Type 2 diabetes — tablet options explained
Reviewed by the My London Pharmacy clinical team, Trishla Shah, Pharmacist Independent Prescriber
·31 July 2026
·7 min read
Quick answer
Metformin is usually the first tablet considered for type 2 diabetes. If it isn't suitable or isn't enough on its own, other tablet options can be added or substituted. Treatment is chosen alongside lifestyle changes and regular monitoring, and is reviewed periodically with your clinician to keep your blood glucose within a healthy range.
What type 2 diabetes is and why treatment matters
Type 2 diabetes develops when the body cannot use insulin effectively, a state often called insulin resistance, and over time the pancreas may also produce less insulin than it needs to. The result is that glucose builds up in the blood rather than being taken up by cells for energy. Left unmanaged over many years, persistently raised blood glucose can gradually damage blood vessels and nerves, contributing to problems affecting the heart, kidneys, eyes and feet.
Type 2 diabetes is common in the UK and becomes more likely with age, excess weight, inactivity and a family history of the condition, though it can affect anyone. Many people have no symptoms at diagnosis and find out through a routine blood test, while others notice increased thirst, passing more urine, tiredness or unintentional weight loss. Whatever the route to diagnosis, the aim of treatment is the same: to bring blood glucose into a healthier range and reduce the long-term risk of complications, while fitting around your day-to-day life.
Treatment is not one-size-fits-all. It usually combines lifestyle changes with medication where needed, and is adjusted over time as your circumstances and blood glucose control change. Tablets are often the starting point for many people, which is why understanding how the main options work can make consultations feel less daunting.
How it's diagnosed and monitored
Type 2 diabetes is usually diagnosed and monitored using a blood test called HbA1c, which reflects your average blood glucose level over the previous two to three months rather than a single snapshot. This makes it a useful way to see the overall picture and to track how well treatment is working over time. Some people are also asked to monitor their blood glucose at home, particularly if they are on medicines that can cause it to drop too low.
After diagnosis, HbA1c is typically rechecked periodically, alongside reviews of blood pressure, cholesterol, kidney function and weight, since these all interact with diabetes and its long-term risks. Annual checks of the eyes and feet are also part of routine diabetes care, as both can be affected by long-term raised glucose. Regular review lets your clinician see whether your current treatment is achieving a sensible target for you personally, since the right target varies between individuals depending on age, other health conditions and how long you have had diabetes.
Metformin: usually the first tablet considered
For most people newly diagnosed with type 2 diabetes, metformin is the tablet usually considered first. It works mainly by reducing the amount of glucose released by the liver and by improving how the body responds to its own insulin, rather than by stimulating the pancreas to produce more. This means it does not typically cause blood glucose to drop too low (hypoglycaemia) when used alone, and it does not tend to cause weight gain, which is one reason it is generally well tolerated as a starting point.
Metformin is usually started at a low dose and increased gradually, partly to reduce stomach upset such as nausea or loose stools, which are the most commonly reported side effects and often settle over the first few weeks. A slow-release version is sometimes used if standard tablets are not well tolerated. Metformin is not suitable for everyone, for example if kidney function is significantly reduced, so your clinician will check this before and periodically during treatment.
Other tablet options if metformin isn't enough or suitable
If metformin alone does not bring blood glucose into the desired range, or if it is not suitable for you, several other classes of tablet may be considered, either on their own or alongside metformin. Your clinician will weigh up your overall health, other conditions such as heart or kidney disease, and your preferences when discussing which option might fit best.
- Sulfonylureas work by encouraging the pancreas to release more insulin. They can be effective at lowering blood glucose, but because they increase insulin release regardless of how much glucose is present, they carry a higher chance of hypoglycaemia than metformin, so timing around meals matters.
- DPP-4 inhibitors help the body release more of its own insulin after eating and reduce the amount of glucose the liver produces, generally with a low risk of hypoglycaemia and without causing weight gain.
- SGLT2 inhibitors work differently again, helping the kidneys remove excess glucose in the urine. Beyond lowering blood glucose, they are also often considered for people with certain heart or kidney conditions because of wider benefits seen in this group.
- Pioglitazone improves the body's sensitivity to its own insulin, though it is used more selectively because of its own particular side-effect profile.
For some people, tablets alone are not enough over time and an injectable treatment, including insulin, may be needed as part of specialist diabetes care. That decision sits outside a tablet-focused consultation and is made with your GP or diabetes team.
Lifestyle steps alongside medication
Whatever tablet is used, lifestyle remains central to managing type 2 diabetes and often improves how well medication works. These changes are worth maintaining alongside treatment rather than seeing them as a separate, lesser option.
- Choose meals built around vegetables, wholegrains, pulses and lean protein, and limit sugary drinks and refined carbohydrates.
- Aim for regular physical activity across the week, building up gradually if you are not currently active.
- Work towards a healthy weight where relevant, as even modest weight loss can improve blood glucose control.
- Stop smoking, which reduces the added risk smoking brings to the heart, circulation and kidneys.
- Keep alcohol within recommended limits, as it can affect blood glucose and interact with some medicines.
Structured education and support programmes are widely available and can make these changes easier to sustain, particularly soon after diagnosis when adjusting to a new routine feels hardest.
What to expect: side effects and ongoing monitoring
Most people tolerate diabetes tablets well, though it is worth knowing what to expect. Gastrointestinal symptoms are the most commonly reported issue with metformin and usually ease with a gradual dose increase or a slow-release formulation. Medicines that increase insulin release, such as sulfonylureas, carry a higher chance of hypoglycaemia, so it helps to recognise the signs: shakiness, sweating, sudden hunger, difficulty concentrating or feeling unusually anxious. Treating a low promptly with a fast-acting source of sugar, followed by a longer-acting carbohydrate, is the standard response, and your clinician can talk you through this if you are prescribed a medicine that carries this risk.
Ongoing monitoring typically includes periodic HbA1c checks, kidney function tests (particularly relevant for metformin and SGLT2 inhibitors), and reviews of blood pressure and cholesterol. Some SGLT2 inhibitors can slightly increase the chance of genital thrush or urinary symptoms, so mention any new symptoms of this kind at a review. Never stop a diabetes medicine abruptly without discussing it with a clinician, as this can allow blood glucose to rise again.
When to seek help
Speak to a clinician if your blood glucose readings are consistently outside the range you have agreed, if you experience repeated episodes of hypoglycaemia, or if you notice new symptoms such as increased thirst, blurred vision, unexplained weight loss or slow-healing wounds. Routine reviews are also the right time to raise any side effects, questions about your current tablets, or concerns about how diabetes is affecting your daily life.
Seek urgent medical help, or call 999, for signs of a severe hypoglycaemic episode such as confusion, loss of consciousness or seizures, or for symptoms that could suggest diabetic ketoacidosis, including persistent vomiting, abdominal pain, rapid breathing or extreme drowsiness, particularly if you also have type 1 diabetes or are unwell with another illness.
Type 2 diabetes is a long-term condition, but with the right combination of tablets, lifestyle support and regular monitoring, most people manage it well and reduce their risk of complications considerably. A consultation is a useful way to review your current tablets, check whether your treatment plan still fits your needs, and get clear answers to any questions before deciding on next steps.
Frequently asked questions
Is metformin the only tablet used for type 2 diabetes?
No. Metformin is usually tried first, but several other tablet classes exist, including sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors and pioglitazone. The right choice depends on your individual health, other conditions and how you respond to treatment.
What happens if metformin doesn't suit me or isn't enough on its own?
Your clinician may adjust the dose or formulation, or add or switch to another tablet type. Treatment is regularly reviewed and adapted, so an initial approach not working well is common and simply prompts a change in plan.
How often will my HbA1c be checked?
This varies, but reviews are typically every few months while treatment is being adjusted, then less often once your blood glucose is stable within an agreed target range.
Can type 2 diabetes be managed with lifestyle changes alone?
For some people, particularly soon after diagnosis, diet and activity changes can bring blood glucose into a healthy range without medication. For others, tablets are needed alongside lifestyle steps, and this can change over time.
What are the signs of low blood sugar I should know about?
Shakiness, sweating, sudden hunger, difficulty concentrating and feeling anxious can indicate hypoglycaemia, particularly if you take a medicine that increases insulin release. Treating it promptly with a fast-acting sugar source is the standard response.
Do I still need GP or specialist diabetes care alongside a pharmacy consultation?
Yes. Type 2 diabetes needs ongoing monitoring, including kidney function, eyes and feet, which sits with your GP or diabetes team. A tablet-focused consultation supports this care rather than replacing it.