A1C - next steps

[Anonymous]

Anonymous wrote:

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.

Metformin is horrible it made me so sick

[Anonymous]

Anonymous wrote:OP here with an update. Not what I was hoping for, but my A1C came back at 6.0. I'm so bummed because I'm struggling to break out of this cycle.

literally what GLP-1s were approved for
my A1c when from pre-diabetic to normal in 6 months

[Anonymous]

Are you still on a GLP-1 or did you stop once you got out of pre-diabetic range?

[Anonymous]

Anonymous wrote:Count carbs. No more than about 125-150 a day. And never more than about 35-40 in a meal.

This. Also if you have two good meals per day with no snacking in between, you will lose weight. Make sure your meals are within an 8 hr window. So if you eat dinner at 6pm, your breakfast/lunch should be around 10am.

[Anonymous]

Anonymous wrote:OP here with an update. Not what I was hoping for, but my A1C came back at 6.0. I'm so bummed because I'm struggling to break out of this cycle.

Is this a fasting measure? How long did you fast prior to this?

[Anonymous]

Anonymous wrote:

Anonymous wrote: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.

Nutritionist. This 99.9% can be dealt with with nutrition. Start following a diabetic diet. Or rather simply a Whole Foods diet where you cut out all added sugars, you start your day with protein and healthy fats, and you avoid flours, grains, carbs that don't come from veggies or fruits.
You do NOT need bread and extraneous sugars and carbs. If you eliminate those unnecessary carbs and limit the others (you cannot eat 400 grams of fruit and veggies a day, follow the diabetic guidelines) you can and will loose weight. You will feel 1000% better and you can keep it off by eating healthy.

You don't need meds to manage this, you simply need to eliminate sugars and starches---they are not healthy for you---eat whole foods and you will feel so much better

How do you feel as a nutritionist about:
substituting low/no net-carb versions of bread and tortillas so you can eat sandwiches and soft tacos along with the family (or pizza on a tortilla)
Rao's marinara sauce
Quest chips and crackers (pretty low carb)
Almond Flour and Swerve sweetener substitutes to make and freeze small desserts
All dressings and sauces very low calories and 2 or less net-carbs
Nuts, cheese, guacamole or almond butter for snacks
Fruit - only berries
Only drink water or 0 calorie lemonade or unsweet plain tea

I eat 2 meals a day and am using the above substitutions so I can go to almost any restaurant know what to order:

Mexican - chicken fajitas, no rice/beans/tortillas, bring my own pack of Quest chips to enjoy the salsas and bring 2 low carb tortillas
Steakhouse - salmon or lobster, salad (bring my own dressing) and grilled vegetable (I don't eat red meat)
BBQ - grilled chicken salad (yeah, sad!)
Breakfast - Omelet with lots of vegetables, bacon & sausage on the side
Deli - request no bread and eat as a salad or bring out my own bun or bread
Pasta - sub zoodles or broccoli for noodles

I live in a small mountain town where nobody cares if I discretely add my own bread or dressing or pour a bag of Quest chips on my plate.

I'm too lazy to add up my nutrition stats every day, but I wondered if nutritionists would be okay with substituting low carb bread and swerve 0 calorie sugar. By substituting everything, I think I'm probably in the 15-20 net carbs a day range.

I find it doable to get the taste of pizza toppings, but on a low carb tortilla. Or a veggie burger with cheese on a low carb bun. Or an occasional sweet made from swerve. If nutritionists think these substitutions are not great, it would be so much harder to give up all the starches and sugars!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Metformin is horrible it made me so sick

Metformin remains the mainstay diabetic treatment. There is an extended release version that often works better for people who have trouble on the regular kind. The extended release helped me when I had side effects from the regular version.

[Anonymous]

Adding: what did you switch to when you couldn’t tolerate Metformin?

[Anonymous]

I eat Ezequiel bread. I think it's 15 grams of carbs per slice. It's in the freezer aisle.
https://www.target.com/p/food-for-life-ezekiel-4-9-organic-frozen-sprouted-grain-bread-24oz/-/A-47100856?TCID=PDS-19859758219&gad_source=1&gad_campaignid=19859758219&gbraid=0AAAAAD-5dfZdwrAPe8wQqt-5AdMWCrgeC&gclid=CjwKCAjw1dLDBhBoEiwAQNRiQXYtOtM3eJtIqdEwEwm5KkuRhnrA3lHI0phdnhgcM1ujZd6Q6NtnNBoCOn0QAvD_BwE&gclsrc=aw.ds

[Anonymous]

Anonymous wrote: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.

Same with my mom. Except if she had started earlier, she would have avoided a heart attack.

[Anonymous]

Anonymous wrote:Adding: what did you switch to when you couldn’t tolerate Metformin?

.

Try XR Metformin. Its important to stay away from white things (breads, pasta, rice, sugar) and spinach while on metformin or you'll be glued to the toilet.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here with an update. Not what I was hoping for, but my A1C came back at 6.0. I'm so bummed because I'm struggling to break out of this cycle.

Is this a fasting measure? How long did you fast prior to this?

A1c is not affected by fasting.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here with an update. Not what I was hoping for, but my A1C came back at 6.0. I'm so bummed because I'm struggling to break out of this cycle.

literally what GLP-1s were approved for
my A1c when from pre-diabetic to normal in 6 months

Does insurance stop paying for GLP-1 when your A1c hits normal? I’ve heard that elsewhere but no real-life knowledge of the topic.

[Anonymous]

OP here. I tried again for thr last 2 months to focus on eating better (i seriously thought I nailed it, I've lost 8 lbs). Got my A1C back at 5.9. I don't get it. Will talk to my doctor

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here with an update. Not what I was hoping for, but my A1C came back at 6.0. I'm so bummed because I'm struggling to break out of this cycle.

literally what GLP-1s were approved for
my A1c when from pre-diabetic to normal in 6 months

Does insurance stop paying for GLP-1 when your A1c hits normal? I’ve heard that elsewhere but no real-life knowledge of the topic.

DP. I asked my PCP this question and she said that it should still be covered since it is required to manage the medical condition of diabetes. But I know Wegovy coverage is not guaranteed if one hits their weight loss goals so I guess I’ll find out at my next renewal.