January 28, 2016
Treat Prediabetes as Type 2 Diabetes
Yes, this should be done. First, some definitions – Prediabetes = blood glucose levels of 100 mg/dl to 125 mg/dl and diabetes is considered anything above 125 mg/dl. As I stated in my previous blog, we should treat prediabetes as diabetes, no more and no less. It isn't even humorous that the majority of doctors ignore prediabetes completely.
You may hear doctors comment that, “watch what you eat as your blood sugar is creeping up,” or “your blood sugar is elevated.” Other doctors still use the older term “borderline diabetic”, or that you have a “touch of sugar.” Most times you will not even be told anything if your blood glucose levels are less than 115 to 120 mg/dl. We recently had a friend of Allen's comment that his blood glucose was 103 mg/dl and his doctor did not say anything. Allen asked him how he knew even this and his friend answered he always asks for a copy of his tests. His blood glucose test before the last one had been 98 mg/dl.
Allen said his friend had asked him if he did not have prediabetes and Allen agreed that he did. Allen said they had talked the rest of the evening about what he could do to gain control of his prediabetes. Allen covered the food plan that most of us use and developing an exercise plan. Allen said he had a substantial exercise regimen in place so they spent most of the time on a food plan. Tim suggest that he tell his friend that if he went above 115 mg/dl that he ask for a minimum dose of 500 mg (off-label) to be taken with his evening meal. Several other members that were gathered with us agreed.
I explained that it really did not matter, as any reading over 99 mg/dl meant that his pancreas was having problems and should receive assistance whether with exercise, a low carb, high fat (LCHF) food plan, or a medication. Tim agreed and added that is best for slowing the decline or healing of the pancreas. The younger a person, the best chance of healing and preventing the onset of type 2 diabetes. In an elder person, healing may not work, but often can delay the onset of type 2 diabetes.
Barry asked if his friend was testing and Allen said they had talked about this, but not made any decisions. Tim said that we should always suggest that they obtain a meter and test strips they can afford and if they have problems with this, they should consider a meter and test strips that they can obtain at Walmart. I agreed with Tim and said that once they have a meter and test strips, someone from this group should spend time explaining the best method of testing and what the test results mean, by teaching Self-Monitoring of Blood Glucose (SMBG). Then we should explain goal setting and what might be reasonable goals for them.
Brenda said that we should suggest various goals. She asked for anyone that disagreed to say something and we would discuss each point. Since we are dealing with prediabetes, fasting should be from 65 to 100 mg/dl and not higher. She said that fasting readings of higher than 100 indicates the need for meal plan concern and possible metformin. Postprandial should always be below 140 mg/dl and preferably not higher than 120 mg/dl. Readings higher that 140 mg/dl indicates meal plan problems and need for metformin possibly two times per day. She said I know this disagrees with the metformin recommended before, but until they bring the number of carbohydrates down and increase the fat consumption, metformin may be necessary.
This generated some discussion and most wanted the postprandial set at 120 or 125 mg/dl. We agreed on 140 to begin until they had a good meal plan (LCHF) and then bring it down to 120 mg/dl. Some felt that fasting should be 65 to 90 mg/dl, but most were comfortable with the 65 to 100 mg/dl. Tim also felt that anyone with fasting numbers 100 or above should ask for an HbA1c test and everyone agreed. We all agreed that even with the term prediabetes, we should consider it as the earliest stage of type 2 diabetes.