Jean - the first question you need to answer to yourself is are you willing to spend a little money.
If so what I would suggest is go back to your Doc and get a script for the Libre and get at least a 2 week glucose profile (AGP) which is one sensor. Saying you have an A1c of 7.1 doesn’t really mean much.
While getting the AGP, log everything you are eating/drinking and times during that 2 weeks. You will then use this to profile against the AGP. This will tell you when you spike, what your baseline is, how high you are spiking and how long it takes to get back to baseline. At this point we don’t even know your baseline. A non-diabetic is about 85.
The big promoter of metformin in the U.S. 25+ years ago was Ralph DeFronzo. He has now flipped on metformin and says its the biggest waste of time in T2 treatment. Why? Because it starts the current treat to fail approach which is currently practiced by most doctors. The current ADA standard of care is a “treat to fail” approach. Ralph now believes beta cells can be saved and will regenerate. IMO, Ralph is correct.
The problem all diabetics face is they are not producing enough insulin for their body’s needs. It would then seem to make sense to augment the body by taking additional insulin. There are a ton studies done over the years on early insulin intervention. The best way to stop T2 progression and potentially gain some beta cell regeneration is through early insulin intervention.
The problem is, is taking most insulins requires needles and they have the risk of hypoglycemia even the RAAs. This led Ralph down the path of taking a GLP-1 and Actos as a combined therapy. http://care.diabetesjournals.org/content/diacare/40/8/1121.full.pdf
IMO Ralph has the right idea by saving the beta cells but the best approach is to go right to the afrezza. The chance of a severe hypo with afrezza is very very small and it provides the body with what it needs which is insulin and offloads the beta cell stress providing the potential for regeneration. It also shuts off sugar production by the liver while eating.
The problem is neither the afrezza or GLP1 will be covered by insurance as a first step. The GLP1 has now moved up in the 2019 standard of care so you might have a chance of getting that covered but if you are willing to even fund 3 months on the afrezza, thats what I would do before the GLP1. Three months was the typical time of the early insulin intervention studies.
IMO stay far away from the SGLT2s. To many toes have been lost and if you see the AGP using them you will see they do not solve the main issue which is after meal spikes and you want to get below 140 asap. Right now you are averaging 157.