standard guidelines recommend a general approach of starting with lifestyle modification (eating and exercise) and then adding medications if blood sugar levels are not adequately controlled. if diabetes is newly diagnosed because a patient presents with symptoms of high blood sugar (such as excess thirst excess urination blurry vision etc. ) then we typically use medication immediately to bring the blood sugar closer to normal and alleviate the symptoms. furthermore metformin is approved to use in prediabetes to delay or prevent the onset of type 2 diabetes and one can justify using metformin in anyone with type 2 diabetes or prediabetes. the threshold for starting medication can therefore be any point between a1c of about 5. 9 to 7. 0. once the a1c is higher than 7. 0 it is harder to justify delaying medication. in any case doctors and patients need to have discussions about the benefits risks and drawbacks of using medications and these benefits risks and drawbacks change depending on the degree of glucose control and the type of drug(s) being considered. personally i start to think about starting metformin if a patient cant keep the a1c below 6. 5. if someone wants to use lifestyle change and weight loss to reduce medication i usually discontinue the sulfonylurea type drugs (glyburide glipizide) if the blood sugar levels start to dip below around 70-80 mg/dl or the a1c goes below 6. 5. i like to stop the metformin once the a1c stays below 6. 0 for about 3 months provided that the patient can maintain or extend the weight loss and lifestyle changes.
do doctors immediately prescribe medication to control blood sugar or do they wait to see if diet and exercise help?