugs that negatively interacts with metformin, and subsequently, a substitute is important. 

Ineffectiveness

And for some folks, metformin merely will not be efficient. It doesn’t assist everybody higher handle their blood sugars, decrease their HbA1c ranges (a measure of glucose management over the earlier 2 to three months), or drop pounds. In reality, some folks even achieve weight when taking metformin.

Insurance coverage or life-style concerns

Lastly, some folks might choose to not take metformin as a result of their medical health insurance doesn’t cowl it, or they want to handle their diabetes with out the usage of prescribed drugs. 

What are alternate options to metformin? 

The next are some alternate options you could focus on along with your physician.

(Keep in mind to all the time work along with your healthcare supplier earlier than making any adjustments to your diabetes administration.) 

Sulfonylureas 

Sulfonylureas are oral diabetes medicines which might be typically taken with or earlier than a meal. They work to decrease blood sugar by growing the manufacturing of insulin from the beta cells within the pancreas. These tablets are normally both taken as soon as a day earlier than breakfast or twice every day, earlier than each breakfast and dinner. 

Sulfonylureas embrace:

• Glipizide (model identify Glucotrol)
• Glimepiride (Amaryl)
• Glyburide (Diabeta, Glynase)

Sulfonylurea uncomfortable side effects

Some doable uncomfortable side effects embrace: 

Thiazolidinediones (TZDs)

TZDs are an oral class of sort 2 diabetes treatment that will increase insulin sensitivity and helps lower glucose manufacturing by the liver.

They’re simply accessible and reasonably priced and should not have a excessive danger of inflicting hypoglycemia.

Thiazolidinediones embrace:

• Pioglitazone (Actos)
• Rosiglitazone (Avandia)

Thiazolidinedione uncomfortable side effects

Some doable uncomfortable side effects embrace:

• Weight achieve
• Elevated danger for coronary heart illness
• Edema (swelling) of toes, legs, arms, and arms 
• Elevated danger for bone fracture 

DPP-4 inhibitors 

DPP-4 inhibitors decrease blood sugar and HbA1c ranges with out inflicting low blood glucose (until taken with different medicines that may trigger hypoglycemia, reminiscent of insulin or sulfonylureas).

They perform by interfering with the breakdown of two hormones within the physique, GLP-1 and GIP, that cut back blood glucose ranges. 

These hormones are usually damaged down in a short time. By serving to gradual this course of, DPP-4 inhibitors permit the hormones to perform for longer, decreasing blood sugar ranges solely when they’re elevated.

These medication are taken orally, usually together with metformin, however they are often taken with out metformin as nicely. 

DPP-4 inhibitors embrace:

• Sitagliptin (Januvia)
• Saxagliptin (Onglyza)
• Linagliptin (Tradjenta)
• Alogliptin (Nesina)

DPP-4 inhibitor uncomfortable side effects

Attainable uncomfortable side effects embrace:

• Low blood sugar, if taken together with insulin or sulfonylureas
• Gastrointestinal points like upset abdomen 
• Elevated danger for pancreatitis (irritation of the pancreas)
• Fever, physique aches, and different flu-like signs 

GLP-1 receptor agonists 

GLP-1 receptor agonists can both be taken orally or by an injection (both as soon as a day or as soon as weekly), relying on the precise drugs used. They perform equally to the GLP-1 and GIP hormones within the physique that decrease insulin ranges however are extra proof against being damaged down. 

Along with decreasing blood sugar and HbA1c ranges, a few of these medicines additionally shield in opposition to coronary heart illness. 

Notably, though they don’t seem to be weight-loss medication, GLP-1 receptor agonists can help with weight reduction. In accordance with the Mayo Clinic, research point out that every one GLP-1 medication can result in a complete weight lack of between 10.5 and 15.8 kilos. 

GLP-1 receptor agonists embrace:

GLP-1 receptor agonist uncomfortable side effects

Attainable uncomfortable side effects embrace:

• Nausea 
• Vomiting
• Low blood sugar ranges (if taken together with insulin)
• Decreased want for insulin, if on insulin remedy 
• Diarrhea 
• Weight reduction 

SGLT-2 inhibitors 

SGLT-2 inhibitors are a category of oral treatment, typically taken every day, used to decrease blood sugar ranges and HbA1c ranges by inflicting the discharge of extra glucose within the urine. They hardly ever trigger low blood sugar.

These medicines can shield in opposition to coronary heart failure and enhance outcomes in individuals who have coronary heart illness, kidney illness, or coronary heart failure.

SGLT-2 inhibitors embrace:

SGLT-2 inhibitor uncomfortable side effects

Attainable uncomfortable side effects embrace:

• Frequent urination
• Elevated frequency of urinary tract infections (UTIs) 
• Elevated danger for kidney injury
• Elevated danger for diabetic ketoacidosis (DKA)
• Dehydration
• Thirst
• Low blood stress 
• For Invokana, particularly, elevated danger of amputations 

GIP/GLP-1 receptor agonists

The primary drugs on this class was accredited in 2022. It’s an injectable drug taken as soon as weekly, and it features by mimicking the actions of each GLP-1 and GIP to assist decrease blood sugar ranges. 

Analysis signifies that this treatment results in a median weight lack of about 15 p.c to twenty p.c.

GIP/GLP-1 receptor agonists embrace:

GIP/GLP-1 receptor agonist uncomfortable side effects

Attainable uncomfortable side effects embrace:

• Gastrointestinal points
• Hypoglycemia, significantly when used with one other drugs that may trigger low blood sugar reminiscent of a sulfonylurea or insulin
• Weight reduction
• Pancreatitis
• Adjustments in ldl cholesterol and triglyceride ranges
• Kidney points
• Fatigue and dizziness

Insulin

Insulin has been a cornerstone in diabetes remedy since its discovery in 1921. In sort 2 diabetes, it’s usually used when different medicines don’t present enough blood sugar management. 

The aim of insulin remedy is to imitate the physique’s pure insulin manufacturing. It’s administered by way of injection, infusion (from an insulin pump), or inhalation. The several types of insulin range in onset, peak instances, and period of motion. 

Among the extra frequent insulins utilized in the US embrace:

Speedy-acting insulin

• Insulin lispro (Humalog, Admelog)
• Insulin aspart (NovoLog, Fiasp)
• Insulin glulisine (Apidra)

Quick-acting insulin

• Common human insulin (Humulin R, Novolin R)

Intermediate-acting insulin

• NPH (isophane) insulin (Humulin N, Novolin N)

Lengthy-acting insulin

• Insulin glargine (Lantus, Basaglar, Toujeo)
• Insulin detemir (Levemir)
• Insulin degludec (Tresiba)

Attainable uncomfortable side effects 

• Hypoglycemia, significantly if the insulin dose will not be balanced with meals consumption and bodily exercise
• Weight achieve
• Adjustments in fats tissue at injection websites
• Allergic reactions, starting from native injection web site reactions to systemic ones
• Swelling of legs and arms
• Insulin resistance, particularly with greater doses over time

Much less-commonly used alternate options

Alpha-glucosidase inhibitors

The starches you eat are damaged down into sugars by your physique. Alpha-glucosidase inhibitors assist decrease blood sugar ranges by blocking the digestion of starches. They’re taken with the primary chunk of every meal.

Alpha-glucosidase inhibitors embrace:

• Precose (generic solely)
• Miglitol (Glyset)

Alpha-glucosidase inhibitor uncomfortable side effects

Frequent uncomfortable side effects embrace: 

• Gastrointestinal points reminiscent of fuel and diarrhea

Meglitinides

Meglitinides are a kind of oral treatment that stimulates the insulin-producing beta cells of the pancreas to launch insulin. They’re taken earlier than every meal to assist decrease after-meal blood glucose ranges.

Meglitinides embrace:

• Repaglinide (Prandin)
• Nateglinide (Starlix)

Meglitinide uncomfortable side effects

Frequent uncomfortable side effects embrace: 

Way of life adjustments 

Lastly, adopting wholesome life-style adjustments is all the time a great strategy, whether or not or not you take treatment. Participating in common bodily exercise and consuming a balanced, nutritious weight-reduction plan can assist handle blood sugar ranges, decrease your HbA1c, and probably result in weight reduction as nicely. 

This can be the most affordable possibility, however it may be arduous to take care of. And it’s additionally not assured that life-style adjustments will assist you to cease taking medicines. 

Different elements, reminiscent of a genetic predisposition for diabetes, could make treatment crucial, even in case you are in nice bodily situation and in any other case wholesome. 

Discuss along with your physician and meet with a registered dietitian (RD) to develop an train and consuming plan that may work in your life-style and well being targets. 

Last ideas

Whereas metformin is an especially widespread, reasonably priced, and accessible drug for sort 2 diabetes administration, it’s not for everybody. 

Some folks expertise debilitating uncomfortable side effects that make taking this drug over the long run inconceivable. Others might not have insurance coverage protection for metformin or might not want to take further medicines, or metformin might merely not be working for them. 

Happily, different choices can be found. Drug courses together with sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT-2 inhibitors, GIP/GLP-1 receptor agonists, and fewer frequent alternate options like alpha-glucosidase inhibitors and meglitinides can be utilized to deal with sort 2 diabetes.

Adopting wholesome life-style approaches reminiscent of elevated bodily exercise and a nutritious weight-reduction plan may assist, whether or not or not you’re taking drugs.

Do a little analysis to see what your medical health insurance will cowl to guarantee that any adjustments in your diabetes medicines are financially sustainable over the long run. 

If metformin will not be working nicely and also you need to make a swap, converse along with your physician about doable alternate options, and focus on what’s going to work finest for you, your life-style, and your well being targets.