Since ALA seems to functioning primarily as an antioxidant re: mitochondrial effects, would it make more sense to go with an easier-to-dose, less risky antioxidant? Since CoQ10 acts as an antioxidant, wouldn't the high doses we're thinking of be sufficient antioxidant protection?
Unfortunately not. Antioxidants aren't interchangeable, the term is far too broad. CoQ10 and ALA perform vastly different functions in the cell. ALA has a number of properties affecting energy production which could be beneficial for ME/CFS. I suspect many people who have recovered their health using Dr Cutler's protocol benefitted primarily from its role in modulating redox signalling, glutathione recycling, pyruvate dehydrogenase complex, alpha ketoglutarate dehydrogenase complex, glycine cleavage system, phase II liver detox etc. - all areas of severe problems in ME/CFS - moreso than its mercury chelating properties.
Given your hyperglycaemia situation, you might be interested in the Pubmed literature on ALA and its role in ameliorating metabolic disorders like obesity and diabetes. Of course the mainstream literature uses harmful high infrequent doses of ALA like 600 mg twice daily and yet still some derive benefits even from this improper dosing. Of course they are relatively healthy people with "just" metabolic syndrome, nowhere near as fragile and disabled as us.
People with ME/CFS are much much sicker and as evidenced by posts on mercury chelation groups are likely to suffer severe adverse reactions to such schedules so taking it at a tiny dose every three hours as Dr Cutler recommends would be wise even if you're not using it for its chelating properties. Even 5 mg every three hours produces noticeable effects for me; I can't emphasise enough how powerful this supplement is.
Of course it cannot be taken by anyone with amalgams since it is a chelator and even once those have been removed it should still be taken in accordance with its half life since taking it on a random schedule will concentrate mercury into the brain because ALA readily crosses the blood brain barrier. Amalgams have to be removed first.