My husband, age 45, weight 97 kg (213 pounds), has mild diabetes. He was prescribed 1 mg SR metformin and a 1200 calorie diet, to be eaten as three or four meals. He is not able to stick with this diet. So, can he occasionally take a 50 mg acarbose on the days when he eats more than the 1200 calories? Or, can he increase the metformin up to 500 mg for that day? What other advice do you have for those days when he overeats?

You ask a good question. This is a common problem. First, I would ask whether a 1200 calorie diet is appropriate for him. He may be able to lose weight gradually with a slightly higher calorie intake and be able to meet the demands of such a diet. Second, if a dietitian is available to you, this would be a good opportunity to evaluate this. I presume you mean he is on 1 gram of metformin SR per day. The dose can be increased to 2 grams per day. The acarbose is not unreasonable. It would be important for him to correlate his blood sugars on good and bad days and see how far out he is from target. If they are not that bad, he may not have to increase his metformin or use acarbose. The most important thing is not to set him up to fail. Do not let him skip over the nutritional interventions that would help him in the big picture.

JTL