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Q: My doctor told me I need to take drugs for something he calls pre-diabetes. After reading your tips on the pharmaceutical industry, can you give me any advice on whether or not I need to take them?
A That’s a great question because it exemplifies how doctors let themselves off the hook by reaching for a prescription pad. Generally, most pre-diabetics are overweight and maybe diabetes runs in the family. You carry your weight in your midsection. Your primary exercise is lifting a fork and you do like your refined “white” carbohydrates.
Here’s what happens: Whenever we eat, our blood sugar (glucose) rises and in order to move the glucose molecule into our cells, where it’s used for energy, the pancreas, a gland safely tucked behind your intestines, produces the hormone insulin.
In pre-diabetes, this entire response system becomes fatigued. The cells receiving glucose become resistant to the insulin (insulin resistance) and the pancreas responds by going into overdrive and producing more insulin (hyperinsulinemia). In time, the system finally breaks down, blood sugar starts to rise, and the “pre-diabetes” of hyperinsulinism and insulin resistance changes to diabetes, which is high blood sugar.
The prescription drug for pre-diabetes is metformin, which works by reducing insulin resistance. Later, when you develop diabetes, a second drug is added that literally flogs your pancreas to make more insulin. When the action of these two meds starts to fail (you can only flog so much before the system collapses altogether), your doctor gives up and you start taking injections of synthetic insulin.
Pre-diabetes is considered a risk not only because it can lead to diabetes but also because it increases your risk of developing heart disease. Doctors do know that most prediabetes can be reversed without medication. What’s needed is a highly motivated patient committed to some major lifestyle changes. When your doctor looks at your health records and is reminded of all the times she said “You need to lose weight” and yet your weight steadily rises, she figures you’re not going to get religion at this stage of your life and writes you a prescription.
Hard work is indeed required. You must get your weight down to a number appropriate to your build and height. You must begin a daily exercise routine and say goodbye to sugary foods, anything containing high fructose corn syrup, and also foods that act just like sugar in your body–“white” carbohydrates prepared with refined white or wheat flour such as pasta, any non-whole grain bread, and most breakfast cereals. Eat a diet of fruits and vegetables along with lean protein and whole grains, including brown rice and oatmeal. Here’s a link that can help.
Taking metformin, which does work, is not a wrong choice, but it can lull you into a false sense of security (“Now that I’m covered with metformin. I’ll have another piece of pie.”). Most people end up steadily increasing their metformin dose until it loses effect. At that point your doctor will add another diabetes drug and then another until finally she says, “Looks like we’ve got to switch you to insulin.”
Be well,
David Edelberg, MD
Hi Kristi
The most recent research on weight loss focuses less on “what” you eat and more on “how much” you eat. Gluten free vegetarians can gain weight just like everyone else if they’re eating too much, no matter how healthful it is. I suggest getting a food scale and learn how to compute the exact number of calories in all your foods. If you limit yourself to a carefully measured 1400-1500 calories a day you should lose weight
Dr E
Hello,
I am following a low sugar, gluten free, vegetarian diet. I am 5 foot 4 inches and 170 pounds. I practice yoga three times a week. I have bought a fitbit and use it every day to make my 10,000 steps or more each day. Did I had I eat 98% organic food with almond milk. I am now on metphorim. I get tired of people telling me I have to stay of refined sugars. I haven’t eaten any of this for years. What to do?
Kristi Dobson
Thanks for your answer. My aunt, a nurse practitioner, emailed me and said that maybe my A1C hasn’t caught up yet.
My doctor said I am looking at it all wrong. She said I could have gone into being a full blown diabetic had I not done anything instead.
Ken W
Hi Ken
What? You expect fairness and justice?
Keep up the exercise and healthful eating, directing yourself to additional weight loss. Try also giving up gluten. After 8 weeks of this, repeat your HbA1c
Dr E
Hi. I am 44 years old, male. 10 months ago, I weighed 285 lbs. My AC1 was 5.9. I am 6’2” I have always been heavy for about 20 years now.
I now weigh 255 lbs. I have lost 30 pounds. I look so much better and feel better! However my AC1 has gone UP to 6.1.
I have regularly engaged in rigorous exercise during this period of time. Sometimes I am so sore I can barely move. I rarely drink alcohol, if ever. Oh also my fasting glucose was 100. Actually I am not sore much these days because I am used to exercising.
What’s happening?
Ken W
Hi Mildred
Your numbers suggested only the mildest of prediabetes and in my opinion your lifestyle choices are sufficient. Your weight is normal; your diet is excellent; you’re exercising regularly.
I think you’ve done quite well
Dr E
I have been diagnosed with prediabetes. I weigh 143 amd 5ft.5 in. 86 yrs old . My Dr. wants to put me on Metformin and before I get a med I want to know what I can do to eat my way to health. I do have belly fat which as been with me even when I lose wt. My number for pre is 125. I was going to pool 5 days a week but since our pool has not had its heaters turned on it is to cool to go in I have been out of pool for 1 week. I thought I was eating right by adding green smoothies every a.m. and watching what I was eating but after 3 months my bld sugar went from 124 to 125. I am at a loss for what to do now.??
Mildred Kiska
Hi Adel
People want their “pre-diabetes” to just go away. That’s a fine goal but it takes serious work. Based on your height, your ideal body weight is between 140 and 150 lbs. By giving you the Metformin (which actually helps with weight loss), your doctor figures that you are among the majority of patients who go from “pre-diabetes” to regular diabetes and he’s starting you on meds early in the game.
If you really really want to avoid becoming a diabetic, work with a nutritionist and get your weight down to ideal level; join a health club and go several times a week. Follow your nutritionist’s guidelines and just accept the fact that you’ll be a watchdog about your eating for the rest of your life. No “going off” the diet, ever.
Dr E
My weight : 205
High:5′ 8″
My A1C is 6.1
My doctor recommended to take two medformin 500 mg
After medication my Glucose reading out of between rang 110 to117
Can you give me any more advice and that reading are good to protect me to be diabetic ?
Thanks
Adel
Excellent site you have here but I was curious if you knew of any message
boards that cover the same topics talked about in this article?
I’d really love to be a part of group where I can get comments from other knowledgeable people that share the same interest. If you have any suggestions, please let me know. Kudos!
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