I can control my diabetes with diet and exercise, but during times of major stress I overindulge in comfort foods (carbs and sweets) and neglect my exercise program. My doctor puts me back on medication until I get my sugar back under control and resume a healthy lifestyle which keeps me in control.

I think he is an excellent diagnostician, but feel he’s something of a “pill pusher”, always prescribing the “latest and greatest” thing on the market. I’m not comfortable with that, preferring the least problematic medication and attempting to delay continual medication until I’m older, if possible. I’m wondering what medication has the fewest side effects (especially back ache, fatigue, heart and liver problems). I already have back problems and both parents with major heart problems, so I’m thinking I don’t need to aggravate those areas in particular.

I hope your physician is following your hemoglobin A1c to guide your therapy. For instance, there is no safe level of elevated blood sugars. The hemoglobin A1c is most helpful because it provide an integrated level of blood sugar control for the previous three months. If you are on no medication but have high sugars, it does not help that you are on no medications.

Of all the oral medications, I am biased toward metformin as the favorite choice for first-line therapy. It avoids hypoglycemia and, at the same time, treats elevated blood sugars. You should not take this medication if you have heart, liver, or kidney problems. If you don’t have those problems this drug will not necessarily bring them on.

The natural history for diabetes is to get worse over time and require additional medications. There is no advantage in waiting for good blood sugar control because the effect of elevated sugars over time is additive as it relates to kidney, eye, and nerve damage.

JTL