I am a 31 year old female, and I weigh 170 pounds and am 5 feet 4 inches tall. I am in good health, but have many genetic factors that put me extremely high risk for getting type 2 diabetes, and I have read some information about Glucophage being used as a preventative, so I want my doctor to prescribe this for me. Past blood test results have shown that I have borderline high blood sugar. Losing weight has always been a problem for me; I think Glucophage might also help with that. I was also wondering if I drink five to six beers, two nights a week, if that puts me at serious risk for the severe side effects (build up of lactic acid) of Glucophage? I really believe that this medicine could help me, but I don’t want to jeopardize my health. What do you think?

When I field questions about the diagnosis of diabetes, I always ask people to try to determine if they truly have diabetes. For instance, terms like borderline diabetes or mild diabetes are not good enough. Either you have diabetes or your don’t. Individuals with diabetes may have mild glucose elevations and few symptoms but have diabetes. I preface my comments about the use of Glucophage [metformin] because it is more acceptable to use this medication if you have diabetes.

It is true that there was a recently reported study looking at individuals at risk for developing diabetes. They were randomized to different interventions designed to test whether diabetes could be prevented. The interventions tested included Glucophage, intensive lifestyle change (including diet and exercise), and a control group. The study showed that the lifestyle change was much more potent in preventing the development of diabetes, although Glucophage had a beneficial, although less potent effect than lifestyle, in preventing type 2 diabetes.

My suggestion to you is that you discuss with your doctor whether you have met the criteria for the diagnosis of diabetes. I would also have you ask the question whether you are doing all you can to change toward a healthier lifestyle. Glucophage would be acceptable if you have diabetes now. In addition, I would insist on a healthy lifestyle. If you do not have diabetes now, you should discuss with your physician the risks and benefits of Glucophage as a prevention. You may have to take the medication for years to see the benefit if you don’t have diabetes at present. However, I would still urge you to address diet and exercise issues. Side effects of the Glucophage include loose stools. It is contraindicated in individuals with heart, liver, or kidney diseases.

JTL