May 18, 2009

Metastudy Confirms Metformin Appropriate Treatment for Prediabetes

A study that reviewed several previous studies about the impact of using metformin on the progression of prediabetes to diabetes confirms that yes, people with prediabtes who take metformin end up with better blood sugars after 3 years than those who don't and are therefore less likely to be diagnosed with full-blown diabetes.

This isn't original research, it's just a look at the major studies that have examined the impact of metformin on prediabetes. But because I hear from so many people with prediabetes whose doctors won't give them any help at all, I though it worth a look.

Treating prediabetes with metformin: Systematic review and meta-analysis Muriel Lilly, Can Fam Physician Vol. 55, No. 4, April 2009, pp.363 - 369

The key issue to remember here is that the concept that "prediabetes" progresses to "diabetes" which treats the two conditions as if they were separate diseases is flawed.

In fact, the medical definition of "diabetes" is completely arbitrary. A committee years ago chose some blood sugar test results and defined them as "diabetes." They could have--and many argue should have--chosen different test result numbers. But they chose the ones they did mainly, their own documentation showed, to diagnose people with diabetes as late as possible, because of the severe penalties the American medical system imposes on people who have pre-existing conditions.

You can read about how the diagnostic standards for diabetes were set HERE.

"Prediabetes" was also defined arbitrarily at the same time as "diabetes" was defined and as has been the case with diabetes, the definition has changed over the years.

But what you, the person with abnormal blood sugar, need to understand is that there's no sudden change in your health that happens when you get an official diabetes diagnosis. Any blood sugar that is elevated above normal for hours each day can and will damage your organs. So if your concern is to keep your nerves, heart, kidneys and retinas healthy your focus should be on keeping your blood sugars normal, not in avoiding a technical "diabetes" diagnosis.

With this in mind you can see why the argument the medical establishment uses to argue that "more research is needed" re the use of metformin in prediabetes is a red herring. The argument is this: "We don't know whether metformin is preventing diabetes or just masking the symptoms by lowering blood sugar."

Those who argue this point out that if people stop taking metformin, their blood sugar may go right up to where it would have been without it. So if that is the case, the metformin didn't "prevent" diabetes and there is no point in prescribing it.

But hold on a minute. The damage from "diabetes" is done by the elevated blood sugars, which clog capillaries, block kidney filtration units, and destroy the nerves of the autonomic nervous system that regulate the heart. If we lower blood sugar we avoid this damage. There has never been a single study that shows that people with "diabetes" by diagnosis who maintain completely normal blood sugars develop any of the complications of diabetes. These are caused by the exposure to high blood sugars, not the underlying dysfunction that caused the high blood sugars.

So if giving people metformin lowers people's blood sugar to where it isn't going up to diabetic levels, this is good no matter how you look at it. Even if it doesn't change a thing except their blood sugar levels.

The real problem with using metformin to "prevent diabetes" lies in how "diabetes" is diagnosed in these studies. Most doctors and studies diagnose diabetes as meaning that the patient's fasting blood sugars have risen over 125 mg/dl. Because metformin often lowers fasting blood sugar 5, 10 or 20 mg/dl, someone who might have a blood sugar of 128 mg/dl and be diagnosed as "diabetic" will take metformin, get a fasting blood sugar of 123 mg/dl and be diagnosed "Non-diabetic" in the studies.

This makes a pretty graph or two for the researcher but it doesn't make much functional difference in the health of this patient. Because functionally there isn't much difference in how much damage you are doing to your body with a fasting blood sugar of 123 mg/dl vs 128 mg/dl.

What is much more significant if you are trying to keep people from going blind or losing their kidneys is what happens to the blood sugar after meals--which is a statistic these large "diabetes prevention" studies rarely track since it requires much more expensive testing.

A person with the fasting blood sugar of 108 mg/dl may be be going up to 180 mg/dl after meals and coming back down to 100 mg/dl in two hours. Or they may be going up to 270 mg/dl and drifting back down to 108 in 4 hours. Both people are prediabetic, but the first person is much less likely to develop diabetic complications than the second. And, in fact, the second is technically diabetic given the ADA diagnostic criteria since they have random blood sugars over 200 mg/dl--except that their true diabetic state never gets discovered since the doctors and researchers only look at their fasting blood sugar.

What people with prediabetes need to understand is this. Organ damage starts when blood sugars spend a few hours a day over 140 mg/dl. It doesn't matter what the fasting blood sugar is. It matters how long blood sugar stays over 140 mg/dl. Neurologists studying neuropathy (nevre damage) have found no relationship at all between fasting blood sugar or A1c and the likelihood of developing neuropathy. They've found a very tight correlation between the rise in incidence of neuropathy and 2 hour blood sugar values that are 140 mg/dl and higher on glucose tolerance testing. (You can read more about studies linking organ damage to blood sugar levels HERE.)

So if you have prediabetes defined either by fasting blood sugar greater than 100 mg/dl or post-meal blood sugars that go over 140 mg/dl for significant periods of time the thing you really want to avoid is neuropathy, because it is among the earliest diabetic complications and one that affects all of your body. (The very earliest appears to be carpal tunnel syndrome.)

Almost half of all "newly diagnosed" Type 2s have neuropathy--a complication that can take up to a decade to develop in people diagnosed with sudden onset Type 1 diabetes. That tells us how damaging all those years of untreated "prediabetes" really are.

Metformin can help lower blood sugar, but if you are a person with prediabetes who tests your blood sugar after meals while taking metformin, you'll often see that your blood sugar will still go high enough to cause damage unless you also cut back on your carbohydrate intake.

But metformin definitely can help, and it can allow you to eat more carbs and still get decent blood sugar numbers, which in turn makes it easier to eat in a way that maintains health since it's a matter of cutting down rather than cutting out the carbs.

So as soon as you find your blood sugar is higher than normal, the better off you'll be if you take steps to get your blood sugar back down to the normal range. Whether or not you reverse the underlying condition that made your blood sugar abnormal is irrelevant. Most of us can't, contrary to what many doctors tell people. But as long as we can keep our blood sugar in the normal range, we'll feel much better, since fluctuating blood sugars make for rabid hunger and depressive mood swings, and we will also maintain the normal blood sugars that will keep our organs functioning in a normal way.

If you are not getting normal blood sugars with reasonable dietary changes and your doctor won't let you try a course of metformin, ask why, and if the reasons don't sound credible, find a doctor who will be a better partner with you in the struggle to maintain your health.

PS: Legitimate reasons not to use metformin are known liver and kidney problems.

If metformin does not lower your blood sugars and they continue to deteriorate, it is possible you have an autoimmune form of diabetes. Metformin does not help diabetes caused by damaged beta cells and immune disease and people whose blood sugar does not respond to metformin often turn out not to have Type 2 diabetes.

 

26 comments:

Anonymous said...

haven't studies demonstrated lesser rates of progression to diabetes through stringent lifestyle modification. Rather going on a drug with modest reductions (approx 35% with metformin) in diabetes progression why not copy the lifestyle modifications employed in those studies that achieved greater than 50% reductions in progression? Wouldn't it be cheaper and potentially safer?

Jenny said...

Lifestyle is indeed the first step. But the people I'm addressing here are the many people I have been hearing from who are not able to get normal blood sugars even after adopting a fairly strict low carb diet and need a bit more help. Also those who have been on low carb diets for a long time but can't lose weight they'd like to lose.

If their problem is intense insulin resistance, metformin can make a big difference.

Metformin may also help with people who have hyperinsulinemia that is causing reactive hypos.

Finally, not everyone can do dietary restriction. Eating is a very complex issue, and when people have abnormal blood sugars and food issues, getting back into dietary control can be very tough.

Metformin, because it curbs both blood sugar excursions and appetite, helps a lot of people who fail at carb restricted dieting get going on a diet they can stick to, because the obsessive hunger is gone. Metformin doesn't work very well UNLESS you cut back on carbs, which is a point I make repeatedly elsewhere.

P said...

Jenny, thank you for the informative post. I take metformin because of PCOS. I think that I need to buy a blood glucose monitor and monitor my blood sugar. I also need to some research about liver issues like lactic acidosis that may result from metformin.

Jenny said...

P,

The data suggests that lactic acidosis occurs at the same rate in people who take metformin as it does in people who don't. It's a tiny incidence.

The only exception to this is people who have seriously compromised kidneys because the kidneys are what excrete it. If you can't clean your blood metformin might over time cause problems. But if your kidneys are working pretty well--not even perfectly, there is no concern.

There are some references about this on my page about Oral Diabetes Drugs

Trinkwasser said...

Incredibly I read of someone recently whose Endo had prescribed metformin for this very reason - to prevent the progression from fairly advanced "prediabetes" and her GP cancelled the prescription because she "wasn't diabetic yet"

Yes it also serves to reduce IR, and hyperinsulinemia as well as the high BG in itself is damaging through other pathways. It works synergystically with exercise in doing this. More than a few people have found that when IR is sufficiently improved the metformin can be reduced or deleted, IMO it's cheap enough to be used more often in prediabetes to help attain control quickly

Anonymous said...

I have tested positive for pre diabetes/insulin resistence and my doctor won't prescribe me with metformin but has told me to lose weight- I have already tried this myself by dieting stricly and cutting out carbs and have not lost any weight!
I just don't know what else to do- they say as I am not 'diabetic' I cannot have metformin even though I know it will help me so much!
I feel tired all the time, hungry a lot, moody, emotional and EXHAUSTED!
Seems like the doctor is happy to let me get diabetes before they treat this condition :(
To add- my fasting glucose is 7mmol and my 2 hour tolerance test was 11mmol which means I am 1mmol off being diagnosed as a real diabetic!? How does that figure?
Will I ever get help? How and what to do- any suggestons?!

Jenny said...

Anonymous,

From the units you report, it's clear you are posting from one of the countries that make it easier to pay for health care but harder to choose your own doctor. In the US the answer would be, find another doctor.

In the UK you probably need to drop into one of the UK support groups (links on the right of this post) and talk to the experts there who have fought with their local health authorities and got the treatment they need. I used to read the alt.support.diabetes.uk newsgroup and that was a common topic.

Metformin is so cheap it's hard to understand why the doc is so resistant. You might ask flat out since you are acutally 2 mg/dl off the diabetic diagnostic cut off which is within the margin of error of the test.

If there is an ombudsman or some way of appealing, print out the studies and document your diet and it's failure to control.

If you can't get normal blood sugars eating low carb, you probably do need medication.

If nothing helps, you probably will cross over the border into frank diabetes within 6 months and at your next appointment bring a meter along, eat something dreadful, and test in front of the doctor so they can see the very high blood sugar.

A little theater sometimes helps.

Trinkwasser said...

I'd suggest getting your own meter and doing this

http://loraldiabetes.blogspot.com/2009/04/test-test-test.html

should give you some ideas as to what to avoid. While you're there read the rest of the site, and Jenny's site too.

You can do a lot with an appropriate diet and appropriate exercise and this is a way to determine the appropriateness.

At the end of the day though it's appalling as the met would obviously make the job a lot easier.

I was just told (by a receptionist) that since I am not Registered diabetic I am not entitled to an A1c, an equally appalling way of saving money. I was told I could not have metformin until my A1c was over 8! Spending pounds to save pennies . . .

Anonymous said...

For a long time about one and half year started to gain weight significantly, wasn't feeling well. I was tired , moody, forgetful and developed insomnia and profound high blood pressure. All the healthy eating habits and exercise didn't help. I continues to gain weight even when all blood work came back normal. I heard about insulin resistance and metformine. I saw an endocrinologist with much reluctance he prescribed metformin. The first time I took it I felt better. I am now 4 wks feeling great. I have lost weight am sleeping better. I feel normal I am back to myself.

Ronzo said...

Beautifully written update! I am a U.S. physician who regularly prescribes metformin "off-label" for my patients who are pre-diabetic, as an adjunct to aggressive dietary and lifestyle changes. My patients regularly report feeling "better", with more energy, and decreased appetite. I am trained in Family Medicine, but now practice "outside the system", focusing exclusively on weight management and preventive care. Many patients report that their primary care physicians are inexperienced in using metformin, and are reluctant, sadly. I have spent many hours trying to "spread the word" to other physicians.

Monicaileana said...

I guess I have syndrom X with high cholesterol, high triglycerides and low hdl and high ldl or metabolic syndrome too I guess it is called. I am 54, female and I weigh 182 pounds at 5'2. About 3 1/2 years ago I went on a beta blocker for high blood pressure due to white coat syndrome, I am sure that that is what it was. I chose a beta blocker for myself as I tend to get rapid heart beats at times. I swear that the 3 years I was on beta blockers it increased my appetite and if I didnt eat every 2 hours I felt hypoglycemic but with normal blood sugar levels. Now here i am fighting high lipids, high blood pressure and pre diabetes. My fastings range anywhere from 93 to 114. Most times after i eat I test about 142, depends on what I eat of course, I've tested as high as 169 too. Because i've tried everything to lose weight as fora s I can, my Dr. gave me Metfomin just today. She said it can help to curb my appetite and thus help me to lose weight. Whn i've lost enough weight we can try to take me off the metformin and see how my blood sugars go. Any thoughts on this? I'm wondering too if pre-diabetes can be reversed with meds. My insulin was 16, cut off for diabetes is 17! My aic was 6.1 and i got it down to 5.8 but back up to 6 cause I got to lax in my diet. so any thoughts most appreciated!

Jenny said...

Monicaileana,

A high insulin doesn't necessarily mean diabetes, all it means is that you are strongly insulin resistant and producing a lot of insulin.

It isn't actually true that most people with Type 2 diabetes produce a lot of insulin. Many of them have lost up to 80% of their beta cells by the time of diagnosis.

Metformin is a very appropriate prescription for insulin resistance. It works even better if you go way easy on your carbs. And it does help with appetite control for many of us.

Give it a week or two for your body to get used to it. The first couple days can be rough, but they you adapt.

Kim said...

I am taking 500mg twice a day of Metformin and also taking Januvia. My fasting blood sugars continue to stay around 200-275. Is the Metformin not working? What's the alternative in that case? No carbs? Insulin?

Jenny said...

Kim,

Those are damagingly high sugars, so metformin is not enough to address your needs and Januvia is not doing what it does in people for whom it works.

Insulin, prescribed correctly, would be the safest drug and the one most likely to lower your blood sugar to a healthier level.

Doctors often delay starting patients on insulin because they think patients would prefer pills. But insulin usually works. Just make sure you read up about it, and don't just use one of the basal insulins--Lantus or Levemir--because with very high sugars, they rarely can control the post-meal spikes. Fast acting insulin at meal times is very effective, but many family doctors aren't comfortable prescribing it. Research it on your own, and then see if you can either a) see an endicrinologist who can prescribe it, or b) get your family doctor to send you to a Diabetes Educator who can help you with the doses.

I'm assuming you have already tried cutting back on carbs. But if getting down to 15-20 grams a meal, tops doesn't make a dramatic improvement in your blood sugars, you probably are low on insulin and would do better with the supplementation.

BTW, if you start insulin STOP taking the Januvia. It's such an unsafe and expensive drug and it is not supposed to be prescribed with insulin, though the drug reps have doctors doing that, even though it makes no sense pharmaceutically.

My Left Foot said...

About a year an a half ago my fasting blood sugar was 5.0 and then went to 6.0 and today it is 5.8 (Some scale I can't remember the name) but the fasting blood sugar level is 125. The doctor is concerned that given my family history I am at an increased risk of developing full blown diabetes.

My mother passed away in 1996 at age 60 from kidney failure due to diabetes. (She removed herself from home dialysis with her doctors permission) She had lost her toes and then one leg. It was a hard life indeed. I should know better, right? But, alas, I have fallen into the trap of "It wont happen to me". I am angry at myself for this diagnosis. I should have learned a lesson.

At any rate, I was prescribed Metformin today and tomorrow will take the first pill. However, I am deathly afraid of medication when I read the side effects. The fatal lactic acidosis scared me. In fact, I already have some symptoms not caused by the medication, of course, like ankle swelling, headaches, tired (Sleep apnea) and some of the other items listed. How will I know what is normal and what is not and when to call the doc to make sure I do not develop this deathly side effect?

Two years ago I went to the neurologist due to a numb right leg. He said pinched nerve, but its worse and now if I touch the nerve above the ankle in my right foot, I get jolts sent down my foot.

How afraid should I be to take Metformin? I don't want to be a diabetic. The only pill I take is my diovan for blood pressure. I have been known to fill medications and not take them after reading the side effects, and I know this is wrong, but some of the side effects seem worse than the disease itself!

Please don't tell me I am over reacting, I know I probably already am, but I really need facts to help me make an informed decision. Also, if I lose weight and exercise, would this mean I can stop the Metformin?

Thank you for your informative article.

Kelly

Jenny said...

Kelly,
Kelly,

If you read the Metformin page on my site HERE you'll learn that good research has found that the incidence of lactic acidosis among people taking metformin is no higher than among those NOT taking it.

Metformin is the safest of all the drugs for diabetes and it even has the "side effects" of lowering the incidence of both heart attack and cancer.

The A1c can be very low in people with high blood sugars if they have certain red blood cell varients. Your fasting blood sugar IS diabetic, and it is the LAST measure of blood sugar health to go up. It is the post meal blood sugars that do the damage.

But you don't have to go the way your poor mom went. Here's what you have to do:

Try the technique that you'll find explained HERE. If you don't have a meter and strips yet, insist your doctor prescribe them. They are the most powerful tools you'll have for controlling your blood sugar.

If you cannot get your blood sugar under 140 mg/dl after meals using the strategy described on that page (though many people with Type 2 can, including those in much worse shape than you), and if metformin doesn't do it either, then you MUST demand that your doctor put you on insuliny. It has been shown that insulin given close to diagnosis (when blood sugars are reaching 200 mg/dl or higher after meals) makes a huge difference in long term outcome--even if the person STOPS the insulin in a few months.

You mom's complications occurred because old fashioned doctors were not aggressive with lowering blood sugars. Now we know that lowering blood sugars with diet, metformin and insulin is completely safe and will go a long way to eliminating all the classic diabetic complications.

So put aside the fear. You can live a long healthy life. But to do that you will have to watch your post-meal blood sugars--they are what cause complications--and keep them as close as you can to normal. Do that and you'll be fine.

My Left Foot said...

Thank you for your reply and I did read on the lactic acidosis which helped calm my nerves. It just seems so much to take in since I was diagnosed with Sleep Apnea in January, and told on Monday that my echo cardiogram showed a slight enlargement to the heart due to High blood pressure.

I woke this morning with a new mindset, but also a realistic one and know that this will not be gone overnight, if ever. I have to change my life with diet, exercise, etc.

I never eat breakfast, but the Metformin is suppose to be taken with food, so, I ate a bowl of cereal and banana. I just gag at eating so early, and usually it makes me sick to my stomach to eat. But, I want to be healthy.

I printed out a coupon last night for a free Onetouch Lance device. My son said "you don't have diabetes, so why get it, you only have pre-diabetes) But what I have read is that there seems to be no difference in pre and full blown when it causes damage. Oh..while typing this right now, the doctors office just called and said I should be testing my blood sugar before meals. The nurse was seeing about a prescription for the lancets. I am on hold. :)

So..the decision is...they are supplying me with a monitor to test my blood. They apologized as they did not give this to me yesterday when he called in the prescription for the Metformin.

My doctor replaced my former doctor who moved and I only saw this man for the first time on Monday. In two days I have had so much more care than I have in 4 years with my other doctor.

I took my first pill and I am at a loss as to what to test for though. I feel like I need classes. Actually, all of this is overwhelming. I want to cry for feeling helpless, hopeful, scared, and an array of mixed feelings.

Can you direct me to a support type group online, or are there organizations? By testing my blood sugar levels, I feel like its not just a diagnosis of pre, but that I do have it. I am so confused. However, it was me who initiated the testing by telling the doctor I was concerned and want to make sure I am not diabetic.

Thank you, I need to go read, research and find ways to help myself get out of this mess.

Thank you again.
Kelly

Jenny said...

Your doctor's advice to check before meals suggests that he is old fashioned and doesn't understand the point of testing. Please follow the technique you'll find at THIS PAGE. Pre-meal sugars are only important if a person is injecting insulin. It is post-meal highs that do most of the damage.

Metformin can take a week or two to adapt to, and you might feel yuk during those first days, but give it time. Most people adapt. Metformin ER, the longer lasting form is easier for most of us to metabolize. If your doctor prescribed regular metformin, ask about the extended form if you have continuing issues with the regular form.

A fasting sugar of 125 mg/dl IS diabetic, and the chances are your post-meal numbers are high. So please start testing and tweaking your food intake the way that the page I mentioned directs. I hear from hundreds of people who have found this technique works really well.

You can find support online on forums listed HERE.

My Left Foot said...

Thank you again, and I am going to look at those suggestions. My doctor called back again today and backed out of giving me a Blood Glucose device to test my blood sugar.

He said I am NOT diabetic yet and that there is no reason to test. He did tell me that I have to have a blood test in a month again to see if it is working. At that point he will decide if I need to test at home and will give me a device they have.

It was the nurse who told me to test before meals, so I am not sure that is his opinion...I am sorry, that was misleading before as I did not state who said it correctly.

So, is there any harm in my getting this free one I printed the coupon for and testing anyway? The nurse told me that if he gives me a device, I need classes. My father was on hospice and living with me. Each day I had to test his blood sugars, so I know how to use the device.

I am confused, why would he say at 125 fasting is NOT diabetes? At any rate, today was not good on the med. I ate breakfast and took a pill. That was 8 am. I did not eat again till 3 pm, but by then, I thought I was going to pass out from hunger. I was faint and dizzy. That did not happen to me prior to the pill. I would get hungry, but not to the point of feeling faint.

Thanks again...I am going to read those links you sent. Oh...my version of Metformin is 500 mg twice a day after two weeks. for now it is once a day. It also says MFG Mylan. Not sure what that is.

Jenny said...

Your doctor is dangerously ignorant. He would say 125 mg/dl fasting isn't diabetic because he's woefully behind in keeping up with diabetes. You MUST find a new doctor who will take aggressive steps to control your diabetes. A doctor who won't give you a meter with a fasting sugar that high is toxic. Most doctors nowadays are getting aggresive when people's blood sugar is in the pre-diabetic range (which starts at 100 fasting.)

Get yourself to Wal-mart and buy a Walmart meter and strips. Test after one of your usual meals and if you see a reading over 140 mg/dl it's time to get to work to lower your blood sugar. If you see a reading over 200 mg/dl you are 100% diabetic and will end up with complications if you don't find a better doctor.

"Diabetic" complications doctors now know begin in the "pre-diabetic range" heart attacks start when people's blood sugar is only a tiny bit over the lower cut off for pre-diabetic--at 150 mg/dl one hour after eating a meal.

Your issues are complex and need to be treated by a good doctor--not dealt with in the comment section of a blog. PLEASE FIND A NEW, YOUNGER DOCTOR who will give you the treatment you need if you are to avoid your mother's fate.

Cathy said...

I read, on a recommended diabetic web site, that a person who DOES NOT have diabetes will have a fasting blood sugar less than 100. Being newly diagnosed with diabetes ( never told what type) I'm confused as to how I could have normal (non-diabetic) a.m. fasting blood sugars yet have postprandial blood sugars over 200- am I really only prediabetic? Would metformin be of help to me even if I have normal fasting blood sugars?
Thanks, Jenny

Jenny said...

Cathy, You'll find your question answered here: The Patterns in Which Diabetes Develops.

The short version is that many people, especially women, develop diabetes in a pattern where the post meal sugars go dangerously high first and the fasting sugars follow later. If you wait until the fasting sugars are high enough for a diagnosis, the person will have full-fledged diabetic complications on the day of diagnosis.

It's the post-meal highs that correlate most closely to organ damage. The good news is that if you catch diabetes early (when you only have short post-meal highs) you can bring the sugars down and avoid the complications.

To do that, try the technique you'll find described HERE.

Sue said...

Hi Jenny,

I have a strong family history for type 1 diabetes in both maternal grandparents and type 2 in both parents. At one point my fasting was 116 with an A1C of 7.0. At that point I was slightly overweight. I have lost almost 25 pounds since then due to another medical issue that required surgery. My latest fasting was 95. I have been taking 250 mg of Metformin for a couple of years. I have not tested after meals. What I am concerned about is the 250 mg dosing (that I pushed the doc to prescribe). I feel that 500 would be the appropriate dose. My feet, legs and lips are still going numb on me. How can I convince him to go to the 500? He was very reluctant to start it at all. My BMI is mid-range normal. I'm 5'0 tall and weigh 110. Taking BP med (that was elevated to 140 2 weeks ago) and cholesterol levels are bad. Thanks,

Sue

Jenny said...

Sue,

Numb lips are not a diabetic symptom, nor are transiently numb legs and feet. Diabetic nerve problems start with tingling, don't go away, and are largely confined to the feet for the early years.

A fasting of 95 is pretty decent, too. What you really want to check, though, is your post-meal blood sugars with a blood sugar meter. You can buy one without a prescription. The cheap Walmart meters will do for your purposes. If you are seeing blood sugars that are rising over 140 mg/dl at 1 hour after eating, and still above 120 at 2 hours that would point to a developing problem.

With your family history, it's possible you aren't making insulin rather than that you are insulin resistant. In that case, metformin might not be all that helpful. But before you worry about that, find out what your blood sugars are doing after meals. If they aren't rising over 140 mg/dl for any significant amount of time, you're fine.

Mama Bear said...

Hi Sue,

I do have to pipe in and say with your past higher bg levels, you could be getting some neuropathy symptoms- I see a lot of pre-diabetics who already have neuropathy in their feet. Hands not as common- might want to have your b-vitamin levels checked.

I've only had diabetics get numb lips when bg levels are dropping. But your ht/wt really make me agree with Jenny about insulin deficiency versus type 2 resistance.
anyway, for what it's worth... that's my 2 cents, :)
Maria (CDE 20 plus years)

Mama Bear said...

Very nice blog you have & if you have pre-dm & your doc won't give you metformin- (as a few people posted here) .... get a new doc! :)

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