What’s next after Metformin?

So many choices.  Medications for diabetes have exploded in number over the past few years.  Metformin, of course, is the first therapy for most people with insulin resistance, prediabetes or Type 2 diabetes.  But if the sugar can’t be controlled, what do you do?

If your A1C is still over 7% on metformin and is not coming down, look at your blood sugars.   Determine when the highest blood sugars are.  (Hint-usually after supper or at bedtime).  To reduce the highest blood sugar, limit starches and sugars in the meal prior to the high time.  Exercise after that meal.  The highest blood sugar peaks one hour after the largest meal.  Try only protein and non-starchy vegetables at that meal prior to exercising.

If these measures do not bring the A1C down, it is possible that your pancreas is wearing out and other medication may need to help the pancreas work better.

If you sugar is higher after eating then tends to drop later, the DPP-4 or GLP-1 classes of medications may work well.  SGLT medications may help with any high blood sugars.

Look at your insurance coverage of medications and that will help you narrow down the possibilities.

Is it possible to reverse the diabetes so that no medication is needed?  Short answer is NO.  By the time the diagnosis of diabetes is made 50% of the ability to make insulin is gone.  Diabetes is a genetic disease and we cannot change the genes (at least, not yet).  Even losing weight which will help insulin resistance will not control swings in BS which is related to delayed insulin release.

Medication for diabetes is taken early enough may improve the ability of the pancreas to last longer.  So embrace your medications as your friends and help them work better by doing your part.