Aubrey Bailey, PT, DPT, CHT  is a physical therapist with over 20 years of experience in a variety of healthcare settings.
Do-Eun Lee, MD, has been practicing medicine for more than 20 years, and specializes in diabetes, thyroid issues and general endocrinology. She currently has a private practice in Lafayette, CA. 
Finding the right type 2 diabetes medication to control your blood sugar may take some time. You might also need to adjust your medication as your diabetes progresses or improves or as changes occur in your life. Understand why you may need to change medications to find a plan that works for you.
This article discusses seven reasons you might need to change your diabetes medication.
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Do not make any changes to your medications without specific instructions from your healthcare provider.
If your current medication isn’t doing a good job of controlling your blood sugar, you might need a change. Your healthcare provider will set targets for your blood sugar levels, but in general, blood sugar should be between 80 and 130 milligrams of sugar to deciliters of blood (mg/dL) and less than 180 mg/dL two hours after eating.

It's normal to have fluctuations in blood sugar levels throughout the day. However, consistently low or high blood sugar levels can signify that your medication is no longer working.
A blood sugar reading below 70 mg/dL is considered low. Symptoms of low blood sugar—called hypoglycemia—can include:
Blood sugar levels above 180 mg/dL are considered high and can cause hyperglycemia. Symptoms of this condition can include:
Rather than replacing ineffective diabetes medication with another type of drug, your healthcare provider might opt for oral combination therapy—adding another drug with your current medication. This has been found to be more effective than switching from one medication to another.
Even if your diabetes medication effectively controls your blood sugar levels, some drugs can sometimes cause intolerable side effects.
Common side effects of diabetes medications include:
Other side effects can include:
Drinking alcohol with certain diabetes medications can cause nausea and/or vomiting.
A variety of medications are used to lower blood sugar. Examples include:

Lifestyle changes, such as incorporating regular physical activity, are essential to managing type 2 diabetes. However, exercise also decreases blood sugar levels as muscles pick up sugar from your blood to use for energy. If you start exercising regularly, your diabetes medication might need to be adjusted, especially if the medication helps to lower your blood sugar.
Always check your blood sugar level before physical activity, as exercise could increase your risk of hypoglycemia. Your healthcare provider might adjust your medication or advise you to eat a carbohydrate-heavy snack to help prevent your blood sugar from dropping too low during or after exercise.
Regular physical activity can also lead to weight loss, which might require adjusting your diabetes medications or dosage.
Pregnant people with diabetes usually have more frequent than normal visits to their healthcare provider. It's crucial to properly manage blood sugar levels during pregnancy with type 2 diabetes, which might require medication changes. Uncontrolled blood sugar during pregnancy can lead to complications, such as:
In some cases, your healthcare provider may decide to change your type 2 diabetes medication when a new one becomes available. Some recent diabetes drugs have been shown to have other health benefits other than controlling blood sugar levels.
For example, sodium-glucose cotransporter-2 (SGLT2) inhibitors can aid in weight loss, lower the risk of cardiovascular (heart) disease, and lower blood pressure.
Examples include:
Glucagon-like peptide-1 (GTP-1) receptor agonists can also aid in weight loss and lower the risk of cardiovascular disease.
Examples include:
As with any medication, you may experience side effects when starting a new type 2 diabetes drug. Some side effects—such as nausea—might improve with time. Talk to your healthcare provider if you are experiencing intolerable side effects of your medication.
Sometimes your healthcare provider will change your type 2 diabetes medication because it interacts with another medication you are already taking. For example, beta-blockers, niacin, thiazides, and glucocorticoids, can have adverse side effects for people with type 2 diabetes, such as decreased sensitivity to insulin and increased blood sugar levels.
Diabetes medications can also interact with herbal supplements, such as:
Be sure to inform your healthcare provider of all medications and over-the-counter (OTC) supplements, medications, and other substances you take to help avoid type 2 diabetes drug interactions.
Type 2 diabetes is a condition that can be in remission (temporary recovery). Technically, this condition isn’t “cured” since blood sugar levels can revert to unhealthy levels and diabetes can return.
People with type 2 diabetes are considered to be in remission when blood sugar levels are in a normal range, without medication, for at least three months. Remission can occur from significant lifestyle changes, such as losing weight through healthy lifestyle changes.
There are many reasons why your healthcare provider might change your type 2 diabetes medication—it isn't working well, your side effects are intolerable, it interacts with another medication you are taking, or your lifestyle changes significantly.
If your blood sugar levels are well controlled, you might need less medication, or none at all. Talk to your healthcare provider before making any changes to your medication.
Keeping blood sugar levels in a healthy range is important for avoiding serious complications that can occur with type 2 diabetes. Always follow your healthcare provider’s instructions when taking medications. Consider making positive lifestyle changes that can also improve your condition.
Medications for diabetes and other conditions, such as heart disease, are often taken together. However, there can be significant drug interactions. Certain heart medications impact blood sugar levels. Be sure your healthcare provider is aware of all of your medications to help prevent these issues.
Talk to your healthcare provider if you suspect your diabetes medication is no longer working. Record your blood sugar readings and bring this information to your appointment to help determine the next steps in your treatment.
Unfortunately, medications are not always covered by insurance. If you face this problem, talk to your healthcare provider—other medications might be available. You can also appeal your insurance company's decision. Drug companies can sometimes provide discounted pricing to make medications more affordable.
Centers for Disease Control and Prevention. Manage blood sugar.
Centers for Disease Control and Prevention. Low blood sugar (hypoglycemia).
National Institute of Diabetes and Digestive and Kidney Diseases. Managing diabetes.
American Diabetes Association. Oral medication. what are my options?
American Diabetes Association. Blood sugar and exercise.
Centers for Disease Control and Prevention. Type 1 or type 2 diabetes and pregnancy.
Harvard Health Publishing. Type 2 diabetes: which medication is best for me?
May M, Schindler C. Clinically and pharmacologically relevant interactions of antidiabetic drugsTher Adv Endocrinol Metab. 2016;7(2):69-83. doi:10.1177/2042018816638050
American Diabetes Association. International experts outline diabetes remission diagnosis criteria.
National Institute of Diabetes and Digestive and Kidney Diseases. Achieving type 2 diabetes remission through weight loss.
By Aubrey Bailey, PT, DPT, CHT
Aubrey Bailey is a physical therapist and professor of anatomy and physiology with over a decade of experience providing in-person and online education for medical personnel and the general public, specializing in the areas of orthopedic injury, neurologic diseases, developmental disorders, and healthy living. 

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