For those of you who managed well for many years on Metformin as your only diabetes medication, and then saw your a1c creeping into the 7s, what additional med did you add? Are there classes of type 2 meds you would avoid?
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Well, that’s precisely what happened to me. My choice was insulin. I figured if I was going to something more effective I might as well go with the most powerful tool available. That’s a purely personal choice, of course.
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do you remember how high your a1c was at the time? The person I’m asking for is not exactly open to taking injections, and just needs a little extra help getting numbers down.
Although I started eating LCHF soon after diagnosis I have always needed drugs in able to meet my A1C goals. My initial A1C was 13.1. I had been undiagnosed for many years and did too much damage to get by on just diet and exercise.
Started on metformin and a sulphonylurea. I experienced random lows and near lows on this combination. A1C 5.6
Next I used Victoza and metformin. Good control, no lows, but I experienced dizziness and weakness in my legs. I used this combo for 6 years but finally gave it up due to deteriorating control and getting tired of the side effects. A1C 5.9 for many years, but my last one was 6.5 .
My Doc suggested some other pills when I said I wanted to abandon Victoza, but I felt insulin was a better option, to get the kind of control I wanted. So I started insulin and metformin. Great control, A1C 5.6
Soon after starting insulin and metformin I had to give up the metformin due to other health issues. My insulin use went way up and I gained weight 
I had trouble getting the hang of insulin without metformin and had severe dawn phenomenon as well as a general increase in my insulin resistance. I started doing intermittent fasting and this helped with the insulin resistance and dawn phenomenon(really two sides of the same coin). My first A1C was 6.5 next was 6.0 . My control has continued to improve due to more experience in using insulin and continued intermittent fasting. My insulin use decreased significantly after I started the intermittent fasting. I expect my next A1C to be back in the 5’s, we’ll see.
Throughout all these changes in medication I have continued to eat LCHF. Daily carbs are 30g to 50g. I have to avoid starch and sugar completely to keep from experiencing unacceptable spikes. Now if I can just loose the weight I put on after starting insulin 
I think I could decrease my insulin use even more.
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It was somewhere in the sevens, that’s all I can specifically recall. And insulin isn’t the only answer, nor necessarily the best one for everyone. It was for me, though. I had done quite a lot of reading by then and had a pretty clear sense of the management task I was signing up for. I wouldn’t change a thing, other than doing it earlier.
I initially had great success (from 10.7 down to 5.0) on a low-carb diet which lasted about 2-3 years. Then my numbers started creeping up. When I was spiking after every low-carb meal to 250 and spending the entire day around 150-180 even when fasting all day.
I eventually persuaded my doctor to prescribe insulin. It took me 1.5 years from when I wanted insulin to when they agreed to do it. I did try Metformin first (and I still take it) but have never noticed a difference with it. I started asking when my A1c was 6.3 and finally started insulin when it was 6.8.
I don’t think my A1C reflected just how hard I was working. Doctors saw it and said “you’re fine” and I was like “I am starving myself, spike high and stay there for 12 hours every time I eat. This is NOT fine.” 
I’m now on a CGM and pump and could not be more happy with my life post-diabetes.
My husband managed with only low carb & exercise for several years. When his A1c increased he added metformin. If he had continued low carb I think it would’ve been fine, but with an A1c at 7.2 last October (after 2 years with metformin) he added Farxiga. His current A1c (2 weeks ago) is 4.9. He’s also back to low carb.
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Metformin and a sulfa gave me great control for two years. An increase in the sulfa dose I just recieved seems to be starting to help as my A1c has shot up to 8.2. I am adding Onglyza soon. I’ll see if that helps. A totally different type of drug.
This new drug is subject to deductible so I am going to pay that in a few days at an imaging center then I can get the new med at no cost.