Diabetes Medication
Guide & Reminder

Metformin is the universally recommended first-line medication for type 2 diabetes in most international guidelines (ADA, EASD, IDF). It is effective, low cost, generally well tolerated and has decades of safety data. It is usually started at diagnosis alongside lifestyle changes. If metformin is not tolerated, SGLT2 inhibitors or DPP-4 inhibitors are common alternatives.

Sulfonylureas (gliclazide, glibenclamide, glipizide) and insulin are the main medications that cause hypoglycaemia. Metformin, SGLT2 inhibitors, DPP-4 inhibitors and GLP-1 agonists do not cause hypoglycaemia on their own — only when combined with insulin or sulfonylureas. Always carry fast-acting carbohydrates if you take insulin or a sulfonylurea.

Yes — and you should. Metformin should always be taken with food or immediately after a meal to significantly reduce gastrointestinal side effects like nausea and diarrhoea. Extended-release metformin (XR) taken with dinner has even fewer GI side effects and is taken once daily instead of twice.

Ozempic (semaglutide) is a once-weekly injectable GLP-1 receptor agonist. It stimulates insulin release in response to meals, slows stomach emptying to reduce post-meal blood sugar spikes, and suppresses appetite to promote significant weight loss (5–15% of body weight). It also reduces major cardiovascular events in people with established heart disease. It is now one of the most prescribed diabetes medications worldwide.

Yes. Metformin must be paused 48 hours before and after any procedure using iodinated contrast dye (CT scan with contrast, angiography, cardiac catheterisation) due to a rare but serious risk of lactic acidosis. It should also be paused before major surgery requiring general anaesthesia. Always tell the medical team you are taking metformin. Your doctor will tell you when to restart it.

SGLT2 inhibitors (Jardiance/empagliflozin, Forxiga/dapagliflozin) cause the kidneys to excrete excess glucose in the urine. They protect the heart and kidneys and cause modest weight loss. They are taken as a daily pill. GLP-1 agonists (Ozempic/semaglutide, Victoza/liraglutide) are weekly or daily injections that stimulate insulin release, slow digestion and cause significant weight loss. Both are now preferred add-on therapies for people with cardiovascular or kidney disease.