Good evening @A DiabetesTeam Member,
The most hypos come from sulfonureas. Hypos can be life threatening.
Metformin has the most history, with fewest life threatening situations.

Insulin has been around the @longest, is what our bodies' need, and is natural.
Personally I will opt for insulin, when I need the help of diabetes medications.

Mentioned Users

A Diabete...

Depends what "best and worst" you are trying to determine

Best in terms of "treatment effect" and worst in terms of "side effects" or vice versa

Metformin and Basil Insulin are the only effective treatments for Fasting Blood Sugars so the "best oral" (metformin) also happens to be the "ONLY" oral treatment for the (condition)

But Metformin often causes "tummy issues" amongst some users, bad enough in about 10% of people that they have to stop using it

For Mealtime (Prandial) blood sugar you essentially have 4 classes of oral medication

- Sulfonylurea Class has been around for over 80 years, have no long term dangerous side effects but can cause a deadly low if used improperly and can cause some weight gain but do an incredibly good job of managing blood sugar as long as you are producing some of your own insulin

- DPP-4 Class which includes Trajenta and Januvia (most popular) work "pretty well" - if you are making your own insulin they help make it work a little longer - not as well as Sulfonylurea's and not as well as some of the new injectables, but "ok" if you only need a "little bit of help" - tummy issues are the most common side effect

GLP-1 Class - this is mostly the injectables (like Ozempic) but Rybelsus which is the Tablet Version taken daily - same tummy issues with regular use until your system get used to it but also increases your risk of thyroid cancer. They also only work if you are making your own insulin at sufficient quantity

On the downside it (the tablets) do NOT work as well as the injection since the digestive system kinda eats up some of the "drug" itself before it gets absorbed - so works "ok" but not as effective as the injectable formats - but if you are petrified of needles this would be an option in this drug class

Last one is SGLT-2 Class and the current favourites are Invokana and Farxiga (this second one also helps with kidney disease)

Both of these work even if your own insulin production is super low. They force the kidneys to suck Sugar and Salt out of your blood and pass it in urine

So positive blood sugar control and heart protection (by removing the salt)

Downside - 20% have to stop using it due to chronic Urinary Tract Infections (all that sugar in the urine is food for infection) and in some cases use can cause gangrene

But the drug works great

There is always pros/cons

Diabetes WILL KILL YOU and you have to keep that in mind when thinking about a treatment - if you need a med to help the "safe option" no longer exists so you choose the "most benefit with the least downside" - that is what you Doc is trying to do when they choose a prescription for you based on YOUR total medical history and risk...

Cutting the Levemir slowly with close doctor's supervision might minimize the nighttime lows. Talk with your doctors.

Good luck as you adjust to each change.

Hi Jennifer. I live in the US . I'm going to check with my insurance company to see my options for a diabetes educator. Thank you so much for your kind words they are so appreciated . I will never give up fighting 🤗

Hi Nana. Personally I am on Synjardy and Basaglar insulin. Seems to keep everything fairly stable. Synjardy is quite expensive if you do not have extended health although in Canada where I am I emailed the drug manufacturer directly and got 3 months at a time covered. No cost. Sometimes they have compassionate care for certain Diabetes medications. Unfortunately none for Ozempic.