Pre-diabetic, questions and concerns. Can anyone help?
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sparky00721 wrote: »5 months of losing 1 lb a week, eating moderate carb, and exercising, my A1C was down to 5.6. Three months later it was 5.3 and I was having low blood sugar moments so I was taken off the glipizide. I have managed my diabetes with moderate carbs and exercise ever since. my A1C has stayed between 5.0 and 5.2 for 2 years.
That is an awesome story to hear; thanks for sharing. I have announced all-out war against my recent diagnosis of Type 2 diabetes with the goal of reducing my a1c readings enough that I might over time wean off recently-prescribed Metformin (plus precautionary medication relating to cholesterol and blood pressure).
It is encouraging to read success stories such as yours.
I agree. @earlnabby it's great to hear that. My husband's father was diagnosed 3 years ago and has managed with Metformin and diet just fine. Boy...to be able to get rid of the drugs would be great. Probably not likely that I'd lose all of mine, even at perfect weight, given my family cardio history...but even a couple pills would be awesome.
My job is so incredibly sedentary it's ridiculous. I have my Fitbit set at 7500 steps and find that hard to manage on busy days. I've had days I literally left my chair 3 x to pee and get something to eat and drink. Since March I've been trying to get a mile+ walk in at noon every day and I get up early and hit the elliptical more often than not. I know it's not enough, but it's more than I've done in years.1 -
Here's to put your mind a ease somewhat.
https://www.diabetesselfmanagement.com/blog/controlling-the-dawn-phenomenon/
I think the dawn phenomenon is giving you your high fasting numbers.
Keep working with your dietitian. Before I lost significant weight (over eighty pounds) I was on cholesterol, blood pressure, and diabetes (Metformin) medications. I'm not on any pills now. Losing the weight with the assistance of a dietitian can make a world of difference.
Squawk to whoever you need to for your own glucometer. Like you, I started taking control as soon as I got the prediabetes diagnosis. It pays to take this seriously, and you are taking all the right steps.
I agree with this, I have the same issue. My fastings are usually anywhere from 113-130, yet my last A1C in April was 5.8 - which is the high end of normal / low end of pre-diabetic. Either way, I need to fix it (hopefully by losing weight) but the fasting isn't always a good indicator of your overall blood sugar health. Also, if you don't feel comfortable with your doctor, switch! Trust your gut - I've done that twice now and finally found a great one. Good luck!
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A lower carb diet may help you with your numbers within days or weeks of starting. It may be something to consider. Dr Bernstein's Diabetes Solution is a fantastic book for any diabetic about reducing your insulin needs and reducing BG. Really good plan.
Dawn phenomenon can be a pain but metformin often helps with that. A change in diet (lowering carbs) can help many too, as can weight loss. Exercise too.
I went LCHF and now the only high numbers I get are fasting BG, but even those are not too high, just higher than what I want, like a 5.6. High BG can be reversible and controlled in many if not most diabetics.2 -
sparky00721 wrote: »5 months of losing 1 lb a week, eating moderate carb, and exercising, my A1C was down to 5.6. Three months later it was 5.3 and I was having low blood sugar moments so I was taken off the glipizide. I have managed my diabetes with moderate carbs and exercise ever since. my A1C has stayed between 5.0 and 5.2 for 2 years.
That is an awesome story to hear; thanks for sharing. I have announced all-out war against my recent diagnosis of Type 2 diabetes with the goal of reducing my a1c readings enough that I might over time wean off recently-prescribed Metformin (plus precautionary medication relating to cholesterol and blood pressure).
It is encouraging to read success stories such as yours.
That is exactly what I did. All out war with the goal of getting off the meds ASAP.0 -
I have a young primary care doctor that graduated just over a year ago. He recommended the ADAPT program which is a pre-diabetes lifestyle (diet) education program for a year. I have already lost 10 lbs....and down now to 269. My doc recommended sleep apnea test.....which came back positive; I ended up 11 seconds without breathing and oxygen level as low as 81 which should be 95. I will be fitted for cpap by the end of the month. Now is time for YOU to SHOP around for another doctor; check with friends or med clinic staff for a better doctor. YOU need to ADVOCATE for your healthcare....and don't accept 2nd class doc....you deserve better!2
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Word of wisdom: My father-in-law had a hemorrhagic stroke yesterday. The neurologist speculated that it was due to a spike in his already high blood pressure. His kidney function is poor, which is an eventuality of his diabetes. I've known this man more than 37 years and I know he has never cared to do or learn anything about his health. Stay fat. Stay sick. And be on track to die after a long and wretched decline.
My point is, you and I have the power to avoid that. Lose weight eating as a person who is slim and healthy. Lose the weight and exit the pre-diabetic state. Lose the weight and get your blood pressure down. Lose the weight and extend the years of your healthy life.3 -
Sorry to hear about your Father in law.0
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LadyLilion wrote: »LadyLilion wrote: »It had been 126 or so the time before that! My husband (a1c of 7) was diagnosed as diabetic and given a meter, so I’ve used his a time or two and my fasting blood sugar is always over 130. For instance, this morning, about an hour after I got up, and with no food, it was 136.
The fasting blood sugar being so high has me quite concerned. Since I don’t have a meter or test strips of my own, I haven’t been taking it regularly so he doesn’t run out. He's only had his meter a couple weeks, so I've only tested a few times. But…he’s the one with diabetes, yet my sugar is always higher than his. Literally every time we’ve tested at the same time, I’m higher.
I want to address this separately. High fasting BG numbers in the morning can often be caused by something called "Dawn Syndrome". Basically, your body releases glucose into your system to prepare you to wake up and start your day. Not everyone has it, but is is very common. My morning numbers average around 120 but my pre-lunch numbers are closer to 100 and pre-dinner are around 95. This is why the A1C is the better number for seeing how well you are managing your BG.
Walmart has an inexpensive meter you can get with no prescription. Relion brand. The meter is $18 and you can get 100 test strips for $18. I use it for my additional readings and use my insurance-paid one for my morning fasting readings.
Thank you, I'll consider that. I appreciate the information as well. I'll try getting a meter of my own and try at later times of the day. My readings are throwing off my husband's average anyway.lynn_glenmont wrote: »If you don't have confidence in your doctor, you should definitely look into changing.
But wouldn't you rather not develop diabetes, than have a doctor who will prescribe something for prediabetes or diabetes? Losing weight and getting more exercise can normalize your blood glucose levels, and no doctor can make you do that. I realize you've already started on that, but I guess (just based on this one post, and I realize that's just a tiny snapshot into who you are) I feel like you're misplacing your mental and emotional energy on worrying about whether to change doctors (yeah, just do that) rather than on the things you can do yourself that could make a doctor's willingness to prescribe something or scold you irrelevant.
Well if no one TELLS me what to do, I don't know...now do I? That's the issue. I already have a Rx and really, I'd rather NOT have someone just throw drugs at me. I don't want to be "scolded". I just want a doctor who will tell me what to do here. What I get is, "Oh your a1c is high. Have a pill and come back in 4 months." I have a concern and I can't even get in to see this woman for weeks generally. So yes, I'm definitely changing doctors.
I guess I was more wondering if this is just par for the course. I don't have any diabetic friends. My husband was literally diagnosed weeks ago, so he's new to this. If it's possible to actually reverse this and NOT become diabetic, that's the best possible outcome. But I don't get any feedback from my doctor. So I'm asking here.
(Please try reading this in the gentlest voice you can imagine. Kermit the Frog? B/c your response to my first post seemed like you were having an intense emotional reaction to it.)
So, I did offer advice, which was that the best thing you could do to try to turn your pre-diabetes around (and you can do this without a doctor, old or new) is to exercise and lose weight. (It's in the part of my post that you didn't bold and didn't respond to, so I'm not sure if you read past it.) @amusedmonkey also suggested weight loss as a powerful tool in addressing a number of your conditions, but I didn't see if you responded to her.
I started on MFP because I was scared by a blood glucose reading at the high end of the pre-diabetic range. I tracked my calories, lost 15% of my body weight, started walking more (and eventually added other exercise, but initially it was just increasing my walking), and at my next doctor's appointment my A1C was completely normal. My cholesterol numbers and blood pressure also improved.
If you want to do more than that, you can try managing your carb intake as though you were diabetic. I didn't find that necessary, but that's not to say it might not help you. I've also seen study reports that suggest increasing your omega-3 intake can help (common sources: fatty fish, flaxseed and flax oil, canola oil, grass-fed beef, eggs from truly free-range chickens, or from chickens whose feed is supplemented with flax and other high omega-3 foods).
I agree with @earlnabby that the A1C reading is more important than momentary glucose readings, and it's great that you've got yours headed back down.
I'm looking back at your OP, and you were concerned your doctor didn't give you "diet suggestions" -- do you mean like certain foods you should eat more of or avoid, or do you mean like an overall plan to lose weight, like keto or LCHF or paleo or IF? Because you don't need to follow some specific plan. Whatever you're doing is working fine. Eighteen pounds in three months is great progress.
I realize your doctor is not responsive, but until you make the jump to a new doctor, you might want to double-check on how you're taking the metformin. Your post indicates that you believe the instruction to take with meals is just to avoid stomach upset, but **one way** it works by decreasing insulin resistance, so the glucose gets out of blood and into your cells. I have no training in pharmacology, so I don't know whether it matters or not, but it certainly seems possible that it's meant to be taken with meals so you have the metformin at the same time that the glucose is hitting your bloodstream. I could be wrong -- it could build up in your system over time, and taking it once a day could be perfectly effective, but if it were me, I would want to know for sure.
ETA **one way**4 -
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!9 -
you should be able to get your husband and your self in to see dietician and diabetic nurse. groups courses and all the fun stuff. you need a doctor who cares that's important. you both can fight it. with clean eating switching food groups up. witch is where a dietician can help. the nurse she can help with meds and exercise. you want to get it nipped in the butt before either of you get put on insulin because poking your self daily sucks1
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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
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