Key points
- Most people with type 2 diabetes start with metformin, and many need a second or third medicine over the years. That is the nature of the condition, not a personal failure.
- Some medicines (sulfonylureas and insulin) can cause low sugar; others rarely do on their own.
- Newer groups such as SGLT2 inhibitors and GLP-1 medicines also protect the heart and kidneys in people at risk.
- Never stop or change a medicine on your own, including when you start herbal or ayurvedic products. Tell your doctor everything you take.
Being handed a prescription with three or four sugar tablets can be unsettling. Many people worry that medicines will "harm the kidneys" or that needing insulin means things have gone badly. Neither is usually true. This page explains the main groups of diabetes medicines used in India, using generic names, so you can have a better conversation with your doctor.
This is general information. Your doctor chooses medicines based on your sugar levels, kidney function, heart health, weight, cost and other conditions. Do not start, stop or change any medicine based on this page.
Why most people need medicines
Food and activity matter at every stage, but type 2 diabetes tends to progress: the pancreas makes less insulin over time. So even people who eat carefully often need a medicine, then sometimes a second, to stay at target. Adding a medicine is simply matching treatment to where your body is now.
Sugar tablets: the main groups
Indian pharmacies sell hundreds of brands, but almost all contain one or more of the medicines below. Many prescriptions combine two medicines in one tablet, for example metformin with glimepiride, or metformin with a gliptin. Check the generic names printed on the strip.
| Group | Generic names | How it works | Side effects to know | Low sugar risk |
|---|---|---|---|---|
| Biguanide | Metformin | Reduces sugar released by the liver and helps insulin work better | Stomach upset, loose motions (often settle; extended-release can help); lower vitamin B12 over years | Low on its own |
| Sulfonylureas | Glimepiride, gliclazide, glipizide | Push the pancreas to release more insulin | Low sugar, especially with missed meals; some weight gain | Yes |
| DPP-4 inhibitors (gliptins) | Sitagliptin, vildagliptin, teneligliptin, linagliptin, saxagliptin | Boost the body's own gut hormones that raise insulin after meals | Usually well tolerated; rarely joint pain or pancreatitis | Low on their own |
| SGLT2 inhibitors (gliflozins) | Dapagliflozin, empagliflozin, canagliflozin, remogliflozin | Make the kidneys pass extra sugar out in the urine | Genital fungal infections, passing more urine, dehydration; rarely ketoacidosis even with near-normal sugar | Low on their own |
| Thiazolidinedione | Pioglitazone | Makes muscle and fat more sensitive to insulin | Weight gain, fluid retention and swelling; not used in some heart failure | Low on its own |
| Alpha-glucosidase inhibitors | Acarbose, voglibose | Slow carbohydrate digestion in the gut | Gas, bloating | Low on their own |
A few points that come up again and again in clinic:
- Metformin and kidneys. Metformin does not damage healthy kidneys. Doctors lower the dose if kidney function falls and stop it if kidney function becomes very low, which is why yearly kidney tests matter.
- Gliflozins and hygiene. Because sugar passes in the urine, keeping the genital area clean and dry helps prevent fungal infections. Drink enough water, particularly in summer. Your doctor may ask you to pause it before surgery or on days when you are vomiting or cannot eat.
- Sulfonylureas and meals. Take them with food and do not skip the meal afterwards.
For people who already have heart disease, heart failure or chronic kidney disease, the ADA Standards of Care 2026 recommend an SGLT2 inhibitor or a GLP-1 medicine with proven benefit, whatever the HbA1c, because these protect the heart and kidneys as well as lowering sugar.
GLP-1 and similar injections (and one tablet)
GLP-1 receptor agonists such as semaglutide, liraglutide and dulaglutide copy a gut hormone that raises insulin after meals, slows stomach emptying and reduces appetite. Most are weekly or daily injections under the skin; semaglutide is also available as a daily tablet. Tirzepatide works on two gut hormones in a similar way. These medicines lower sugar strongly, help with weight loss and, for some, protect the heart. Nausea is common at first, so doses are increased slowly. They are prescription medicines and are not suitable for everyone.
Insulin types
Insulin is the oldest and most powerful diabetes medicine. It is needed by everyone with type 1 diabetes, and by many people with type 2 at some point, sometimes only for a while. Needing insulin is not a punishment and it is not addictive. It simply replaces what your pancreas can no longer make.
| Type | Examples (generic) | Starts working | Lasts | Usually taken |
|---|---|---|---|---|
| Rapid-acting | Insulin aspart, lispro, glulisine | About 15 minutes | 3–5 hours | Just before meals |
| Short-acting (regular) | Human regular insulin | 30–60 minutes | 5–8 hours | About 30 minutes before meals |
| Intermediate-acting | NPH (isophane) insulin | 1–2 hours | 12–18 hours | Once or twice a day |
| Long-acting (basal) | Insulin glargine, detemir, degludec | 1–2 hours | About 24 hours, longer for degludec | Once a day, same time daily |
| Premixed | 30/70 human, or premixed analogue insulins | Depends on the mix | Up to about 24 hours | Usually twice a day before meals |
Premixed insulin is very commonly prescribed in India because it means fewer injections. Whichever type you use, your doctor or educator should show you how to inject, where to rotate sites (abdomen, thighs, upper arms), and how to adjust for meals and illness.
Storing insulin in Indian heat
- Unopened insulin goes in the fridge door or middle shelf (2–8°C). Never in the freezer, and never against the cooling plate.
- The pen or vial in use can usually stay at room temperature for about 4 weeks if it is kept below roughly 25–30°C, depending on the brand. Check the leaflet.
- In a hot room without AC, keep it in a cool, shaded place, or use a clay pot or a cooling pouch. Do not leave it in a parked car, on a windowsill or in a bag in direct sun.
- When travelling, carry insulin in hand luggage with a cool pack, not in checked bags.
- Throw it out if it has frozen, has been very hot, or looks cloudy or clumpy when it should be clear.
Low sugar: signs and what to do
If you take insulin or a sulfonylurea, learn the signs of low sugar (hypoglycaemia): shaking, sweating, a fast heartbeat, sudden hunger, irritability, confusion or blurred vision. Many people say they "just felt strange".
If your sugar is below 70 mg/dL, or you have these symptoms and cannot check:
- Take 15 g of fast sugar: 3 teaspoons of sugar or glucose powder in water, or half a glass (about 150 ml) of regular fruit juice or soft drink (not diet).
- Wait 15 minutes and check again.
- If still below 70 mg/dL, repeat. Once it is back up, eat a snack or your next meal.
If someone with diabetes is unconscious or cannot swallow, do not put food or liquid in their mouth. Call 112. Tell your doctor about every low, because your medicines may need changing.
Taking medicines safely
- Take medicines at the same times each day. Linking them to a routine, such as breakfast, helps.
- If you miss a dose, follow the advice your doctor or the leaflet gives. Do not take a double dose to catch up.
- Tell your doctor about all herbal, ayurvedic, homeopathic or "sugar control" powders you take. Some lower sugar further and can cause lows when combined with tablets or insulin.
- Do not stop medicines because your sugar is now normal. Normal readings usually mean the medicine is working.
- Carry a list of your medicines and doses on your phone for emergencies and new doctors.
Keeping costs down
Diabetes is lifelong, so costs add up. Generic versions of metformin, glimepiride, many gliptins and gliflozins, and human insulin are widely available at lower prices, including at Pradhan Mantri Bhartiya Janaushadhi Kendras. Ask your doctor whether a generic or a less expensive option in the same group suits you. Do not switch on your own, as doses can differ between products.
Questions to ask your doctor
- What does each of my medicines do, and what side effects should I watch for?
- Can any of them cause low sugar? What should I do if it happens?
- Should I take them before, with or after food?
- Would an SGLT2 inhibitor or GLP-1 medicine help protect my heart or kidneys?
- Are there cheaper generic options that would work as well for me?
- What should I do on days I am unwell or fasting?
When to get help urgently
- Sugar below 70 mg/dL that does not come up after two rounds of fast sugar, or any low with confusion.
- Vomiting, stomach pain, fast breathing or drowsiness, especially if you take a gliflozin, even if your sugar is not very high.
- Severe stomach pain that goes through to the back.
- Swelling of the face, lips or throat, or difficulty breathing after a new medicine. Call 112.
Frequently asked questions
What are the most common sugar tablet names in India?
The most common generic names are metformin, glimepiride, gliclazide, sitagliptin, vildagliptin, teneligliptin, dapagliflozin, empagliflozin, pioglitazone and voglibose. Many brands combine two of these in one tablet, so check the generic names printed on the strip.
Does metformin damage the kidneys?
No. Metformin does not harm healthy kidneys. Because the kidneys clear it from the body, the dose is reduced if kidney function falls, and it is stopped if kidney function becomes very low. Yearly kidney tests guide this.
Once I start insulin, do I have to take it for life?
Not always. Some people with type 2 diabetes use insulin for a period, for example when sugar is very high at diagnosis or during an illness, and then go back to tablets. Others need it long term because the pancreas makes too little insulin. It is not addictive.
Can I stop my diabetes tablets if my sugar becomes normal?
Do not stop on your own. Normal readings usually show that the medicine is working. If you have lost weight or changed your lifestyle a lot, your doctor may be able to reduce or stop some medicines while checking your sugar closely.
Sources
- American Diabetes Association Professional Practice Committee. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1).
- American Diabetes Association Professional Practice Committee. 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1).
- American Diabetes Association Professional Practice Committee. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1).
- American Diabetes Association Professional Practice Committee. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026. Diabetes Care 2026;49(Suppl 1).
This article is general information for adults in India and is not a diagnosis or a treatment plan. Always discuss results and any changes with your own doctor. Read our editorial policy.