A1C - next steps

[Anonymous]

I've been on the pre-diabetic range for A1C since my early 30's. It was 5.9 back then.
I'm now 45, and have an A1C of 6.1 back in sept 2024. Got it down to 5.8 as of feb 2025. But not very confident that I am able to get it lower nor that I won't go back to whatever habits cause it to be higher.
I had gestational diabetes with all of my pregnancies. I'm 10 lbs overweight and 20lbs to what I think would be a healthy weight for my 5.5 ft frame.

What else should I explore? GLP meds? Nutritionist? I want to get this down and not keep the risk of diabetes and other comlications.

[Anonymous]

What does your physician say?

[Anonymous]

My mom struggled her whole life and eventually became full blown diabetic. Meds are basically miraculous. She has lost so much weight (around 40lbs) and is a lot better, but had she started 20 years before she'd be in a much much better situation healthwise. Definitely intervene now with the help of a doctor of course.

[Anonymous]

My doctor isn't concerned. She says it is borderline prediabetes only at this point.

But I don't want it so worse and then do something.

[Anonymous]

I would go to a GLP1, especially since they are likely to be covered as a prediabetic.

[Anonymous]

Get on Metformin and continuous glucose monitoring device first.

Then get with a nutritionist and come up with a diet.

Start walking (wear a smart watch or use some tracking app). Every day, aim to increase around 100 steps, so that you can reach 3000 steps by end of month. Don’t be in a rush to do too much because you may end up injuring yourself.

Stick to 3000 steps for a month or so and then start increasing steps by 100 steps again, until you reach 6000 steps.

5000 - 10000 steps are more than enough for your health.

[Anonymous]

Anonymous wrote:I would go to a GLP1, especially since they are likely to be covered as a prediabetic.

Almost no insurances cover for pre-diabetes.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I would go to a GLP1, especially since they are likely to be covered as a prediabetic.

Almost no insurances cover for pre-diabetes.

What? Yes they do.

[Anonymous]

They definitely do cover it for pre-diabetes but OP’s numbers don’t look high enough. That said, it could be covered depending on the insurance and the doctor.

[Anonymous]

Anonymous wrote:Get on Metformin and continuous glucose monitoring device first.

Then get with a nutritionist and come up with a diet.

Start walking (wear a smart watch or use some tracking app). Every day, aim to increase around 100 steps, so that you can reach 3000 steps by end of month. Don’t be in a rush to do too much because you may end up injuring yourself.

Stick to 3000 steps for a month or so and then start increasing steps by 100 steps again, until you reach 6000 steps.

5000 - 10000 steps are more than enough for your health.

This is pretty decent advice. Metformin is pretty benign and may actually have some non-diabetic benefits. And “start slowly” is really important for exercise. If you hurt yourself you lose your progress and more. CGM’s are expensive but it looks like Abbot is coming out with a “consumer level” OTC version at somewhat lower expense. You probably wouldn’t need it very long — just until you found out how that baked potato, for example, impacts you. Regular glucose monitoring with a finger stick meter is less pleasant but again you probably wouldn’t need it for too long at any given time.

[Anonymous]

how much do you exercise everyday?

[Anonymous]

OP here. Thanks for all the replies and input.

I have started using a CGM/dexcom (last 20 days) and it has been helpful for me to see the blood sugar after I eat my meals. I have a hard time with making good food choices when I am stressed (kids whining, long meetings at work, etc). So I'm trying to replace the habit of eating when stressed with something else...but it is a work in progress.

Before being focused on making improvement, I was only walking for exercise. Getting 6k average steps a day, sometimes more, sometimes less.

In the last 6 weeks, I have joined a studio and I do pilates 2 times a week (50 minute classes). I've started to walk 20 mins in the morning. I have started to do a light arm workout (10mins) once a week - this is via video/peloton app. If I try to do too much, I end up not doing it.

[Anonymous]

OP, you say that your A1C was 5.8% in February and that you have increased exercise since then. You have also started using a glucose monitor and are learning from that.

It seems like things are trending in the right direction for you, though you are concerned about maintenance. What else are you specifically concerned about? Because with your stats and the info you have, I wouldn't do anything different than the regular monitoring you get at an annual exam.

[Anonymous]

Anonymous wrote:OP here. Thanks for all the replies and input.

I have started using a CGM/dexcom (last 20 days) and it has been helpful for me to see the blood sugar after I eat my meals. I have a hard time with making good food choices when I am stressed (kids whining, long meetings at work, etc). So I'm trying to replace the habit of eating when stressed with something else...but it is a work in progress.

Before being focused on making improvement, I was only walking for exercise. Getting 6k average steps a day, sometimes more, sometimes less.

In the last 6 weeks, I have joined a studio and I do pilates 2 times a week (50 minute classes). I've started to walk 20 mins in the morning. I have started to do a light arm workout (10mins) once a week - this is via video/peloton app. If I try to do too much, I end up not doing it.

I struggle with this and Binge Eating Disorder. Zepbound has been a complete game changer. I think it is good that you are making these changes on your own but if it becomes more difficult or stops working it's something to consider. It is not an easy ride for me financially or with side effects but it has changed my life for the better.

[Anonymous]

Anonymous wrote:OP here. Thanks for all the replies and input.

I have started using a CGM/dexcom (last 20 days) and it has been helpful for me to see the blood sugar after I eat my meals. I have a hard time with making good food choices when I am stressed (kids whining, long meetings at work, etc). So I'm trying to replace the habit of eating when stressed with something else...but it is a work in progress.

Before being focused on making improvement, I was only walking for exercise. Getting 6k average steps a day, sometimes more, sometimes less.

In the last 6 weeks, I have joined a studio and I do pilates 2 times a week (50 minute classes). I've started to walk 20 mins in the morning. I have started to do a light arm workout (10mins) once a week - this is via video/peloton app. If I try to do too much, I end up not doing it.

You need to do cardio 5X a week for at least 30 min.