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Confused With Doctor Advice for Prediabetes treatment

Discussion in 'Prediabetes' started by Discus, Feb 24, 2012.

  1. Discus

    Discus Member

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    Love this website and hope to get some advise from the wonderful people here.

    I have done a medical examination recently and found to have Prediabetes. The doctor asked me to start diabetes medication (half tablet of Januvia 100mg per day). The doctor said that the risk of getting cardiovacular disease for prediabetes is of no diffrence from a diabetes patient. Starting the diabetic treatment now will help delaying diabetes type II too. Hence he recommended for diabetic medication. I was somehow not comfortable with his advise.

    The following are some of my personal infor and test results:

    (1) 47 yo male, Height (173cm) and Weight (71kg), non smoker and non drinker, do regular exercise.
    (2) HBA1C - 5.5% (Under non diabetic range)
    (3) GTT result:
    Blood Glucose Fasting (0 hr) - 5.2 MMOL/L
    Blood Glucose (1 hr) - 8.5 MMOL/L
    Blood Glucose (2 hr) - 9.8 MMOL/L
    (4) Total Cholesterol - 6.0 MMOL/L (normal < 5.2)
    HDL Cholesterol - 1.46 MMOL/L (normal > 1.03)
    LDL Cholesterol - 4.11 MMOL/L (normal < 2.58)
    Triglyceride - 0.94 MMOL/L (normal < 1.70)

    My questions is:

    (a) Do I really need to start the diabetic medication? I read that for newly diagnosed diabetes patients, the doctor normally will advise them to go for diet change and also exercise first before recommending medication. In my case (pre-diabetic) with HBA1C shown normal result (indicating good glucose control for the past few months), do I really need to start medication? Why this conservative (diet and exercise) treatment plan is excluded?
    (b) For diabetes patient, one of the important tests to monitor the blood glucose control is HBA1C. But for my case if I started my prediabetic medication, how do I monitor the effectiveness of my treatment? Do I still look at HBA1C (which most likely will be normal) or to look at GTT and observe the improvement of Blood Glucose at 2 hr.

    My diabetes knowledge is limited, how I get some help and advise. Thank you.
  2. Sid Bonkers

    Sid Bonkers Well-Known Member

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    The in range margins for cholesterol lipids are in fact as follows: (I hate the word 'normal' as there never seems to be a 'normal' anything :D )
    Trigs........0 to 2.3 (mmol/L)
    HDL.........should be greater than .9 (mmol/L)
    LDL..........0 to 4.0 (mmol/L)

    Not sure whether an A1c of 5.5% is considered non diabetic, my A1c is currently 5.4% but I am still diabetic, just a well controlled one.

    Having been diagnosed as pre diabetic you may want to change your lifestyle/diet and keep those numbers down, whether you choose to get help from drugs is your choice but there is a school of thought that early introduction of meds can buy you the time and stop the condition becoming full blown. Whatever you do next though will have a big impact on the rest of your life so whether you choose diet only as a first step or diet and meds now is the time to act :thumbup:

    Good luck
  3. phoenix

    phoenix Well-Known Member

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    Sid, I'm not sure where you got your figures from though I did read on a BBC website that UK norms for cholesterol are somewhat less stringent than those elsewhere in Europe and the US.
    These are what my doc would use, I have a feeling the OP is not from the UK.
    http://www.prolipid.com/cholesterol-ref ... alues.html

    I can see where your doc is coming from in that diabetes itself seems to be a risk factor in CVD (I've just seen the statistics in practice , my elderly father has just had a heart valve replaced, he spent some weeks in hospital, in various wards. It seemed that every other patient I came across in those cardiac wards was diabetic. ) Your,LDL is quite a bit higher than they would want. Whether that sensibly translates into taking medication for pre diabetes I'll leave others to comment on.
  4. Grazer

    Grazer Well-Known Member

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    Hi Discus! Welcome to the site. Wether you go onto medication or not is a matter for you and your belief in using drugs or not. Lots of us prefer to control our diabetes on diet and exercise alone while we can. I know you are only pre-diabetic, but if you choose to avoid drugs, here is a post I gave another member on how to control using diet, and how to test to see if it is working. You may find it useful:-
    In general terms you will need to reduce the total number of carbohydrates you eat per day. All carbohydrates turn to sugar when we eat them, and no type 2 diabetic on diet only, or on diet and metformin only, can control their blood sugars (BGs) without controlling their carb intake. Even those on strong medication normally choose to control their carb intake to keep the level of medication they take down. The total number of carbs per day you can eat depends on how advanced your diabetes is. It’s perhaps worth starting at about 50% of normal levels for a non-diabetic then adjusting up or down according to how you get on. That’s 150 grams of carbs per day for a man, 125 for a woman. You can read the total carb content of food under “nutritional info” on the packet or wrapping, or look it up on the internet for loose food. Just google “carb content..”
    You also need to stop or reduce the bad carbs; that is the starchy ones that make your BG go up quickly.
    So obviously no sugar or glucose! But also no white bread, white rice, pasta, flour products like pastry, cake and batter. You can eat a little basmati rice, wholewheat pasta or the tri-color pasta fusilli ones in small quantities. Boiled new potatos are OK but not old pots mashed, boiled or in their jackets. (Roast is not so bad, the fat slows their absorption and conversion to glucose in the blood) Amongst other veg, parsnips are about the worst for BG, and carrots not great but ok in smaller amounts.
    Multi grain bread (not wholemeal) is not SO bad, but lots of us eat Burgen soya and linseed bread from tescos and sainsburys, although all bread should be in limited amounts.
    All fruit has carbohydrates, and needs to be included in the amounts of carbs you eat in a day. For most people, bananas are about the worst for pushing our BG up and berries (like strawberries, raspberries etc) are the least bad.
    No sweeties!
    Exercise is important. I tend to exercise about an hour after eating when I know my BG will be peaking. This helps to bring it down quicker and further. I do ten minutes hard work on an exercise machine, but you could run up and down stairs for ten minutes or go for a brisk walk.
    Returning to types of food and quantities of carbs - you can only find out how many you can eat by testing. The glucose test you did isn't appropriate for regular testing, so you will need a blood glucose testing meter. Most type 2’s are not given access to testing equipment, so you should get your own – although try arguing with your Doc that you want to manage to NICE guideline blood sugar levels, and can’t do that without testing! If you have to buy a meter, they are cheap and most manufacturers will give them away for free. They make their money on the strips you have to use! So go for the meter with the cheapest testing strips. Some people test before and after eating, on waking (fasting test) and before bed. But if you have limited strips because of cost, the key to me is testing 2 hours after eating. If your BG is above, say, 7.8 at that stage, you need to cut down on the carb content the next time you have that meal. Test after various different meals and you soon get to see a pattern of what you can and can’t eat, and in what quantities. You can then reduce your testing. I said “below, say, 7.8” because NICE guidelines are below 8.5 but most of us think that’s a little high. 7.8 is the max. Level at 2 hours after eating that a non-diabetic normally gets to so is perhaps a better target. Some then set progressively lower targets. As a pre-diabetic, you may wish to adjust your carb content so all readings are even lower, say below 7.0. All the figures I've given here are in mmol/l, the UK standard measurement. For USA equivalents, multiply by 18. For other countries, you may have to convert to their units.
    Do ask lots of questions; there is normally an answer on here. The more you get to learn about your diabetes, the better it will be.
    Good luck!
  5. Discus

    Discus Member

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    Dear All, thanks for the reply. Grazer, your dietary control tips are very helpful to me. Thanks for the time and effort to answer my query. It certainly helpful and add values to life! I will try to control my blood glucose level via diet and exercise first, and monitor my blood glucose level (2 hrs after food) regularly.
  6. Sid Bonkers

    Sid Bonkers Well-Known Member

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    Hi Phoenix, the figures I quoted are from a hospital print out of the path lab report from a blood test I had done about a year ago :thumbup:

    It is of course possible that Doctors like to see lower levels in diabetics and the above could be normal non diabetic levels :D
  7. Bonnington

    Bonnington Member

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    Hi Sid,

    I have just been diagnosed pre-diabetic too, however my doctor just said "lose weight" so far I have lost 16lbs using a diet plate which I bought off the site and I am feeling excellent - in the pink! i still have no idea what my blood sugars are though but I guess losing 16lbs will have helped, just another 40lb to go and i will be back to the weight i was at 18! :lol:
  8. robertconroy

    robertconroy Member

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    Well doctors see a person that's overweight and figure they're on their way to diabetes, bucause a lot of doctors believe being overweight causes diabetes. Well that's a bit of a jump because 80% of all type 2 are overweight. In the U.S. 80% of people over 25 are overweight. Actually the truth is, high insulin causes both. If your triglycerides are high, your insulin is probably high as well meaning you already have insulin resistance. Well, I lost 62 lbs. and didn't make a bit of difference in my HbA1c. My doctor said losing 30 lbs. would make a huge difference, it didn't.

    Let's put it this way, if your waist is over 38 inches for a man or 35 inches for a woman, you probably already have insulin resistance and you need to learn about glycemic loads of foods to lower your insulin levels. If you don't, good chanced you'll be diabetic. Exercise will make you more sensitive to insulin, this is good, but it won't make you lose weight just by burning calories. You have to burn 3,500 calories just to lose 1 pound. Try that some time. Besides, if you have high insulin, it will come right back in a day or so.

    Diabetes is only a number, insulin resistance will surely get worse if you do nothing. Grains and dried fruits seem to be the worst for glycemic load. Cut out all grains and you will see an improvement right away. To prove I know what I'm talking about, I lost 24 lbs. in 28 days by just eating low glycemic load. Low glycemic load is the best way to lose weight and improve both your cholesterol and blood glucose. You see, insulin is the fat storage hormone. When it's high, carbs. are stored as fat rather than being burned for energy. When it's low, you can lose a pound a day by just regular activities, even walking a bit each week.

    Your doctor is well meaning, thank God for that. We are now seeing lots of skinny newly diagnosed type 2s. They have a diet quality issue, not a diet quantity issue, but probably a high metabolism. If your insulin isn't high, you won't gain weight and you won't get type 2 diabetes. Why aren't doctors checking insulin levels? Good question. Maybe because they believe being overweight is the cause, but maybe they're wrong. :shock:
  9. mthinsi

    mthinsi Member

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    guys i have been recently diagonised prediabetes i want to know if i can get help to normalise my blood sugar and to nkow when it is likely to develop to a full blown diabetes :problem:
  10. daisy1

    daisy1 Moderator

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    Hi mthinsi and welcome to the forum :)
    To avoid the progression from pre-diabetes to diabetes, which is possible, follow the parts of this information concerning food to eat and avoid, and generally looking after yourself, which we give to new members. Although these members are diabetic, this information will be useful to you too.

    BASIC INFORMATION FOR NEWLY DIAGNOSED DIABETICS


    Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

    A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you’ll find well over 30,000 people who are demonstrating this.

    On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

    The role of carbohydrate

    Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

    If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

    The bad news

    Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

    The good news

    People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

    Controlling your carbs

    The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.
    There are two approaches to controlling your carbs:

    • Reduce your carbohydrate intake
    • Choose ‘better’ carbohydrates

    Reduce your carbohydrates

    A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

    The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

    Choosing better carbohydrates

    Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
    http://www.diabetes.co.uk/food/diabetes ... rains.html

    The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

    Read more on carbohydrates and diabetes

    Eating what works for you

    Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

    To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

    The blood sugar ranges recommended by NICE are as follows:

    Blood glucose ranges for type 2 diabetes
    • Before meals: 4 to 7 mmol/l
    • 2 hours after meals: under 8.5 mmol/l
    Blood glucose ranges for type 1 diabetes (adults)
    • Before meals: 4 to 7 mmol/l
    • 2 hours after meals: under 9 mmol/l
    Blood glucose ranges for type 1 diabetes (children)
    • Before meals: 4 to 8 mmol/l
    • 2 hours after meals: under 10 mmol/l
    However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

    Access to blood glucose test strips
    The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

    • structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
    • self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

    Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

    You may also be interested to read questions to ask at a diabetic clinic

    Note: This post has been edited from Sue/Ken's post to include up to date information.
    -------------------------------------------------------------------------------------------------------------------------------------------------------

    Please sign our e-petition for free testing for all type 2's; here's the link:
    http://www.diabetes.co.uk/petition/

    Do get your friends and colleagues to sign as well.
  11. hallii

    hallii Active Member

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    Discus, the GTT is a diagnostic tool and has no use in ongoing treatment.

    I suggest that your doctor is offering good treatment, it is well known that early treatment can slow the progression of T2 greatly.

    I am not saying that diet and excercise are not teatment. they are and they work. But despite managing to get to 5.4% hbA1c my DSN was keen to start me on one 500mg of Metformin. It has protective effects on organs and helps with BGs by allowing me a slightly more varied diet.

    So consider your options, maybe you can reduce carbs and still take the small amount of medication, or maybe you might want to keep control by strict diet and excercise. I know what I would do :)

    H
  12. mthinsi

    mthinsi Member

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    Thanx Daisy1
  13. Paul_c

    Paul_c Active Member

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    take the news that you're pre-Diabetic seriously... my GP did not stress to me how important it was to cut back on things that raised my glucose. I'd failed a glucose tolerance test, but no word of what exactly that meant was given to me... just some pre-printed leaflets that explained what the test was about. I was not told I was pre-Diabetic at all, that would have woken me up.

    In fact what the nurse told me was to get onto a low fat diet (which I did) because I had high bad cholesterol levels... and we all know know just how they make their products low-fat by adding sugar to make the product more palatable.
  14. Frida_11

    Frida_11 New Member

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    There are many doctors all around us and if you aren't sure in some treatment you can always see another doctor. If you think that some doctor doesn't have enough knowledge about something, check out the specialist. Due to the variety of illnesses there are many doctors, if you don't know which doctor visit you can do a little research. That is what I have done and I have found one interesting site where you can find out about every type of doctor and that is http://www.doctorstypes.com/. I hope it will help.

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