# Prediabetes? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [July 22, 2018, 10:08pm UTC](https://boards.straightdope.com/t/prediabetes/818389 "2018-07-22T22:08:38Z")\ **Posts on this page:** 19\ **Page:** 2
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [July 25, 2018, 12:45am UTC](https://boards.straightdope.com/t/prediabetes/818389/21 "2018-07-25T00:45:41Z")
> [@anomalous1](#): > > Sorry for delay in reply, everyone. Been anxiety ridden. > > To make clear my FBG tests were at an office. 102 and 107 (second one is after dropping 14LBS)… I usually go most of the day without eating or just have small snacks (olives, almonds, pickles, turkey deli meat) and pretty much binge eat at night/eat the most (probably about 80-100G worth of carbs). I did this the nights before the tests too (time slept + 1-1/2 hours waiting before bed/reading in bed). During the past 3 months (well not the last month) I ate a lot of sugary stuff, I mean ridiculous amounts of it, ice cream, chocolate, graham crackers, peanut butter and jelly sandwiches multiple times per day). > > My sleep schedule is currently 4AM-12PM most days as well. I had my tests done in the afternoon around 2-3PM. > Nobody in my immediate family has diabetes and my mother had gestational with me. I am very trim in comparison to many around me, though by definition still a little overweight. > > Could any of that have something to do with it? I failed to mention all of that to my physician. I am going to seek out another doctor, hopefully getting another test done shortly with absolutely no eating the evening before the test (including fasting). Got a meter on the way to check it out as well… > > Any other thoughts? Anxiety is killing me here. > > Thanks again everyone. I really, truly appreciate it. Yeah it sounds like your sleep schedule and the large meal before bed is a big factor. I’ve heard it said that not all eight hours of sleep are the same, that a 9 PM to 5 AM is far better for the body than a 2 AM to 10 AM. Hang in there bro. I got my FBS reading of 107 not long ago and I am planning to get things checked out on this front next week or next-next week. In the meantime, I’m cutting out carbs and sugar… Apparently, coffee does good for blood sugar as well. ---
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [July 25, 2018, 12:47am UTC](https://boards.straightdope.com/t/prediabetes/818389/22 "2018-07-25T00:47:07Z")
> [@Mean\_Mr.Mustard](#): > > I’m not certain but I don’t believe the OP is anywhere near that old. > mmm Maybe this is a whoosh/lame/Poe’s Law but the context is clearly fasting blood sugar. Over 90 is cause for concern, over 120 and you’re diabetic. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [July 25, 2018, 1:30am UTC](https://boards.straightdope.com/t/prediabetes/818389/23 "2018-07-25T01:30:21Z")
> [@Velocity](#): > > Over 90 is cause for concern, over 120 and you’re diabetic. This is **incorrect**. Per the American Diabetes Association: A fasting blood sugar at or over 126 is diagnostic of diabetes. A fasting blood sugar under 100 is **normal**. A fasting blood sugar between 100 and 125 indicates impaired glucose tolerance. A HgbA1c at or over 6.5 is diagnostic of diabetes. Persons with 5.7 to 6.4 HgbA1c levels are at definite increased risk for developing diabetes, and values in this range should not be solely used to rule diagnosis of diabetes either in or out. The World Health Organization differs slightly from the ADA in that they feel the FBS must be at or over 110 before it indicates impaired glucose tolerance. And yet again: Do **NOT** rely on home glucose monitor readings to make a diagnosis of diabetes when the readings are coming in under 120. Meanwhile, the OP should chill. There’s no evidence of diabetes from the numbers he’s presented. And the evidence is pretty meager for making a case for glucose intolerance too. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 25, 2018, 2:47am UTC](https://boards.straightdope.com/t/prediabetes/818389/24 "2018-07-25T02:47:03Z")
> [@DSeid](#): > > My other thoughts are that the worst case here is not so bad. Worst case is you pay more attention to the quality of your nutrition, to regular exercise, and maybe at some point end up taking metformin anyway. Which is cheap, fairly well tolerated by most, and associated with all sorts of good outcomes. Out of curiosity, how long can lifestyle changes and metformin hold off the complications of diabetes? I was under the impression that oral meds and reasonable lifestyle changes can slow the progression of diabetes, but by how long? 20 years? 40 years? The people I know were only able to use oral meds for about 20 years before they had to go on insulin (they were all diagnosed in their 40s and started oral meds, were on insulin by their 60s). But they had poor lifestyles. ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [July 25, 2018, 3:07am UTC](https://boards.straightdope.com/t/prediabetes/818389/25 "2018-07-25T03:07:02Z")
Hm. I’ve never had an HgbA1c at or over 6.5, but I am diagnosed with diabetes. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [July 25, 2018, 12:30pm UTC](https://boards.straightdope.com/t/prediabetes/818389/26 "2018-07-25T12:30:58Z")
> [@Wesley\_Clark](#): > > Out of curiosity, how long can lifestyle changes and metformin hold off the complications of diabetes? > > I was under the impression that oral meds and reasonable lifestyle changes can slow the progression of diabetes, but by how long? 20 years? 40 years? > > The people I know were only able to use oral meds for about 20 years before they had to go on insulin (they were all diagnosed in their 40s and started oral meds, were on insulin by their 60s). But they had poor lifestyles. Metformin _alone_ can result in Type 2 diabetics have [all-cause mortality rates _lower than_](https://www.ncbi.nlm.nih.gov/pubmed/28802803) non-diabetic controls (matched for age, gender, smoking, etc.). > [@](#): > > Patients with type 2 diabetes initiated with metformin monotherapy had longer survival than did matched, non-diabetic controls My personal WAG is that someone who _is_ able to control their diabetes with diet and exercise alone would do even better. (Not sure though how many of those people exist.) I can’t speak for the guideline makers but my impression has been that one intent of the lower threshold for “prediabetes” by the ADA criteria is to identify more people at a level where diet and exercise can be more effective at preventing or at least significantly delaying progression to actual disease. Per the CDC, something like [one out of four American adults have prediabetes](https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html). ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [July 25, 2018, 12:38pm UTC](https://boards.straightdope.com/t/prediabetes/818389/27 "2018-07-25T12:38:37Z")
> [@susan](#): > > Hm. I’ve never had an HgbA1c at or over 6.5, but I am diagnosed with diabetes. You don’t have to have an A1c over 6.5 to be diagnosed with DM. If your fasting serum glucose was over 125 that is sufficient. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 25, 2018, 12:44pm UTC](https://boards.straightdope.com/t/prediabetes/818389/28 "2018-07-25T12:44:25Z")
> [@DSeid](#): > > Metformin _alone_ can result in Type 2 diabetics have [all-cause mortality rates _lower than_](https://www.ncbi.nlm.nih.gov/pubmed/28802803) non-diabetic controls (matched for age, gender, smoking, etc.). > My personal WAG is that someone who _is_ able to control their diabetes with diet and exercise alone would do even better. (Not sure though how many of those people exist.) > > I can’t speak for the guideline makers but my impression has been that one intent of the lower threshold for “prediabetes” by the ADA criteria is to identify more people at a level where diet and exercise can be more effective at preventing or at least significantly delaying progression to actual disease. Per the CDC, something like [one out of four American adults have prediabetes](https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html). Yeah but supposedly metformin has some anti-aging properties. So I’m not sure how many of the benefits are due to that vs its control of blood sugar. > **[Metformin - its potential anti-cancer and anti-aging effects - PubMed](https://pubmed.ncbi.nlm.nih.gov/28258677/)** > > The generally accepted mechanism of metformin's effect is stimulation of adenosine monophosphate (AMP)-activated protein kinase (AMPK). AMPK is directly activated by an increase in AMP:ATP ratio in metabolic stress conditions including hypoxia and... > **[Metformin as a Tool to Target Aging](https://pmc.ncbi.nlm.nih.gov/articles/PMC5943638/)** > > Aging has been targeted by genetic and dietary manipulation and by drugs in order to increase lifespan and health span in numerous models. Metformin, which has demonstrated protective effects against several age-related diseases in humans, will be... I can’t find it right now, but I believe a study comparing metformin vs Sulfonylureas found that metformin had much better outcomes despite both having similar effects on blood sugars. ---
**Author:** ![Hari\_Seldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hari_seldon/32/5173_2.png) [@Hari\_Seldon](https://boards.straightdope.com/u/Hari_Seldon)\ **Post date:** [July 25, 2018, 5:22pm UTC](https://boards.straightdope.com/t/prediabetes/818389/29 "2018-07-25T17:22:04Z")
I have been on metformin for 13 years. My last A1c was something like 4.6% and the blood sugar was also low. Low enough that I might have wondered except I know that metformin cannot cause hypoglycemia. There was an article in yesterday’s Science Times that suggested that metformin even helped prevent pancreatic cancer. ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [July 25, 2018, 11:14pm UTC](https://boards.straightdope.com/t/prediabetes/818389/30 "2018-07-25T23:14:13Z")
> [@](#): > > You don’t have to have an A1c over 6.5 to be diagnosed with DM. If your fasting serum glucose was over 125 that is sufficient. It wasn’t. More like 110. I did have moderate elevation on a glucose challenge at the time. I’ve still never had an A1c or FBS that high (except once during chemo when I was full of steroids), but I do take metformin and do diet/exercise interventions, so I don’t really know know I’d test without it at this point. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [July 25, 2018, 11:33pm UTC](https://boards.straightdope.com/t/prediabetes/818389/31 "2018-07-25T23:33:07Z")
> [@Wesley\_Clark](#): > > … I can’t find it right now, but I believe a study comparing metformin vs Sulfonylureas found that metformin had much better outcomes despite both having similar effects on blood sugars. Well, it wasn’t _too_ hard to find … it was the cite I provided! Yes, the impact of metformin, and/or diet/exercise, appear to be by way of _more_ than glucose control alone. They both seem to also impact various other diseases of aging. They do not seem to be completely additive however and of the two exercise seems to have the bigger impact. Metformin might even [blunt the full effect of exercise training](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241331/) on insulin sensitivity anyway, and [“metformin may attenuate the effects of training on some CVD risk factors and metabolic syndrome severity in IGT [impaired glucose tolerant] adults”](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499683/) So **anomalous1** , worst case is that you may, like roughly 25% of other American adults, be at some risk of developing diabetes in the future. Your best crack at preventing it is further improving your nutrition plan and your exercise program, which as an aside, also lowers your risks for many other diseases associated with aging, lowers your chances of being disabled fairly young and lowers your chances of premature death. If diet and exercise somehow does not do it and you creep into diabetic range anyway then metformin is a back up plan and also delivers quite well. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [July 25, 2018, 11:33pm UTC](https://boards.straightdope.com/t/prediabetes/818389/32 "2018-07-25T23:33:23Z")
> [@susan](#): > > It wasn’t. More like 110. I did have moderate elevation on a glucose challenge at the time. I’ve still never had an A1c or FBS that high (except once during chemo when I was full of steroids), but I do take metformin and do diet/exercise interventions, so I don’t really know know I’d test without it at this point. There are also guidelines for how to diagnose diabetes based on glucose tolerance testing, so you may have hit the criteria for a DM dx based on those challenge test results. What have your docs told you? Have you been given the diagnosis of DM? Or of glucose intolerance? There’s a growing body of evidence for the benefit of giving folks metformin just based on glucose intolerance. ---
**Author:** ![Spectre\_of\_Pithecanthropus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/spectre_of_pithecanthropus/32/12343_2.png) [@Spectre\_of\_Pithecanthropus](https://boards.straightdope.com/u/Spectre_of_Pithecanthropus)\ **Post date:** [July 26, 2018, 5:53am UTC](https://boards.straightdope.com/t/prediabetes/818389/33 "2018-07-26T05:53:22Z")
I had the blood drawn a couple of years ago and was told I was prediabetic. Then about ten months ago I had the same test, only this time I was told to fast the night before, which I did, and my results came back as non-prediabetic. I’m sixty, in decent shape, and wear a smaller waist size than I did in high school. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 26, 2018, 1:53pm UTC](https://boards.straightdope.com/t/prediabetes/818389/34 "2018-07-26T13:53:42Z")
> [@DSeid](#): > > Well, it wasn’t _too_ hard to find … it was the cite I provided! Well that is embarrassing. I was in a hurry when I replied to this thread. ---
**Author:** ![katgirl](https://avatars.discourse-cdn.com/v4/letter/k/6de8d8/32.png) [@katgirl](https://boards.straightdope.com/u/katgirl)\ **Post date:** [July 26, 2018, 9:46pm UTC](https://boards.straightdope.com/t/prediabetes/818389/35 "2018-07-26T21:46:09Z")
I thought you said you watch what you eat! Are you eating a lot of grains and root veggies? You are just lazy about food, check out this guy’s recipes. He’s into yoga and iron man type athletic events. He has more than a hundred recipes, all grouped into categories, they’re awesome. Even seemingly junky type food can be healthy. It just takes different ingredients. Once you get used to it, you’ll love to make your own meals. And when you make desserts using healthy ingredients it makes a difference. Get rid of the standard american diet foods like cereal, there’s much tastier and healthier stuff available. > **[Recipes](https://www.theironyou.com/p/recipes.html)** > > Healthy Recipes, Fitness and Health My two favorites right now are the almond crusted baked zucchini crisps and the chocolate caramel avocado brownies. Did you ever think chocolate brownies could be anything besides junky? You just need to get some stuff you have probably never bought before, like almond flour. The zucchini crisps sound and look boring but they’re totally addicting. And after eating healthy food for a while, things like Lean Cuisine just don’t taste good anymore. good luck ---
**Author:** ![anomalous1](https://avatars.discourse-cdn.com/v4/letter/a/e56c9b/32.png) [@anomalous1](https://boards.straightdope.com/u/anomalous1)\ **Post date:** [July 27, 2018, 6:05pm UTC](https://boards.straightdope.com/t/prediabetes/818389/36 "2018-07-27T18:05:23Z")
Sorry for the delay in reply. I didn’t mean to be rude I have just had too much going on lately to even check the board, let alone my email. \*\* Thank you everyone\*\* for the replies and advice. Just to be safe I have switched to low carb and low sugar+no added or refined. Eating about 60 grams of carbs spread throughout the day. Its not so hard when you get used to it. Eat smaller portions, slower and more often with low carbs and exercise every day. Pretty simple I suppose. Just been really depressed about it. Got a second opinion as well and that doctor showed me her own numbers and she said “i’ve been ‘prediabetic’ for ten years, it doesn’t mean you’re diabetic, it means without change you are at higher risk”. **Qadgop** and **DSeid** Thank you for the advice, it really helps. I am still sticking to lower carb diets and lots of exercise for life now. Its really not so bad, I just really really really really don’t want to get diabetes. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [March 31, 2019, 1:44am UTC](https://boards.straightdope.com/t/prediabetes/818389/37 "2019-03-31T01:44:42Z")
Bumping based on a[recent Science articl](http://science.sciencemag.org/content/363/6431/1026)e (full thing behind paywall). > [@](#): > > The war on “prediabetes,” a diagnosis applied to 84 million people in the United States, has been shaped by uncertain science and backed by entities with clear conflicts of interests, according to this investigative report. What started in 2001 as an effort by the American Diabetes Association (ADA) to persuade complacent doctors and the public to take small elevations in blood glucose more seriously quickly turned into a massive medicalization of what was previously considered normal. ADA then broadened its definition of prediabetes to include many more people, and the Centers for Disease Control and Prevention followed suit. Other experts accuse those authorities of “scaremongering.” Call for urgent action on prediabetes aren’t well-supported by medical and epidemiological data, specialists say. … It is unclear how big the risk of progression from “prediabetes” to diabetes is and much is being spent with little evidence of its helping much. I’m still of the mind that motivating improved nutrition and fitness is a good thing. And even if a few go on metformin, well that is a pretty cheap drug and often very well tolerated with possible other good outcomes that may be associated with it. But still it is clear that the label has pathologized and medicalized many people who do not actually have any current problem, on the unproven assumption that they are at increased risk that can be successfully reduced. From the other side of the paywall - > [@](#): > > CDC’s own data show progression from prediabetes to diabetes at less than 2% per year, or less than 10% in 5 years. (Other studies show even slower rates.) > > The push to diagnose and treat prediabetes has come at a cost. When told they have the condition, many people face psychological and financial burdens trying to address it. ADA, CDC, and other groups have spent billions of dollars on research, education, and health improvement programs—generally focused on weight loss and exercise—that have generated lackluster results, according to critics. … > > … Kahn adds that even people whose elevated blood sugar does lead to diabetes progress slowly. “If you screen for diabetes every 3 to 5 years, you’re fine,” he says. Prediabetes itself does not raise the risk of cardiovascular disease or other complications of diabetes, says former ADA President Mayer Davidson, a physician now at Charles R. Drew University of Medicine and Science in Los Angeles. **anomalous1** - you sticking with your plan so far? It’s been nine months … ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [June 21, 2019, 3:38am UTC](https://boards.straightdope.com/t/prediabetes/818389/38 "2019-06-21T03:38:50Z")
> [@DSeid](#): > > … They do not seem to be completely additive however and of the two exercise seems to have the bigger impact. Metformin might even [blunt the full effect of exercise training](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241331/) on insulin sensitivity anyway, and [“metformin may attenuate the effects of training on some CVD risk factors and metabolic syndrome severity in IGT [impaired glucose tolerant] adults”](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499683/) > > So **anomalous1** , worst case is that you may, like roughly 25% of other American adults, be at some risk of developing diabetes in the future. Your best crack at preventing it is further improving your nutrition plan and your exercise program, which as an aside, also lowers your risks for many other diseases associated with aging, lowers your chances of being disabled fairly young and lowers your chances of premature death. > > If diet and exercise somehow does not do it and you creep into diabetic range anyway then metformin is a back up plan and also delivers quite well. Bumping almost a year later [for more data](https://www.nytimes.com/2019/06/19/well/move/an-anti-aging-pill-think-twice.html?action=click&module=Discovery&pgtype=Homepage). > [@NYT](#): > > A popular diabetes drug sometimes taken to slow aging may diminish some of the expected health benefits of aerobic exercise in healthy older adults, according to a new report. The drug, metformin, can blunt certain physical changes from exercise that normally help people to age well. … > > … The researchers measured the volunteers’ current aerobic fitness, blood-sugar levels, insulin sensitivity and body mass. They also took tiny leg-muscle biopsies and randomly assigned the volunteers to start taking either metformin or a placebo. > > All of the volunteers then began a supervised exercise program, visiting the lab three times a week to jog on a treadmill or pedal a bike for 45 minutes, a routine that lasted for four months. > > Afterward, the researchers repeated all of the measurements from the study’s start and compared the two groups. > > It turned out, to no one’s surprise, that most of the volunteers now had better aerobic fitness and blood-sugar control than before, as well as improved insulin sensitivity. Each of these physiological changes would be expected to improve how well the volunteers aged. > > But there were notable disparities between the two groups. Over all, the men and women taking metformin gained less fitness, upping their endurance by about half as much as those swallowing the placebo. Many of those taking the drug also showed slighter, if any, improvements in insulin sensitivity. (Hardly anyone’s weight changed much, in either group.) > > The scientists next looked microscopically inside their volunteers’ muscles and found telling discrepancies between the two groups. The muscle cells of the exercisers on placebo teemed with active mitochondria, which are the cells’ powerhouses. Mitochondria transform oxygen and sugar into cellular fuel in a process referred to as mitochondrial respiration. Higher respiration generally means better cellular health. > > In the muscle cells from the men and women on placebo, mitochondrial respiration rose by about 25 percent, compared to levels at the study’s start. But not so in the muscle cells from the metformin group, which showed little if any upswing in mitochondrial respiration. > > In effect, metformin had road-blocked the normal exercise-related gains in muscle-cell mitochondrial respiration, says Benjamin Miller, a principal investigator in the aging and metabolism research program at the Oklahoma Medical Research Foundation, who oversaw the study. … > > … metformin and exercise “did not seem to play together very well.” … ---
**Author:** ![ZipperJJ](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/zipperjj/32/211_2.png) [@ZipperJJ](https://boards.straightdope.com/u/ZipperJJ)\ **Post date:** [June 21, 2019, 1:54pm UTC](https://boards.straightdope.com/t/prediabetes/818389/39 "2019-06-21T13:54:06Z")
Aw geez. So those of us on Metformin are going to live longer but be more blobby and less fit? Yay. [Previous page](https://boards.straightdope.com/t/prediabetes/818389.md?page=1)