For people who have been diagnosed with type 2 diabetes mellitus, finding the right medication to control varying blood sugars and ensure a healthy metabolism can be a challenge.

There are several diabetes medications for people with type 2 diabetes, as you might know from television advertisements or research. Two of the most common antidiabetic medications available today are Metformin and Ozempic. Both medications are only available via prescription.

To obtain one of these medications, a person with type 2 diabetes mellitus should make an appointment with their physician to discuss options and form a care plan to begin a pill regimen or weekly injection treatment plan.

Before speaking to a doctor, people with type 2 diabetes should understand the difference between these two medications. Read on for an explanation of the differences and similarities between Metformin and Ozempic.

Drug classBiguanidesGlucagon-like peptide 1 (GLP-1) receptor agonist, semaglutide
Mechanism of actionDecreases blood glucose absorption from food & lowers glucose production in the liverStimulates insulin secretion & lowers glucose production in the liver
Side effects
  • nausea
  • vomiting
  • diarrhea
  • flatulence,
  • constipation,
  • heartburn
  • indigestion
  • bloating
  • abdominal pain
  • muscle cramps
  • skin flushing
  • nausea
  • vomiting
  • diarrhea
  • flatulence
  • constipation
  • heartburn
  • indigestion
  • bloating
  • abdominal pain
  • reduced appetite
  • burping, fatigue
Rare Complications
  • Allergic reactions
  • Hypoglycemia
  • Lactic acidosis
  • Liver damage
  • Allergic reactions
  • Hypoglycemia
  • Pancreatitis or liver damage
  • Thyroid disease or thyroid cancer
PriceUp to $77 but may be partially or fully covered by insuranceUp to $2,544 but might be partially or fully covered by insurance
RoutePer Oral pill form. Taken once or twice daily.Subcutaneous injection into adipose tissue. Once per week.
Discovered1957, but established in the U.S. in 1995Approved by FDA in 2017

Metformin (Glucophage, Riomet, Glumetza)

What is Metformin?

Metformin is an antidiabetic medication that has been prescribed to people with type 2 diabetes since 1957 in France and was popularized more recently in 1995. This medication has a common reputation among medical professionals and has been around for several decades.

It is only available by prescription and cannot be used to treat type 1 diabetes mellitus.

Common Metformin brands include:

Multi-ingredient medications containing metformin:

  • ActoPlus (Pioglitazone, Metformin)
  • Avandamet (Rosiglitazone, Metformin)
  • Invokamet (Canagliflozin, Metformin Hydrochloride)
  • Janumet / Janumet XR (Metformin Hydrochloride, Sitagliptin Phosphate)
  • Jentadueto (Metformin Hydrochloride, Linagliptin)
  • Synjardy (Metformin Hydrochloride, Empagliflozin)
  • Xigduo (Dapagliflozin Propanediol Monohydrate, Metformin)

What does Metformin do?

Metformin is in a drug class called biguanides. The mechanism of action of biguanides is to decrease the amount of blood glucose (or blood sugar) that your body absorbs from your food, plus also lower glucose production in the liver.

So, rather than the intestines absorbing the full amount of glucose in food, they only absorb some glucose, lowering overall blood glucose. This can help control hyperglycemia or high blood sugar. Lowered blood sugar can lead to improved vascular and heart health, weight loss, lowered risk of diabetic ketoacidosis, and improved overall health.

Metformin is taken once or twice per day in pill form (by mouth, per oral/PO) with or without food. This medication is best used in conjunction with exercise and healthy eating habits such as limiting portions and improving nutritional choices.

Common Side Effects Associated with Metformin:

There are a few known side effects of Metformin, although not every person is affected by these conditions.

Some reported side effects include nausea, vomiting, diarrhea, flatulence (or gas), heartburn and indigestion, bloating, stomach cramps, muscle cramps, skin flushing, and constipation. There are also occasional reports that the medication can taste unpleasant, leaving a metallic taste in the mouth.

These side effects do not occur in every person, and can sometimes be managed with the help of a primary care doctor and lifestyle changes. Most often, these side effects are outweighed in the long-term by the longevity type 2 diabetes control can offer.

Rare Complications Associated with Metformin:

There have also been reports of serious reactions to the Metformin medication. These rare complications usually warrant stopping or switching medications with the help of one’s primary care doctor.

Signs of an allergic reaction, such as a growing rash, shortness of breath, and throat and lip swelling, all require immediate emergency medical treatment. Chest pain is another reason to immediately seek emergency medical attention.

Metformin can lead to low blood sugar, or hypoglycemia reactions, when overused or used with too little food/water consumption. This will present as shakiness, sweats, nervousness, dizziness, lightheadedness, and skin pallor. Some people with diabetes know how to check and treat low blood sugar at home. If a person is not confident in this matter, they should seek immediate medical treatment for signs of hypoglycemia. Upon examination, a physician might also diagnose someone with lactic acidosis or high blood acidity in this condition.

Long-term use can rarely lead to liver damage or liver inflammation, and therefore, annual liver enzyme testing at a primary care doctor is recommended.

Alcohol use is highly discouraged while taking Metformin. Consuming alcohol at the same time as taking Metformin can lead to increased risks of uncomfortable side effects, liver damage, gastrointestinal complications, and lactic acidosis.

Cost of Metformin

Annually, the price of Metformin should not exceed $77 but can be sold for as much as $119 for 100 tablets. Many health insurance policies will partially or completely pay for this medication.

Through, Metformin can be purchased for as low as $29.

Glucophage (Metformin Hydrochloride)

Ozempic (semaglutide)

What is Ozempic?

Ozempic is used to control high blood sugar in people with type 2 diabetes mellitus. Additionally, it can help prevent blood clot formation that can lead to life-threatening events (stroke, heart attack, embolism). Ozempic is sometimes also used to promote weight loss.

Ozempic was approved by the FDA in 2017 so it is a newer medication than Metformin.

While Metformin is taken in pill form, Ozempic is taken in subcutaneous injection form. This means that a person who takes Ozempic will use a small needle to poke themselves once per week. Often subcutaneous injections are given in the stomach area, where there are a lot of fat pads, and this will make the injection less painful than an intramuscular shot. For someone who doesn’t like to swallow pills or cannot swallow pills, subcutaneous injections are an alternative option.

What does Ozempic do?

Ozempic is a semaglutide, or glucagon-like peptide 1 (GLP-1) receptor agonist, which lowers blood sugar. Rather than limiting the absorption of glucose as Metformin does, Ozempic stimulates the secretion of insulin from the body. Insulin is the body’s natural defense against high blood sugar. Ozempic’s stimulation of insulin combats type 2 diabetes insulin resistance, leading to lower blood glucose and improved vascular health.

Furthermore, Ozempic lowers glucagon secretion from the liver. This means that the liver will not produce as much glucagon (the enzyme that breaks down food into sugar to be added to the blood) and therefore, leads to lower blood sugar levels.

Ozempic, like Metformin, also works best when combined with healthy eating habits and physical activity.

Common Side Effects Associated with Ozempic

Ozempic can cause similar side effects to Metformin. The most common reported side effects may include nausea, vomiting, constipation, diarrhea, abdominal pain or cramping, reduced appetite, indigestion, burping, heartburn, flatulence or gas, and fatigue.

In some cases, Ozempic can lead to hypoglycemia or low blood sugar. This will typically occur if a person has eaten/drank very little in a day, or if a person has taken a double dose (too high of a dose) of their medication. Warning signs of hypoglycemia include dizziness, shakiness, sweating, anxiety, and lightheadedness. If you have not been taught to treat hypoglycemia at home, seek immediate emergency medical attention for signs of hypoglycemia. Upon examination, an emergency professional might also diagnose someone in this condition with lactic acidosis or high blood acidity.

Rare Complications Associated with Ozempic:

There are less common but more serious complications that can occur while taking Ozempic. Allergic reactions, which can present as a worsening rash, angioedema (facial swelling), throat swelling or closing, and tongue swelling, are life-threatening and should lead a person to seek immediate emergency care. Other rare complications include vision changes, decreased urination, yellowing of the skin or eyes (jaundice), or rapid heartbeat (tachycardia).

Pain in the abdominal area and signs of jaundice can indicate liver damage or pancreatic damage and therefore should lead a person to seek medical attention. Vision changes might be a side effect of diabetic neuropathy, which is a sign that the medication is not controlling diabetes.

Importantly, anyone with a history of thyroid disease or thyroid cancer in their family should know that Ozempic can increase the risk for thyroid cancer and thyroid tumors. A person must inform their doctor of this risk factor. A person with thyroid medical conditions will most likely want to pick an alternative medication such as Metformin.

Ozempic should also not be consumed at the same time alcohol is consumed. However, mild alcohol consumption that is balanced with regular food consumption and controlled blood sugar via Ozempic/lifestyle modifications, may be acceptable in certain situations.

Ozempic can interact with some medications, vitamins, and herbs, so it is important to provide a full list of medications to your doctor.