Metformin is almost always the first medication that you primary physician will prescribe, along with dietary restrictions. There's a reason it's first on almost every single list of diabetes medications. The side-effects are super low and rare, and maximum dosage of it is rather high.

Three months later they check your A1C, and if you aren't responding to Metformin well enough then they'll slap on a second medication from one of the other categories. I think Sulfonylureas combine pretty well with it.

If you're still not responding well your primary will give up and send you to an endocrinologist, who should have enough knowledge of the alternatives to discuss which one is best for you. It's completely fair to say "I'd like to try XYZ because the side effect of <side effect> appeals to me".

If you are open to controlling Type II diabetes by changing your diet, look up anything by Dr. Eric Westman.

In addition to following your doctor’s directions, It can’t hurt to also check your diet is including enough vitamins and minerals - magnesium for example is a common deficiency and effects insulin. Although also make sure you doctor is aware of the supplements !

Guidelines call for metformin first for most people, add ons from there are usually chosen based on the individual patient's comorbidities.

What are the other options?