Hesperian Health Guides

Manage Blood Sugar with Medicines

Learn how eating, exercise, and medicines affect your body to prevent your blood sugar from going so high that it makes you feel unwell or becomes an emergency (hyperglycemia). Medicines for diabetes can help lower blood sugar levels even more, but too much insulin or sulfonylureas can make them go too low and cause low blood sugar (hypoglycemia). If you take these medicines, check your blood sugar levels often until you know what makes them go up and down. That way you can know you are managing your diabetes well.

Testing your blood sugar levels

As discussed in Testing for Diabetes, blood tests can be used to diagnose diabetes. People also use blood tests to manage diabetes. Using a blood sugar meter (glucometer) and getting an A1C test are two ways of keeping track of blood sugar levels. They give different information, but both are helpful.

A glucometer is a simple machine that reads the amount of sugar in blood at the moment you test. It is best to test at different times of the day to see how your test results change before and after meals, and from day to day. You can test:

  • before a meal. A good range is between 4.4 - 7.2 mmol/l (80 - 130 mg/ dl).
  • 2 hours after starting a meal. A good level is less than 10 mmol/l (180 mg/dl).

To test, put a drop of blood from the finger on a test strip and the blood sugar level will show on the glucometer. Depending on the glucometer, instructions may say to put the test strip in the glucometer before adding the drop of blood to the test strip (see below) or the instructions may say to put the drop of blood on the test strip first.

a hand being stuck with a needle.
a hand touching a test strip of a glucometer.
Use a needle or a lancet to get a single drop of blood that goes on the test strip. For this kind of glucometer, put the test strip in first, then touch the end of the test strip to the drop of blood on your finger.
a woman in a waiting room with sign that says "Diabetes group today.

Some people have glucometers in their home and can test themselves often. Others use a glucometer at a local clinic or with a diabetes support group. Glucometers can be shared among many people safely. But do not share the needles or lancets for drawing blood— they can spread HIV or other illnesses that are carried by blood.

The A1C test (glycosylated hemoglobin test) is only available at a clinic or hospital. This test gives the average blood sugar level for the previous months, so it shows how you are managing your diabetes in general, rather than your level for that day. For most people with diabetes, a good level is less than 8.0%. If this test is available, try to get it done once or twice a year.

Your health worker or diabetes program might use slightly different numbers for your personal situation. The important thing is for you to understand your body, what affects your blood sugar level, and what level makes you feel your best.

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Medicines for diabetes

Medicines cannot cure diabetes. But some medicines can lower blood sugar levels. So can some plant medicines.

Most people start managing Type 2 diabetes without medicines. Healthy eating, exercise, and plant medicines are often enough to lower blood sugar levels so a person stays healthy.

If healthy eating, more exercise, and plant medicines do not help improve a person’s signs, medicines can help keep the blood sugar level from getting too high and prevent new problems from beginning. Sometimes a health worker might have you combine two medicines or, after some time, might change the dose or which medicines you use.

Medicines have to be taken regularly and at the right times. Make sure family members also understand the common side effects of your medicines and what to do in case of an emergency. And remember: medicines are only one part of self-care. You still have to eat healthy foods and remain active when taking diabetes medicines.


Metformin is a very common diabetes medicine and is the best choice for many people. Metformin is usually taken 2 times a day. When you start metformin, it may cause stomach upset and diarrhea. This usually goes away in 1 to 2 weeks and can often be avoided by taking metformin with a meal. If the side effects get too bad or do not get better with time, your health worker might stop the medicine or reduce the dose. People with kidney or liver disease should not use metformin.


Sulfonylurea medicines, such as glibenclamide, glipizide, and tolbutamide, are usually taken 1 to 2 times a day before meals.

The danger with sulfonylureas is that they can cause blood sugar levels to drop too low, causing dizziness, weakness, fainting, tremors, sweating, or even death. If any of these signs begin, eat something sweet quickly to raise your blood sugar. Make sure family members also know the signs and what to do to help.

To prevent blood sugar getting too low while on sulfonylureas:

  • do not miss meals. If you have not eaten, do not take the sulfonylurea medicine.
  • eat protein foods or other nutritious foods for breakfast.
  • eat extra food when doing physical work, exercise, or sports.
  • keep fruit juice, sweets, or sugar with you in case you start to feel weak or dizzy.

If blood sugar gets low too often, your health worker might stop the medicine or reduce the dose.

Another possible side effect of sulfonylureas is weight gain. You may need to pay more attention to diet and exercise, or switch to metformin or insulin. After a person has taken sulfonylureas for many years they may not work as well to keep sugar levels low enough. If this happens, talk to a health worker.


Insulin is given by injection. It is the fastest way to lower blood sugar. Injecting insulin can be scary at first, but people learn how to do it and get used to it. People with Type 1 diabetes need insulin to live.

Insulin is a hormone that your body makes to keep blood sugar levels in a good range. People with Type 1 diabetes do not make any insulin. People with Type 2 do not make enough. There are many myths about insulin. Insulin does not cause blindness, does not make diabetes worse, and does not create dependency once you start taking it. Insulin lets you manage your diabetes and live a healthy life.

There are different types of insulin. Long acting insulins are used once or twice a day to keep blood sugar at a good level day and night. Short acting insulins are used before meals so that the food you eat does not raise your blood sugar level too much.

One danger of insulin is that it can lower blood sugar levels too much. A person can become confused, dizzy, lose consciousness, and can even die from too much insulin. Prevent low sugar levels in the same way as for sulfonylureas by trying not to miss meals and carrying sweets with you for emergencies.

If you take insulin, a home blood sugar meter (glucometer) helps you monitor sugar levels more often to make sure they do not get too low. If you have no meter, it is best to use a lower insulin dose to prevent blood sugar levels from getting dangerously low. Without a way to check, having the blood sugar level be a little too high is safer than too low.

a syringe and a bottle of insulin. an insulin pen.
Most people use a syringe to inject insulin Insulin also comes in special ‘pens’ where a needle is attached for each injection. These are easier to use but are more expensive

Insulin must be kept cool. If there is no refrigerator, keep it in a bowl of cool water and out of the sun.

Plant medicines lower blood sugar

All over the world, healers have found foods and plant medicines that can help reduce blood sugar.

Ask local healers what plant medicines are available in your area for lowering blood sugar, the best way to use them, and if they are safe to use while also using insulin or other medicines.

  • Bitter melon
  • Fenugreek
  • Berberine
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  • Cinnamon
  • Nopal
  • Turmeric
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  • Vinegar
  • Mulberry leaf
  • Mate tea
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  • Ginger root
  • Gymnema
  • Bitter leaf
  • Moringa leaf
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This page was updated:13 Nov 2020