My last AIC was 7.1, I am not taking insulin or any medication (was 10.1 when identified 2 years back, now A1C is 7.1). I believe that I can drop my A1C below that with tightening up the diet and stepping up my exercise program more -- I want to stay away from meds as long as possible. What do you think?
Congratulations. That's a great accomplishment. Excercise is the best medecine. Exercise and TZD's are the only ways to sensitize the muscle and fat to insulin, and promote the mobilization of free fatty acids from where they shouldn't be to where they should. If you can keep tight control with just diet and excercise that's great. However, keep in mind that in the last two years plus your elevated A1C's have been wreaking havoc on your body. Micro and macrovascular complications are already in the developement stage. So, if you are not able to lower your levels quickly and keep them lower, medication would probably be a good addition.
Jason, what are TZDs?
TZD's, or Thiazolidinediones, are a class of oral antidiabetic medications. They act by binding to the PPAR gamma receptor inside the cell, activating transcription and reducing the resistance on the insulin signaling pathway.
In order for glucose to enter a cell, a number of things must occur. Insulin must first bind to the insulin receptor on the outside of the cell. This in turn sends a message inside the cell, of moblization and multiplication. The cell must mobilize GLUT 4 molicules to the cell surface. They act sort of like ushers to usher glucose into the cell. The cell must then muliply the GLUT 4 molecules because some of them are lost in the process of "ushering." Type 2 diabetes is often referred to as a post receptor defect because of the resistance on the insulin signaling pathway. The message of mobilization and multiplication doesn't really get communicated. Thus, the GLUT 4 molecules never make it to the cell surface, and therefore, glucose doesn't get uptaked by the cell. Hence high blood glucose levels.
When this happens the cells are starving for energy. They trigger the breakdown of free fatty acids, which can be freely uptaked by the cells to be used for energy. Free fatty acids are also utilized by the liver to produce glucose in a process called gluconeogenesis.
I know this is a little lengthy, but hope it helps.