Type 2 diabetes treatment options

A plain-language guide to treating type 2 diabetes: healthy habits, metformin, SGLT2 inhibitors, GLP-1 medicines, DPP-4 inhibitors, sulfonylureas and insulin, plus what we know about remission.

7 min read · last reviewed October 3, 2026

There are more ways to treat type 2 diabetes today than ever before. Your plan will be built around you: your blood sugar, your other health conditions, your goals, side effects, and what your medicines cost. This guide explains the main options in plain words. It uses generic (non-brand) names. Your team will decide on doses with you.

The foundation: healthy habits

Everyday habits help every other treatment work better:

• Eating well. There's no single diabetes diet. The plate method is a simple start: half vegetables, a quarter protein, a quarter whole grains or starchy foods.
• Moving more. Activity helps your body use insulin. Build up to about 150 minutes a week, plus some strength exercise.
• Sleep, stress and not smoking all affect blood sugar and heart health.
• Diabetes education. A diabetes educator and dietitian can help you put it all together.

Some people start with habits alone. Many start a medicine at the same time. Both are fine. Taking a medicine doesn't mean your habits don't matter, and it isn't a sign of failure.

Metformin

Metformin is a pill that's often the first medicine for type 2 diabetes. It helps your liver release less sugar and helps your body use insulin better.

• Good to know: it rarely causes low blood sugar on its own, doesn't cause weight gain, and has been used safely for decades.
• Side effects: an upset stomach, loose stools or gas are common at first. Taking it with food and starting low usually helps. Over many years, it can lower vitamin B12 levels, so your team may check it.
• Sick days: it's one of the medicines you may need to pause if you're throwing up or dehydrated.

SGLT2 inhibitors (names end in "-gliflozin")

These pills, such as empagliflozin, dapagliflozin and canagliflozin, help your kidneys remove extra sugar in your pee.

• Heart and kidney protection: some of these medicines lower the risk of heart failure, of kidney disease getting worse, and in some people, of heart attack, stroke or heart-related death. Diabetes Canada recommends them for people with heart disease, heart failure or kidney disease, even if their A1C is already on target.
• Side effects: peeing more, and genital yeast infections. Keeping the area clean helps.
• Rare but serious: diabetic ketoacidosis (DKA), sometimes with normal-looking blood sugar. Pause them on sick days and before some surgeries, as your team advises.

GLP-1 receptor agonists (names often end in "-glutide")

These medicines, such as semaglutide, dulaglutide and liraglutide, act like a natural gut hormone. They help your pancreas release insulin when your blood sugar is high, slow down how fast your stomach empties, and help you feel full sooner. Most are injections given once a day or once a week, with a tiny needle. Semaglutide also comes as a pill.

• Heart protection: some lower the risk of heart attack, stroke and heart-related death in people with heart disease or at high risk. Some also help protect the kidneys.
• Weight: many people lose weight on these medicines.
• Side effects: nausea, fullness, throwing up or diarrhea, usually at the start and when the dose goes up. Eating smaller meals helps.

Tirzepatide is a newer, related medicine that acts on two gut hormones (GIP and GLP-1). It's given as a weekly injection and can lower blood sugar and weight a lot.

DPP-4 inhibitors (names end in "-gliptin")

These pills, such as sitagliptin and linagliptin, gently boost your own gut hormones to help lower blood sugar after meals. They rarely cause lows, don't usually affect weight, and are generally well tolerated. They don't have the extra heart and kidney benefits of SGLT2 inhibitors or GLP-1 medicines.

Sulfonylureas

These pills, such as gliclazide, glimepiride and glyburide, push the pancreas to release more insulin. They work well and usually cost little.

• Low blood sugar: they can cause lows, especially if you skip a meal, are more active than usual, drink alcohol or have kidney problems. If you take one, learn how to treat a low and carry fast-acting sugar.
• Weight: they can cause some weight gain.

Other pills

Pioglitazone helps the body use insulin better. It can cause fluid build-up and isn't used in people with heart failure. There are other, less common options your team may mention too.

Insulin

Some people with type 2 diabetes need insulin, either for a while (for example, when blood sugar is very high at diagnosis, during illness or in pregnancy) or long term. Many people start with one injection of long-acting (basal) insulin a day, often while continuing their other medicines. Modern insulin pens are easy to use, and the needles are tiny.

Insulin can cause low blood sugar and some weight gain. Your team will teach you how to adjust it safely. Starting insulin is not a failure. It's a powerful, natural treatment.

Something you can do today: Make a list of your diabetes medicines and write next to each one what it does. Ask your pharmacist to fill in any gaps.

Can type 2 diabetes go into remission?

For some people, yes. In the DiRECT trial in the UK, adults who had type 2 diabetes for less than 6 years followed a structured weight-loss program, starting with a few months of low-calorie meal-replacement shakes and soups. After one year, 46% were in remission (normal blood sugar without diabetes medicines), compared with 4% who had usual care. After two years, 36% were still in remission. The more weight people lost and kept off, the more likely they were to be in remission.

Some important points:

• Remission is more likely soon after diagnosis and with substantial weight loss. It isn't possible or right for everyone.
• Programs like this need medical supervision, because diabetes and blood pressure medicines often need to be changed or stopped quickly.
• Blood sugar can rise again, so you'll still need yearly checks, including eye exams.
• For some people, weight-loss surgery or medicines may be options to discuss.

If remission interests you, ask your team whether it's a realistic goal and what support is available.

Your treatment will change over time

Your team will review your treatment every few months at first. Medicines may be added, changed or reduced. That's normal.

Something you can do this week: Ask your team, "Would a medicine that protects my heart and kidneys be right for me?"

Questions to ask your care team

• What does each of my medicines do? What side effects should I watch for?
• Can any of my medicines cause low blood sugar?
• Would an SGLT2 inhibitor or GLP-1 medicine protect my heart or kidneys?
• Which medicines should I pause on sick days?
• Is remission a realistic goal for me? What support is there?
• Are my medicines covered? Are there less costly options?

This article is general information, not medical advice. Talk with your health care team about your own situation. In an emergency, call 9-1-1 or your local emergency number.

In an emergency, call 9-1-1 or your local emergency number.

General information, not medical advice. It does not replace your own care team. If you think you or someone else is having a medical emergency, call 9-1-1 or your local emergency number. If you are in crisis or thinking about suicide, call or text 9-8-8 (Canada and the US).

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