oral hypoglycaemic

An oral hypoglycaemic is a pill you swallow to bring blood sugar down, in contrast to insulin, which must be injected. It is the workhorse of type 2 diabetes treatment, where the body still makes some insulin but does not use it well or does not make quite enough. The convenience of a tablet is a big reason these drugs are first reached for before injections.

The term is an umbrella covering several drug classes that lower glucose by completely different mechanisms. Metformin reduces the liver's glucose production; sulfonylureas squeeze more insulin out of the pancreas; thiazolidinediones make tissues more sensitive to insulin; DPP-4 inhibitors and SGLT2 inhibitors act through the incretin system and the kidney respectively. Because the routes differ, they can be combined, and each has its own side-effect profile.

A caveat about the name: "hypoglycaemic" can mislead, because not all of these drugs cause low blood sugar. Metformin and the newer agents rarely push glucose below normal on their own, whereas sulfonylureas and meglitinides genuinely can. Many clinicians now prefer the broader term "oral antidiabetic agent" for exactly this reason. None of these pills works in type 1 diabetes, where the pancreas makes no insulin at all and injected insulin is mandatory.