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Pakistan has one of the highest rates of diabetes in the world, and many people take two or three diabetes medicines without knowing what each one does. This guide explains the main families of type 2 diabetes tablets sold in Pakistan, with the brands you will see on prescriptions. It is prepared by the Medicine Online pharmacy team under the medical oversight of Dr. Farhan Rashid Abbasi. Your doctor chooses the medicine and dose; never start, stop or switch on your own.

1. Metformin: usually the first medicine

Brands: Glucophage 500 mg, Glucophage XR 750 mg, Glucophage XR 1 g.

Metformin lowers the sugar released by the liver and helps the body respond to insulin. It does not usually cause low blood sugar on its own. Stomach upset and loose stools are common at the start; taking it with food, or using an extended-release (XR) tablet, often helps. Long-term use can lower vitamin B12, so your doctor may check it.

2. Sulfonylureas: gliclazide and glimepiride

Brands: Diamicron MR 60 mg (gliclazide), Amaryl and Getryl (glimepiride).

These make the pancreas release more insulin. They work well and are affordable, but they can cause low blood sugar (hypoglycaemia), especially if you skip meals, fast or exercise more than usual. Learn the signs: shaking, sweating, fast heartbeat, hunger and confusion. Keep glucose tablets or sugar with you.

3. DPP-4 inhibitors (gliptins)

Brands: Sitaglu (sitagliptin), Galvus (vildagliptin), and combinations with metformin such as Sitaglu Met and Galvus Met.

Gliptins boost the body's own sugar-lowering hormones after meals. They rarely cause low blood sugar by themselves and are generally well tolerated. Tell your doctor about severe, persistent stomach pain, which can rarely be a sign of pancreatitis.

4. SGLT2 inhibitors

Brands: Empaa 10 mg and 25 mg (empagliflozin), Empaa-M (with metformin), Empaa-L (with linagliptin).

These remove extra sugar through the urine. Besides lowering sugar, empagliflozin has shown benefits for the heart and kidneys in people with those conditions. Because they work through the urine, drink enough water, especially in Pakistan's heat, and keep the genital area clean and dry to reduce the risk of thrush. Your doctor may advise pausing them during a severe illness with vomiting or before surgery.

5. Pioglitazone combinations

Brands: Zoliget 15/2 and Zoliget 30/2 (pioglitazone with glimepiride).

Pioglitazone improves insulin sensitivity. It can cause weight gain and fluid retention, so tell your doctor about swollen ankles or breathlessness. The glimepiride part can cause low blood sugar.

When insulin is needed

If tablets no longer control sugar, your doctor may add insulin. See our insulin storage and cold-chain guide.

Checking that your treatment is working

• HbA1c every 3–6 months shows your average sugar. Many adults aim for under 7%, but your doctor sets your target.
• Home testing with a glucometer shows how food, activity and medicines affect you day to day. See how to choose and use a glucometer.
• Yearly checks of kidneys, eyes, feet and cholesterol. Many people with diabetes also need a statin; see our cholesterol guide.

Browse all diabetes medicines.

Frequently asked questions

Can I fast in Ramadan on diabetes medicines?

Many people can, but sulfonylureas and insulin often need dose and timing changes. Speak to your doctor at least a month before Ramadan.

Is Empaa the same as Jardiance?

Both contain empagliflozin. Brands made by different companies contain the same active ingredient; switch only on your doctor's or pharmacist's advice.

Does metformin damage the kidneys?

No. Metformin does not damage healthy kidneys, but the dose may need lowering if your kidneys are already weak, which is why doctors check kidney function.

Medically reviewed under the oversight of Dr. Farhan Rashid Abbasi. This article is for general information only and is not medical advice.