Oral Medications and The Risk of Hypoglycemia


Do you have type 2 diabetes? Then you’re probably familiar with the concept of taking oral medications to manage your blood sugar, and for others, taking oral medications with insulin.  Oral medications have various functions to improve type 2 diabetes management such as:

  • Increasing insulin production.
  • Improving the sensitivity to insulin.
  • Reducing insulin resistance.

With that said, taking blood glucose-lowering drugs carries risks of experiencing hypoglycemia (low blood sugar). Part of learning to live with diabetes is learning about hypoglycemia and how to prevent or treat it. Although the objective of oral medications is to lower blood glucose levels and keep them within desired ranges, the risks of hypoglycemia increase when:

  • Taking an increased dose of medication or forgetting to take a dose and then doubling it.
  • Not eating after taking medication or eating less than intended.
  • Increased physical activity.

Oral Medications and the Risks of Hypoglycemia

Some medications have a higher risk of causing hypoglycemia than others. As a rule of thumb, taking insulin with these drugs also generally increases the chances of experiencing hypoglycemia.

Medications with Higher Risks of Hypoglycemia:

  • Sulfonylureas (SFUs): These medications stimulate insulin production by the pancreas and have effects on the action of insulin in the tissues that are sensitive to it, which causes a decrease in blood glucose levels. Recognizable names for SFUs include: Orinase, Glucotrol, Diabeta and Amaryl. 
  • Glinides: Lower blood sugar by stimulating the secretion of insulin by the beta cell of the pancreas, which can cause hypoglycemia. Recognizable names are: Prandin and Starlix. 

Medications with Lower Risks of Hypoglycemia

  • Biguanides: They help the liver release less sugar. Biguanides are also known as metformin, but other recognizable names are: Glucophage, Fortamet, Glumetza and Riomet. 
  • GLP-1 Receptor Agonists (GLP-1 RAs): These increase the secretion of insulin and reduce the release of glucose from the liver after meals. The risks of having a low blood sugar rise when combined with insulin or other insulin secretagogues such as SFUs or Glinides. The only oral GLP-1 RA on the market is Rybelsus (semaglutide).
  • DPP-4 Inhibitors: These help your body put out more insulin and less glucose when you eat. Names for DPP4-Inhibitors are: Nesina, Januvia, Tradjenta and Onglyza.
  • SGLT2 Inhibitors: Cause your kidneys to take in less glucose and move it out of the body through urine. Names for SGLT-2 Inhibitors are: Invokana, Farxiga and Jardiance.
  • Thiazolidinediones (TZDs): They improve how well your own insulin works. Other names for TZDs are: Actos and Avandia.

How to Prevent Hypoglycemia

A low blood sugar episode can occur at any time and sometimes, an episode can be severe enough to require assistance. Severe hypoglycemia can also result in serious health issues such as seizures, coma and loss of consciousness. Here are some helpful tips to prevent hypoglycemia while taking oral medications:

  • Learn the signs and symptoms of hypoglycemia.
  • Don’t skip any meals.
  • Keep track of the timing of meals when taken with medication.
  • Take the medicine according to your doctor’s instructions.
  • Have an emergency treatment, such as nasal glucagon or another form of glucagon, on hand.
  • Keep fast-absorbing carbohydrates such as candy, juice, or one of these snacks.

For more information on how to create a plan to prepare for a severe low blood sugar emergency, check out our guide here.

This content was made possible with support from Baqsimi, a Founding Partner of Beyond Type 2. 

WRITTEN BY Eugenia Araiza, CDE Nutritionist, POSTED 04/01/21, UPDATED 10/11/22

Eugenia has a degree in nutrition specializing in diabetes and she is a diabetes educator. She was diagnosed with type 1 diabetes 25 years ago, she is the creator of Healthy Diabetes. She really enjoys studying and helping others in managing their different types of diabetes. She loves studying, managing type 1 diabetes and nutrition. She especially enjoys writing about the impact diabetes has in her life. She lives surrounded by the love of her family, who are Luis Felipe, who lives with latent autoimmune diabetes in adults (LADA) type diabetes and her teenage son, Indigo.