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Using GLP-1s

Sulfonylurea

An older class of type 2 diabetes pills (glipizide, glimepiride, glyburide) that force the pancreas to release insulin — and the main non-insulin reason a GLP-1 user might experience low blood sugar.

By the glp1.how editorial teamReviewed

Sulfonylureas are an older, inexpensive class of oral type 2 diabetes medications — glipizide, glimepiride, and glyburide are the common ones. They work by pushing the pancreas to release insulin whether or not blood sugar is actually high, which is effective at lowering A1c but is also why they can cause hypoglycemia on their own.

That mechanism matters for anyone starting a GLP-1. Because a GLP-1 improves blood sugar through its own routes, adding it on top of a sulfonylurea can drive glucose too low; the prescribing information for GLP-1 medications specifically flags this combination, and prescribers commonly reduce or stop the sulfonylurea when a GLP-1 is started. See GLP-1s with insulin or sulfonylureas: understanding hypoglycemia risk. The Ozempic label, for example, warns that combining it with an insulin secretagogue such as a sulfonylurea may increase the risk of hypoglycemia (FDA label via DailyMed (external link)).

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Revision history

Updated 1 time since Sep 2, 2026 · show changes
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Related terms

  • Hypoglycemia · Blood sugar that drops below the normal range (typically under 70 mg/dL), causing shakiness, sweating, confusion, or worse.
  • GLP-1 · A gut hormone (glucagon-like peptide-1) that stimulates insulin release, slows digestion, and reduces appetite; the target of drugs like semaglutide and liraglutide.
  • Ozempic · Novo Nordisk's brand name for semaglutide for type 2 diabetes, sold as a weekly injection and, since May 2026 in the US, as daily Ozempic tablets.

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