Adjusting high glucose levels

Dear Dr. Roach: I am a 64-year-old female who’s 5 feet, 2.5 inches tall and weighs 157 pounds. I take Lipitor (20 mg). My fasting glucose in the morning is consistently high (112-123). After breakfast it falls to normal (under 100). My A1C is 5.7. Should Iworry?— T.K.

There are several reasons for you to be concerned. Your BMI is 28.3, in the overweight range. Your age is 64, which tends to predict progression to diabetes at a higher rate than younger people. You are taking Lipitor, which also tends to speed progression to diabetes. Finally, yourA1Cis 5.7%, which is just in the prediabetes range. With all of these, you have a significant risk of developing diabetes in the next few years.

Fortunately, there are steps you can take to reduce your risk of developing diabetes. The most important are diet and exercise. Your diet should have very little concentrated sweets, such as fruit juice or candy. You should also avoid processed starches, such as white bread, white rice, and pasta— all of which are rapidly converted to sugar, starting as soon as your saliva starts to digest them. A dietitian nutritionist can provide much more personalized help after looking at your eating pattern.

Exercise is equally important. Regular moderate exercise allowsyourbodyto metabolize sugar better. A large trial showed that careful adherence to a good diet and exercise regimen dramatically dropped the rate of progression to diabetes.

Losing even a few pounds can help. Between the exercise and dietary changes, most people will lose a few pounds.

Finally, some physicians will prescribe medication to help prevent progression to diabetes and promote weight loss. Both metformin and liraglutidehavebeen used for this, but metformin is better studied. I do not rush to prescribe medication, though it is very useful for some.