I was diagnosed with Type II a little over 2 months ago. I’m a 31 year old female, 5’2, 119 pounds. My A1C is 5.4. I took a 3 hour GTT and my fasting was the high end of normal (99) but my 2 hour was 201, so I was diagnosed with Type II. My endocrinologist sent me back to get another check on my fasting level and it was 89 the second time. There is also a history of Type II on my mother’s side of the family.

Here’s my new dilemma. I told my dr. I wanted to try controlling this with diet initially. (He wanted to start me on metformin but agreed to allow me 3 months diet controlled with the condition that I’d let him know if my fasting levels got high). But I’ve been checking my fasting levels on my glucose meter, and for the past several weeks they’ve consistently been high, ranging between 100 and 110.

My husband notes that the high fasting levels are due to my liver producing glucose at night(?) which is characteristic of Type II diabetics, and that diet and exercise will not resolve this issue at all. While I have been generally good with my diet, I have had a few indiscretions here and there. My highest 2 hour reading after an indiscretion was 160 I think. I did tell my dr. about this and he noted that every time my sugar goes that high my pancreas “takes a hit”.

Anyhow, my mom and hubby are really pressuring me at this point to go on meds, noting that I can’t live my life in deprivation and that they'd rather not see me on insulin down the road. Frankly, after reading some other posts on this board regarding the side effects of metformin (fatigue, weakness, joint pains, etc.) I feel very reluctant to go on meds. But at the same time, I don’t want to my pancreas to suffer and hasten the need to go on insulin as my dr. has pointed out, and I don’t know of any other way of addressing the high fasting numbers.

Does anyone have any advice here? I’m feeling a bit conflicted.

Oh, I should also note that I've been weight training in an effort to build muscle so I can improve my glucose metabolism. Apparently that hasn't been helping with the fasting levels either.

I was diagnosed with Type II a little over 2 months ago. I’m a 31 year old female, 5’2, 119 pounds. My A1C is 5.4. I took a 3 hour GTT and my fasting was the high end of normal (99) but my 2 hour was 201, so I was diagnosed with Type II. My endocrinologist sent me back to get another check on my fasting level and it was 89 the second time. There is also a history of Type II on my mother’s side of the family.

Here’s my new dilemma. I told my dr. I wanted to try controlling this with diet initially. (He wanted to start me on metformin but agreed to allow me 3 months diet controlled with the condition that I’d let him know if my fasting levels got high). But I’ve been checking my fasting levels on my glucose meter, and for the past several weeks they’ve consistently been high, ranging between 100 and 110.

My husband notes that the high fasting levels are due to my liver producing glucose at night(?) which is characteristic of Type II diabetics, and that diet and exercise will not resolve this issue at all. While I have been generally good with my diet, I have had a few indiscretions here and there. My highest 2 hour reading after an indiscretion was 160 I think. I did tell my dr. about this and he noted that every time my sugar goes that high my pancreas “takes a hit”.

Anyhow, my mom and hubby are really pressuring me at this point to go on meds, noting that I can’t live my life in deprivation and that they'd rather not see me on insulin down the road. Frankly, after reading some other posts on this board regarding the side effects of metformin (fatigue, weakness, joint pains, etc.) I feel very reluctant to go on meds. But at the same time, I don’t want to my pancreas to suffer and hasten the need to go on insulin as my dr. has pointed out, and I don’t know of any other way of addressing the high fasting numbers.

Does anyone have any advice here? I’m feeling a bit conflicted.


You have been doing all the right things for a few months now. Get a 1ac done to see if it's improved. You will know what you can achieve by diet only

Try the metformin. There is a big possibility you will have no side effects. I tried it and had no side effects. Many people tolerate it well, some take a few weeks to get used to it, some never do. Give it a try.

See what it does to your 1ac. If it helps, and you tolerate it, the answer is easy. If it does nothing for you and you can't tolerate it, the answer is easy. In between the two scenarios you can work out with your doctor

You did what you had to do, get a result (the 1ac), try met and see if it further improves.

Met did nothing for me.

That's what I would do (actually what I did)

Just want to make sure I'm understanding you correctly. You're saying get an A1C first to see how it is with diet alone, and if it's higher or the same, then go on met? That sounds very reasonable. I'm getting tested again right before my next appt with my endocrinologist in July. It's not harmful to wait until then (to go on met), is it?

Just want to make sure I'm understanding you correctly. You're saying get an A1C first to see how it is with diet alone, and if it's higher or the same, then go on met? That sounds very reasonable. I'm getting tested again right before my next appt with my endocrinologist in July. It's not harmful to wait until then (to go on met), is it?

Even if your 1ac is better, and if your doc thinks you should still be on it, try the met, especially since your fasting levels are a bit high. See how it affects your fasting level and 1ac. If it improves further and you tolerate it, continue. There is a very real possibility it will make little difference. It doesn't work for everyone.

This is why I think it is important to see how much of a difference diet makes before starting. Had you done both at the same time, you would not have known what difference diet made vs the met. If the met makes no difference, why take it.

Are you finding your post meal highs better than when you started testing ? Are any of your numbers getting worse ?

I have been controlling diabetes via diet/exercise only for the past 8 years. Last 3 years has been diet only due to feet problems.

On my last visit the doctor said he did not think Met would do anything for me. My A1c was 6.1. My fasting is between 115-126. Two hours after meals is usually between 104-130. I aim for 120 or less after meals.

EXERCISE as well as diet is a necessity. Walking the treadmill helps my BS the most.

What I'd like to know is, at what A1C number is best to begin meds? I always thought that the 5's were considered really good control! Is this not true? Are you still running the chance of complications in the 5's?

What I'd like to know is, at what A1C number is best to begin meds? I always thought that the 5's were considered really good control! Is this not true? Are you still running the chance of complications in the 5's?

I believe it's the spikes after meals that cause the long term complications.

If you are going to 180 after a meal that's when damage occurs. Now, if you are 180 after a meal the probability of a 5 1ac s low unless you are also doing hypos.

To the question when to start meds, I always thought it was when your 1ac was above 6.5 or 7. At that level meds are a must. Below, it's the opinion of your doc. Some believe there is no harm for meds and the lower the 1ac the better.

My doc was quick to want to put me on met. It is a time proven safe medication. But when it did nothing he really hesitated to try other meds. He thought my control was good enough to outweigh the risk of other meds. With the recent heart issues caused by other type 2 meds, he did not believe it was worth it.

I believe it's the spikes after meals that cause the long term complications.

If you are going to 180 after a meal that's when damage occurs. Now, if you are 180 after a meal the probability of a 5 1ac s low unless you are also doing hypos.

To the question when to start meds, I always thought it was when your 1ac was above 6.5 or 7. At that level meds are a must. Below, it's the opinion of your doc. Some believe there is no harm for meds and the lower the 1ac the better.

My doc was quick to want to put me on met. It is a time proven safe medication. But when it did nothing he really hesitated to try other meds. He thought my control was good enough to outweigh the risk of other meds. With the recent heart issues caused by other type 2 meds, he did not believe it was worth it.

When you say going to 180 after a meal, are you saying at the one hour mark? I ask this because my friend's husband, who is not a diabetic, just out of curiosity had me check his sugar shortly after he drank a soda, and much to my surprise, it was over 200! I always thought that complications occurred if your sugar remained high over periods of time, not just at the one hour after a meal number??? I am so confused!

Thanks for all of your advice. My aunt who’s a dr (though not an endocrinologist so I take what she says with a grain of salt) said that having a normal A1C still doesn’t tell the entire story of what’s going on in my body. She said that I could still have normal sugars after a meal, but my pancreas is working very hard (harder than a nondiabetic’s) to maintain those normal blood sugars. She noted that hyperinsulinemia could also be a problem, and that these underlying problems could be masked by a normal A1C. Though again, I would believe the word of an endocrinologist.

Lilbit1973, not sure about your friend though my husband once said that if everyone in this country were to be screened for diabetes the rate would probably double or triple since there are currently so many undiagnosed cases.

uma_anne, your fasting BG's don't seem to be in the DM range, and your 2hr OGTT was at the low limit to make the Dx of DM, so you seem to sit in the impaired glucose tolerance/borderline DMII range

what people have told you about hyperglycemia is true, elevated blood sugars are toxic for many cells(including your pancreatic islet cells that produce your body's insulin), whether it be periodic/episodic like I suspect will be the case for your vs. chronic elevated BS ..

you say you have a family hx of diabetes ... is it type 2 DM, were your relatives diagnosied young as <25, from the brief hx you gave, you not far off from factors suggestive of MODY(maturity onset diabetes of the young) especially with your BMI of approx 21

determining the initiation of pharmacotherapy is quite physician variable .. some are aggressive over treatment of DM, especially with the known complications of DM ... some are happy to continue on with diet/lifestyle changes with number's like yours ... it's interesting because fewer and fewer physicians are using OGTT to diagnosis diabetes(except in the pregnant population to rule out gestational DM) .. and from the numbers you quote, your fasting BGs and random BGs do not even give you the diagnosis of DM(impaired glucose tolerance yes)

it would be interesting to set what your hgba1c is, but I suspect it won't be that high .. maybe high 5's/low 6's, but it's true that while MD's use hbga1c to f/u DM management in the long run, hgba1c is just a 3 month average and can be "fooled" by periodic hyperglycemia, even though your blood vessels and pancreas may be "taking a beating" from post prandial hyperglycemia

Thanks for all of your advice. My aunt who’s a dr (though not an endocrinologist so I take what she says with a grain of salt) said that having a normal A1C still doesn’t tell the entire story of what’s going on in my body. She said that I could still have normal sugars after a meal, but my pancreas is working very hard (harder than a nondiabetic’s) to maintain those normal blood sugars. She noted that hyperinsulinemia could also be a problem, and that these underlying problems could be masked by a normal A1C. Though again, I would believe the word of an endocrinologist.

Lilbit1973, not sure about your friend though my husband once said that if everyone in this country were to be screened for diabetes the rate would probably double or triple since there are currently so many undiagnosed cases.

I agree with yout husband's assessment. I'd go one further. If we screened everybody for high sugar, high pressure, high cholesterol......2 thirds of the people over 45 would have a serious condition. More serious than what you have.

As for long term complications, I believe the way to avoid them is to have a profile as close as possible to a healthy non diabetic. A non diabetic will have a first insulin response to a rise in glucose, followed by more insulin if the levels remain high. A non diabetic should not see his glucose jump to 180 even 1 hour after a meal.

I personally try not to go over 140 1 hour after and prefer to be back down under 108 after 2 hours. I don't always make this. Night is easiy. Morning is very tough. Stupid liver ! I struggle with my morning fasting level and that one is tough to control by diet.

They spend a lot of time talking about complications, but if I was a betting man, I'd say neither of you two will have them. Because you know of your condition, you are being followed and you will keep your levels under control. The complications come to those who don't know, do not care or don't have the education and resources to deal with it. That's the sad part.

By the way, stress makes control WAY harder. So try not to stress over this.