How to handle worsening pre-diabetes?

I am in a situation that I find rare. I have known I am on a track towards diabetes for at least 9 years, and possibly as many as 20 years if you go by the first time it was mentioned as a possibility. As such, I have tracked my sugars and gotten A1C tests during many years when someone else may have had no clue as to what their blood sugars were doing. My fasting numbers have always been acceptable (until very recently), so without a history of hypoglycemia and three rounds of gestational diabetes I would never have given it a second thought. However, I have been warned by many doctors that diabetes is in my future and, therefore, am aware of my blood sugar condition. Which is getting worse. I am (and have always been) a very healthy weight and stay pretty active. My diet isn’t ideal, but is better than most and is good enough that my doctor is impressed (she says she can’t believe I have such good numbers and that I must be really diligent about what I eat). However, I am not currently considered diabetic, only prediabetic. That was rather rambling. Here is my question:

  • Do I just watch my BG numbers get worse and worse until I cross the magic threshold and get labeled ‘diabetic’?

I don’t have anything left that I can really manage on my own. I am taking metformin, I eat as low-carb as I can manage, I stay a healthy weight, I stay active. Yet my fasting numbers are always above 100 (and I’ve had occasional numbers above 126). And my after meal numbers are getting to be high regularly (as in sometimes over 200 and often over 140 mg/dl). Do I just keep watching or is there a better path? As far as I know I am not insulin resistant, I just make too little insulin. My fasting c-peptide values are sometimes below the ‘normal’ level or, at best, at the very lowest limit of ‘normal’, My A1C has been hovering just under 6.0 for the last 5 years.

Thanks for listening! I hope someone has some insight into this. I feel like I just am watching a train wreck about to happen and there is nothing I can do about it but wait for it to happen. Rather frustrating!

I would get some sort of treatment plan in place with your doctor. Has she mentioned starting any medication to help you? Did you take meds during your pregnancies? I think there is a lot you can do. I would get antibody testing also = your c peptide is low. 6 is pretty high for not being on any treatment. Damage is being done over time so it’s a good idea to get a plan in action. I think some other people will come along with more specific advice for you- I hope this helped a bit.


Have you been tested for lada? Given your history you may be a good candidate, particularly with low c-peptide.

Hba1c of 6 should be high enough to get you officially diagnosed.

Treatment for lada is insulin. At this point probably low dose. If i were in your position i would be pushing for treatment. I like to keep my a1c as close to normal as possible, definitely low 5s. This is the only known way to head off complications.

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Hi CQJ1,

Have you considered working with an ACSM Registered Clinical Exercise Physiolgist?

I ask this question because I am hearing you say you are active yet you haven’t describe the type of activity you engage in.

Here’s a bit of science related to how the body manages glucose. Basic at best…

You already know that diabetes is a metabolic disease. Hence, we need to know the organ systems associated with metabolizing glucose. Did you know that skeletal muscle is an organ?

It is important to keep the organ skeletal muscle healthy because it is metabolically active. It does a great job in removing glucose from the blood.

Were you aware that after the age of 20-25 if you are not engaging in resistance training (that is lifting up heavy things) you use 4 pounds of muscle tissue annually? Think about how that affect one’s metabolism. When the body has plenty of muscle tissue whether we are asleep or are awake, (because skeletal muscle required blood, and needs to be oxygenated) it works for us by improving glucose uptake.

Think about this…

At night when we are asleep we really need glucose in order to keep the body functioning Glucose is the fuel that makes ATP (adenosine triphosphate). We need ATP for all bodily contractions voluntary or involuntary. The liver produces glucose while we are asleep and moves it through the Krebs cycle so that we stay alive while we fast during the night.

If the body doesn’t have enough skeletal muscle and one’s pancreas doesn’t produce enough insulin, what do you think happens when one takes there fasting blood glucose upon awaking? On the other hand, if one has maintained sufficient muscle mass and the liver does what it does over night (production of glucose) skeletal muscle can do with is does really well and by removing glucose from the blood and by store it in muscle tissue for when we need it.

I encourage you to locate an clinical exercise physiologist who can teach you how to safely engaging in resistance training with the objective of hypertrophy (building muscle mass)…

On another note…

Can I invite you to take part in my research… My aim to is educate people about successfully managing their diabetes. It’s pretty basic, but I feel strongly about reaching the masses regarding diabetes self-management education.

Thanks for listening. 8))

Have you done a IGT with insulin levels? If you really aren’t making enough insulin and aren’t insulin resistant, I would think taking insulin would be totally appropriate and would be healthier than maintaining a high glucose level. I’m not a doctor, just saying that if it were me, I’d be asking an endo those questions. Good luck!

Thanks! I have talked with my doctor many times over the years. Hence, I am taking metformin and I have my A1C checked twice a year. I know it is not ideal, but my doctor doesn’t feel there is a need to do anything until I cross the diagnosis levels. I, on the other hand, would prefer not to see my sugars get that high in the first place.

I did get antibody testing a couple of years ago and it came back negative.

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Thanks! I thought the same thing about lada but my antibodies test came back negative (and I had more than just the GAD65 tested, although I don’t remember what others at this point).

According to my doctor, diabetes is an A1C of 6.5. My A1C was 6.1 about 6 years ago and I brought it down to more like 5.8 and 5.9 with increased exercise, better diet, and better overall health (more sleep for one!).

I have thought about pushing for insulin, but my doctor seems reluctant (she says I am doing great and to just keep it up). Also, I am very intimidated by insulin. I can handle the needles (I took basal insulin during my first pregnancy), but I worry about getting the dosing right. Currently my reaction to meals is all over the place - one day I am at 109 after a meal and the next day I am at 202 for the same exact meal. So, I am hesitant to make a big fuss. However, I certainly will if that is the only way I can bring my BG back into the ‘safe’ region.

Thanks! That is very interesting. I have done weight lifting in the past. Perhaps it is time for me to return to that activity. Currently I am absorbed in the world of horses.

I haven’t had an IGT since my first pregnancy. I currently don’t see an endo, just a general practitioner. Perhaps my next step is to find an endo to talk with. Thanks!

An endo may be more willing to treat this aggressively.
So seeing one may be a good idea.


i also, think a endo is a good idea, but don’t do, what i did, find one you like,.

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I would find a doctor who will be more aggressive, I agree with whoever else said that. No reason to wait for things to get worse.