Prediabetes is like the two minute warning just before the end of the first half in a football game. You have those minutes of reflection and then perhaps the entire second half, but if you’re too far behind much of the second half might be a hopeless effort. This isn’t an exact analogy, of course, but if you’ve got that two minutes, that A1c rising into the diabetic zone at about your own midpoint or even later, your response to the warning could have everything to do with the nature of the second half.
Studies suggest that prediabetes leads to type 2 diabetes within ten years or less, often far less, so it makes sense to do whatever you can to avoid the next step. At least that’s what I’ve decided.
My A1c has risen in the last three years of annual blood tests from 5.7% to 6.1%. At 5.9% last year my doctor suggested I cut back on carbs. I did it in a half-hearted way. I switched to whole grain bread and I stopped eating pasta three or more times a week, but the natural progression of 0.2% per year stayed the same. Furthermore, my triglyceride levels were rising yearly along with the glucose levels and my HDL cholesterol levels were dropping. A little reading pointed out pretty clearly that body’s chemistry was announcing, from its primary microphones, my two minute warning.
My doctor seemed to hear it less clearly than I did. She gave me a choice, a drug, metformin, which would reduce the amount of glucose produced by my liver, or just waiting another year or so until my A1c reached 6.5% at which time she could officially label me as a diabetic. Then, she, or any other doctor could prescribe from among the usual dietary and medicinal remedies. I would be a full fledged member of the club giving me the capacity to share all of the deficits, and what seemed to me the single benefit, the clarity of an absolute label. I chose the metformin. The doctor warned me about possible side effects, mainly gastrointestinal.
I began taking metformin 500 mg twice a day and I started reading even more about the effects of carbohydrates on a body like mine that was becoming more insulin resistant by the year. My reading influenced above all by Gary Taubes, Good Calories Bad Calories and other works promoting fats over carbs has been pretty convincing.
When I began taking metformin, I felt as if I was like a teenager taking precautions against acne. I wasn’t sick, and had only the beginnings of feeling tenderness beneath the skin. But after a few months of reading about diet and diabetes I’m not only more certain of my decision to go on metformin, I am doing everything I can to purge carbs from my diet.
I’m also trying to go back to my old ways of regular exercise. For many years I ran three miles at noon every day with the same friend. When I moved to a new job in a less friendly running climate I switched to a stationary bike and a treadmill. But even adding TV and books didn’t make me look forward to exercise and, gradually, I realized that what for years was built into my schedule had become something I had to force myself to do.
I miss the outdoor experience of running, but even more, I miss my old friend. The camaraderie and friendship that developed over years was something that silent reading and passive TV watching couldn’t replace. There’s nothing I can do about missing my friend on a daily basis, but recognizing that the problem is more emotional than physical has helped me go back to regular exercise. That realization, along with the rising A1c, has made even the treadmill look pretty good.
I’m only two months into my two minute warning so I don’t have any quantifiable results yet. It’s possible that carb restriction without metformin might be all that I need. And, of course, it’s possible that my genetic makeup might lead me to the diabetic club no matter what I do to keep from joining. But I can report from the sideline of prediabetes, no problems from metformin and almost no dietary distress from carbohydrate restriction. The hardest part of my change in eating is the mental jujitsu. I’ve spent my adult life avoiding fat and cholesterol so the switch to what was formally taboo gets to me, especially at breakfast. My instinct is to reach for the cereal, toast, and low-fat milk. Instead, I grease the frying pan with butter, drop cream into my coffee and listen to the eggs sizzle. I’m not certain where my glucose level is heading, but at least I’m not standing still waiting for the inevitable.
March 11, 2012 Metformin and Low-Carb – an Incompatible Couple Dear Max, Here’s some info not available elsewhere (yes, really). Your doctor knew that metformin acts to stop the liver from manufacturing glucose (gluconeogenesis). That’s terrific, since most doctors, even researchers, seem to think that metformin is an “insulin sensitizer.” Extra glucose is stored – a lot in your liver, a little in your muscles, and almost none in your brain. The liver fuel tank awaits a drop in blood glucose which will summon the stored glucose in your liver to enter your bloodstream. Glucose stored in your muscles or… Read more »
Max, Your glucose might be fine but what about your arteries?? Dr. Esseltyn, former surgeon at Cleveland Clinic, advises to stay away from all fats if you want to stay away from heart trouble. Of course, you can find thousands of other experts who say the opposite. The best thing is probably to enjoy those football games. And the grandkids and whatever other joys we can manage. Much love,
Max, if your body reacts any way similar to the way mine has, I know that you have a pleasant surprise waiting for you with your next check up. Congrats on being able to step up and take care of your body.