During the past 11 months, my blood sugars have frequently been in the 200 mg/dl [11.1 mmol/L] to 220 mg/dl 12.2 mmol/L] range. But, my A1cs have been between 5.0 and 6.8. My doctor says the higher blood sugars are related to obesity and insulin resistance and are unlikely to remain that high for more than 24 hours. For me, metformin is not working and I am concerned about other drugs’ harmful effects on the heart. Are there any newer drugs that can work with metformin and are not harmful? How about acarbose? Are there any useful health supplements or herbs I could take?

You are thinking correctly about the treatment. The strategy would be to adjust the metformin up to the maximum tolerated dose. Once you get there, if the glucose levels are still elevated, if the hemoglobin A1c is still elevated, than a second agent may be used. It is a point of dispute as to what the best second agent is amongst the other drugs. The problem with the other agents is that they are associated with weight gain. Some others are also associated with low blood sugar reactions. Remember that the A1c lags behind the blood sugars when things begin to change. When the A1c gets around 7% (1% above the normal), you and your doctor should be talking about potentially adding another agent.

JTL