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June 26, 2003

Research: Causes and Prevention, Type 2

Question from Ark, Virginia, USA:

I am 58 years old, I have no family history of diabetes, and my primary care physician has been testing my blood glucose level. After I had readings of 114 mg/dl [6.3 mmol/L], 193 mg/dl [10.7 mmol/L] (fasting), and 212 mg/dl [11.8 mmol/L] (after a meal), at different visits, he said that I have prediabetes. Recently, I have had complete blood work, including an A1c test which was 6.4%. I monitor my blood glucose levels at home, and they have been 68-126 mg/dl [3.8-7 mmol/L], depending on what I eat. The dietitian has prescribed 250 mg. of Glucophage, plus diet and exercise. Is the Glucophage necessary? Should I see a diabetes specialist?

Answer:

In many laboratories, the hemoglobin A1c you describe is elevated, but this will need verification from the lab your physician uses. The blood sugar numbers you describe are abnormal, and I would be concerned that you already have type 2 diabetes since the fasting value of 193 mg/dl [10.7 mmol/L] is very high. See Classification and Diagnosis of Diabetes.

Glucophage [metformin] is a medication that is used for insulin resistance and type 2 diabetes. It has been shown to lower glucose levels without hypoglycemia and without weight gain. I do not think it is bad to use Glucophage in this situation, but I would be concerned that you are not using enough.

JTL

[Editor’s comment: For more information about diabetes prevention, see Diabetes Prevention Program (DPP).

By the way, the dietitian did not prescribe the Glucophage. She may have recommended it, but only physicians (and in some states advanced practice nurses and physician assistants) have prescriptive authority.

SS]