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    • A prediabetic patient does not necessarily need to take medication
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    A prediabetic patient does not necessarily need to take medication

    Pabio Posted on

    Dr. Keith Roach
    | To your health

    Dear Dr. Roach: I am a healthy 63 year old woman. I walk or ride the elliptical four to five times a week for 30 to 40 minutes, and I also strength train at the gym three times a week. I eat most of my meals at home and eat mostly healthy: daily salads, fruit, fish and chicken. Although I go out to eat on the weekends and enjoy a few snacks, I maintain a 30 pound weight loss since 2018 and I weigh 149 pounds at 5 feet 7 inches.

    In November 2022, my A1C was 5.7% and my glucose level was 124 mg/dL (even though I hadn’t fasted for these tests). My endocrinologist was very concerned about prediabetes. Over the next few months, I was very rigid about my diet and my HbA1c level recently varied from 5.3% to 5.8%. I really can’t maintain the rigid diet that has dropped my HbA1c to 5.3%, but I still eat healthy.

    I have an appointment with my endocrinologist next week and I know he will suggest medications based on our previous conversations. My questions are: Should I start taking medication to lower my HbA1c level? Is my body being damaged by a slightly elevated HbA1c level? If I wait and monitor my HbA1c level, at what level should I start treatment? All my other tests are normal and my cholesterol level is excellent.

    —DP

    Dear DP: Prediabetes is most commonly defined as an HbA1c level between 5.7% and 6.4%, so you are still in the prediabetes range, despite what appears to be an excellent diet and exercise program. exercise. I advise my patients not to feel guilty about not being able to keep their blood sugar levels in the perfect range; it’s just not possible for some people.

    Your endocrinologist’s goal will be to prevent you from developing diabetes, which is most commonly diagnosed by an HbA1c level of 6.5% or higher on two occasions. Although medications are sometimes used to achieve this, a healthy diet and regular physical activity have been shown to be more effective than medications. Of course, a combination of a careful, ongoing diet (that you can maintain) and regular physical activity would be more effective than either alone.

    The decision to take medication is yours. If your HbA1C level is 5.8%, it’s likely minimal. The most common A1C goal for a healthy 63-year-old with diabetes is 7.0%, and you are well below that goal.

    Dear Dr. Roach: My mother-in-law had a herpes simplex virus (HSV) infection and now wants to kiss my newborn. She says once cold sores are crusted over, it’s no longer contagious. When would you say that an HSV infection is no longer contagious?

    — DG

    Dear CEO: Cold sores are most commonly caused by the herpes simplex virus 1. In adults, cold sores are a nuisance, but in a newborn, HSV-1 infection can be devastating and cause complications, including skin, eye and mouth diseases. An infection of the meninges (meningitis) and the brain (encephalitis) is particularly feared. Disseminated disease, where the virus spreads, is incredibly dangerous.

    All babies are at risk of HSV infection. When a baby is born to a mother who has never had HSV, the newborn has no protection. For this reason, it is essential to keep family members away with symptoms of HSV infection.

    The stage where the sores are covered with a crust is not an adequate period. The child’s grandmother must wait until there are no more lesions or symptoms, which usually takes about two weeks.

    Readers can email questions to [email protected].

    Pabio
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