I’ll also readily concede that there are people who for whatever emotional/mental/brain chemistry reason will never reach that goal, but for many of us, it can be done. But I think that a concerted effort should be tried before turning to lifelong meds.
The reason you fast before a glucose test is that any food will cause a spike in glucose level. They were so erratic that my doctor stopped using them. On the other hand the A1C gives more like a 3 month moving average.
In the first year I took metformin, I spontaneously (no conscious dieting) lost 20 lb. I think of it as wegovy lite. I took it for about 16 years. At first, the A1C dropped from about 8% to a bit below 7%. Then about 1 1/2 years ago, it was suddenly 4.6%, too low, although not dangerously so. My doctor then halved the dose (two 500 mg pills a day to one). Last June, the A1C was 5.4 and he stopped it entirely. I had blood tests 3 days, but I have not seen the results yet.
I have gained about 5 lb since I stopped the metformin, which does not please me, although the BMI is still only 28 and my doctor does not recommend I lose weight. A little bit of overweight seems to be good at my age. But I believe there is some evidence of anti-inflammatory action from metformin. So unless you suffer digestive upset, I see no reason not to.
Yes, it’s not uncommon to use it as a weight loss aid.
My husband saw a nutritionist and lost a lot of weight, and as best as i can tell he’s still doing all the same things, but he’s gained back all the weight. And he spends all day fretting about his diet. He has much better self control than i have. I’m sure i could lose weight. As several people have said, anyone can lose weight. It’s maintaining a lower weight that’s hard. And yo-yo-ing weight is worse for your health than a consistent weight, unless you are a lot more overweight than i am.
Probably, I’d lose weight if i wore a continuous glucose meter all the time, because it tells you right away, “you shouldn’t have eaten that cookie”. But that’s an expensive and uncomfortable option that I’d prefer not to do.
Go find me one with clear statistics showing that more than 10% of the people on it lose more than 20 pounds and keep the weight off consistently for more than five years.
If you find one, please cite it in another thread; this probably isn’t the right place for this argument.
It’s all timing.
Meals, snacks, exercising, sleeping.
If you can get the ratios right you can maintain your glucose. If your pancreas works properly.
Metformin is pretty safe. I’ve not looked into statistics.
If you can maintain without it. More better.
Do you drink sodas?
Maybe. Maybe not. With or without weight loss an improved nutrition plan and regular exercise are excellent interventions to minimize the risk of prediabetes progressing into diabetes. Personally I would encourage doing your best to ignore the scale and focus on the behaviors. Fat loss, and looser fitting clothes, might follow. Might not. Improved health outcomes almost certainly will.
True. And there are good arguments to be liberal with metformin, as otherwise noted it may have other substantial benefits broadly against the diseases of aging … but so do a healthy diet and regular exercise.
My WAG is that latter has more powerful positive impacts on a broader set of outcomes than metformin does and would see if you can move in a positive direction with them first.
My doctor also said that metformin has shown promising results in cancer prevention, as well.
When I started metformin, I fairly drastically changed my diet and have kept it up for about a year. I used to eat a lot of ice cream. I’ve only had one scoop of ice cream in the last year. It was surprisingly easy to stop. For me, it’s establishing the pattern. Once I get in the groove, I can usually keep going. Also, psychologically, I’m considering this an until-the-end-of-my-life change. Not like other diets in my life where I wanted to reach a particular goal (i.e. a goal weight, a particular event).
Adding a shout out to past post by @psychobunny.
I offer metformin to prediabetics with HBA1C >6% but I offer a choice since the data is not absolutely clear. While metformin does seem to decrease the rate of progression to full-blown diabetes, the effect is less than that of diet and exercise and there is no good data combining both.
I didn’t see a point to starting on metformin without changing my diet and increasing my exercise.
Maybe a couple times a year at parties. My beverage of choice is cool water. (Not ice water, that’s too cold.) I keep cans of soda in the house for guests, because i realized that if i bought the larger bottles, it would just take up space in the fridge as it went flat, and then i poured it down the drain.
That’s basically what my doctor said. It seems weird there’s not good data looking at both.
The effects of a solid chunk of aerobic exercise were striking in the cgm. All the focus on “daily steps” led me to think that it doesn’t matter how exercise is spread through the day, but i think it does matter. I’ve been pretty good about getting out and walking for the last couple of weeks. I’m worried i won’t be able to maintain that when the weather gets warm, though, and I’ll fall out of the habit. I bought a small treadmill about a year ago, but it doesn’t really work well enough to get my blood glucose down. And i don’t have a good place to put a full-sized one. But that’s another thing i can work at, finding space for a better treadmill.
Nice.
Water is my drink. I like ice though. Small chips.
I tend to bite the half moon ones.
My under counter icemaker makes cubes. I don’t use those much as they get depleted by ice chests.
I use the crushed thing on the fridge.
Sonic ice is my favorite.
I can’t drink the amount of water I’d like. It interferes with dialysis.
I look at it like this(probably incorrect), if you drink enough water it dilutes the mistakes you’ve made in your diet, that day.
With an a1c of 5.6-5.7 and a FBG routinely around 100, I absolutely would not take Metformin. Your numbers are virtually normal and you don’t need Metformin. Sure, lose weight, exercise, whatever. Can’t hurt. I’ve had type 2 diabetes for ~15 years. My late husband had type 1 diabetes for 30+ years, an insulin pump, and eventually a kidney transplant. This is a subject I know something about.
The medical community did away with the term “borderline diabetes” for some reason, but now doctors seem eager to medicate people with normal numbers by calling it “pre-diabetes.”
Metformin does not lower blood sugar. Google “how does Metformin work.” With your normal metabolism, exercise will lower your blood sugar, and losing some weight will improve your sensitivity to the insulin that your body is happily and normally producing.
JMHO.
The hard part is remembering to continue to eat less after you’ve lost the weight. You’ll likely never be able to go back to the amount you ate when you were were maintaining a higher weight. But if I haven’t missed something, you’re saying you haven’t tried to eat less to lose weight? You may find it’s not as hard as you think if you remember not to go back to your previous level of eating. Especially since you eat well now.
There is some. Just not powerful enough to be confident about. For example:
Apparently metformin blunts exercise adaptations rather than them working synergistically.
The primary results showed that metformin blunted exercise mediated increases in insulin-stimulated skeletal muscle glucose uptake by ~30%, suggesting that metformin diminishes both single and repeated bouts of exercise benefit on glucose metabolism (23, 31, 32). Although to date no follow up studies have been conducted using stable isotopes to understand skeletal muscle insulin-stimulated glucose disposal, recent work has tested the effect of metformin on aerobic or resistance exercise skeletal muscle cellular adaptation (33, 34). The results of these studies collectively show that metformin opposes skeletal muscle mitochondrial adaptations as well as inhibits fat-free mass accretion
Don’t overthink the BMI/weight issue. Yes, in an ideal world you might be better off weighing 10-20 pounds less (broad range because I don’t actually know you or how much weight would be needed to get you into “ideal” territory) but weight and blood sugar aren’t always as tightly related as supposed. A person can be overweight but have great blood sugar control. A person can be underweight with terrible blood sugar (which, in fact, can be a sign of Type 1 diabetes, but I digress).
Your concern re: metformin is about your blood sugar levels, not the number on the scale. I’m not saying weight isn’t important, just that it’s not the only factor at play here.
Now, you also say (emphasis added):
Right there you have an actionable thing with an objectively proven result. Since you now know, for a fact, that a “brisk walk of more than 20 minutes” has an impact in the direction you want take brisk walks of more than 20 minutes every day that you can. Do that for X period of time and see what happens to your blood sugar over time.
Sure, there could be other benefits… you might lose some weight (or maybe not) and it will definitely benefit your lower body’s muscle and bone, if you’re doing it outside it will probably improve balance and mental health, maybe catch a bit of vitamin D from direct sunlight. Those are all bonuses.
Personally, I’d try that first. Try for whatever time period you/your doctor thinks is prudent and maybe, after that time, you won’t need metformin, you might be able to achieve good blood sugar control, or at least better, with that change alone. Bonus: it’s cheaper and can’t be denied by a healthcare company, and you don’t have to ever worry about medication shortages.
And, OK, you might after that interval decide to use metformin anyway. Or brisk walks might work now but later on maybe not so much, or for some reason those walks might become more difficult to do or whatever and you’ll use metformin then. Either way, those walks carry benefits beyond just blood sugar control, plus, of course, in you they do improve those numbers. You’ll get better results from metformin if you make it part of an overall plan and don’t rely on just that to control your blood sugar issues.
And bravo for actually consulting a nutritionist - that can be very helpful for a lot of reasons. Also, bravo for knowing how different foods affect you, personally.
(Re: the rice and beans - yes, rice has a lot of carbs. So, in fact, do beans even if not as much as the rice. This is why “eat vegetarian” isn’t always the best advice for people with blood sugar control problems. Not all vegetarian diets are created equal.)
Yes, I’ve been overweight for decades, and only now creeping into pre-diabetic status. I weigh a few pounds less than i did after my second child was born. He’s now 30. Basically, getting old sucks.
Since I started metformin, I have dropped from 290 lbs to 273.
Yes, I have changed my diet.
But still…
I mentioned that i gained a lot of weight when i had kids. There was clearly some weird metabolic fight between my body and the fetus. I was hungry ALL THE TIME, and felt weak and lacked energy if i didn’t eat. My gestational diabetes test showed low blood sugar. And I gave birth to tiny skinny babies with no baby fat.
Anyway, there i was, newly fat, with a full time job and babies to care for. And partly, i decided i didn’t have the energy to also think about my weight, but also, i realized that psychologically, i enjoyed feeling “substantial”. So i bought larger clothing, and moved on with my life.
I’ve had several doctors over that 30 year span. This is the first one who’s wanted me to lose weight. Partly, he’s the first one who both cares about me as a person and is, himself, thin. (My prior doctor cared about me, but was about as fat as i was, and perhaps felt okay about that.) But doctors aren’t gods, they are human beings with different ideals and concerns. This doctor cares about weight, and has been nagging me about it for years, including when all my blood tests were totally normal.
But i know that lots of people are like pregnant-me, constantly craving food. And there’s some evidence that dieting leads to that hunger. Not just enjoying food (which i do, a lot) but being troubled by thoughts of food when doing other stuff. If i was sure that i could lose weight and not mess up my appetite, i would be more willing to try it. But I’m kind of frightened to break something that mostly works. And my husband’s experience is very discouraging.
Increasing my exercise from my current level is clearly an improvement, though. And I’ve had lots of intervals in my life when i exercise substantially (admittedly, mostly vacations, not long term) and i didn’t think there’s any significant risk to doing a lot of walking.
Which is why i do plan to walk more, but am very hesitant to try to lose weight.