Failing to inform someone of issues directly relevant to their health and quality of life because of what you anticipate they might or might not do about it isn’t just wrongheaded. It’s outright malfeasance.
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Lets face it someone somewhere in some lab got the idea about selling more medication. They developed a test for t2 prediabetes just so they could sell more medications of course it made no difference what you did because if you are going to get diabetes you are simply going to get diabetes. No matter what you do it won’t change anything. It will only make more money for some drug company Oh! by the way I am a t1 but I had this thought when they first mentioned this Idea of prediabetes Just like they are looking fo a cure
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As someone in this age group, please don’t make this decision for me. It doesn’t matter if 99 out of 100 won’t do a thing about this diagnosis the 1 out of 100 deserves to know whats up.
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I just took the test. it says I am at risk for prediabetes. funny, I’ve had diabetes for 50 years.
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I agree with @BadMoonT2. Any hint of being written off as too old makes me mad.
Like the country song says " I’m not as good as I once was, but I’m as good once as I ever was" At least I keep telling myself that 
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I don’t always put my thought to page as well as I should. I would never try and make a choice for someone else. Heck, I have a harder enough time making choices for me at times.
But the point I was trying to make here, is by this point many doctors feel is it worst the risk, headache, chanllenge (put whatever word you’d like). That is also why they don’t push lower A1C numbers, or super tight control, or more exercise. Many feel it is dangerous and risky for an older patient. And please, again YMDV. But those of us who put in the work and try to maintain sound numbers and eat healthy and exercise. Who are not the norm in the diabetes world.
My case in point, a few years ago I ended up in the ER and than admitted due to DKA. It was the first and only time I had been admitted to the hospital for my diabetes and the first time in the ER in about 30 years. Everyone was shocked to hear that. ER Doctor said he was on a first name basis with many people with diabetes who were in the ER often. And the endo on duty had to come meet me because he also couldn’t believe I had never been in the hospital for my diabetes. As Mike has said and his videos “we are all little snowflakes” each very different. Hopefully I tried to clear up my comment and hope I haven’t again offended anyone. We are all in this together!
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Well you certainly haven’t offended me. I’m glad you started this topic and value your viewpoint.
I am 67 yrs old and had a brush with this type of advice from my doc just a few weeks ago. I started insulin about a year ago and my A1C’s have been up and down. Early on I got a 5.6 and was pleased as punch. Then I had to stop metformin due to other health issues. I started having very severe dawn phenomenon and had trouble keeping in range in general.
My next to last A1C was 6.5 my worst since diagnosis 7.5 yrs ago. I have gotten better at insulin so a few weeks back I got a 6.0 and was very pleased.
My doc was not pleased and said 6.0 was dangerous. Apparently the ACCORD study has risen from the dead due to a reanalysis of the data.
I might be proven wrong, but I’m not going to loosen control to levels where my neuropathy gets worse and I have increased chances of micro vascular complications.
At this point in my life I have decided that there may not be a perfect protocol to deal with my diabetes and other health issues. The choices I make may well involve balancing pluses and minuses.
I just want to make these choices with the best info I can get and not have it made for me.
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I just want to be certain I am not misinterpreting. She thinks 6.0 is dangerously low?
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She said she liked it much better at 6.5. I think I can get get it back to mid 5’s as I get better with insulin. So we have a disagreement as to goals:) Of course the D gods have a say. I may be back to 6.5 next time.
At 6.5 my neuropathy was noticeably worse, so that’s enough reason as far as I’m concerned to keep as tight control as I can manage.
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Yeah. I consider my recent 6.2 way too high. In this matter I keep my own counsel. Based on 20+ years of managing this best 365 days a year, I feel considerably more qualified to determine my own targets than anyone else can possibly be, regardless of how many letters they have after their name. That’s not a criticism, just a pragmatic fact.
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The ACCORD study has made a comeback I’m sure she was referring to it. It used a treatment protocol very different from mine. So who knows if it applies to me. I just figure the closer to normal I can keep my blood sugar the better off I am
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@BadMoonT2, do you use a CGM? I’ve found my pile of CGM data I bring into endo appointments will quickly reveal the standard deviation of the dataset. If you had a SD of 30 mg/dL then about 2/3 of your data falls between 96 and 156 mg/dL. (I know, I know! This data is not symetrically situated about the mean – it’s close enough!)
You can also characterize your lows to make the doc understand. Every one percent of the day equals 14 minutes. I’ll say to me doctor, “So I spend 14-28 minutes on average each day between 55-65 mg/dL. Even non-diabetics spend time every day in this range.”
That’s the trouble with the A1c number. The measure of BG variability must also be communicated for it to gain meaning. Doctors reflexively react to the a sub-6.5% A1c as a sure indication of severe hypoglycemia.
Did you know that the 2017 ADA Standards of Care draw the line for “serious clinical hypoglycemia” at BGs < 54 mg/dL?
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Yeah she’s worried about lows.
I’m able to keep it between 90 and 135 most of the time. Lows aren’t much of a problem. One 71 and that’s it.I recently read T2s often have lows that develop slowly, I test often enough to be able see them coming. Dawn phenomenon keeps me from going low at night.
For me eating LCHF is still the key. I’m not dealing with huge spikes and my insulin doses are predictable.
I started insulin b4 my pancreas gave out, home grown insulin production is a definite advantage. I think this helps me avoid both lows and highs.
My doctor lists my diabetes as controlled so insurance would never pay for a CGM.
I may download my meter data and print out some graphs next visit. She doesn’t believe I don’t have a problem with lows
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Have you ever considered a short run on a CGM, like 14 or 30 days? When she sees the numbers, maybe she’ll stop bugging you. One low at 71??!
I have a feeling that you’re not like most of her other patients and she won’t concede that point until she sees proof. If you can simply “smile and nod,” at least you can remain confident in your knowledge of your solid results. Good luck.
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Yeah that’s an understatement 
We actually have a pretty good collaborative relationship. When I wanted to quit Victoza because I was tired of dealing with the side effects she wanted to put me on Januvia. I rejected that option and asked instead to try insulin. She was happy to write me a prescription. I really appreciate that.
To be fair you can certainly find studies that point to an increase of macro vascular complications and a decrease in micro vascular complications with tight control. That’s why I say sometimes you have to balance pluses and minuses. Since I have reduced kidney function micro vascular complications are important to me.
It’s also hard to compare studies because many define tight control as <7.0 Not really my definition.
I found a study called the ADVANCE study that seemed to support my position. It showed a decrease in micro vascular complications with no increase in macro vascular. But upon closer reading their definition for tight control was < 6.5 where as my goal is < 6.0
Insulin has resulted in weight gain for me so that is a negative.
The other wild card is my LCHF diet. No studies have been done of people following my diet and insulin to achieve control <6.0.
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Love the balanced, thoughtful propaganda. (NOT)
Actually, now that I review what I just wrote, “balanced, thoughtful propaganda” is an oxymoron. Which is okay because I intended it to be snarky all along. 
But this is what i really wanted to comment on: [quote=“BadMoonT2, post:56, topic:59182”]
No studies have been done of people following my diet and insulin to achieve control <6.0.
[/quote]
SOOOO true. One of the most profound problems we have in discussing nutrition and disease is that many of the conclusions we have to draw are based on circumstantial evidence, not the definitive studies that would prove a point one way or the other. Sometimes this is because of ingrown prejudice in the affected scientific community, e.g., low carb, and often it’s because the cost of doing the definitive study on the scale necessary to nail down a point is, simply, prohibitive.
Gary Taubes makes this point again and again in his newest book.
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This is the 50th time you’ve mentioned that book. I think it’s finally time for me to order it and read it.
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50th???
Michael, Michael, Michael. If I’ve told you once, I’ve told you a million times: don’t exaggerate!
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On the one-hand, early diagnosis can lead to delay (or prevention?). On the other, it can lead to gross overprescription of medications which have their own side effects, requiring more medications with more side effects, and so on in a spiral that only ends with death.
I think that just because we CAN treat cheaply (metformin and ILM) and early, doesn’t mean we necessarily SHOULD do so. (The same thing is happening with “prehypertension” and “dyslipidemia (high cholesterol)”.)
What we need is more research into the CAUSES of “real” type 2 diabetes, and the TYPES of type 2 diabetes, what their development markers (e.g., genes and risk factors) are, and then consider what sort of counseling and/or treatment is needed based on the specific CAUSES, rather than just the SYMPTOMS.
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