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Curbside Consult: 56-year-old patient on high dosage of metformin

A 56-year-old African-American woman came to the clinic. She has had type II diabetes since she turned 40 and has taken Metformin/Glucophage. Her A1C level has not decreased significantly over the years, with the A1C averaging at 10 and blood sugar at levels over 200. She presently takes 2,000 miligrams of Metformin each day, and she also has concerns regarding high blood pressure and high cholesterol. As many as 80% of patients with type II diabetes do have high blood pressure, but we want to take steps to reduce her risk of stroke and other cardiovascular conditions. What would you do to help manage A1C, blood sugar and blood pressure?

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