What to Do if Your Type 2 Diabetes Medication Isn’t Working
Health ConditionsDiabetesType 2 Diabetes

Switching Medications: What to Do if Your Type 2 Diabetes Treatment Isn’t Working

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Published on January 29, 2026
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W hen first diagnosed with type 2 diabetes, you may have been able to manage blood sugar levels with diet, exercise, and a first-line medication. But as the condition progresses, the body becomes more resistant to insulin, causing those same lifestyle modifications and treatments to lose their effectiveness.

If your A1C has started to rise, it doesn’t mean you’re doing anything wrong, says Bismruta Misra, MD, division director of endocrinology at Stamford Health in Connecticut. But it’s a sign that it may be time to revisit your treatment plan.

Read on to find out whether you should give the current treatment you’re on more time to take effect or talk to your doctor about making a switch.

6 Reasons to Switch Medications for Type 2 Diabetes

There are many reasons people with type 2 diabetes switch medications. Sometimes there are too many side effects. Other times, the cost is too high. Telling your doctor what, exactly, isn’t working with a current medication can help pinpoint a treatment that may work better for you.

1. Your Blood Sugar Is Not Under Control

If it’s getting harder to reach blood sugar goals, you may need a medication adjustment. Ongoing high blood sugar can put you at higher risk of conditions such as heart disease, nerve damage, and stroke.

1. Your Blood Sugar Is Not Under Control

2. You Can’t Tolerate the Drug’s Side Effects

Type 2 diabetes medications can cause side effects such as diarrhea, fatigue, and nausea. If these interfere with your daily life, your doctor can recommend a different drug or a lower dose that you might tolerate better. Always talk to your doctor before stopping a medication, though, says Dr. Misra.

2. You Can’t Tolerate the Drug’s Side Effects

3. Related Conditions Are Unmanaged

If you start having heart, kidney, or liver problems, your care team might suggest switching to a newer therapy designed to do double duty — namely, keeping A1C levels in check while actively shielding vital organs from further damage. “Switching usually happens when diabetes-related conditions like high blood pressure, high cholesterol, or heart disease are not well controlled,” says Misra.

3. Related Conditions Are Unmanaged

4. A New Medication Is Available

Medical research is constantly evolving, bringing newer drugs that may be more effective, be easier to use, or offer additional benefits, such as heart protection or weight loss. “I like to save some of the newer medications in my back pocket for when diabetic control isn’t as good or if a person is not tolerating their medication,” says Misra. At the same time, she emphasizes that if you’re meeting your goals and feel good on your current plan, there’s no need to switch just to have the latest drug. The goal is always the right treatment for your body at the right time.

4. A New Medication Is Available

5. You’ve Reached Remission

If you’re in remission — meaning, your A1C has been under 6.5 percent for at least three months without glucose-lowering medication — you may be able to safely reduce or stop some medications under your doctor’s guidance.

You’ll still need to eat a healthy diet, exercise regularly, and manage your weight. If not, blood sugar levels may start to rise again.

5. You’ve Reached Remission

6. The Medication Is Too Expensive

If you’re struggling with the price of prescriptions, you aren’t alone, and you have options. Your care team can guide you toward manufacturer-sponsored assistance programs or copay cards that can significantly lower out-of-pocket expenses. When discussing a switch, remember to look at the “total cost of care,” including things such as lancets and test strips, to ensure the new plan is truly affordable in the long run.

6. The Medication Is Too Expensive

Quiz: Assess Your Type 2 Diabetes Treatment

It may take a few tries to find the right diabetes treatment. Other times, the medication may just need more time to work. Answer these questions to help evaluate whether you should ask your doctor about switching to a new treatment plan.

Should You Consider Changing Type 2 Diabetes Medications?

Question 1/6

How long have you been on the current treatment?

  • Under 6 months
  • Over 6 months

Treatment Options for Type 2 Diabetes

Whether it’s side effects, cost, or something else, if your current treatment plan isn’t serving you, your doctor will likely recommend making a change.

5 Treatment Changes Your Doctor May Recommend

If your treatment plan can be improved, your doctor may want you to:

  1. Adjust your current dose. Increasing or decreasing the dose of the current medication can help bring your blood sugar levels back within target range without adding new drugs.
  2. Add a second medication. If one medication isn’t enough, your doctor may prescribe another one from a different class of drugs. A combination may provide better blood sugar control and reduce side effects more than a higher dose of a single drug.
  3. Switch to a different medication. Sometimes a different class of medication works better for your body or lifestyle. For example, newer drugs, such as glucagon-like peptide-1 (GLP-1) receptor agonists, may help lower blood sugar while supporting weight loss.
  4. Consider insulin therapy. If oral medications and other injectables aren’t enough, insulin may be necessary to reach your A1C goals. Your doctor will guide you on how and when to start.
  5. Make lifestyle adjustments. Even with medication, improvements in diet, exercise, and weight management remain essential. These changes can enhance the effectiveness of the treatment plan.
Currently, there are several classes of diabetes drugs — each of which helps manage diabetes and its related conditions, such as heart disease and obesity — as well as nondrug approaches.

Metformin Usually the first medication prescribed for type 2 diabetes, metformin works by reducing glucose production in the liver and making your body more sensitive to insulin. It rarely causes low blood sugar or weight gain and has a strong safety record. Some people may experience mild stomach upset, especially when starting treatment, but this usually improves with gradual dose increases.

Sulfonylureas and Meglitinides These medications, including glimepiride (Amaryl), glipizide (Glucotrol), and repaglinide (Prandin), prompt the pancreas to release more insulin. They are generally affordable and effective at lowering blood sugar quickly. But because these drugs increase insulin production, they carry a higher risk of weight gain and low blood sugar (hypoglycemia) than other options.

Alpha-Glucosidase Inhibitors Drugs such as acarbose (Precose) and miglitol (Glyset) work by slowing down the digestion of carbohydrates, which prevents blood sugar from spiking after eating. These are helpful for people who need to avoid low blood sugar, but they can often cause digestive side effects, such as bloating, diarrhea, and gas.

TZDs Drugs such as pioglitazone (Actos) help your body respond better to its own insulin and can improve overall blood sugar control. Using these early on may even help protect your pancreas. But they can cause the body to hold onto fluid, which may lead to swelling or weight gain, and may be associated with an increased risk of bladder cancer and osteoporosis. TZDs may play an important treatment role in people who store excess fat in the liver, leading to inflammation and fibrosis. Because these drugs carry long-term risks for heart failure and bone density loss, your doctor will closely monitor your heart health.

DPP-4 Inhibitors Medications such as sitagliptin (Januvia) and saxagliptin (Onglyza) help block the production of the enzyme DPP-4, which allows the body to release more insulin. They generally don’t cause weight gain or low blood sugar, and some research suggests they may even have a positive effect on cholesterol levels.

GLP-1 and Dual GLP-1/GIP Receptor Agonists GLP-1s, such as dulaglutide (Trulicity), liraglutide (Victoza), and semaglutide (Ozempic and Rybelsus), and dual GLP-1/GIPs, such as tirzepatide (Mounjaro), mimic incretins, which are hormones produced in the gut. When you eat, these hormones signal the pancreas to release insulin, helping keep blood sugar steady. Beyond lowering blood sugar, these drugs slow digestion. This keeps you feeling fuller for longer and helps prevent hunger between meals, often leading to significant weight loss and better heart health. Digestive issues, such as diarrhea and nausea, are the most frequent side effects. Low blood sugar is rare, unless the drug is paired with insulin. They are also recommended for people at high risk of cardiovascular disease.

SGLT2 Inhibitors SGLT2 (sodium-glucose cotransporter-2) inhibitors, such as canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance), and ertugliflozin (Steglatro), help lower blood glucose levels by stopping the kidneys from reabsorbing sugar the body creates. The American Diabetes Association recommends SGLT2s specifically for people with (or at high risk of) heart failure, heart disease, or chronic kidney disease. The drugs may also support modest weight loss. Because they cause more sugar in the urine, it is common to see an increase in yeast infections and urinary tract infections. It’s also important to stay hydrated, as these medications can make you urinate more frequently.

Combination Therapy To help you achieve better blood sugar control, your doctor may prescribe two or more medications to work together. Many of these are available as a single combination pill, such as glyburide and metformin (Glucovance) or metformin and sitagliptin (Janumet). These pills are highly effective and help reduce pill burden, making it much easier to manage your daily routine by taking fewer pills. One drawback is that your doctor cannot adjust the dose of each medication individually. Additionally, if you have side effects, it can be harder to tell which of the two medications is causing the issue.

Insulin Insulin therapy is used when other medications aren’t enough for meeting your A1C target. Insulin allows precise blood sugar control and rapid correction of high glucose levels. Most people with type 2 diabetes start with a single daily dose of long-acting (basal) insulin, such as insulin degludec (Tresiba), insulin glargine (Lantus), or insulin glargine U-300 (Toujeo). If your blood sugar still spikes after eating, your doctor might add rapid-acting insulin, such as insulin aspart (Novolog) or insulin lispro (Humalog), to be taken before either your largest meal or every meal.

Lifestyle and Nondrug Therapy Dietary changes, regular physical activity, stress reduction, and weight management are essential components of any diabetes plan. Behavioral therapy, diabetes education, and support groups can also help improve medication adherence and long-term success.

How to Talk to Your Doctor About Changing Treatments for Type 2 Diabetes

If you’re considering a change in type 2 diabetes treatment, your doctor will want to know how the current medication is working and where it’s falling short. You live with this condition every day, so symptoms, side effects, and how you feel about taking the medication matter just as much as test results.

Here are a few things to discuss when considering a medication switch for type 2 diabetes.

8 Things to Tell Your Doctor

Let your doctor know if:

  1. Your A1C and daily blood sugar levels are still high.
  2. You regularly feel dizzy, shaky, or sweaty due to low blood sugar — and how often it happens.
  3. It’s difficult to remember to take a daily pill, or you have a fear of injections.
  4. You’re having any ongoing digestive issues, fatigue, or other discomforts that affect your daily life.
  5. You have new or worsening health problems, especially ones related to your blood pressure, heart, or kidneys.
  6. The current medication is causing weight gain or making it harder to reach your weight loss goals.
  7. Diabetes management is interfering with your work, social life, sleep, or sex life.
  8. The cost of the current medication has become a burden, or your health coverage has changed.

7 Tips for Switching Type 2 Diabetes Treatments Successfully

It’s natural to feel a bit anxious about how your body will react or whether a new treatment will be more effective than the last.

“While the period of adjustment can be physically and mentally taxing, finding a medication that balances blood sugar control with heart protection and ease of use is an investment in your future,” says William Woo, MD, a family medicine doctor at Kaiser Permanente in Anaheim, California. "A successful switch can lead to significantly better long-term health outcomes and a much higher quality of life.”

The Bottom Line About Switching Treatments

Changing type 2 diabetes medications can feel overwhelming at first, and it’s okay to have questions about making the switch. Your body’s needs naturally shift over time, so updating your plan isn’t a sign of failure. It’s simply ensuring you have the right tools at your disposal.

Be sure to let your care team know about any side effects, and don't hesitate to reach out with questions. Your providers are here to support you as you adjust to your new treatment plan and make progress toward your health goals.

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Anna L. Goldman, MD

Medical Reviewer
Castle Connolly Top Doctor

Anna L. Goldman, MD, is a board-certified endocrinologist. She teaches first year medical students at Harvard Medical School and practices general endocrinology in Boston.

Dr. Goldman attended college at Wesleyan University and then completed her residency at Icahn School of Medicine at Mount Sinai Hospital in New York City, where she was also a chief resident. She moved to Boston to do her fellowship in endocrinology at Brigham and Women's Hospital. She joined the faculty after graduation and served as the associate program director for the fellowship program for a number of years.

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Susan Jara

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Susan Jara is a health communications strategist and writer with more than 15 years of experience transforming complex medical information into clear, accurate, and engaging content for diverse audiences of patients and caregivers. She specializes in patient education, health literacy, and SEO-driven content strategy, with expertise across chronic disease, mental health, addiction, arthritis, autoimmune conditions, and wellness.

Susan holds a bachelor’s degree in journalism and media studies from New York University’s Gallatin School of Individualized Study. Her career includes leadership roles at the Global Healthy Living Foundation and Health Monitor Network, where she developed multichannel health content across web, email, podcasts, video, social media, and print. Susan's work reaches millions of readers each year, and she collaborates with leading healthcare providers, researchers, advocacy groups, and industry partners to create resources that reach millions of readers each year.

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