There isn't a single "No. 1" diabetes medicine, but Metformin is universally the first-line, most common, and widely used drug for Type 2 diabetes due to its effectiveness, safety, affordability, and long history. Other important classes include SGLT2 inhibitors (like empagliflozin) and GLP-1 agonists (like liraglutide), which are crucial for cardiovascular and kidney health, often added to metformin for better management.
Medically reviewed by Carmen Pope, BPharm. Last updated on Sep 8, 2025. Metformin is widely considered the safest first-line medication for type 2 diabetes.
Insulin is the traditional first-choice drug for blood glucose control during pregnancy because it is the most effective for fine-tuning blood glucose and it doesn't cross the placenta. Therefore, it is safe for the baby.
Side effects that you should report to your care team as soon as possible: Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat. High lactic acid level—muscle pain or cramps, stomach pain, trouble breathing, general discomfort and fatigue.
Under certain conditions, too much metformin can cause lactic acidosis. The symptoms of lactic acidosis are severe and quick to appear, and usually occur when other health problems not related to the medicine are present and are very severe, such as a heart attack or kidney failure.
In a 12-week, randomized, parallel-group, double-blind, placebo-controlled study, patients assigned to dapagliflozin 10 mg daily presented a 2.7% reduction in body weight (95%IC -3.5 to -1.8%) as compared to a weight loss of 1.7% in those assigned to the metformin group (95%CI -2.4 to -0.9%) and 1.2% in patients ...
Metformin is safe in pregnancy and appears to produce better results than insulin, including reduced gestational weight gain (GWG) and smaller gestational-age newborns. Few studies have been conducted on this topic in low- and middle-income countries.
Often, testing is advised before meals and at bedtime if you take more than one shot of insulin a day. You may need to test only before breakfast and sometimes before dinner or at bedtime if you use an intermediate- or a long-acting insulin.
How long to take it for. Treatment for diabetes is usually for life. But if your kidneys are not working properly, your doctor will tell you to stop taking metformin and switch you to a different medicine. Do not stop taking metformin without talking to your doctor.
Taking metformin can cause vitamin B12 deficiency if you take it for a long time. This can make you feel very tired, breathless and faint, so your doctor may check the vitamin B12 level in your blood. If your vitamin B12 levels become too low, vitamin B12 supplements will help.
Metformin is a first-choice medication for managing Type 2 diabetes. But it can sometimes lower your vitamin B12 levels. You can increase the amount of vitamin B12 in your diet to help keep your levels up while taking metformin. But it's best to avoid taking a B12 supplement unless your prescriber recommends it.
Insulin. Insulin is the primary type 1 diabetes treatment. People with type 1 diabetes (T1D) must take insulin to survive because their body does not make enough of it. Insulin is administered by injection, inhalation, or insulin pump.
Walking, like other exercise, can help: Lower blood sugar. Increase your body's ability to use insulin better.
A: Yes. Adults over 60 may have slightly higher fasting and post-meal blood sugar due to changes in metabolism and insulin sensitivity. Fasting sugar may range 80–110 mg/dL, and post-meal sugar may be less than 150 mg/dL.
In the early hours of the morning, hormones, including cortisol and growth hormone, signal the liver to boost the production of glucose, which provides energy that helps you wake up. This triggers beta cells in the pancreas to release insulin in order to keep blood glucose levels in check.
The recommendation to transition to insulin is informed by several considerations: 1) elevated risk of adverse effects from noninsulin medications during acute illness or surgery, 2) rapidly changing factors, such as diet or medications, that can impact glucose levels, and 3) strong support from clinical trials ...
The downside of insulin therapy is the need to increase the dose and the regimen complexity with time, the increase in severe hypoglycemia, and the potential increase in mortality as well as the potential increased risk for specific cancers.
Metformin does not increase the concentration of insulin in the blood and does not cause low blood glucose levels (hypoglycemia) when used alone. Metformin can reduce complications of diabetes such as heart disease, blindness, and kidney disease.
Dapagliflozin is mainly used to treat type 2 diabetes. It can also be used to treat heart failure and chronic kidney disease (CKD). Dapagliflozin is usually prescribed if: you have type 2 diabetes and cannot take metformin.
Other serious side effects
Call your doctor or call 111 now if: you have a very dry or sticky mouth, feel very thirsty, sleepy or tired, are not peeing (or peeing very little), and have a fast heartbeat – these can be signs of dehydration.