Recently NICE has changed it's guidance to GPs on Metformin. They are now encouraged to prescribe it to pre-diabetics in the hope of preventing their progression to full diabetes. My latest A1c was 37, so as far as my GP is concerned I am worried well. However I have for years been suffering from a whole range of health problems, and I now think quite a number of them are attributable to raised bg. (From 2014 unbeknownst to me my A1c rose from 37 to 40 to 41. I then began to reduce the carbs I was eating and reduced it to 37.)
As you wisely pointed out, diabetes does not play by the rules or stick to a timetable. Also, many research studies have shown that the risk to the heart doubles as soon as a person has even low pre-diabetic levels of bg. I am at risk for heart problems, due to atrial fibrillation and also family history, so I take this seriously. I am due for another A1c soon and I am hoping against hope for 34. Given the daily test results I am getting, I probably won't get it. I am very strict about my LC diet, but my bg has not fallen in response nearly as much as I see with other people here who eat a lot more carbs than me. I think I am probably pre-LADA and will end up on insulin whatever I eat.
Here is some info. on blood glucose, normal and otherwise, from Jenny Ruhl's site:
"Normal Fasting Blood Sugar
Fasting blood sugar is usually measured first thing in the morning before you have eaten any food. A truly normal fasting blood sugar (which is also the blood sugar a normal person will see if they have not eaten for a few hours) is:
Between 70 mg/dl (3.9 mmol/L) and 92 mg/dl (5.0 mmol/L) .
This is the finding of a considerable body of research. People whose blood sugar tests at this level do not develop diabetes over the next decade or longer. Those with supposedly normal blood sugars above 92 mg/dl often do. Nevertheless, most doctors consider any fasting blood sugar below 100 mg/dl (5.6 mmol/L) as completely normal
Post-Meal Blood Sugar (Postprandial)
Independent of what they eat, the blood sugars of truly normal people are:
Under 120 mg/dl (6.6 mmol/L) one or two hours after a meal.
Most normal people are
under 100 mg/dl (5.5 mmol/L) two hours after eating.
What A1c is Truly Good Enough for a Person with Diabetes?
Doctors have been taught that any A1c below 7.5% (58.5) is "good control" for people with diabetes. However, this is true only if you define "good control" as meaning "Very likely to get neuropathy, retinal damage, and heart disease." Those of us who have had diabetes for decades have found that when we keep our post-meal blood sugars below 140 mg/dl most of the time we see A1cs that range from the 5.7% (38.8) level down. This level appears to be good enough to avoid the classic diabetic complications.
Heart attack risk rises in a straight line fashion as A1c rises from 4.6% (26.8) but only becomes a significantly raised threat as A1cs go over 6% (42.1). You can learn more about the relationship of heart disease and blood sugar test results on this page: A1c and Post-Meal Blood Sugars Predict Heart Attack."
You can read more here: http://www.phlaunt.com/diabetes/16422495.php