Metformin for prediabetes question

[MarcR]

Another +1 for Tincup's advice.

I too recommend that you review Kraft's and Crofts' work and do a two-hour postprandial insulin test. Fasting blood glucose is not a good surrogate test for insulin sensitivity. Many insulin resistant people have normal FBG, and some insulin sensitive people have elevated FBG. The 1PP glucose and the 2PP insulin are much more meaningful.

Also, the HbA1c test is far from authoritative. We have discussed its limitations here previously; I recommend these topics to you:

Odd A1C/Insulin results
More about HbA1c limitations

I agree with Tincup that your lipids look good and would like to highlight your TG/HDL ratio of 1.4. After converting units from mmol/L to mg/dL if needed, anything under 2 indicates insulin sensitivity, and optimal is <1. For more on this ratio, I recommend this blog:

The Most Important Lipid Panel Marker

Ultimately, glucose, insulin, HbA1c, triglycerides, and HDL are just surrogate markers for insulin sensitivity / resistance. In my opinion, the most direct and convincing test is how you feel when you fast. If you're metabolically healthy, fasting for 16 hours while engaging in a full range of physical activity should be comfortable. Your mitochondria should seamlessly switch among glucose, fatty acids, and ketone bodies as needed to produce the ATP that fuels your cells. Hunger pangs should come and go within 15-30 minutes and be unaccompanied by other symptoms like shakiness, brain fog, or energy deficit. In this way, you can use fasting to test as well as maintain (or improve) your metabolic health. I found this presentation from J. Stanton to be informative and inspirational:

What Is Metabolic Flexibility, and Why Is It Important?

[Newtothis3/4]

If one of you out there had an A1C of 5.8 and fasting glucose of 104 with alow sugar diet and paleo following, coupled with having a good BMI, daily exercising and needing a statin to keep my cholesterol in check, would you be fine with being pre-diabetic 5.8 and having a fasting sugar of 104-114? Or would you consider medication intervention (Metformin). I’m 42 and realize I would already have to take it presumably for life. I’m already blown away that I need a statin and bp meds to keep me in range. It’s quite a defeating sense of lack of control when you can’t control the body through environmental influences. I’m curious for opinions. My fear is I will keep climbing up A1C and become full blown T2, or that my current level will be of an adverse effect on my body for AD versus controlling it with meds. I have read other people’s threads on here whose lipid profile, diet and body composition is nowhere similar to mine (In the wrong direction), yet they have low A1C and fasting sugar.

[slacker]

If one of you out there had an A1C of 5.8 and fasting glucose of 104 with alow sugar diet and paleo following, coupled with having a good BMI, daily exercising and needing a statin to keep my cholesterol in check, would you be fine with being pre-diabetic 5.8 and having a fasting sugar of 104-114? Or would you consider medication intervention (Metformin). I’m 42 and realize I would already have to take it presumably for life. I’m already blown away that I need a statin and bp meds to keep me in range. It’s quite a defeating sense of lack of control when you can’t control the body through environmental influences. I’m curious for opinions. My fear is I will keep climbing up A1C and become full blown T2, or that my current level will be of an adverse effect on my body for AD versus controlling it with meds. I have read other people’s threads on here whose lipid profile, diet and body composition is nowhere similar to mine (In the wrong direction), yet they have low A1C and fasting sugar.

I appreciate your frustration Newtothis, and agree that a HbA1C of 5.8 should be improved if possible. We all want to help you as best we can, without knowing the specifics of your diet, lipid results prior to statin, or if you have had a more in depth lipid panel drawn. How are your trigs and HDL? These are all complicated areas that can sound simple on the surface. Consider taking a look at our wiki on insulin resistance; it might be of assistance to you.

While most of us here have at least one E4 allele, there are still other factors that drive our lipid, vascular, and glucose metabolism pathways. One size will not fit all. Many of us have to continue to tweak and retest.

[MarcR]

If one of you out there had an A1C of 5.8 and fasting glucose of 104 with alow sugar diet and paleo following, coupled with having a good BMI, daily exercising and needing a statin to keep my cholesterol in check, would you be fine with being pre-diabetic 5.8 and having a fasting sugar of 104-114?

If I were in your situation, I would question very seriously the need for a statin, especially given that statin side effects include elevated blood sugar and type 2 diabetes risk. From the Mayo Clinic:

Statin side effects: Weigh the benefits and risks

In my opinion, resolving insulin resistance is crucial, and the science suggesting that micromanaging serum cholesterol is good for human health is highly suspect.

[tenhorses]

Hi Newtothis3/4 -
I am in a similar situation. I am a strict Keto-diet follower, take no prescription meds, have a good BMI, exercise regularly, good markers, but my fasting blood glucose is consistently 118. My "Bredesen" medical practitioner scratched his head, advised I have insulin resistance, and suggested Metformin. After repeating the fasting blood tests four times, all with the same results, I agreed. I've been on Metformin for about 2 weeks, and don't know if its a good thing or bad, but my on-line research shows it is probably a good thing. I'll be repeating the fasting blood test soon. I'm not sure what other option I have besides Metformin, given the "typical" fixes for insulin resistance (diet, exercise, etc.) are not working. I'm certainly all ears if anyone has any ideas on the subject....thanks for posting!!!

[dcox]

Hi Newtothis3/4 -
I am in a similar situation. I am a strict Keto-diet follower, take no prescription meds, have a good BMI, exercise regularly, good markers, but my fasting blood glucose is consistently 118. My "Bredesen" medical practitioner scratched his head, advised I have insulin resistance, and suggested Metformin. After repeating the fasting blood tests four times, all with the same results, I agreed. I've been on Metformin for about 2 weeks, and don't know if its a good thing or bad, but my on-line research shows it is probably a good thing. I'll be repeating the fasting blood test soon. I'm not sure what other option I have besides Metformin, given the "typical" fixes for insulin resistance (diet, exercise, etc.) are not working. I'm certainly all ears if anyone has any ideas on the subject....thanks for posting!!!

Welcome tenhorses!
Insulin resistance can be a tough one to crack even when we think we are doing everything right! Remember that you are a unique individual and what works for others may not necessarily work for you in the same ways. I'm wondering, without knowing your specific details, if maybe dialing back the "strict" keto a little might help. Also, other lifestyle areas affect insulin production/sensitivity such as quality and quantity of sleep; type, duration, intensity and timing of exercise; the everyday, and accumulated, toxic burden of our body; how we handle or transform stress, among other possible factors. For example if you are exercising to an extreme level, you could actually be putting your body in a state of stress which decreases insulin resistance (in a nutshell). It sounds like what you are doing is keeping your fasting blood glucose stable, albeit a little high, so looking beyond diet and exercise might give you some new insight into why your level stays at 118.

I encourage you to explore ApoE4.info, there are so many motivated, caring and hopeful people here all sharing information and stories, with a common goal to beat Alzheimer’s! Here are a few pages that may will give you great places to start taking a deeper dive into the site: the Wiki Page, where you will find some more in depth topics; "How-To" get the most out of the APoE4.info website page, it is very easy to use and will allow you to spend your time on the site more efficiently. I also highly recommend the Primer it's a great place to glean information even if you already have a good handle on AD, it was written by Stavia, one of our most active members who is also a doctor, and is E4/E4 herself.

The Wiki page on Insulin Resistance as slacker noted above would be a great place to start. Also, here is the link to our more indepth information on Ketosis. The Main Wiki page (above) also gives you a lot of information about the other lifestyle factors you may want to check out.

We would love to hear more about your ApoE4 journey, what is working along with what may not be (as you have shared in this post), and your experience with your "Bredesen" provider. You can post your story on theOur Stories forum as you are ready to share.

Please feel free to reach out to me our anyone else as questions arise, we are all here to support and encourage each other on this journey.

We look forward to hearing more about your journey as you share and learn along with us.

Find your joy and hope in each new day and each new discovery along your path,
Deb

PS Do you raise horses? My husband and I raise/train horses on a small scale, they are my stress relief in so many ways!

[tenhorses]

Thanks so much for the warm welcome! I am enjoying this amazing site very much, and am very encouraged! And yes, I am a lawyer by day, and a horse trainer/owner/competitor/boarding stable owner by night. It is absolutely my stress relief too!

[Whatnow]

Hi Newtothis and tenhorses,
I, too, suggest checking post-prandial glucose levels. In particular, you want at the very least to ensure that your after meal blood sugar does not spike above 140. I believe it has been shown that high post-prandial blood sugars precede the development of high fasting blood sugar. If you want to avoid transitioning to full blown T2D, monitor post-prandial and adjust your diet as necessary to avoid blood sugar spikes at any time (whether 30 minutes, 1 hour, 1.5 hours or later) above 140. At levels above 140 you begin to see damage to capillaries and also, I think, to the beta cells which produce the insulin.

[mike]

I’ve become paleo and have adhered completely to the diet. I just got my labs back and was confident my A1C and glucose would be down. Not at all!

Newtothis3/4,

I've been a diabetic for 20 years. Metformin is the standard first medication, and is supposed to be an okay drug. I stopped using it a couple of years ago, and saw no change in my blood sugars, but I think it was helpful early on. When you say "paleo" what do you mean exactly. You are probably not to this point, but I can't tolerate most carbs any more. Things like sweet potatoes, or even carrots and onions have too many carbs. I know this because I test my blood sugars. Often with pre-diabetes, they will say stay away from white (bread, pasta, etc.) and stay with the more-complex carbs (whole grain). I'm beyond that, and just have to say no to all grains and any underground vegetables. You need to test to see what carb load you can tolerate.

[MarcR]

Hi Newtothis3/4 -
I am in a similar situation. I am a strict Keto-diet follower, take no prescription meds, have a good BMI, exercise regularly, good markers, but my fasting blood glucose is consistently 118. My "Bredesen" medical practitioner scratched his head, advised I have insulin resistance, and suggested Metformin. After repeating the fasting blood tests four times, all with the same results, I agreed. I've been on Metformin for about 2 weeks, and don't know if its a good thing or bad, but my on-line research shows it is probably a good thing. I'll be repeating the fasting blood test soon. I'm not sure what other option I have besides Metformin, given the "typical" fixes for insulin resistance (diet, exercise, etc.) are not working. I'm certainly all ears if anyone has any ideas on the subject....thanks for posting!!!

Tenhorses, have you ruled out physiological insulin resistance? If your triglycerides to HDL ratio in mg/dL is under 2, and you haven't already looked into this, I suggest googling "physiological insulin resistance" and "adaptive glucose sparing". Many people believe that high FBG with low fasting insulin is benign.