Metformin Alternative: What to try when metformin isn’t a fit
If metformin causes side effects or isn’t advised because of kidney issues or another reason, you still have options. This page explains common drug alternatives, non-drug choices, and quick questions to bring to your clinician. Read on to find what fits your health, lifestyle, and budget.
Common prescription alternatives — short, practical notes
GLP‑1 receptor agonists (like liraglutide/Victoza or semaglutide) lower blood sugar and often help with weight loss. They can be injected and cost more, but they’re a strong choice if weight and heart health matter.
SGLT2 inhibitors (eg, empagliflozin/Jardiance) work through the kidneys to lower glucose and can cut heart-failure and kidney risk in some people. Watch for dehydration and genital infections.
DPP‑4 inhibitors (like sitagliptin/Januvia) are pills with fewer side effects but smaller glucose-lowering effects than GLP‑1s or SGLT2s.
Alpha‑glucosidase inhibitors (acarbose/Precose) slow carbohydrate absorption and help with post-meal spikes. They can cause gas or bloating.
Sulfonylureas and insulin work well to lower blood sugar fast but can cause low blood sugar (hypoglycemia) and weight gain, so dosing and monitoring matter.
Thiazolidinediones (pioglitazone) can improve insulin sensitivity but may cause fluid retention and aren’t ideal if you have heart failure.
Lifestyle, procedures, and how to choose
Diet and exercise are powerful. A lower‑carb or Mediterranean-style diet, consistent aerobic and resistance exercise, and modest weight loss can cut A1C as much as some pills. These changes also improve energy and heart health. If pills aren’t right, ask whether intensive lifestyle change or a referral to a diabetes educator or dietitian makes sense.
Bariatric surgery is an option for some people with obesity and type 2 diabetes; it can produce big improvements in blood sugar and sometimes remission. Surgery requires evaluation and long-term follow-up.
How to pick? Think about your A1C target, kidney and heart health, weight goals, risk of low blood sugar, cost and access, and whether you mind injections. Your doctor should review labs (A1C, kidney function), meds you already take, and side effect risks before switching.
Want a deeper comparison? We publish a full guide that lists nine metformin alternatives with pros and cons—search "Exploring 9 Effective Alternatives to Metformin" on this site for the detailed breakdown.
Practical next steps: 1) Write down your current A1C, meds, and side effects. 2) Ask your clinician which alternatives match your kidney and heart profile. 3) If you switch, schedule follow-up labs within 1–3 months and learn how to spot low blood sugar. Simple planning makes changes safer and faster.
