David’s Guide To Getting Our A1c Under 6.0
The A1C test is our best scorecard to show how well we are controlling our diabetes. It measures how much glucose has been sticking to our red blood cells for the previous two or three months. Since our bodies replace each red blood cell with a new one every four months, this test tells us the average of how high our glucose levels have been during the life of the cells. The experts recommend that we should get our A1C level tested at least twice a year. People who take insulin need to get it about four times a year. If the test shows that our blood glucose level is high, it means that we have a greater risk of having diabetes problems. Think of the A1C as an early warning system for the insidious complications that we can get down the road when we don’t control our condition. But what do we mean by a “high” A1C level? Here the experts disagree. The American Diabetes Association says that we need to keep our A1C results below 7.0 percent. The American Association of Clinical Endocrinologists sets the target at 6.5 percent. The International Diabetes Federation, or IDF, also recommends that most people with diabetes keep their levels below 6.5 percent. The more our A1C level is higher than normal, the greater the likelihood that we will suffer from one or more of the complications of diabetes. And here too the experts disagree with how they define “normal.” People who don’t have diabetes have A1C levels below 6.0 percent. That’s the gist of what I wrote here recently in “The Normal A1C Level.” The IDF agrees. But more aggressive endocrinologists say that a truly normal A1C ranges from 4.2 percent to 4.6 percent. That’s what Dr. Richard K. Bernstein wrote in Dr. Bernstein’s Diabetes Solution. No matter what our level is, we can be sure that lower is Continue reading >>
Metformin For Prediabetes
The oral biguanide metformin (Glucophage, and others) is generally the drug of choice for initial treatment of type 2 diabetes. It has also been used to prevent or at least delay the onset of diabetes in patients considered to be at high risk for the disease. Recent guidelines recommend considering use of metformin in patients with prediabetes (fasting plasma glucose 100-125 mg/dL, 2-hr post-load glucose 140-199 mg/dL, or A1C 5.7-6.4%), especially in those who are <60 years old, have a BMI >35 kg/m2, or have a history of gestational diabetes.1 Metformin has not been approved for such use by the FDA. CLINICAL STUDIES — In the Diabetes Prevention Program (DPP) trial, 3234 nondiabetic adults with a BMI ≥24 kg/m2 (≥22 kg/m2 in Asian patients) and elevated fasting and post-load plasma glucose concentrations were randomized to receive intensive lifestyle intervention focusing on weight loss and exercise, metformin 850 mg twice daily, or placebo.2 After a mean follow-up of 2.8 years, the incidence of diabetes was reduced, compared to placebo, by 58% with intensive lifestyle intervention and by 31% with metformin. Metformin was as effective as lifestyle intervention among patients <60 years old or with a BMI ≥35 kg/m2. When the 3-year DPP trial ended, the intensive lifestyle intervention group was offered semi-annual counseling and the metformin group could continue to take the drug. During a follow-up of 15 years, the average annual incidence of diabetes, compared to placebo, was 27% lower in patients originally randomized to lifestyle intervention and 18% lower in those randomized to metformin.3 ADVERSE EFFECTS — No significant safety issues have been detected with long-term use of metformin. The drug can cause adverse gastrointestinal effects such as metallic taste Continue reading >>
A1c Between 5.7 And 6.4% As A Marker For Identifying Pre-diabetes, Insulin Sensitivity And Secretion, And Cardiovascular Risk Factors
OBJECTIVE A1C is an optional method for diagnosing diabetes and also for detecting individuals at increased risk of the disease. However, how A1C compares with fasting (FPG) and 2-h plasma glucose for detecting at-risk individuals is not well known. RESEARCH DESIGN AND METHODS A 2-h glucose tolerance test, frequently sampled intravenous glucose tolerance test, and A1C were obtained at the follow-up examination in 855 participants in the Insulin Resistance Atherosclerosis Study (IRAS). For this report, 385 individuals were at increased risk of diabetes as defined by A1C between 5.7 and 6.4%, impaired glucose tolerance (IGT), and/or impaired fasting glucose (IFG). RESULTS IFG and IGT identified 69.1 and 59.5% of all individuals at increased risk of diabetes, respectively. A1C 5.7–6.4% detected 23.6% of all at-risk individuals, although more African Americans (31.4%) and Hispanics (35.2%) than non-Hispanic whites (9.9%). Relative to A1C, FPG was more strongly related to fasting insulin (r = 0.38 vs. 0.26; P < 0.01), acute insulin response (r = – 0.20 vs. – 0.09; P < 0.01), and waist circumference (r = 0.43 vs. 0.25; P < 0.001) by the Spearman correlation test. Similarly, 2-h plasma glucose was more strongly related to Si (r = – 0.40 vs. – 0.27; P < 0.01) and triglycerides (r = 0.30 vs. 0.08; P < 0.001). CONCLUSIONS A1C 5.7–6.4% is less sensitive for detecting at-risk individuals than IFG and IGT, particularly among non-Hispanic whites. Single determinations of FPG and 2-h plasma glucose seem to be more precise correlates of insulin resistance and secretion than A1C and, in general, better for other metabolic disorders. A1C has been proposed by the American Diabetes Association (ADA) as an optional assay for diagnosing diabetes and also for detecting individuals Continue reading >>
Do I Have Prediabetes Or Diabetes? Guide To The A1c, Fpg, And Ogtt Tests, Plus Tips For Prevention
If you’ve been diagnosed with prediabetes, you may wonder what that means. It’s a condition where your blood glucose levels are above normal, but not high enough for you to be diagnosed with diabetes. Many doctors consider prediabetes to be the first stage of type 2 diabetes. Studies show that 15 to 30 percent of people with prediabetes will develop diabetes in as little as five years without intervention, such as weight loss or increased physical activity. In fact, most people who get type 2 diabetes had prediabetes first. Prediabetes is serious in and of itself. People with this condition have a greater risk of developing cardiovascular disease than those without it. There are three tests that doctors can do in order to determine whether you have high blood sugar. A1C This blood test, which is also called hemoglobin A1c, HbA1c, or glycosylated hemoglobin, measures the percentage of sugar that is attached to your hemoglobin. Hemoglobin is a protein in your red blood cells. The higher the A1C, the higher your average blood sugar levels have been running over the past two or three months. A normal A1C is below 5.7 percent. An A1C between 5.7 percent and 6.4 percent suggests prediabetes. An A1C of 6.5 or more indicates type 2 diabetes if the test is confirmed. If your results are questionable, your doctor will retest your A1C on another day to confirm the diagnosis. Fasting plasma glucose The fasting plasma glucose (FPG) test is a blood test that’s done after you’ve been fasting overnight. It measures the sugar in your blood. A normal fasting glucose test is lower than 100 milligrams per deciliter (mg/dL). A result between 100 and 125 mg/dL is diagnostic for prediabetes. One that is 126 mg/dL or above is indicative of diabetes. It’s recommended to retest this an Continue reading >>
Effect Of Metformin Glycinate On Glycated Hemoglobin A1c Concentration And Insulin Sensitivity In Drug-naive Adult Patients With Type 2 Diabetes Mellitus
Go to: Abstract This study evaluated the effect of metformin glycinate on glycated hemoglobin A1c (A1C) concentration and insulin sensitivity in drug-naive adult patients with type 2 diabetes mellitus (T2DM). A randomized, double-blind, placebo-controlled clinical trial was carried out in 20 patients with drug-naive T2DM. Ten subjects received metformin glycinate (1,050.6 mg) once daily during the first month and force-titrated twice daily during the second month. Ten additional patients received placebo as the control group. Before and after the intervention, metabolic profile including A1C and insulin sensitivity (euglycemic-hyperinsulinemic clamp technique) was estimated. A1C concentrations decreased significantly with metformin glycinate administration (8.0±0.7% vs. 7.1±0.9%, P=0.008) before and after the intervention, respectively. There were significant differences in changes from baseline of A1C between groups (0.0±0.7% vs. −1.0±0.5% for placebo and metformin glycinate groups, respectively; P=0.004). A reduction of ≥1% in A1C levels was reached in 60.0% of patients with metformin glycinate administration (P=0.02). Insulin sensitivity was not modified by the intervention. Administration of metformin glycinate during a 2-month period showed a greater decrease in A1C concentrations than placebo in a selected group of drug-naive adult patients with T2DM. Go to: In accordance with several algorithms for the medical treatment of patients with type 2 diabetes mellitus (T2DM), metformin hydrochloride along with lifestyle changes is the first line of treatment to achieve metabolic goals and, in combination with other oral agents or insulin, provides an efficacious therapeutic option.1,2 Metformin is a biguanide that activates the 5′-AMP-activated protein kinase Continue reading >>
- Relative contribution of type 1 and type 2 diabetes loci to the genetic etiology of adult-onset, non-insulin-requiring autoimmune diabetes
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
5 Simple Ways To Lower Your A1c This Week
The A1C blood test is a simple test that analyzes your glucose (blood sugar) levels by measuring the amount of glycated hemoglobin in your blood. Hemoglobin is a protein in your red blood cells; when glucose enters the blood, it attaches to the hemoglobin. The result is glycated hemoglobin. The more glucose in your blood, the higher your glycated hemoglobin. The A1C is a valuable indicator of how well your diabetes management plan is working. While your individual A1C goal will depend on factors including your age and your personal medical profile, most people with diabetes aim to keep their A1C below 7 percent. By keeping your A1C number within your target range, you can reduce the risk of diabetes complications. While it is important to develop a long-term diabetes management plan with your physician, there are several steps you can take right away to help reduce your A1C. Small changes add up, so consider trying some of these strategies to lower your A1C this week. 1. Try Short Sessions of High Intensity Exercise According to research presented at the American Heart Association's Scientific Sessions 2015, type 2 diabetes patients who did 10 minutes of exercise three times a day, five days a week at 85 percent of their target heart rate had a twofold improvement in A1C levels compared to patients who exercised for 30 minutes a day at 65 percent of their target heart rate. Be sure to check with your doctor before trying high intensity exercise, and wear a heart rate monitor so you don’t overdo it. 2. Shrink Your Dinner Plate Instead of a large dinner plate for your meals, use a smaller salad plate. This simple swap can trick your eyes and brain into thinking you’re eating more than you really are, and you’ll feel satisfied with less food. It’s especially helpfu Continue reading >>
A1c And Metformin
Good morning. When I had lab work done mid last year my A1c was 6.9, then I went on a diet and 3 months later it was 7.3. Doctor said it wasn't my fault and wrote me out a prescription for metformin. Well I never took the metformin. Instead I stayed on my diet and got a home A1c test. It went to 6.4 and about a month ago it went to 6.2. I am scheduled for lab work finally this coming week. My question is: Since my A1c has gone down to 6.2 or maybe down further - do you think I need to be on Metformin at this time. I have been really watching my food intake for the last 9 months. I do have an appointment with my family doctor next week (first appt this year) but I really feel you know more than my doctor does regarding diabetes! Your input would be very much appreciated. Thanks, Julie D.D. Family Getting much harder to control I guess my question would be is how is the weight loss. Do you need to lose any, metformin helps both weight loss and controlling bgl. I know folks do not want meds and hey I was there 30 yrs ago, we do what we have to do. It would seem the numbers are good so its up to what you need it to do. Julie that's a decision you have to make entirely for yourself. My A1C in June 2013 (at diagnosis) was 10.5 and I was immediately put on 2000 mg of Metformin ER. In early October I had my follow-up A1C and it was at 6.1 and I had lost over 30 pounds (20 to go). The Metformin was a choice and I chose to stay on it. Metformin has many benefits and since I tolerate it well I choose to stay on it and will for some time to come. My goal at diagnosis was to be drug-free but my outlook has changed. Others here feel the absolute, complete opposite of me and they're doing great. It's entirely a personal choice and one that you can change at any time. My HbA 1 c wrnt Continue reading >>
When “normal” Blood Sugar Isn’t Normal (part 2)
In the last article I explained the three primary markers we use to track blood sugar: fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and hemoglobin A1c (A1c). We also looked at what the medical establishment considers as normal for these markers. The table below summarizes those values. In this article, we’re going to look at just how “normal” those normal levels are — according to the scientific literature. We’ll also consider which of these three markers is most important in preventing diabetes and cardiovascular disease. Marker Normal Pre-diabetes Diabetes Fasting blood glucose (mg/dL) <99 100-125 >126 OGGT / post-meal (mg/dL after 2 hours) <140 140-199 >200 Hemoglobin A1c (%) <6 6-6.4 >6.4 But before we do that, I’d like to make an important point: context is everything. In my work with patients, I never use any single marker alone to determine whether someone has a blood sugar issue. I run a full blood panel that includes fasting glucose, A1c, fructosamine, uric acid and triglycerides (along with other lipids), and I also have them do post-meal testing at home over a period of 3 days with a range of foods. If they have a few post-meal spikes and all other markers or normal, I’m not concerned. If their fasting BG, A1c and fructosamine are all elevated, and they’re having spikes, then I’m concerned and I will investigate further. On a similar note, I’ve written that A1c is not a reliable marker for individuals because of context: there are many non-blood sugar-related conditions that can make A1c appear high or low. So if someone is normal on all of the other blood sugar markers, but has high A1c, I’m usually not concerned. With all of that said, let’s take a look at some of the research. Fasting blood sugar According to cont Continue reading >>
Your Highest A1c And How You Lowered It!
RUSSELL38 That is wonderful! your an inspiration!! Hugs,Verm Because those that matter... don't mind... July of this year it was 12.6 two months later after some really hard work, 8.7, the doctor couldn't believe it!! still lowering it!! check again in December, will let you know! Hugs,Verm Because those that matter... don't mind... Mine was 9.4, and I regularly had 300 blood sugars, some as high as 600. I was 361 lbs. I started low carb 3 and a half years ago, and have been off all diabetes meds for 28 months now. My last A1C was 5.1, lower than my 28 year old doctor's, who is 130 lbs. I dropped 140 lbs also, put back on 40 over the summer, and now back down to 248, but overall, down 113. That helped. "We can't solve our problems with the same thinking we used when we created them " Whether you think you can, or you think you can't--you're right. My first A1C was 9 when first diagnosed in 6/11 and was put on Glypizide 5 mg and Metformin 500 mg at morning and evening. Cut out sodas, candy and all white carbs, started an exercise and weight loss program and found Sparkpeople !! Got an appointment with the endocrinologist after three months and she took me off the Glypizide, A1C in 9/11 was 6.0. In January it was 5.5 and off came the morning Metformin. Next A1C in 5/11 was 5.0 and off came the last Metformin. Now controlling with diet, exercise and Sparkpeople and due for my next A1C later this month. My A1c when diognosed over 20 yrs. ago was 14.? Three months after that, on Metformin,but, still not getting it, it was still up at 11.0 Six months later, after Diabetes Education Classes, finally figuring the rules out, still on Metformin, it was down to 8.5 And now 23 yrs into the game, still on Metformin it is 6.0. In the last 12 -16 years the highest it has gone is 7.2 Continue reading >>
Inpatient Glucose Control
The following four cases and commentary address glucose control in the hospital setting. They are excerpted from ACP's Medical Knowledge Self-Assessment Program (MKSAP14). A 71-year-old woman with type 2 diabetes is hospitalized with new congestive heart failure. She had an inferior-wall myocardial infarction treated with percutaneous coronary intervention three years ago. A recent echocardiogram showed a left ventricular ejection fraction of 35%. A stress myocardial perfusion scan demonstrates a large, fixed inferior defect and a small, reversible anterolateral defect. Her cardiovascular disease is treated medically with furosemide, lisinopril, a statin, aspirin and metoprolol. Her diabetes regimen is glyburide, 10 mg twice daily, and metformin/rosiglitazone, 1,000 mg/4 mg twice daily. Capillary blood glucose values have recently been in the 140 to 180 mg/dL range, with an occasional result in excess of 200 mg/dL. Her hemoglobin A1c level has recently climbed to 7.6%. Combination therapy with metformin/rosiglitazone is stopped in the hospital. Which of the following would be the most appropriate discharge antihyperglycemic regimen for this patient? C. Stop glyburide and begin insulin therapy D. Continue glyburide and begin metformin; add insulin E. Continue glyburide and begin rosiglitazone; add insulin A 68-year-old woman is scheduled for arteriography of the lower extremities for progressive claudication. She has type 2 diabetes that is well controlled (hemoglobin A1c level, 6.4%) with rosiglitazone, metformin and glipizide. On the day of the procedure she is to receive nothing by mouth all morning except for medications until after the procedure. Which of the following would be the most appropriate oral regimen on the day of the procedure? B. Hold metformin, contin Continue reading >>
Management Of Blood Glucose With Noninsulin Therapies In Type 2 Diabetes
A comprehensive, collaborative approach is necessary for optimal treatment of patients with type 2 diabetes mellitus. Treatment guidelines focus on nutrition, exercise, and pharmacologic therapies to prevent and manage complications. Patients with prediabetes or new-onset diabetes should receive individualized medical nutrition therapy, preferably from a registered dietitian, as needed to achieve treatment goals. Patients should be treated initially with metformin because it is the only medication shown in randomized controlled trials to reduce mortality and complications. Additional medications such as sulfonylureas, dipeptidyl-peptidase-4 inhibitors, thiazolidinediones, and glucagon-like peptide-1 receptor agonists should be added as needed in a patient-centered fashion. However, there is no evidence that any of these medications reduce the risk of diabetes-related complications, cardiovascular mortality, or all-cause mortality. There is insufficient evidence on which combination of hypoglycemic agents best improves health outcomes before escalating to insulin therapy. The American Diabetes Association recommends an A1C goal of less than 7% for many nonpregnant adults, with the option of a less stringent goal of less than 8% for patients with short life expectancy, cardiovascular risk factors, or long-standing diabetes. Randomized trials in middle-aged patients with cardiovascular risk factors have shown no mortality benefit and in some cases increased mortality with more stringent A1C targets. Clinical recommendation Evidence rating References Metformin should be used as first-line therapy to reduce microvascular complications, assist in weight management, reduce the risk of cardiovascular events, and reduce the risk of mortality in patients with type 2 diabetes mell Continue reading >>
At What A1c Level Do Adverse Pregnancy Outcomes Begin?
The results from a new study show that risk increased in women with an early HbA1c of at least 5.9% regardless of a gestational diabetes diagnosis later in pregnancy. Risk of obstetric complications increases linearly with rising maternal glycemia. Testing HbA1c is an effective option to detect hyperglycemia, but its association with adverse pregnancy outcomes remains unclear. Emerging data sustains that an early HbA1c≥5.9% could act as a pregnancy risk marker. The purpose of the study was to determine, in a multi-ethnic cohort, whether an early ≥5.9% HbA1c could be useful to identify women without diabetes mellitus at increased pregnancy risk. Primary outcome was macrosomia. Secondary outcomes were pre-eclampsia, preterm birth and Caesarean section rate. 1,228 pregnancies were included for outcome analysis. Women with HbA1c≥5.9% (n= 48) showed a higher rate of macrosomia (16.7% vs. 5.9%,p= 0.008) and a tendency towards a higher rate of preeclampsia (9.32% vs. 3.9% ,p= 0.092). There were no significant differences in other pregnancy outcomes. After adjusting for potential confounders, an HbA1c≥5.9% was independently associated with a three-fold increased risk of macrosomia (p= 0.028) and preeclampsia (p= 0.036). They evaluated data on 1,228 pregnant women from April 2013 to September 2015 to determine whether an early HbA1c of at least 5.9% can identify women at increased risk for adverse pregnancy outcomes. Participants were screened for gestational diabetes at 24 to 28 weeks’ gestation, and HbA1c measurement was added to first antenatal blood tests. The primary outcome of the study was macrosomia, and secondary outcomes included rates of preeclampsia, preterm birth and caesarean section. Compared with participants with an HbA1c less than 5.9% (n = 48), parti Continue reading >>
- Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study
- World Diabetes Day - Research uncovering link between gut health and pregnancy outcomes
- Cellular markers of aging could reveal how insulin-producing cells begin to fail in type 2 diabetes
Diagnosis
Print The American Diabetes Association (ADA) recommends that blood glucose screening for adults begin at age 45, or sooner if you are overweight and have additional risk factors for prediabetes or type 2 diabetes. There are several blood tests for prediabetes. Glycated hemoglobin (A1C) test This test indicates your average blood sugar level for the past two to three months. Specifically, the test measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. In general: An A1C level below 5.7 percent is considered normal An A1C level between 5.7 and 6.4 percent is considered prediabetes An A1C level of 6.5 percent or higher on two separate tests indicates type 2 diabetes Certain conditions can make the A1C test inaccurate — such as if you are pregnant or have an uncommon form of hemoglobin (hemoglobin variant). Fasting blood sugar test A blood sample is taken after you fast for at least eight hours or overnight. In general: A fasting blood sugar level below 100 milligrams per deciliter (mg/dL) — 5.6 millimoles per liter (mmol/L) — is considered normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 7.0 mmol/L) is considered prediabetes. This result is sometimes called impaired fasting glucose. A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher indicates type 2 diabetes. Oral glucose tolerance test This test is usually used to diagnose diabetes only during pregnancy. A blood sample is taken after you fast for at least eight hours or overnight. Then you'll drink a sugary solution, and your blood sugar level will be measured again after two hours. In general: A blood sugar level less than 140 mg/dL (7.8 mmo Continue reading >>
Metformin For Prediabetes
Prediabetes is, for many people, a confusing condition. It’s not quite Type 2 diabetes — but it’s not quite nothing, either. So how concerned should you be about it? For years, the jargon-filled names given to this condition — impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) — may have made the task of taking it seriously more difficult. But in 2002, the American Diabetes Association (ADA), along with the U.S. Department of Health and Human Services, inaugurated the term “prediabetes” to convey the likely result of not making diet or lifestyle changes in response to this diagnosis. In 2003, the threshold for prediabetes was lowered from a fasting glucose level of 110 mg/dl to one of 100 mg/dl. Then, in 2008, the American Diabetes Association (ADA) began recommending the drug metformin for some cases of prediabetes — specifically, for people under age 60 with a very high risk of developing diabetes, for people who are very obese (with a body-mass index, or BMI, of 35 or higher), and for women with a history of gestational diabetes. The ADA also said that health-care professionals could consider metformin for anyone with prediabetes or an HbA1c level (a measure of long-term blood glucose control) between 5.7% and 6.4%. But according to a recent study, metformin is still rarely prescribed for prediabetes. The study, published in April in the journal Annals of Internal Medicine, found that only 3.7% of people with prediabetes were prescribed metformin over a three-year period, based on data from a large national sample of adults ages 19 to 58. According to a Medscape article on the study, 7.8% of people with prediabetes with a BMI of 35 or higher or a history of gestational diabetes were prescribed metformin — still a very low rate for t Continue reading >>
Hba1c 6.4 Is It Curable?
by Wendy QUESTION: Hi Dr. Alba, No Charge Glucose Meter - OneTouch Verio Flex® Meter Ad Compact Design to Track Your Glucose On-the-Go. Get It At No Charge. OneTouch Learn more I'm Wendy from the Philippines. I was told by my Doctor that i have Hba1c of 6.4% does it mean that i have a diabetes? She gave me medication and she gave me metformin hydrochloride 500mg. Does it mean that i have diabetes? Can this still be cured? Because she told me that if my Hba1c falls down to normal then i will stop taking medications & i have no diabetes. Is my HBa1c curable? im 33 yrs. old and my dad has diabetes when he was 55. I would appreciate if u would answer my questions thanks From Wendy ANSWER: Hi Wendy, I have to inform you that no one is able to confirm or exclude diabetes as diagnose based only to the result of HbA1c test. Other tests are necessary to be carried out to determine this diagnose. For example, oral glucose tolerance test, fasting blood glucose test and others are needed and you haven’t mentioned if you have run these test or not. In addition, I will mention that normal ranges of HbA1c result is less than 6.5% and your result is 6.4. This means that you have normal amount of glycated hemoglobin in your organism. 2. Second thing is that metformin is really an effective drug and it is used on patients with confirmed diabetes and not on those, who have elevated HbA1c result. Other thing is that patients, who were recently diagnosed with diabetes, are trying to keep their blood glucose concentration within the normal ranges by diet and exercises. If these manners are not effective, drug treatment starts and in most cases metformin is the drug of choice, commonly used. However, my advice for you is to start following a healthy diabetic diet and begin to do some exerc Continue reading >>
