Pre Diabetes

My A1C tests have been 6.1-6.4% for the last few times. I check two hours after every meal to ensure that I am keeping it below 140. However, my doctor has been prescribing Metformin, which I do not take, preferring to do my controlling by diet only, because I believe that if I take this medicine as well, I will end up reducing blood sugar level too much. Am I taking a dangerous risk?

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  • Readings of 6.1 to 6.4 are considered to be within normal parameters although slightly higher than the official guidelines NICE recommends, that being between 4.1 to 4.6. Your treatment depends on various criteria being met; are you overweight being the main one. If so then metformin would be a valuable drug to take. Metformin on its own will not cause your blood glucose levels to fall to a dangerous low but will help maintain your readings so that pre-diabetes does not develop into a full blown Type 2 diabetes condition. Should that happen then there is a likelihood that you will need injectable insulin which is far more difficult to deal with in terms of hypos. The starting dose of metformin is usual 1 500mg pill taken twice daily. This may be increased if your doctor forms the opinion that it needs to be. Excercise and diet are important too.

  • Pre-diabetes is a term employed by your GP and diabetic specialist nurse until they are given confirmation of their suspicions by results of blood tests analysed by the hospital laboratory. Until then you are pre-diabetic.

    When I initially presented with symptoms my GP examined me from head to foot, asked whether or not I had had my appendix removed or had had any other kind of surgery or had been taking any drugs other than prescription ones. It was not until I mentioned what I had been drinking the day before and had been throwing most of that back up that the light bulb over her head suddenly switched itself on. She did the finger prick test and the reading was so high that the meter could not read it. She told me that I needed admission to hospital immediately or I might slip into a fatal diabetic coma. I refused and so she gave me some metformin and telephoned me every hour that night until midnight to see whether or not I needed an ambulance.

    I was, thankfully, okay and three days later I had to go for an insulin resistance test. That consists of the nurse taking your glucose level readings before drinking a high glucose drink, waiting an hour and then having those readings taken again. It is then that the label pre-diabetic is either referred to as diabetic or non-diabetic. There are numerous health conditions that can mimic diabetes by giving a high glucose reading which is not related to diabetes in any way.

    Following that a medication regime is instigated which, to begin with, is usually metformin alone. If your reading goes any higher or lower changes to medication are made by the GP until the correct treatment is discovered. Everyone's diabetes is different. I managed for four years on metformin and gliclizide without any changes in my treatment. Three years ago, however, my readings once again began to creep up consistently and I was referred to a Consultant under the two week rule. He immediately put me on insulin which I am still on at the moment.

    These days I still take metformin together with a statin and aspirin alongside insulin. The insulin though took quite a while to get to a level which better suited my diabetes. The dosage these days is split into 72 units at 7 in the morning, the same again at 7 in the evening with a long lasting insulin and then 22 units of short acting insulin ten minutes before meals three times a day. This has proved the best regime for me and now I see the diabetic nurse every three months, the podiatrist every two months and the retinopathy people once yearly.

    Diet has been left to me to control which, again, has proved most beneficial . Last Christmas I had a friend to stay, an American, and her management of her diabetes had to be seen to be believed. How many carbohydrates did a particular food contain in relation to the portion she wished to eat, how much insulin did she need to cover her various meals all of which resulted in mathematics scribbled on paper. I said to myself then that I would never be able to live my life in such a fashion, that being what seemed to be the only focus in her life. Accordingly her visit to England was not very productive.

    Excercise is advised but not essential if you do not live a predominantly sedantry life.

    I have no idea why organic apple cider vinegar is recommended and to be frank it does not exactly sound very tasty. It's like Marmite, I suppose.

    Yet you have to remember, this is the best plan for me, everyone's plan will differ since, as said before, everyone's diabetes s different.

    I hope this addresses your comments. But then, one must imagine Sisyphus happy.

    Regards

    John

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