A new prescription for diabetes often comes with long, similar-sounding names: glimepiride, sitagliptin, dapagliflozin, sometimes three of them in one tablet. Knowing which group each belongs to helps you understand why it was chosen, what side effects to watch for, and what to ask at your next visit.
For how diabetes is diagnosed and how treatment fits with food and activity, read our diabetes guide covering symptoms, tests and treatment.
Only generic names are included, without brands, prices or doses to follow. Do not start, stop, skip or change any diabetes medicine without your doctor. Stopping suddenly can push sugar dangerously high, and some combinations can drop it dangerously low.
How diabetes medicine works, and why there are so many
Type 2 diabetes involves several problems at once: the body responds poorly to insulin, the pancreas makes too little of it, the liver releases too much glucose, and gut hormones that control sugar after meals work less well. Each medicine group targets one or two of these. That is why many people end up on two or three medicines, often combined in one tablet.
The Indian Council of Medical Research (ICMR) 2018 guideline recommends metformin as the usual first medicine, alongside food and activity changes, unless there is a reason not to use it. Doctors then add other groups based on your sugar levels, weight, kidney function, heart health, risk of low sugar, cost and preference. The American Diabetes Association (ADA) 2026 standards add that people with heart disease, heart failure or chronic kidney disease should be offered certain medicines for their protective effect, whatever their sugar level.
Type 1 diabetes is different: insulin is always needed from the start, and tablets cannot replace it.
Diabetes medicine names by group
These are the main groups available in India, with generic names as listed by ICMR and ADA. The ending of the name often tells you the group: "-gliptin", "-gliflozin", "-glutide".
| Group | Generic names | How it is taken | Common side effects and cautions |
|---|---|---|---|
| Biguanide | Metformin, including slow-release forms | Tablet, usually with or after meals | Stomach upset, loose motions, metallic taste; low vitamin B12 with long use; dose depends on kidney function |
| Sulfonylureas | Glimepiride, gliclazide, glipizide, glibenclamide | Tablet, usually before breakfast | Low sugar, especially if a meal is skipped; some weight gain |
| Gliptins (DPP-4 inhibitors) | Sitagliptin, vildagliptin, linagliptin, saxagliptin, teneligliptin | Tablet, once daily; vildagliptin twice | Usually well tolerated; low risk of low sugar on their own; weight neutral |
| Gliflozins (SGLT2 inhibitors) | Dapagliflozin, empagliflozin, canagliflozin | Tablet, once daily | Genital fungal infections, urine infections, passing more urine, dehydration; rare ketoacidosis |
| Glitazone | Pioglitazone | Tablet, once daily | Weight gain, swelling of feet, fracture risk; avoided in heart failure and bladder cancer |
| Alpha-glucosidase inhibitors | Acarbose, voglibose, miglitol | Tablet, with the first bite of a meal | Gas, bloating, loose motions |
| Glinides | Repaglinide, nateglinide | Tablet, just before meals | Low sugar, though shorter acting than sulfonylureas |
| GLP-1 medicines | Liraglutide, dulaglutide, semaglutide, exenatide; tirzepatide works on a related pathway | Injection, daily or weekly; semaglutide also as a tablet | Nausea, vomiting, fullness, constipation; usually weight loss |
| Insulin | Human insulins, such as regular and NPH, and analogues, such as glargine, degludec, aspart and lispro | Injection or pen | Low sugar; weight gain; needs correct technique and site rotation |
DPP-4 stands for dipeptidyl peptidase-4 and SGLT2 for sodium-glucose co-transporter-2; NPH is an intermediate-acting human insulin. Check the generic names printed on your strip or pen, not just the brand, and keep a written list to show every doctor you see.
Metformin: usually the first choice
Metformin lowers the amount of glucose the liver releases and helps the body use insulin better. It does not cause low sugar on its own, does not cause weight gain, and has been used for decades.
- Stomach side effects are the most common reason people stop it. Doctors usually start low, often 500 mg once a day after food, and increase slowly; slow-release forms are often easier on the stomach.
- Vitamin B12 levels can fall with long-term use. ADA advises checking B12 periodically, especially if you have tingling or numbness in the feet.
- Kidneys matter. ICMR advises full doses when the estimated glomerular filtration rate, a kidney test, is above 60, closer monitoring between 45 and 60, halving the dose below 45, and stopping it below 30.
- Your doctor may pause it during severe illness, dehydration or some scans that use contrast dye.
Which tablets can cause low sugar
Sulfonylureas, glinides and insulin push the body to release, or directly add, insulin whether or not you have eaten. They are effective and affordable, but they carry a real risk of low blood sugar, which ADA defines as a reading below 70 mg/dL.
- Eat regular meals; do not skip a meal after taking the morning tablet.
- Watch for shaking, sweating, sudden hunger, a fast heartbeat, dizziness or confusion.
- If you have a meter, check. If the reading is low, or you cannot check, take 15 g of fast-acting sugar, such as 3 teaspoons of sugar dissolved in water or half a glass of fruit juice, and recheck after 15 minutes. If it is still low, repeat.
- Tell your doctor about every low, even mild ones. Repeated lows often mean the dose or medicine needs to change.
Older adults, people with kidney disease, people who drink alcohol and those fasting for religious reasons are at higher risk and need a plan agreed in advance.
Injections: GLP-1 medicines and insulin
GLP-1 medicines
These copy a gut hormone that tells the pancreas to release insulin after meals, slows stomach emptying and reduces appetite. They lower sugar, usually cause weight loss, and some protect the heart. Nausea is common at the start and often settles as the dose is increased slowly. ADA advises not combining them with gliptins, because the combination adds no extra sugar lowering. They are prescription medicines that need medical follow-up, not weight-loss shortcuts.
Insulin
Insulin is not a punishment or a sign of failure. Type 2 diabetes tends to progress, and many people eventually need insulin, sometimes only for a period, such as during pregnancy, illness or surgery. Types include long-acting basal insulin, taken once a day, mealtime insulin, and premixed insulins, such as 30/70, that combine both. Your diabetes team will teach you injection technique, storage and how to rotate sites, and how to handle low sugar.
Medicines that also protect the heart and kidneys
ADA 2026 recommends that people with type 2 diabetes and established heart disease be offered a gliflozin or GLP-1 medicine with proven heart benefit, and that people with heart failure or chronic kidney disease be offered a gliflozin, largely regardless of their glycated haemoglobin (HbA1c). ICMR also notes the heart benefit seen with gliflozins. If you have any of these conditions, ask your doctor whether your current medicines include one of these options.
Safety rules that apply to every medicine
- Never stop on your own, even when readings look good. Good readings usually mean the medicine is working.
- Do not copy someone else's prescription or switch tablets because a relative's worked better.
- Ask about sick days. With vomiting, diarrhoea or poor eating, some medicines, especially metformin and gliflozins, may need to be paused. Agree a sick-day plan with your doctor in advance.
- Tell every doctor and dentist what you take before surgery, scans or new prescriptions.
- Herbal and ayurvedic products are not a replacement. Some can lower sugar and add to the risk of lows; tell your doctor if you use them.
- Food and movement still matter. Medicines work better with a steady routine; see our Indian diabetes diet chart.
When to see a doctor
Our diabetes guide has the full list of warning signs.
Emergency: get help now
- Confusion, a seizure or unconsciousness in someone taking insulin or a sulfonylurea.
- Vomiting, stomach pain, deep or fast breathing or marked drowsiness, including while on a gliflozin, even if sugar is not very high.
Prompt review: within a few days
- Repeated low readings, or readings that stay high despite taking medicines as prescribed.
- Side effects that stop you taking a medicine, such as persistent vomiting or repeated genital infections.
Routine review
- You want to understand why each medicine was chosen, or discuss cost, timing or fewer tablets.
- You have been on metformin for years and have not had a vitamin B12 or kidney test.
Not sure who to see? Our guide to which doctor to see for diabetes explains when a general physician is enough and when to see a diabetologist.
How Disha can help
Disha is an AI health coach that chats and calls in Hindi, English and Hinglish. After an onboarding call of about 15–20 minutes, conducted by Disha itself, it can help you keep meal timing, walking and sleep steady around your medicines, and remind you to raise side effects or worrying readings with your doctor. Disha does not diagnose, prescribe, change doses or provide emergency care, and it does not replace your doctor. Read how Disha coaching works.
This is not medical advice. This page is general information for adults and does not cover every medicine, dose or side effect. Only the doctor treating you can choose, start, stop or change a diabetes medicine. If you are pregnant, have kidney or heart disease, or take other medicines, agree any change with your doctor. In an emergency, call 112.
Frequently asked questions
Which is the best sugar tablet for diabetes?
There is no single best tablet. Metformin is the usual first choice in Indian and international guidelines because it is effective, safe and affordable. What comes next depends on your sugar levels, weight, kidney and heart health, risk of low sugar and cost. The best medicine is the one your doctor chooses for you and that you can take consistently.
Can I stop diabetes medicine once my sugar is normal?
Not on your own. Normal readings usually mean the medicine is working, and stopping can make sugar rise again within days or weeks. Some people, especially after significant weight loss early in diabetes, can reduce or stop medicines, but only with their doctor's plan and close testing. Ask about it at your next review rather than experimenting.
Is metformin safe for the kidneys?
Metformin does not damage the kidneys, but the kidneys clear it, so the dose depends on kidney function. ICMR advises full doses when the estimated glomerular filtration rate is above 60, closer monitoring between 45 and 60, a lower dose below 45 and stopping below 30. Your doctor will check a kidney test at least once a year.
Why does my diabetes medicine cause frequent urination or infections?
Gliflozins such as dapagliflozin and empagliflozin work by passing extra sugar out in the urine. That can increase urine volume and raise the risk of genital fungal infections and urine infections. Good hygiene and enough water help. Do not stop the medicine yourself; tell your doctor if infections keep coming back or if you feel dizzy or dehydrated.
Does starting insulin mean my diabetes is very bad?
No. Insulin is simply the most powerful way to lower sugar. Type 2 diabetes tends to progress over years, and many people need insulin at some point, sometimes only temporarily, such as in pregnancy, illness or very high sugar at diagnosis. Starting insulin on time protects the eyes, kidneys and nerves. It is not a failure.
Are generic diabetes medicines as good as brands?
Medicines with the same generic name and strength contain the same active ingredient, and generics can lower the cost considerably. Ask your doctor or pharmacist before switching, check that the generic name and strength match exactly, and watch your readings for a few weeks afterwards. Do not switch between groups based on price alone.
Can I take herbal or ayurvedic products with diabetes medicine?
Tell your doctor before you do. Some products marketed for sugar can lower glucose and add to the risk of low sugar with insulin or sulfonylureas, and their content can vary. They are not a replacement for prescribed medicine. If you already take one, mention it at your next visit and keep checking your readings.
Sources
- Indian Council of Medical Research. ICMR Guidelines for Management of Type 2 Diabetes. 2018. Supports: medicine groups available in India and their generic names; metformin as first-line; metformin dose adjustment by kidney function; side effects of sulfonylureas, gliptins, gliflozins, pioglitazone and alpha-glucosidase inhibitors; taking alpha-glucosidase inhibitors with the first bite; ketoacidosis with normal sugar on gliflozins; insulin types.
- American Diabetes Association Professional Practice Committee. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2026. 2026. Supports: choosing medicines by heart, kidney, weight and hypoglycaemia factors; gliflozins and GLP-1 medicines for heart and kidney protection; periodic vitamin B12 checks on metformin; not combining GLP-1 medicines with gliptins; insulin in type 1 diabetes.
- American Diabetes Association Professional Practice Committee. 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes—2026. 2026. Supports: low blood glucose defined as below 70 mg/dL; treatment with 15 g of fast-acting carbohydrate and rechecking after 15 minutes; higher risk with insulin and sulfonylureas.
- NHS. Metformin. Current page. Supports: nausea, diarrhoea, stomach pain and taste changes; vitamin B12 deficiency; the risk of dehydration with vomiting, diarrhoea or fever.
- NHS. Gliclazide. Current page. Supports: the risk of low blood sugar and its symptoms, such as dizziness, hunger and shaking.
- NHS. Dapagliflozin. Current page. Supports: fungal genital infections, passing more urine, dehydration during illness, and the warning signs of diabetic ketoacidosis.
- NHS. Sitagliptin. Current page. Supports: low blood sugar mainly when a gliptin is combined with other diabetes medicines.
Related reads
- Diabetes: symptoms, tests, treatment and Indian food: the full overview of diagnosis, treatment and red flags.
- Prediabetes: numbers, signs and prevention: when metformin may be considered before diabetes.
- Which doctor to see for diabetes: general physician, diabetologist or endocrinologist.
- Indian diabetes diet chart: steady meals that work alongside your medicines.
- All diabetes articles: every Disha guide on diabetes in one place.
- BMI calculator with Indian cut-offs: one screening measure that does not capture waist or individual health.
