Your diabetes medication guide

This guide is designed to help you understand your oral diabetes medications, stick to your treatment plan, and get the best results for your health.

Included Health doctor smiling and talking to her patient on her computer.

Things to know about oral diabetes medication

  • Purpose of oral diabetes medication
  • Types of oral diabetes medication (and how they work)
  • How to take oral diabetes medication
  • Risks of skipping doses or stopping medication
  • How to stick to your medication schedule
Purpose of oral diabetes medication

Oral diabetes medication is often used to treat Type 2 diabetes. It can be an effective alternative to insulin (often injected) and primarily helps to:

  • Lower blood glucose (sugar) levels: The main objective is to help reduce a patient’s A1C levels (a measure of your average blood sugar over the last 2 to 3 months) to a healthy target range.
  • Improve insulin function: Oral diabetes medication helps fight insulin resistance, a condition in which the body's cells don't respond well to the insulin the pancreas still produces.
  • Prevent health complications: Lastly, medication helps mitigate the high risk of serious health issues (like heart disease, kidney failure, and nerve damage) caused by years of uncontrolled high blood sugar.

When combined with a healthy diet and regular physical activity, oral diabetes medication can help you regulate your blood glucose levels and effectively manage your diabetes.

 

In search of a diabetes specialist (endocrinologist) or health coach? You can use Included Health to find an in-network provider:

    1. Log in to your Included Health account
    2. In Home, go to Get Care and select Search for local care
    3. Next, select Find in-network local care
    4. In the next screen, search by either the condition (“diabetes”) or provider type (“diabetes doctor”)

 

Prefer that Included Health match you instead?
Our Care Team will be happy to help with this. Log in to Included Health, select Messages, and either send us a message or give us a call to get started.

Types of oral diabetes medication (and how they work)

Oral diabetes medications come in many forms, and they all work on your body's systems in different ways. Below we list some of the most commonly prescribed medications with information on how they work and their potential side effects.

Metformin (a Biguanide)

How it works: Often the first pill prescribed in treatment, it mainly works by limiting the amount of sugar your liver makes and sending out. It effectively helps your body use insulin better.

Common potential side effects:

  • Stomach upset*
  • Diarrhea*
  • Nausea, or a metallic taste in the mouth*

*Taking with food often helps reduce these side effects.

 

Sulfonylureas (e.g., Glipizide, Glimepiride)

How they work: These low-cost pills stimulate your pancreas to release more insulin, effectively helping at lowering blood sugar.

Common potential side effects:

  • Low blood sugar (hypoglycemia)
  • Weight gain

 

Meglitinides (e.g., Repaglinide)

How they work: These pills trigger the pancreas to release more insulin, especially right after a meal.

Common potential side effects:

  • Low blood sugar (hypoglycemia)
  • Headache
  • Minimal weight gain

 

TZDs, or Thiazolidinediones (e.g., Pioglitazone)

How they work: These pills help your muscle and fat cells become more sensitive to the insulin your body already makes.

Common potential side effects:

  • Weight gain
  • Fluid retention (swelling in the legs and feet)
  • Increased risk of bone fractures

 

DPP-4 inhibitors (e.g., Sitagliptin)

How they work: These pills increase the level of natural hormones that signal the pancreas to release insulin only when blood sugar is high, which helps keep levels stable.

Common potential side effects:

  • Headaches
  • Upper respiratory tract infection
  • Diarrhea
  • Joint pain

 

SGLT2 inhibitors (e.g., Empagliflozin)

How they work: These pills cause your kidneys to remove excess sugar from your body through your urine.

Common potential side effects:

  • Urinary tract infections (UTIs)
  • Genital yeast infections
  • Increased urination
  • Dizziness

 

Alpha-glucosidase inhibitors (e.g., Acarbose)

How they work: These pills slow down how quickly your body breaks down starches and sugars from food in your stomach.

Common potential side effects:

  • Gas (flatulence)
  • Bloating
  • Abdominal pain
  • Diarrhea

 

To learn more about these or other medications, chat with your Included Health digital assistant — available 24/7.

How to take oral diabetes medication

Taking your diabetes medication correctly is key to managing your health. Here are a few things you need to know:

  • Take exactly as prescribed: Always follow your doctor’s instructions. This includes never changing your dose or stopping medication without doctor consent.
  • Talk to your doctor if your regimen feels overwhelming: If you’re struggling to juggle multiple pills, let your doctor know. They may recommend a combination medication that reduces the number of pills you need to take each day.
  • Timing matters: Some medications, like Metformin, may cause nausea or diarrhea when you first start taking them. Taking them with food can help ease these side effects. Your doctor will recommend the best time to take your specific medication.

For personalized guidance, always check with your healthcare provider or pharmacist.

To learn more about oral diabetes medication, try chatting with your Included Health digital assistant — available 24/7.

Risks of skipping doses or stopping medication

Frequently skipping doses or suddenly stopping medication altogether often lead to uncontrolled high blood sugar. This, in turn, can cause damage to blood vessels and nerves, significantly increasing the risk of serious, debilitating, and costly complications over time, including:

Short-term risks

  • Higher than usual blood sugar readings
  • Symptoms of hyperglycemia, including increased thirst, frequent urination, tiredness, and blurry vision.

Long-term risks

  • Cardiovascular disease, including heart attack and stroke
  • Kidney disease, eventually leading to kidney failure
  • Nerve damage (Neuropathy) that often affects the feet and legs, which can lead to poor wound healing and even potential amputation in some cases
  • Vision problems, including retinopathy and potential blindness
  • Other severe complications of prolonged, high blood sugar include life-threatening conditions like Hyperosmolar Hyperglycemic State (HHS) or Diabetic Ketoacidosis (DKA) 

 

Missed a dose and not sure what to do? Don’t hesitate to call the Included Health nurse line. To get in touch:

    1. Log in to your Included Health account
    2. In Home, go to Get Care and select Get a second opinion or advice
    3. Select Call for advice, then Get advice now to view the phone number
How to stick to your medication schedule

Sticking to a rigorous oral diabetes medication schedule can sometimes be a challenge. Some of the most common challenges include:

  • Forgetfulness, the most commonly reported reason
  • Complicated regimens that require multiple pills or doses throughout the day
  • High cost of medication 
  • Side effects, both in the short and long term
  • Insufficient understanding of how or why to take the medication

The good news is that there are tools and tactics you can use to overcome any of these barriers. Below are some strategies you can try to help you stick to your medication regimen.

  • Tie your doses to habits: Link taking your medication to a daily action you never forget, like brushing your teeth or eating breakfast (Habit Stacking).
  • Use digital reminders: Use apps on your phone to set alarms or reminders so that you’re alerted exactly when to take your pill.
  • Simplify your pill regimen (if possible): Ask your doctor to review your medications to see if you can use fewer pills or combination pills to simplify your daily schedule.
  • Track your progress: Use either a digital or written journal to self-monitor when you take your medication and check your blood sugar.
  • Address the cost: Talk to your doctor or pharmacist about generic options, coupons, or assistance programs if cost is making it hard to buy your medication.
  • Talk honestly with your doctor: Maintain continuous, open dialogue about any side effects, costs, or difficulties you have following the regimen.
  • Walk after meals: Physical activity helps your body use insulin better, which supports the work of your medication.
  • Get personalized help: Enroll in programs that offer personalized text messages or remote monitoring with coaching and feedback.

For additional information and guidance, try chatting with your Included Health digital assistant — available 24/7.

Diabetes and Holiday Feasts

  • Before the Feast: Planning and Preparation

    Before the holiday meal, consider these tips:

    • Consult your doctor: Ask your doctor if they recommend any temporary adjustments to your medication or meal plan for a large feast, especially if you take a class of medication (like sulfonylureas) that carries a risk of low blood sugar (hypoglycemia).
    • Don't skip doses: Continue taking your oral diabetes medication exactly as prescribed. Skipping your dose to "make room" for food is dangerous and leads to high blood sugar.
    • Balance your day: If your holiday feast is at dinnertime, try eating a healthy breakfast and lunch to avoid arriving overly hungry. This will decrease your chances of overeating during the feast.
  • During the Feast: Smart Swaps and Portion Control

    Focus on what you put on your plate to manage carbohydrate and fat intake:

    • Prioritize protein and vegetables: Fill half your plate with non-starchy vegetables (like green beans, salad, etc.) and lean protein (turkey breast, ham, etc.)
    • Choose complex carbs wisely: If you eat starchy sides (like potatoes, stuffing, or rolls), take small, controlled portions and be mindful of high-sugar additions like sweet potato casserole with marshmallows. Remember that these foods raise your blood sugar.
    • Limit high-fat sides: High-fat dishes (like gravy and rich sauces) can slow down digestion, leading to a delayed but prolonged rise in blood sugar. Use them sparingly.
  • After the Feast: Activity and Monitoring

    Your actions right after eating are crucial for controlling the blood sugar spike:

    • Move your body: A short walk (even 15-20 minutes) after the meal is highly effective. Physical activity increases your body's sensitivity to insulin, helping to lower blood sugar naturally.
    • Check your glucose: Monitor your blood sugar levels as recommended by your doctor. This is especially important after a large or unusual meal to ensure your medication is keeping your levels in a safe range.
    • Get back on track: If you overindulge, don't panic or stop your medication. Simply resume your normal eating habits and medication schedule immediately for the rest of the day and following days.
man-on-tablet-kitchen
group of friends making a holiday dinner
Black adult checking glucose

Frequently asked questions

For additional information and guidance, try chatting with your Included Health digital assistant — available 24/7. 

In general, if you realize you missed a dose, take it as soon as you remember — unless it’s almost time for your next scheduled dose. In that case, it’s often best to skip the missed dose and resume your normal schedule. Never take a double dose to make up for a missed one, as this can increase the risk of side effects or low blood sugar (hypoglycemia). Always check the specific medication’s instructions, as rare exceptions or drug interactions may require tailored guidance.

If you’re unsure what to do, don’t hesitate to call the Included Health nurse line:

  1. Log in to your Included Health account
  2. In Home, go to Get Care and select Get a second opinion or advice
  3. Select Call for advice, then Get advice now to view the phone number

Hypoglycemia occurs when your blood sugar drops too low, often defined as below 70 mg/dL (3.9 mmol/L). Symptoms can include shakiness, sweating, fast heartbeat, hunger, confusion, or slurred speech. If you experience these symptoms, treat them immediately with a fast-acting carbohydrate like juice or glucose tablets.

The most common side effects of Metformin are diarrhea, nausea, and stomach pain, especially when starting treatment. To help reduce these side effects, take the medication with food. If symptoms are severe or persistent, contact your doctor; they may adjust your dosage or suggest a different formulation.

You should always consult your healthcare provider or pharmacist before taking any OTC medications. Some pain relievers (like ibuprofen) can interact with diabetes medications or cause kidney issues, especially if you already have kidney disease. Decongestants found in cold medicines can also raise your blood glucose levels.

The effect on weight varies significantly by medication class. For example, Metformin and SGLT2 inhibitors (e.g., Jardiance) often cause weight loss or are weight-neutral, which is generally beneficial. However, Sulfonylureas and TZDs (Thiazolidinediones) may be associated with weight gain.

It is crucial to discuss alcohol consumption with your doctor, as it can interact with diabetes medications and impact blood sugar. Alcohol can cause your blood sugar to drop too low (hypoglycemia), especially if you drink on an empty stomach or take certain drugs like sulfonylureas. Excessive or binge drinking is strongly discouraged as it increases the risk of a serious complication called lactic acidosis with Metformin.

No, diabetes is a chronic, progressive condition that requires ongoing management. Feeling well usually means your medication, diet, and exercise are working effectively to control your blood sugar. Continue your current regimen and attend all scheduled lab tests and doctor’s appointments.

Diabetes is often a progressive disease, meaning the first medication may become less effective over time as your body changes. Your doctor may add a second medication with a different mechanism of action to help achieve or maintain your blood sugar target. This combination therapy does not necessarily mean you failed but is a normal part of diabetes management.

Your doctor will use two main tools: at-home blood glucose monitoring and the quarterly A1c blood test. The A1c test measures your average blood sugar over the past two to three months and is the primary measure of long-term control. Your provider will work with you to ensure these numbers are within your personalized target range.

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