Diabetes: Drug Classes

Metformin: The First-Line Drug That Doesn't Cause Hypos

Metformin is the most prescribed diabetes drug in the world, and for good reason: it lowers glucose, is cheap, doesn't cause weight gain, and almost never causes a hypo. It works not by pushing out more insulin but by making the body listen better — starting with the liver. Understanding that one difference explains its greatest strength and its rare but serious danger.

GLP-1 Agonists & DPP-4 Inhibitors: The Incretin Revolution

The drugs behind the household names — Ozempic, Wegovy, Mounjaro — all trace back to a single gut hormone released when you eat. Understand that hormone, GLP-1, and you understand why these medicines lower glucose without causing hypos, cause dramatic weight loss, and come in two flavours: a powerful injection and a gentler pill.

SGLT2 Inhibitors: Lowering Glucose by Peeing It Out

The flozins do something no other diabetes drug does: they lower blood glucose by making the kidneys dump sugar into the urine. It sounds almost too simple — yet this odd mechanism turned out to protect failing hearts and kidneys so powerfully that these drugs are now prescribed even to people without diabetes. One clever kidney trick, two of the biggest breakthroughs in modern medicine.

Sulfonylureas, Thiazolidinediones & the Rest

Before the incretins and flozins, these were the drugs that filled the gap after metformin — and they're still widely used because they're effective and cheap. But unlike the newer classes, the sulfonylureas can cause hypos and weight gain. Knowing exactly why tells you when they help and when to be careful.