Blindly following medication trends for a decade, her experience serves as a cautionary tale for all diabetics.

A woman nearing 70, a former hospital nurse with a medical background, has been living with type 2 diabetes for over a decade. She had been consistently administering insulin subcutaneously for nearly 12 years. However, during a recent follow-up evaluation at the diabetes prevention and control center, the doctor was surprised to discover that her pancreatic function remained relatively intact, and her blood sugar could be fully controlled with oral medications alone.

When asked why she had persisted with insulin for so long, she replied firmly, "I heard that insulin is better than oral medications, with fewer side effects! So I've stuck with it all these years."

It's not uncommon to encounter patients like her who blindly place faith in a single type of diabetes medication. Throughout the long journey of diabetes management, many patients and their families have earnestly searched for the "best" hypoglycemic drug.

01 The Truth About Diabetes Medications

There is no "best," only the "most suitable."

There is no "miracle drug" in the field of diabetes treatment that works for everyone. Patients with different types of diabetes, at different stages of the disease, and with varying physical conditions require completely different treatment approaches.

The view that insulin is the "ultimate weapon" is one-sided. Insulin is indeed an effective means of controlling blood sugar, but not all diabetic patients need or are suitable for insulin. For early-stage type 2 diabetes patients whose pancreatic islet function is still functional, blood sugar can be effectively controlled through oral medications or lifestyle interventions.

New or expensive drugs do not equate to "good drugs." Drug selection should be based on scientific evidence and individual circumstances, not on price or how new they are.

Individual differences determine the medication regimen.

Every diabetic patient is a unique individual, and medication regimens must be tailored to the person:

Patients with type 1 diabetes, due to complete loss of pancreatic islet function, must rely on insulin therapy. The treatment plan for patients with type 2 diabetes is much more complex and must be determined based on a combination of factors such as pancreatic islet function, blood glucose levels, complications, age, and liver and kidney function.

Diabetic patients with cardiovascular and cerebrovascular diseases, kidney disease, or obesity have special considerations when choosing glucose-lowering medications. For example, patients with cardiovascular diseases may prioritize glucose-lowering drugs that have been proven to offer cardiovascular benefits.

The side effects of medications vary from person to person.

The concept of a drug with the "least side effects" does not exist. Metformin is well-tolerated by most people, but may cause significant discomfort in those with weaker gastrointestinal function.

Sulfonylureas have a pronounced blood sugar-lowering effect, but may increase the risk of hypoglycemia in some patients. SGLT2 inhibitors are beneficial for weight loss and cardiovascular protection, but may raise the risk of urogenital infections.

The side effect incidence of any medication varies from person to person, and the risks and benefits must be weighed under the guidance of a doctor.

02 Main Categories of Hypoglycemic Medications and Their Characteristics

Biguanides (e.g., Metformin): First-line medication, does not increase the risk of hypoglycemia, may provide cardiovascular benefits, but some patients experience gastrointestinal side effects.

Sulfonylureas: Promote insulin secretion, strong hypoglycemic effect, but may cause hypoglycemia and weight gain.

DPP-4 inhibitors: Glucose-dependent hypoglycemic effect with low risk of hypoglycemia, weight-neutral, but some drugs are relatively expensive.

SGLT2 inhibitors: Excrete excess glucose through urine, with weight loss, blood pressure reduction, and cardiovascular protective effects, but may increase the risk of genitourinary tract infections.

GLP-1 receptor agonists: Injectable formulations with strong hypoglycemic effects, offering weight loss and cardiovascular benefits, but require injection and may cause gastrointestinal reactions in some patients.

Insulin: The most potent hypoglycemic agent, suitable for patients with pancreatic islet failure, but requires injection and may cause hypoglycemia and weight gain.

03 Professional Guidance is Irreplaceable

Why Should You Not Self-Medicate?

Diabetes medication selection is a complex medical science that requires consideration of multiple factors, including drug interactions, effects on liver and kidney function, and the risk of complications. Self-adjusting medications can lead to blood glucose fluctuations, hypoglycemic events, or even serious complications.

Regular Follow-Up and Treatment Plan Adjustment

Diabetes is a progressive disease, and the treatment plan needs to be continuously adjusted as the disease progresses. Regular blood glucose monitoring, assessment of pancreatic islet function, and screening for complications form the foundation for adjusting treatment plans.

The Era of Individualized Treatment

Modern diabetes management has entered the era of "individualized treatment." Doctors develop the most suitable treatment plan based on the specific circumstances of each patient. This plan may include a combination of one or more medications, along with dietary control and exercise therapy.

04 Guidelines for Rational Medication Use

Abandon the "Miracle Drug" Mindset: Accept that no single medication is suitable for all patients with diabetes.

Comprehensive Self-Assessment: Fully communicate your condition, complications, lifestyle, and economic situation with your doctor.

Regular Monitoring and Follow-up: Schedule timely rechecks of blood glucose, glycated hemoglobin (HbA1c), and related complication indicators.

No Arbitrary Changes to the Treatment Plan: Any medication adjustments should be made under a doctor's guidance; do not increase, decrease, or switch medications on your own.

Emphasize Lifestyle Interventions: Medication therapy must be combined with a reasonable diet and appropriate exercise to achieve optimal results.

Managing diabetes is a long-term battle, and choosing the right weapon is crucial. The most suitable glucose-lowering regimen for you is a personalized "combination punch" carefully designed by your doctor based on your specific situation, rather than blindly pursuing a single "trump card."

That nurse's experience reminds us: on the path of diabetes treatment, professional guidance is more reliable than personal experience, and individualized plans are more important than popular beliefs. Let's approach glucose-lowering medications with a scientific attitude, work hand in hand with doctors, and find a treatment plan that truly suits us.