I have controlled my diabetes by a planned food program and discontinued the medicines. Sometimes I eat more than usual. Can I take Xenical and 25mg of Acarbose at those times? If I stay on a strict diet, can I skip my metformin? My doctor says that metformin’s effect can last for a few days.

I know my patients here in the United States would prefer to be off of medications. However, metformin is such an effective drug that I don’t recommend that strategy. The American Diabetes Association does not recommend that diet alone be used without metformin therapy because the risk of progression is too great. Type 2 diabetes has a story line. It may not start off serious enough to require regular medication. However, with time, the disease usually progresses. The ability to hold the sugars down now, with metformin, may impact your diabetes and decrease the absolute progression or the rate of progression and decrease your exposure to high blood sugars over your lifetime and, hopefully, spare you from the complications of diabetes. My recommendation would be to continue the metformin under the direction of your physician, along with your dietary restrictions.

JTL