I am 54 years old, have been overweight all of my life, and I had an insulin level of 238 (I think normal is 16-28) following a glucose tolerance test, which my doctor says indicates I have “pre-diabetes”. I am on Glucophage [metformin] and Topamax, but have been given no other guidance except to exercise and eat a healthy diet. What am I looking at?

“Pre-diabetes” is not one of my favorite terms. It appears you have insulin resistance. Individuals with insulin resistance tend to be at risk for diabetes. It appears that those individuals who can mount enough of a beta cell response (to make insulin), avoid diabetes. However, others do not and develop diabetes or fatigue over time. Either way, individuals tend to be at risk, have elevated lipids, hypertension, and are also at risk for cardiovascular disease.

Therapy is at multiple levels and includes diet, exercise, and even medication if blood pressure is elevated, lipids are high, or if diabetes is present. Your insulin level is high. If you want to look this up, research insulin resistance or the “metabolic syndrome” or “syndrome X” [these last two are synonymous terms].

JTL

[Editor’s comment: See The Role of Diet in the Etiology and Treatment of Insulin Resistance and Glucose Intolerance.

SS]