My mother has just been diagnosed with type 2 diabetes, and the family practice doctor prescribed Glucophage once a day. She started testing herself, and her blood sugars are high (400-500+ mg/dl [22.2-27.8 mmol/L]). My concern is that she has a pacemaker. What medication should she be on?

Glucophage [metformin] is a good medication for type 2 diabetes and is often used as the first treatment. It should not be used with certain heart conditions, such as congestive heart failure, but having a pacemaker does not necessarily mean that your mother should not take it. If her glucose levels are still that high, she will need more medication, either more Glucophage, possibly the addition of another oral hypoglycemic agent, or possibly insulin. Glucose levels that high often indicate that someone’s diabetes will be difficult to control without insulin. These issues should be discussed with your mother’s doctor or health care team.

ML