mackycarroll

Q:

Am I a type 2 diabetic? Am I going to have to get a meter? Is insulin in my future? What do you think? I went to the doctor because my shrink's nurse said my blood pressure was climbing. The doc drew blood and wrote a prescription to control blood pressure. When I went back to get my blood tests my blood serum (no fasting) was 390. The A1c was 14.3. My cholesterol was 314 and tri gl 370. Vldl cholesterol was 74. my ldl cholesterol was 200. He put me on 1000mg metformin twice a day. I'm age 60.

Dr. David Erani

A:

Both a random (non-fasting) blood glucose test and an A1C test can be used to diagnose diabetes. If your test results indicate a high value for either, they should be confirmed by repeat measurement. Your values for each of these tests are well above the levels that would indicate diabetes – a random blood glucose result greater than 200 mg/dl and an A1C greater than 6.5%. Most people with diabetes have type 2 diabetes. Most people who are are diagnosed with diabetes as adults have type 2. Metformin is a very good drug for type 2 diabetes and is generally considered the first choice unless the patient has a specific reason not to take it. These reasons could include kidney or liver disease. Metformin can lower A1C by 1-2%. Since the A1C goal is less than 7.0% for most patients, it is likely that metformin will not be enough to get your A1C to where it needs to be. The American Diabetes Association guidelines call for insulin for any person with an A1C greater than 9.0% who is on diabetes medication or who has symptoms of hyperglycemia, and also for those who have an A1C greater than 9 and are on three non-insulin diabetes medications . Some psychiatric medications can raise blood glucose levels. It would be a good idea to discuss these issues with your healthcare team. Please do not stop or change any of your medications without checking with your doctor.

December 4, 2012 at 8:30 pm