FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER IS DIABETIC, NEEDS MEDICATION AND LIFESTYLE CHANGE

Question: My doctor says I am prediabetic. My blood sugars have been in the 180 range in the mornings and my hemoglobin A1C has been around 8. My doctor has not started me on any medications because he is watching me and does not want to bring my sugar down “too fast.” He has been watching me for about a year. My friend says I need medications, and that I have been watched too long. Who is right?

Answer: Based on the information that you have given me, I would say your friend is right, not your doctor. Since you specified that the readings were in the morning, I’m assuming that the blood was drawn before you ate breakfast. With this type of “fasting” test, your 180 milligrams per deciliter (mg/dL) level would put you in the diabetic range -- not the prediabetic range.

For the record, most authorities say that your fasting blood sugar is normal if it’s in the range of 70 mg/dL to 100 mg/dL.  Prediabetes is usually classified as a fasting blood sugar between 100 mg/dL and 125 mg/dL.

Let me also clarify another point. While we do not want a person’s blood glucose to go too low, there is really no such thing as bringing your sugar down too fast.

I am hoping that in the last year your doctor has counseled you on diet, exercise and weight loss. In some cases it is acceptable to “watch” a patient for a few months while he or she makes lifestyle changes, but a year is a bit long, considering your glucose and hemoglobin A1C levels.

Diet is the key to controlling your blood sugar. Your doctor should prescribe the diet that he wants you to have. Eating a low-calorie, low-fat, low-sweets diet can improve your sugar and promote weight loss. I’d recommend eating reasonable amounts of food at the same times every day, rather than a cycle of skipping meals and then “binging.” This can stabilize your sugar. Keep in mind that not eating for long periods of time can be just a harmful to your glucose levels as overeating.

Daily walking or some sort of exercise for at least 20 minutes is important. This helps to lower your sugar as well as promote weight loss. Exercising every day is better than a few times a week as it promotes a good habit. Every other day activities are too easy to put off until tomorrow.

You should be monitoring your blood sugar on a regular basis, two to four times a day. And yes, you should ask your doctor to put you on medication since your sugars are outside of the normal range. If your doctor will not do that, you should find a physician that specializes in diabetic care and consult him or her regarding your treatment. Your body will function better with a normal sugar level, and there is no benefit to you to simply watch a chronically elevated sugar.

Now let me end with a bit of good news.  If you get treatment for your diabetes and change to a healthier lifestyle, there’s a decent chance that in a year or so, you might be able to cut back or eliminate your diabetes medication.  A real key here is getting your weight to a normal or near-normal level.  I know this may appear to be a difficult goal, but if you follow my dietary and exercise advice, you can improve your health little by little, day by day. 

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.