Pre-diabetic, questions and concerns. Can anyone help?
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Some endocrinologist give you meters for free and some sample test strips and lancets. They will give you a script for strips and lancets for that particular meter. There are also classes, usually held in a hospital setting for 4 to 5 sessions discussing food, when you are sick etc. They may explain the 15 carb thingie - telling you how many carbs at a meal you should eat. For example, they consider one glass of milk 1 carb (15) so they may tell you you can have 45 per meal. An endocrinologist and many internists will check your thyroid glands in your throat, feel them and also have you remove your shoes to check you pulse in your foot. It is great that you are being proactive in your health. Some times you may need a late snack at night and then your numbers in the morning may be better. The classes may tell you what types of foods should be eaten together.-1
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LadyLilion wrote: »Sorry to hear about your Father in law.
Thanks, but did you read my second paragraph? The first was a downer.0 -
biancasabanpdt wrote: »I'm trained and worked as a dietitian for a few years (full disclosure, I'm no longer licensed since I went back to school for something else). I'm not terribly comfortable posting on here since I don't want to be mobbed with questions but diabetes was one of my biggest interests as a dietitian, so I had to weigh in.
I'm sorry to hear that your Dr. is cold and not taking your concerns seriously. I absolutely suggest trying to find a new Doctor. I would also suggest asking that doctor if you should be seeing an endochronologist, but with pre-diabetes it might not be necessary at this time.
When it comes to fasting glucose vs A1c vs post meal sugars it can get a little complicated but the simplest way I can explain it is that your sugar normally goes up and down with, and between, meals. This is normal since the food we eat is broken down into glucose (so it goes up after eating) and is used for energy and slowly depleted in the blood (will go down a few hours after a meal, assuming you haven't eaten anything else).
A1c is an amazing indicator of your AVERAGE blood sugar over the past 3 months. So it can be great, or it is sometimes misleading. The dawn phenomenon is definitely something that sounds like what You've been experiencing but to know for sure I'd suggest testing your sugars at other "fasting" times during the day (over 2 hours after a meal, or right before the next meal). But the fact that your A1c is within "normal" and that you've lost 18 lbs (good for you!!!) I would say you're definitely heading in the right direction.
I would also always suggest taking your meds as prescribed, but in response to the previous post, metformin is one that doesn't HAVE to be taken with a meal since it won't induce low blood sugar episodes.
So to answer you original question; this is mostly normal and doesn't mean you necessarily have type 2 diabetes. The guidelines are just that, they're not set in stone and should be use patient to patient. You are doing everything you should be doing by eating healthy, educating yourself, and (hopefully) finding a better doctor.
Hope this helps you!
OK, but this really isn't responsive to what I was suggesting. Both the OP's stomach upset concern and your point that it won't induce low-blood sugar episodes relate to possible adverse-effect reasons for the advice to take it at meal times. My point was that it's possible -- and again, I want to be very clear that I don't know enough about how metformin works in terms of how long it stays in the body to suggest that this is actually the case -- that the recommendation for taking it at meal-time could be intended to maximize its efficiency with respect to its effect in lowering insulin resistance
And I completely agree with you about taking meds as prescribed.1 -
You have probably gotten many diet recommendations by now-- but in case you need one more0
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if you can I would recommend seeing an endocrinologist. I have met very few general docs that are qualified to treat diabetes. Esp with your other issues, you need someone to keep track of the interactions.
It's good that you are at least seeing a dietitian. Hopefully, he/she is also a diabetic specialist. There are often community programs available or hospital programs available to learn lifestyle management. I know our hospital has one. Diabetes requires a multifaceted approach--you have to take charge of the overall plan because it requires most attention than any docs can give you.
If you have insurance I would recommend getting your own strips and meter and testing yourself multiple times per day for a few weeks. Upon waking, 2hr after each meal, and after exercise.
The single most helpful thing you can do is lose weight. That will be more powerful than any pill.
Good luck. Sounds like you have the right attitude.0 -
I'm sure my advice isn't going to be popular here, but its very effective. Eat a whole foods plant based diet (no animal products at all) and your health will improve greatly. I started with eating plant based five days a week with two days of a 'cheat' one for each weekend day.
It will help you lose weight, lower your cholesterol and is the most effective way to treat diabetes.
Look up dr. Gregor and dr. McDougal. It seems impossible to give up meat, eggs and dairy but its not. I rarely miss it, and my health is so much better.
I had high cholesterol, pre-diabetes, and I suffered from migraines and IBS at the age of 28. I was always sick. The doctors wanted to put me on a bunch of expensive drugs I couldnt afford and then one day I decided to try going plant based. I figured what did I have to lose?
Within weeks I felt like a new person. IBS was gone (i suffered from that since i was 13) migraines gone. Cholesterol lower. Blood sugars lower. I'm not going to lie. It was difficult at first trying to figure out what to eat, but after a month it became second nature.
Honestly, I think you could benefit from a plant based diet.
I mean what do you have to lose?
Good luck!0 -
Hi .
The latest guidelines in Diabetes typeb2 treatment recommend the following of A1c ratter than the old mesure of fasting blood glucose because A1C is more proportionally correlated with morbidity and mortality.
I agree with you that you dont seem to have a doctor who value your efforts at weight loss as much as it should. A loss of 5% of body weight can cure 10 to 15% of de novo diabetics.
Your A1C is fine so you don.t need any more tests. Or pills.
I as a doctor seriously think that a doctor who prescribes a lot of blood work (somebody mentionned vitamines and such) is at risk of overdiagnosis. Iatrogenic harm and definitely disagree with the choosing wisely approach to modern medecine.
What i recommend
Continue your great efforts on your weigt loss journey ans the dieteticians
Get more physical activity
Talk to your doctor about how you feel concerning the patient doctor relationship
Dont hesitate if you have any questions0 -
If you're pre-diabetic, and losing weight, then you're on the right track! Losing 7-10% or more of your body weight can completely reverse pre-diabetes development. Luckily for you the metformin is helping. When they put me on it, I had a deadly adverse reactions and ended up in the hospital. My blood glucose was normal, but the rest of my adrenal system was really unhappy with the medication. In the end I was told to completely change my diet and to lose weight. If only I could convince my parents to and the least try to eat healthier instead of buying a bunch of high saturated fats containing junk food with no real nutrition.0
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Good job losing weight.
Call your pharmacist because metformin works with meals.
Losing weight will lower your A1C. The test is usually run every three months.
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if you can I would recommend seeing an endocrinologist. I have met very few general docs that are qualified to treat diabetes. Esp with your other issues, you need someone to keep track of the interactions.
It's good that you are at least seeing a dietitian. Hopefully, he/she is also a diabetic specialist. There are often community programs available or hospital programs available to learn lifestyle management. I know our hospital has one. Diabetes requires a multifaceted approach--you have to take charge of the overall plan because it requires most attention than any docs can give you.
If you have insurance I would recommend getting your own strips and meter and testing yourself multiple times per day for a few weeks. Upon waking, 2hr after each meal, and after exercise.
The single most helpful thing you can do is lose weight. That will be more powerful than any pill.
Good luck. Sounds like you have the right attitude.
CDE's (Certified Diabetic Educator) can also be very helpful without needing the expense of a specialist. Here is a link to see where they are in your area: https://www.ncbde.org/living-with-diabetes/findcde/ Some CDE's are MD's or APNP's, both of which can become your primary care physician. Others are RD's and can help with food questions.
You can also call the clinic where you go and ask if any of their physicians have advanced diabetes training or even check with your insurance and see if they have anyone in your area that is on your plan.
Two other websites that have been very helpful resources are:
The American Diabetes Association: http://www.diabetes.org/
Bloodsugar 101: http://www.phlaunt.com/diabetes/1 -
In addition to the helpful advice others have already given, I'd recommend seeing whether your/your husband's medical group or your local hospital has diabetes education classes or groups. Many hospitals and medical groups have 6-12 week diabetes education programs that focus on a lot of the things that it sounds like you're looking for: how to meal plan, how to fit more activity into your day, etc.0
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Wow, I've gotten many, many more replies than I expected. I'll do my best to respond to them, but if I miss you, please don't think that I didn't read and appreciate your response. I truly do appreciate the input.
@lynn_glenmont I'm sorry if I came across upset. Type has a way to just not grasp the inflection you intend. I suppose I haven't responded to all the "lose weight - be active" replies because it should be obvious I'm already working on that. I said in my first post, "You know, I don’t even know what I’m asking here…I just saw that 136 this morning – again – and it kind of freaked me out when I realized that is a high fasting blood sugar even for a diabetic." Completely true. I'm not even sure what I'm asking. I posted that just kind of freaked out after doing a quick google search that told me 136 was WAY too high. I didn't even know what a "normal" fasting number was since my doctor just never talked to me about any of this. She never suggested monitoring. She just, literally, told me to take pills and come back in 4 months.
I really didn't talk about any of this to the dietician, because I really was just seeing her for weight loss. Kind of stupid in retrospect.
On the issue of how to take the Metformin...this is the first time anyone's told me that with food was the way to take it for a reason other than stomach upset. Even my husband's doctor told him to take it with food but stressed it was because he has IBSD and gets digestive issues regularly. My dietician - who is a certified diabetes educator - mentioned she takes hers with food - but given how young and slim she is I suspect she doesn't have a dozen pills to keep track of and she mentioned stomach upset...so I just figured that was why she took it that way. I'll certainly look into whether I'm taking it too late at night or if it is necessary to take it with meals, for me and my husband, who has started taking his like I do. It's just so much easier to remember at bedtime.
@biancabantoto - thank you. Your reply calmed me down a bit. I think I've been stressing about that morning number so much that, combined with not really trusting my doctor, I've had myself worked up more than necessary.
Thank EVERYONE who mentioned the dawn phenomenon - I looked it up. Gives me some peace of mind to know that this could just be "me".
@150poundsofme - My dietician can likely give me a meter - she gave my husband his but didn't offer me one. Probably because he's "diabetic" and I'm not. (After we began our diet and I was on Metformin my number went from 6.5 to 6. His, with the same diet, much more activity normally than I get, and no Metformin, went from 6.5 to 7.) I know she can't give strips, but they aren't terribly expensive without a prescription and with a prescription are free. When I change doctors, I'll ask the new one.
@JeromeBarry1 - Yes, I read the second paragraph. Thank you for the encouragement.
@Azdak - Our dietician is a certified diabetes educator, and diabetic herself. I suspect based on her age and how very fit she is she's a type 1 diabetic...but I don't actually know. I've actually been seeing her for over a year - the first year not terribly regularly, we get six free visits per year with a dietician through our insurance and I was referred by the nurse practitioner that staffs a clinic connected to our wellness program. Anyway, I paid attention and did okay for a while the first year, then for lots of reasons that aren't important to anyone but me - family issues - I kind of stopped paying attention and actually gained weight. Now that life has resolved (or at least I've become resolved to it) and our lives are back on track, we are seeing her monthly together. Seemed to make no sense to have my husband one month and me the next when we eat the same food after all. She seems to think we're doing fine, really. She offered the classes to us...but has said she thinks we're going about things the right way - now. When I see her in a couple weeks, I'll talk to her more about the testing.
@masaku_88 - thanks for your suggestion.
@phoenixmed - I suppose I should talk to her...but I really don't know how to say what I need to. Truthfully, I just don't like the very large medical group format she's a part of. My last doctor was in the same group, but had a separate, smaller clinic and it was just...better. I felt like when you called, the people remembered your name. Maybe I'm just old and small-town, but the feeling of being "faceless" just really bothers me and I think she's so rushed, the response would be, "I have 500 patients. Who are you?"
Yeah...I need a different doctor.
@earlnabby - good suggestions. Thank you.
@RoteBook - I may see if I can fit a class or two in and see what they're like. The dietician didn't push them. She thinks we're doing okay...I'm the one who's not so sure.
Again, @RodaRose , @katieiwoosley @donnalhoff @BlueSkyShoal @YvetteK2015 @amusedmonkey @jgnatca @Daddy78230 @eissacf25 @nvmomketo @eskimodeb2 @michael1976_ca - Thanks to all of you. I do appreciate all your responses.
As I said, I think I was just momentarily freaked out when I realized what a "normal" fasting glucose should be and how abnormal my readings were! Combined with my general unhappiness with my doctor, I overreacted. I do that. My plan at the moment is 1- keep up with the weight loss and exercise (of course), 2 - find a new doctor, 3 - Make a list of things to discuss with the dietician when I see her next, including those classes. 4 - look into the "when to take Metformin" issue.
Thanks again.3 -
Be careful of carbs they they are pretty much the same as sugar for a diabetic. Both will raise blood sugar. Talk to a dietitian, a diabetic diet can be complicated.0
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I just want to point out that some people will develop diabetes regardless of their weight. Weight is a risk factor, but not the only factor. I may have to go back on Metformin one day.
More about how Metformin works. It builds up in the system gradually so there's no magic as to when to take it. It can induce nausea, especially at the beginning. Which is why it is suggested to take it with food. Because also of the potential for nausea, dosage is usually increased slowly.3 -
eileenmccaskey wrote: »Be careful of carbs they they are pretty much the same as sugar for a diabetic. Both will raise blood sugar. Talk to a dietitian, a diabetic diet can be complicated.
See...this is why I get so concerned about what I'm doing. I have people saying, "Carbs are terrible. Diabetic's diets are complicated. Don't do this, don't do that."
I have people saying, "Oh my wonderful keto diet with 20 grams of carbs a day! I've lost 20 lbs in the time you've lost 5! I'm never hungry and I feel awesome!"
I have a dietician who is a CDE who says, "If you want a potato, eat a potato. You're doing great." and who is absolutely, 100% vehemently opposed to the keto-type diets...I asked her last visit about that. Thinks they are terrible for you and impossible to maintain long-term. (And I think for me that second part is definitely correct. Could I go a month without a carb? Yes. Could I go the rest of my life without bread? Not unless it was definitely going to kill me.)
I have a doctor saying...nothing.I just want to point out that some people will develop diabetes regardless of their weight. Weight is a risk factor, but not the only factor. I may have to go back on Metformin one day.
More about how Metformin works. It builds up in the system gradually so there's no magic as to when to take it. It can induce nausea, especially at the beginning. Which is why it is suggested to take it with food. Because also of the potential for nausea, dosage is usually increased slowly.
My doctor warned me about nausea...and told me I'd likely lose weight. The first few months I took it, I gained.
lol I've had ZERO side effects.
You know, diabetes was simply not anything I ever anticipated. Stupid of me. I mean, the human body simply isn't designed to be healthy at 300+ lbs. But my family has zero diabetic history. Heart disease and hypertension out the wazoo...but no diabetes. I worried about eating saturated fats, not sugar. My husband's family has a history...so his was always a concern. But I guess that means I simply ate my way here, which makes it somehow worse.0 -
@LadyLilion - in regards to carbs, they are not bad - it's all how much you have, how much sugar make up those carbs and pairing it with protein. Everyone reacts to food differently, and at different times of day. What raises my blood sugar in the morning, doesn't raise it as high in the afternoon. Getting a meter and checking your blood for a couple weeks after meals will help you see how your body reacts to the food you're eating. I aim for 7 g of protein for every 15g of carbs and found that ratio works well for my numbers.1
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LadyLilion wrote: »eileenmccaskey wrote: »Be careful of carbs they they are pretty much the same as sugar for a diabetic. Both will raise blood sugar. Talk to a dietitian, a diabetic diet can be complicated.
See...this is why I get so concerned about what I'm doing. I have people saying, "Carbs are terrible. Diabetic's diets are complicated. Don't do this, don't do that."
I have people saying, "Oh my wonderful keto diet with 20 grams of carbs a day! I've lost 20 lbs in the time you've lost 5! I'm never hungry and I feel awesome!"
I have a dietician who is a CDE who says, "If you want a potato, eat a potato. You're doing great." and who is absolutely, 100% vehemently opposed to the keto-type diets...I asked her last visit about that. Thinks they are terrible for you and impossible to maintain long-term. (And I think for me that second part is definitely correct. Could I go a month without a carb? Yes. Could I go the rest of my life without bread? Not unless it was definitely going to kill me.)
I have a doctor saying...nothing.I just want to point out that some people will develop diabetes regardless of their weight. Weight is a risk factor, but not the only factor. I may have to go back on Metformin one day.
More about how Metformin works. It builds up in the system gradually so there's no magic as to when to take it. It can induce nausea, especially at the beginning. Which is why it is suggested to take it with food. Because also of the potential for nausea, dosage is usually increased slowly.
My doctor warned me about nausea...and told me I'd likely lose weight. The first few months I took it, I gained. lol I've had ZERO side effects.
You know, diabetes was simply not anything I ever anticipated. Stupid of me. I mean, the human body simply isn't designed to be healthy at 300+ lbs. But my family has zero diabetic history. Heart disease and hypertension out the wazoo...but no diabetes. I worried about eating saturated fats, not sugar. My husband's family has a history...so his was always a concern. But I guess that means I simply ate my way here, which makes it somehow worse.
Think of the carbs thing as a sliding scale rather than an "all-or-nothing" thing. I have been managing my diabetes just fine on moderate carbs (160 g per day) and I get to spend them however I want, just spread out over the day rather than in one meal. These are the instructions give to me by my CDE and they work for me.
Others need to eat fewer carbs and some can eat more than I do. It really depends on how advanced the diabetes is. Since you are pre-diabetic, chances are really good that you can eat on the higher end of the scale like I do. Don't be afraid of carbs, just make sure that whatever you are doing is working for you. Yes, if you want a potato, eat a potato.
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I know you would rather not be tossed Metformin without any guidance but if you tolerated well, you could probably double the dose (with your new doctor's OK).
I didn't lose any weight on Metformin either. I lost when I tracked and ate at a deficit.0 -
Oh yeah, I started to feel a whole lot better after I lost my first twenty pounds. Any control you get back is going to help you feel a whole lot better.
About being sedentary. I was where you are. Don't worry about hitting a minimum or an ideal. The trick with exercise is to start where you are and gradually increase. (Add 10% at a time). This gives your body time to adapt to new demands. And it does. I find exercise to be more rewarding than the scale as I start to feel the difference right away.0 -
I know you would rather not be tossed Metformin without any guidance but if you tolerated well, you could probably double the dose (with your new doctor's OK).
I will say this for my doctor. The one thing she's done that pleased me was ASK me if I wanted to up to dosage of Metformin and when I said I'd rather wait and see what happens as I lose weight, her response was, "Okay, we'll leave it where it is for now." So while she was quick to prescribe...she didn't push when I balked at more.About being sedentary. I was where you are. Don't worry about hitting a minimum or an ideal. The trick with exercise is to start where you are and gradually increase. (Add 10% at a time). This gives your body time to adapt to new demands. And it does. I find exercise to be more rewarding than the scale as I start to feel the difference right away.
I was horrified when I got my Fitbit and realized I get like 2000 steps a day unless I actually work at it. I have my goal set at 7500 and I can usually get that...but not always. It constantly surprises me how few steps it takes to actually do something. It just seems like a mile should take more than about 2000 steps. I skipped my morning elliptical this morning and took a 1.6 mile walk at lunch. I'm barely over 5,000 now.
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LadyLilion wrote: »I know you would rather not be tossed Metformin without any guidance but if you tolerated well, you could probably double the dose (with your new doctor's OK).
I will say this for my doctor. The one thing she's done that pleased me was ASK me if I wanted to up to dosage of Metformin and when I said I'd rather wait and see what happens as I lose weight, her response was, "Okay, we'll leave it where it is for now." So while she was quick to prescribe...she didn't push when I balked at more.About being sedentary. I was where you are. Don't worry about hitting a minimum or an ideal. The trick with exercise is to start where you are and gradually increase. (Add 10% at a time). This gives your body time to adapt to new demands. And it does. I find exercise to be more rewarding than the scale as I start to feel the difference right away.
I was horrified when I got my Fitbit and realized I get like 2000 steps a day unless I actually work at it. I have my goal set at 7500 and I can usually get that...but not always. It constantly surprises me how few steps it takes to actually do something. It just seems like a mile should take more than about 2000 steps. I skipped my morning elliptical this morning and took a 1.6 mile walk at lunch. I'm barely over 5,000 now.
That is the biggest eye opener when you get a tracker. I had no idea I got so few steps in a day. Over time, you will find ways to fit more activity in.2 -
Your fasting blood glucose is not high enougjt to mandate an increasing of dose. It is truly the a1c that is important.
Metformin is a stable weight hypoglycemiants ( wich means it is not supposed to make your lose or gain weight.
Keto diets and such is a great way to regain all your wight when you give up and are no good for long term. I perfectly agree with your dietetician. Eat a potatoe if you want. Just not 3 in the same meal2 -
phoenixmed wrote: »Your fasting blood glucose is not high enougjt to mandate an increasing of dose. It is truly the a1c that is important.
Metformin is a stable weight hypoglycemiants ( wich means it is not supposed to make your lose or gain weight.
Keto diets and such is a great way to regain all your wight when you give up and are no good for long term. I perfectly agree with your dietetician. Eat a potatoe if you want. Just not 3 in the same meal
Thanks.
I would never usually ask a doctor a question outside of the office - I'm a lawyer, hate it when people do that to me...BUT, since you offered:
You previously said, "I as a doctor seriously think that a doctor who prescribes a lot of blood work (somebody mentionned vitamines and such) is at risk of overdiagnosis. Iatrogenic harm and definitely disagree with the choosing wisely approach to modern medecine."
I don't think I understand you. Why would you disagree with choosing wisely? Can you explain what you meant?
The metformin...with dinner, or just before bed, given that I only take it once a day?0 -
LadyLilion wrote: »phoenixmed wrote: »Your fasting blood glucose is not high enougjt to mandate an increasing of dose. It is truly the a1c that is important.
Metformin is a stable weight hypoglycemiants ( wich means it is not supposed to make your lose or gain weight.
Keto diets and such is a great way to regain all your wight when you give up and are no good for long term. I perfectly agree with your dietetician. Eat a potatoe if you want. Just not 3 in the same meal
Thanks.
I would never usually ask a doctor a question outside of the office - I'm a lawyer, hate it when people do that to me...BUT, since you offered:
You previously said, "I as a doctor seriously think that a doctor who prescribes a lot of blood work (somebody mentionned vitamines and such) is at risk of overdiagnosis. Iatrogenic harm and definitely disagree with the choosing wisely approach to modern medicine."
I don't think I understand you. Why would you disagree with choosing wisely? Can you explain what you meant?
The metformin...with dinner, or just before bed, given that I only take it once a day?
Pharmacists can be partners and resources for you in getting healthy. Call the pharmacy where you get your metformin to ask when is the best time to take your medication.
In a way, your doctor did the right thing by handing you a prescription for a pill and telling you to return at a certain scheduled time. Sometimes that system works well. If you want more than that, get another doctor.
If you want, ask the doctor's office for the blood testing monitor. They get them free from the companies. What costs your insurance company are the strips.
At one point in my life many years ago, I was married to a type 1 diabetic. Later I had a close friend with diabetes 2 who struggled with managing her diabetes. Both had very serious consequences from diabetes. I say this to show that I have an understanding of diabetes from the perspective of a loved one.
I have a brother-law who is managing his diabetes well. He lost weight and makes good food choices now. His test results are good. He is still on a small dose of medicine.
The blood glucose monitors sometimes are not extremely accurate even when the monitor is calibrated. https://diatribe.org/fda-publishes-final-recommendations-blood-glucose-meter-accuracy
The A1c counts the most.
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There are several schools of thought on what to eat. Things can be confusing because some schools even contradict each other. There is lots of information available if you want it. YouTube has some good videos explaining the role of the liver and glucose for example. Find a book or two by a reputable respected writer. Otherwise, find a doctor you can trust and who pays attention to your questions and concerns. Pay attention to your body. Good luck to you and your husband.
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