"Question - should my friend start getting more pro-active about her condition?"
Yes, by all means. It's difficult to change someone in denial but keep trying you might succeed for her own good.
"As I understand it, there is no such thing as ''pre-diabetes'' or ''borderline''. "
When a persons fasting glucose range is between 100 and 125 mg/dl they are considered prediabetic but at the same time borderline, meaning a lifestyle change can reverse the condition back to normal. When a persons glucose level reaches 126 mg/dl and above they are considered diabetic. A level of 127 mg/dl is considered diabetes but is at an early stage and can be reversed like prediabetes or borderline IF your friend makes lifestyle changes.
By all means encourage your friend to make lifestyle changes that will help reduce her glucose levels. These include maintaining normal body weight [BMI], avoid sugary foods and white foods [potatoes, white rice, starchy foods], foods made with white flour [white breads, crackers], pasta, and high carbohydrated foods. Fruits contain fructose, fruit sugar. Eat fruits with other foods to slow fructose absorption. Google 'diabetic foods to avoid' to see the offenders. Also include 30-60 minutes of daily physical exercise.
A home glucose meter is a must have to check levels. Times to test are:
Fasting - first thing in morning before eating or drinking
Preprandial - Before a meal to get a baseline measurement
Postprandial - 2-3 hours after a meal. This informs you how the foods consumed affected your glucose level by comparing preprandial level against postprandial.
Most primary care doctors are not clued in on diabetes care and treatment. This is where an Endocrinologist, a diabetes specialist, comes into play. If push comes to shove where she needs to hear from an expert get her to one.
Thanks for your interesting and concise reply.
I'm really astounded that you say most primary internists aren't clued in on diabetes. How can that be? The condition is at epidemic levels in the USA! This is something I just cannot fathom. Luckily my own primary automatically includes diabetes tests in my regular labwork. Perhaps because it runs in his family, so he's more aware. But just unbelievable that such a common and widespread condition isn't more familiar to family practice and internal med docs. BTW, is hereditary diabetes more difficult to treat than diabetes due to being overweight?
"BTW, is hereditary diabetes more difficult to treat than diabetes due to being overweight? "
If you meant hereditary as in inheriting the diabetes gene/s from one or both parents, the answer is yes. Often children subconsciously pick up on parents diabetic bad habits and carry them into their own adulthood, considered non-hereditary. As far as weight is concerned more and more evidence points to "non-inherited and medicinally induced" diabetes being caused by overweight/obesity. Losing the excess mass has shown to reduce glucose levels. But they must continue following lifestyle changes to maintain glucose levels in check/normal.
I'm not saying ALL PCP's are not familiar with diabetes only initial diabetes treatment and care can be handled by most PCP's. Of course some, like your PCP, has extended knowledge. Key word is "most". Beyond that an endo - the specialist - should be obtained. A good example are LADA [Latent Autoimmune Disease in Adults] aka type 1.5 patients.
This statement in the above post needs clarification -
"As far as weight is concerned more and more evidence points to "non-inherited and medicinally induced" diabetes being caused by overweight/obesity."
Should read, "As far as weight is concerned more and more evidence points to the onset of diabetes caused by overweight/obesity, but not for those who inherited the gene, or are medicinally induced."