Anonymous asked 8 years ago
Hello Dr. Dean,

I’m on metformin but my numbers in the morning are 170-189. What can I do to reduce them?
Thank You, Jose

1 Answers
Ward Dean, MD answered 8 years ago
First, you might consider increasing the dose of Metformin. Although I generally don’t go above 2,000 mg per day, a recent article in the New England Journal of Medicine reported on a series of non-diabetic pregnant women who were treated throughout their pregnancies with a whopping dose of 3,000 mg per day!(1) The treatment resulted in reduced maternal weight gain, less preeclampsia, and no adverse fetal or neonatal outcomes.

Next, I’d add Acarbose, which blocks the conversion of complex carbohydrates into sugar. See my article in a recent issue of Aging Matters Magazine.(2) Chew 25-100 mg of Acarbose with any carbohydrate-containing meal.

You might also consider the herb berberine,(3) in a dose of about 500 mg three times/day.

Other pharmaceuticals to consider are the SGLT2 transporters Invokana, Jardiance, or Farxiga; or GLP-1 agonsits like Byetta, Victoza, Trulicity, Tanzeum or Bydureon. Unfortunately, these drugs are all frightfully expensive without insurance (and are often difficult to obtain even with insurance). Byetta goes off patent in 2016, so the price should be coming down on that one.

Of course, a low carbohydrate diet and plenty of exercise will also be of inestimable help in maintaining normal blood glucose and insulin levels.

Ward Dean, MD

1. Syngelaki A, Nicolaides KH, Balani J, Hyer S, Akolekar R, Kotecha R, Pastides A, Shehata H.Metformin versus Placebo in Obese Pregnant Women without Diabetes Mellitus. N Engl J Med. 2016 Feb 4;374(5):434-43.
2. Dean, W. Acarbose – An Anti-Diabetic and Potential Weight Loss Agent. Aging Matters Magazine, 2015, No. 2, 6-10.
3. Block W. Berberine Gives Diabetes the 1–2 Punch Life Enhancement Magazine August 2011