Answered by: Dr. Mariela Glandt

Based on the information you’ve provided, it doesn’t sound like you have an urgent need for medication, however, it is always best to consult with your personal physician for a correct assessment.  It is of great importance that you stick to your diet and exercise plan, and continue to monitor your blood sugar, as you have been.

Answered by: Dr. Mariela Glandt

It is wonderful you lost so much weight! Congratulations!

While liraglutide helps to increase insulin after the meals, it seems it is not enough in your case.  If the post meal spike is not too bad, you could ask your doctor about trying repaglinide (Prandin) or nateglinide (Starlix) with meals, which also lower blood glucose by stimulating the release of insulin from the pancreas. Any sulfonylurea should also help. These options are worth considering before you jump to insulin, since they might give you the extra insulin push, at least for a while.

Answered by: Dr. Mariela Glandt

One of metformin’s very rare side effects is that it can cause lactic acidosis. Although rare, lactic acidosis is potentially a very severe, even fatal,side effect mostly related to kidney function.
If the liver is not working well, this is also a reason not to take metform since it could also make you more prone to lactic acidosis.Because drinking excessive alcohol at one time, or drinking hard drinks on a regular basis can harm your liver, it is not recommended. A hard drink once a week seems acceptable, but consult your physician for his/her recommendation.

Answered by: Dr. Mariela Glandt

There is definite rationale in what your doctor suggested, it’s just very difficult to do.  We as a society are intoxicated with carbohydrates. If you think about the fact that rice, potatoes, and bread are actually a very recent addition to the human diet, it starts to make sense. For millions of years humans were hunters and gatherers, and ate mostly meats, nuts, and fruits.  Only recently (10,000 years or so ago) with the advent of agriculture, did they start making carbohydrates a large part of the diet.  We are supposed to eat carbs, yes, but at much, much lower quantities than what we encounter in our current diet. Try eating much smaller portions, substituting rice with a salad, and don’t drink any soft drinks–ever! (that is just liquid candy).  Soon you will be amazed at how well you are doing without large quantities of carbohydrates. This will make it a lot easier to lose weight, too, and that in itself might make the insulin resistance much better.
 

Answered by: Dr. Mariela Glandt

It is expensive to check blood sugar levels 7 to 8 times a day. While it is fine to eat some bread or brown rice when you exercise, perhaps you need to check with your doctor to make sure that
your medication doses don’t need to be adjusted.  If you are trying hard to keep the blood sugar level above 100, even on the days you are not exercising, then you might be taking too much medication.