7 Alternatives to Metformin: Your Guide to Other Blood Sugar Control Options

If you've ever taken metformin and dealt with an upset stomach or just didn't see the results you hoped for, you're not alone. People switch diabetes meds, or look for extras to add on, all the time. There are several other drugs out there that lower blood sugar in different ways, from blocking carbs in your gut to ramping up the insulin your body makes.

Some of these meds work best for specific issues, like big blood sugar spikes after you eat, while others target fasting sugar numbers. It's not just about effectiveness, though. You also need to think about side effects, dosing schedules, and how much the drugs fit into your daily routine. And let’s be honest—nobody wants unpleasant surprises like sudden lows or constant bathroom trips.

This article breaks down each real alternative to metformin, using plain talk about what you’ll actually notice if you try one. You’ll see quick lists of pros and cons, plus practical facts for everyday use. Whether you care most about low hypoglycemia risk, flexibility, or just want something easy to remember, there’s something here for you.

• Alpha-Glucosidase Inhibitors (e.g., Acarbose)
• Sulfonylureas
• DPP-4 Inhibitors
• GLP-1 Receptor Agonists
• SGLT2 Inhibitors
• Thiazolidinediones
• Insulin Therapy
• Comparison Table and Takeaways

Alpha-Glucosidase Inhibitors (e.g., Acarbose)

If you ask doctors about non-metformin blood sugar control options, you’ll probably hear about alpha-glucosidase inhibitors, like acarbose. These pills work right in your gut, slowing down how fast carbohydrates from food hit your bloodstream. Imagine putting the brakes on sugar spikes after meals— that's basically what these drugs do by blocking certain gut enzymes.

You’ll mostly see these prescribed for people who struggle with high post-meal numbers instead of fasting sugars. They’re not usually a first choice, but if your sugar jumps right after eating, acarbose could be worth a look.

Pros

• Take with your first bite of a meal—helps your blood sugar control right when it's needed most.
• Not likely to cause low blood sugar (unless combined with other meds).
• No weight gain risk.
• Flexible dosing—can be adjusted to meals.
• Doesn’t get absorbed into the blood much, so side effects stay mostly in the gut.

Cons

• Common side effects: gas, bloating, and sometimes diarrhea (honestly, the gut complaints top the list for most people).
• Less effective for controlling fasting glucose compared to options like metformin.
• Needs to be taken right with food, which can be hard to remember if you snack often or have unpredictable meal times.
• If you eat a lot of carbs, the gut side effects might be stronger at first.
• Not recommended if you have major digestive diseases (like IBD).

Fun fact: In studies, people who managed to stick with acarbose longer often reported that the annoying stomach symptoms faded after a couple weeks of use. Starting low and going slow really helps.

Bottom line? Acarbose and similar drugs make sense if your biggest struggle with diabetes medications is after-meal spikes and you don’t want the risk of low blood sugar. Just keep those gut side effects in mind, especially the first few weeks, and talk with your doctor if your meal schedule is all over the place.

Sulfonylureas

If you’ve ever wondered what doctors gave people before metformin alternatives took off, you’ll find sulfonylureas high on that list. These meds—like glipizide, glyburide, and glimepiride—have been around forever. They make your pancreas kick out more insulin. Sounds good, right? But there are some things you should know before swapping out your prescription.

What’s convenient is that sulfonylureas come in pills, usually taken just once or twice a day. They can bring your blood sugar down pretty quickly—so you might notice results fast, especially if you’re frustrated with slow changes on other meds.

Pros

• Affordable and widely available (many are generic and cheap at most pharmacies)
• Usually work fast, often lowering blood sugar in days
• Simple dosing (once or twice daily with or before meals)
• Pair well with other diabetes medicines if you need extra help

Cons

• Higher risk of low blood sugar (hypoglycemia), especially if you skip meals
• Possible weight gain over time
• Some people see effectiveness drop off after a few years
• Not great for anyone with certain kidney or liver problems

A 2022 review showed that sulfonylureas reduce A1C by about 1-2%, which is similar to metformin alternatives like acarbose, but with a higher risk of hypoglycemia. Older adults and people who don’t eat on a regular schedule need to be especially careful. Always carry a quick sugar source just in case. If you get shaky or sweaty, that’s a sign your sugar might be too low—don’t ignore it.

Bottom line? Sulfonylureas could work for you if you need something that’s fast, simple, and cheap. Just stay alert to any signs of low blood sugar, especially if you miss meals or have unpredictable eating habits. Talk with your doctor to see if your overall health and daily routine match what these meds offer.

DPP-4 Inhibitors

DPP-4 inhibitors—often called "gliptins"—include meds like sitagliptin (Januvia), saxagliptin (Onglyza), and linagliptin (Tradjenta). These drugs work by stopping the DPP-4 enzyme from breaking down hormones known as incretins. When incretins stick around longer, your body releases more insulin after you eat and dials back the amount of sugar it makes. That can help smooth out those stubborn blood sugar spikes after meals.

Unlike some diabetes meds, DPP-4 inhibitors are taken once a day (with or without food), which many people find easier to remember. They don't usually cause weight gain or big swings into hypoglycemia. As one article from the American Diabetes Association puts it,

“DPP-4 inhibitors are well tolerated, have a low risk of hypoglycemia, and do not cause weight gain, making them suitable for many adults with type 2 diabetes.”

If you're already on metformin alternatives and still need a boost, doctors sometimes add a DPP-4 inhibitor on top of metformin, or switch you if side effects get too annoying. They're not the strongest glucose-lowering drugs out there, but for a lot of people with mild-to-moderate type 2 diabetes, they do the trick without a lot of drama.

Pros

• Low risk of low blood sugar (hypoglycemia).
• Weight neutral—doesn’t make you gain (or lose) pounds.
• Usually once-daily dosing, easy to fit into your routine.
• Works well with other diabetes meds, including metformin and SGLT2 inhibitors.
• Well-tolerated by most people, including older adults.

Cons

• Not as effective for lowering blood sugar control as GLP-1 agonists or some other types.
• Can be pricey if you don’t have good insurance coverage.
• In rare cases, may cause joint pain or increase the risk of pancreatitis (inflammation of the pancreas).
• Does not help with weight loss.

If your main concerns are easy dosing, steady results, and low risk of lows, a DPP-4 inhibitor is worth chatting about with your doctor. Just keep in mind, it won’t drop your A1C as much as some of the heavy hitters, but the tradeoff in side effects and convenience might be worth it for your daily life.

GLP-1 Receptor Agonists

GLP-1 receptor agonists are a newer class of diabetes meds that have gotten a lot of buzz lately. Drugs like semaglutide (Ozempic), liraglutide (Victoza), and dulaglutide (Trulicity) fall in this group. They work by mimicking a natural gut hormone (GLP-1) which boosts insulin when you need it, cuts down how much sugar your liver makes, and slows down your stomach emptying. That means you feel fuller longer and don't get the same huge blood sugar spikes after meals. Metformin alternatives like these are also showing up in headlines because of their impact on weight loss—many people taking them lose weight as a bonus.

The injection style is kind of a deal-breaker for some, but others get used to it fast. Most options are once a week; a few are daily. When you compare effectiveness, GLP-1 drugs can drop your A1C even more than metformin, and they're really solid for people with heart disease risk.

Pros

• Help with blood sugar and promote weight loss at the same time
• Once-weekly injection options promote convenience
• Lower the risk of heart attack and stroke in people with type 2 diabetes
• Minimal risk of hypoglycemia when used alone

Cons

• Usually require an injection, either weekly or daily
• Nausea, vomiting, and stomach upset especially at the start
• Pretty expensive if your insurance doesn’t cover them
• Can’t be used in people with certain thyroid or pancreas problems

For some folks, the biggest selling point is the chance to lose 10, 15, or even 20 pounds over the course of treatment. On average, GLP-1 agonists can lower A1C by 1% to 1.5%, similar or better than metformin alternatives in other classes. But here’s a useful tip: starting at a very low dose and ramping up slowly can help with the stomach side effects, so don’t be afraid to ask your doctor about easing in.

If you’re looking for the most bang for your buck, especially if weight or heart health is on your mind, GLP-1 receptor agonists are definitely worth a look. Always ask about coverage and side effects, because these meds aren't cheap and the stomach issues can hit some people hard.

SGLT2 Inhibitors

SGLT2 inhibitors are a newer class of metformin alternatives that lower blood sugar by making your kidneys filter extra sugar right into your urine. You take them by mouth, just like metformin. Brands you might see around include Jardiance (empagliflozin), Farxiga (dapagliflozin), and Invokana (canagliflozin).

Here’s the scoop: these drugs don’t rely on insulin to lower your blood sugar. Instead, they block a protein in your kidney (the SGLT2 transporter). No more sugar reabsorbed—your body gets rid of the extra through urine. This gives steady results for both fasting and after-meal blood sugar levels, which is a win for a lot of patients.

Not only do SGLT2 inhibitors lower blood sugar, but some research shows they can help lower blood pressure and may reduce heart failure risks. That’s a pretty big bonus, especially if you have type 2 diabetes and heart issues.

Pros

• Work whether you eat or skip a meal, so they’re flexible in scheduling
• Help with weight loss in many people
• Low risk of low blood sugar (hypoglycemia) unless combined with insulin or a sulfonylurea
• May benefit heart and kidney health (especially in patients with known risks)
• Easy once-daily dosing

You might be wondering how SGLT2 inhibitors stack up for weight and heart benefits. Check this out:

Cons

• Increased urination (and sometimes dehydration if you don't drink enough)
• Higher risk of urinary tract and genital yeast infections, especially in women
• Rarely, can increase risk of diabetic ketoacidosis (especially when sick or fasting)
• Can be expensive if insurance doesn't cover them well
• May not be the best choice if you have kidney disease—dose adjustments or other options might be needed

Tip: Drink plenty of water while taking SGLT2 inhibitors. If you suddenly feel nauseous, or your doctor tells you your ketones are high, reach out to your care team quickly. Most people who use them daily say the benefits outweigh the downsides, but hygiene is key—especially for preventing those annoying yeast infections.

Thiazolidinediones

Thiazolidinediones—usually called TZDs—show up in diabetes talks a lot, especially when people need another metformin alternative that targets insulin resistance. The most common ones you might see are pioglitazone (brand name Actos) and rosiglitazone (brand name Avandia). They work by making your body's cells more responsive to your own insulin, so sugar moves out of your blood more easily. If you’ve heard the phrase “insulin sensitivity,” this is what folks are talking about.

TZDs don’t lead to hypoglycemia on their own, which takes some anxiety out of trying something new. They are taken once daily, usually with or without food—super simple, and great if you worry about remembering multiple pills a day. These meds have been around since the late ’90s and have solid research backing up their use for blood sugar control.

Pros

• Improves insulin sensitivity, helping your body use its own insulin better
• Low risk of hypoglycemia (especially when not used with other blood sugar meds)
• Usually only requires once-daily dosing
• Can help lower triglycerides and increase HDL cholesterol in some people

Cons

• Can cause weight gain and fluid retention (swelling in legs and ankles)
• May worsen or trigger heart failure in people with a history of it
• Increases risk of bone fractures, especially in women
• Rosiglitazone has been linked to an increased risk of heart attack in some studies (though this is debated)
• Pertinent to have regular monitoring of liver function and heart symptoms while using TZDs

Clinical trials have shown that TZDs can reduce HbA1c (that’s your average blood sugar over 2-3 months) by about 1%—a real, significant drop for many people. Here’s a quick look at how TZDs compare to metformin on some key aspects:

Bottom line: If you’re struggling with insulin resistance and don’t have heart failure, a TZD might be worth talking to your doctor about, especially if you want something besides metformin in your blood sugar control toolbox. Keep an eye on weight and swelling, and check in regularly to stay ahead of side effects.

Insulin Therapy

When you hear "insulin therapy," you probably think of something people try later in the game, but it can be a solid alternative to metformin for some. Insulin isn't just for type 1 diabetes—plenty of folks with type 2 use it, especially if other meds aren't cutting it or if blood sugar goes super high after meals or overnight.

There’s a range of insulin types. Some are quick-acting, working in as little as 15 minutes, perfect for tackling blood sugar jumps after eating. Others are long-acting and keep your sugar steady all day or night. Your doctor can help you find a routine that fits your life, whether that's a once-a-day shot or timed doses around meals.

Pros

• Most effective way to lower blood sugar—can bring high A1C down fast
• No limit on the dose: you can keep adjusting until levels are right
• Works even when other meds stop working
• Lots of types and delivery options (pens, pumps, syringes)

Cons

• Needs injections, so not everyone is into that
• Can cause low blood sugar if you get the timing or dose wrong
• Weight gain is a common side effect, especially with higher doses
• Requires regular blood sugar checks and close monitoring
• Cost can be an issue unless you have good insurance

Using insulin means you’ll probably have to check your blood sugar more often—especially at first. Finger pricks aren’t fun, but newer continuous glucose monitors can make this easier and less painful. A little planning goes a long way, too: always carry a snack just in case your blood sugar dips. And if you’re worried about injections, insulin pens are much more user-friendly than old-fashioned syringes.

Here's a quick look at different types of insulin and how fast they work:

Insulin therapy isn’t as scary as it sounds, especially with the right support. It can be your best bet if you’re looking for tight blood sugar control or if other diabetes medications just aren’t working for you.

Comparison Table and Takeaways

Picking the right metformin alternative isn't just about swapping one pill for another. Every option has a different way of controlling blood sugar. Some are awesome for post-meal spikes (like Alpha-Glucosidase Inhibitors), while others might bring better results for fasting glucose or folks who eat at odd hours.

Here's a side-by-side look at some of the most popular metformin alternatives and how they stack up for real-world use:

It's not about picking the “best”—it’s about matching the med to your own life and health goals. For example, if you eat out a lot and have trouble with timing, pills you take with meals (like Acarbose) could be annoying. Worried about weight? GLP-1 drugs might help, but they come as shots and can upset your stomach. Cost, side effects, and your overall health each play a part.

If you're considering switching off metformin or adding something new, chat with your health provider. Ask about what fits your daily routine and what you really want out of your diabetes treatment. Sometimes a combo works best, and sometimes just tweaking the dose solves the problem. The most important thing? Stick with it, keep tracking your blood sugar control, and don’t be shy about bringing up what matters most to you.