I’m pre-diabetic. My fasting blood sugar is generally just above 100, and my last A1c reading was 5.7, up from two readings at 5.6.
I already discussed it with my doctor. He says:
You could certainly try metformin if you wish. However, when a colleague of mine looked at the trial that compared metformin to lifestyle intervention and the heterogeneity of benefit based on individualized risk for developing diabetes, it was the minority of prediabetic patients (those at highest risk) that benefited from metformin.
By which, i think he means i ought to lose weight. But he sent me to a nutritionist who said, “why do you want to lose weight?”, and basically said she doesn’t think i should do anything dramatic, because my metabolism appears to be working well, and there’s a risk of messing that up. She endorsed eating a little less, but also thought it would be okay to just maintain my weight (my BMI was at the top of “overweight”, but i seem to have shrunk an inch, so I’m now just barely “obese”.)
And anyway, it’s not either-or. They are separate actions.
One lifestyle intervention i plan to do whether or not i try metformin is to add 30-45 minutes of brisk walking a few mornings a week. I wore a continuous glucose monitor for two weeks (you can get one over the counter, now) and learned that most of the exercise i do doesn’t have much impact on my blood sugar, but a brisk walk of more than 20 minutes reduces my blood sugar levels.
I’ve heard that people sometimes have intestinal upset when they take metformin, but i took it for 10 days when i had covid, and didn’t notice any problems. The drug is cheap and well studied. It seems to have a good safety profile.
I don’t eat much junk food. And I’ve been working with this nutritionist for most of a year. She agrees that my diet is pretty good. Like, i kept a daily diary of everything i ate for 2 weeks and gave it to her. It wasn’t my “ideal” diet, it was what i eat. I don’t really enjoy vegetables and should probably eat more of them, but i do eat fresh fruit.
Also, my weight has been stable for years. It’s basically stable except when something happens. I gained a few pounds when i got my first desk job. I gained a lot of weight with each pregnancy, which is when i became fat I lost 15 pounds over covid when i didn’t ever eat “socially”, and i regained 5 of those after covid, and have been stable since. I’m maybe a pound or two less than a year ago, because I’ve been “eating a little less”.
Anyway, let’s just say I’m not planning on losing enough weight to matter. And I’m planning to do a little more exercise either way. I hate exercise, too. Or really, i hate sweating. It just makes me feel gross. And if i don’t shower after sweating, i get skin rashes. But I’m going to do my best to do that, because the health benefits are overwhelming. (I already do a reasonable amount of weight bearing exercise, and general moving around and bursts of aerobic exercise. It’s specifically a solid chunk of aerobic exercise that i think i need to add.)
I agree that a healthy diet low in carbs along with daily moderate exercise should get you where you want to be. I was at 29 BMI myself and dropped enough weight to get me down to 25 and have been able to maintain that weight with exercise and a healthy diet. My blood glucose is well under control and I don’t eat snacks, fast food, and avoid anything with added sugar. YMMV.
I would, myself, never medicate if lifestyle changes would work at least as well. Eating wholesome foods (very little meat, sugar, processed food) and getting daily exercise will likely solve your problem and have a lot of beneficial side effects. Medications very rarely have no adverse side effects, and they also give you a false sense of your overall health.
Eating differently rather than trying to limit calories is easier to do and has no down side.
I’m not a doctor obviously, so take what I say with a grain of salt.
It was my understanding that among type 2 diabetics, there was controversy whether an A1C of 7% or 8% was the goal. An A1C of 8% doesn’t seem to have more health consequences of an A1C of 7%, despite it being an easier goal for diabetics to achieve. The goal used to be <7%, now its 7-8% because the risk vs reward ratio doesn’t promote the idea of a sub 7% A1C as the goal.
“The evidence shows that for most people with type 2 diabetes, achieving an A1c between 7 percent and 8 percent will best balance long-term benefits with harms such as low blood sugar, medication burden and costs.”
So if the benefits/risks ratio means that an A1C of 7-8% is the marker for treatment, would an A1C of 5.6% require treatment? I don’t have the answer for that.
I know metformin seems to have health benefits above and beyond the blood sugar lowering effects.
I do eat sweets once or twice a week (and more at the holidays) but otherwise it is pretty much what you describe. And i was surprised to see what increased my blood sugar wearing the monitor. Basically any meal, even one with almost no carbs. (Like, leftover steak and leftover spinach, cooked with a little butter and lemon juice. That’s not a high-carb meal.) I had bigger spikes from carbs, of course
Three “stick” style pretzels, for instance. And to my surprise, “beans and rice” really spiked my blood sugar. I suppose it is the rice, but lentils and barley, lentils and rice, and black beans with some carb-y side all produced much larger spikes in blood sugar than, say, roast chicken with rice, or steak and potato. I’m not going to stop eating legumes, because they have other nutritional benefits, and nutrition certainly isn’t all about blood sugar. But that was surprising.
Anyway, i think it will take giving up a lot more than “added sugar” to get my BMI to 25. I really dropped basically all added sugar over the pandemic, because we cooked everything from scratch and didn’t buy junk food. And i did loose 15 pounds, but it wasn’t heading any lower.
I know correlation doesn’t equal causation, but Metformin is reputed to cause chronic diarrhea in some people. I took it for ~20 years and had chronic diarrhea for that entire time, and still fight it.
Eventually I changed doctors and my new PCP told me it wasn’t doing that much for me and I should quit taking it.
And you remind me, i had an errand this morning, so I haven’t taken my brisk walk, yet. The weather is nice, with sun and fresh snow. I’ll go do that now, and have leftovers for lunch when i get home. (Probably lots is carbs. I baked a couple of sweet potatoes the other day, and I’ll eat the second one and maybe some leftover stewed beef with carrots and aromatic veggies, if I’m still hungry.
Believe it or not, a high protein/low carb meal can cause a glucose spike, although not as large as having a high carb meal would, at least for me. I verified that with a CGM.
I wore a CGM for a month and learned that rice, pasta, potatoes, and wheat products, such a bread, along with any sugary food or drink will cause a very large spike, so I had to give them up, except I will have beef once in a while as a treat. I will also have a piece of birthday cake a few times a year, but that’s my only sweet indulgence. The holidays are a real challenge for me since I always had a sweet tooth. Old habits die hard.
The CGM taught me how to consistently keep my glucose below 140 and that, along with daily exercise equivalent to 500+ calories, will keep my weight where I want it to be. Getting 8 hours of sleep every night also helps.
I lost 35 pounds and have managed to keep it off for almost two years. For most of the people I know, losing the weight isn’t the problem, but keeping it off is. So far I’ve managed to do that.
Keep fighting the good fight and you’ll achieve your goal eventually. Doing so without using pharmaceuticals is always the better option.
Yeah, i know. But i thought the fiber might slow the impact, some. I got much faster, larger, spikes from lentils and rice than from breakfast cereal and milk. And the breakfast cereal is mostly carbs.
This isn’t a great attitude when you’re considering medication, probably longterm if not lifelong, to treat the consequences instead.
Eating smaller meals, or eating foods that give you the biggest bang for your nutritional buck, isn’t an insurmountable problem for many people, as people here have attested.
And for many people, as attested both here and elsewhere, weight loss diets result in the long run in weight gain; and in the short run in an inability to get any work done due to multiple physical downsides. Eating well is of course a different issue; but a fair number of fat people do eat well.
FWIW, my doctors seem quite happy if my A1C is significantly below 7 (last they checked it was 6.6). I think there may be some adjustment for age – they may not expect it to be as low in older people as in younger people.
Some people get diarrhea from metformin; some don’t. Psyllium fiber may (or may not) help those who do.
I started taking metformin last February when my A1C spiked to 5.9. My doctor said to lose weight or die. Well, maybe not in so many words, he was a lot nicer about it, but I heard the hidden message. I don’t know what I weigh now. I find it’s really non-productive for me to weigh myself often. Little ups and downs affect me too much. I’d rather see how I’m doing when I see my doctor. Plus, I’ll be weighed by something more accurate than the scale I have at home.
I lost 25 pounds the first six months, and I know I’ve lost around that much in the last six months. In September, my A1C was 5.5, and my glucose was 88. I’ve also lost 3 to 4 sizes, and I feel and look a lot better. I also have arthritis in my knees due to years of jogging, and I was using a cane when I saw my doctor in February. After only a couple of months, I was able to walk without the cane which I love.
As for diarrhea, I only have issues when I eat “bad” food. Like, when I had a glass or two of Proseco on my birthday with a filet mignon and a baked potato with sour cream. Also, if I eat too much sweet stuff. I haven’t cut all the stuff I shouldn’t eat out of my diet. I just don’t eat anything like that more than once a month (twice at a stretch). I’ve been surprised how easily I’ve lost the weight without significant exercise, but I’m happy. I do have some small weights for my upper body. I have poor arm strength, so I’m working on that.
Again, everyone is individual, and it sounds like you’re doing most of the right things.