Repaglinide and Rise in HB1a

I developed an adverse response to Metformin (a long story) but am now taking
- 25mg Sitagliptin and 4mg Repaglinide before breakfast,
- 1.5mg before my evening meal.
Over the last 12 months mt HB1a reading has been slowly rising. I am being tested at 3 monthly intervals. I have been complaining throughout about inadequate blood sugar control. I am eating a low carb, no sugar diet. I don't drink alcohol or smoke.
However I have put on 16lbs in the last 6 months, and my BMI is now 27.5
Today I received an HB1a test result of 69, a big leap from 3 months ago of 52, which had risen from 48 at the beginning of this process.
I used to have excellent control, at 42-44 for 8 years. I can no longer take metformin, but feel the current drug regime isn't helping.
I have a GP surgery which insists I see their diabetes nurse but do not feel very confident that she keeps up to date.
I would like to go into our next discussion a little better informed - any advice would be very welcome

Thank you so much for replying

I have done intermittent fastjng in the past - 1 x 6 month period when wanting to get my weight down before I got married

I’m only 5’2” - I’m now 69, I’m a trans man - I transitioned 50 yrs ago in 1974 so that has long been a very settled matter - and tend to get the familial tummy when I over 10st, & then I look like a short guy with a beer belly. I saw a photo of myself with a student at their graduation & decided it was not a good look. But as I got older the paunch got harder & harder to control no matter what weight I am at, so eventually I settled into my short fat mad professor look & grew a handlebar moustache to distract from the belly.

Then 3 yrs ago I developed the adverse reaction to metformin. I lost 24lbs in 2 months & it was assumed I had pancreas or bile duct problems (after it was worked out I didn’t have pancreatic cancer).

For 2 yrs as I underwent investigations I was placed on an extremely low fat diet with intermittent fasting & the weight stayed off, but I was also pooping for up to 12 hrs a day, & developed bowel incontinence - which was awful.

Nobody could come up with the cause, so eventually I asked to review my medical notes & I found out I had gone to the doctors 10 weeks after my metformin had been doubled following my 3rd bout of Covid.

I did some research & found out that about 10% of T2 diabetics develop an issue after 8-10yrs & often an increase ion dose. Spoke to my Dr (in June 2023), stopped tge metformin and within 3 days was back to my normal self.

That was when the hunt for an alternative regime started.
As for exercise. I have MS. I am mobile & try very hard to do activity daily - but there is a limit to how far I can walk - a trip round the 1/2 mile block with the dog is often too much & I look like I’m extremely drunk by thr last 200!yds.

But I do stuff that I can do - play with the dog, decorate a room slowly for example - or as my wife calls it ‘have a project on the go’ in my basement workroom eg have been learning how to French polish & am renovating a Victorian sewing table

I l retired from University teaching when I was in a bad way in 2022, but I work one day a week chairing an NHS board, and still do work on Human Rights cases across the world as an expert in asylum, and in transgender issues

The HBc is now really impacting how I feel about food, & often increases my fatigue - which is also an MS problem. I cannot get the diabetic nurse to be anythjng but vague. I’ve made an appointment with the pharmacist so working to be better informed before that chat next week