" I’m of the opinion that he should look for another doctor. "

I agree. I'd look for one about half this guy's age. Check with friends for referrals. Good luck to your "friend".

Thanks. The doctor is perhaps in his late 40s. He was suggested when friend asked his well trained but new gastroenterologist for recommendations. The new PCP’s age seems fine, but I think the friend should stay on metformin and get educated about pre-diabetes and diabetes. It is a serious situation. Some people are reluctant to listen, pay attention, act.

BTW, what sort of doctor for a senior with ”pre-diabetes?” Endocrinologist?

He needs an aware attentive overall competent internist (Internal Medicine). The person (friend/patient) is increasingly retiring, oblivious, passive.

I knew someone who had dementia from diabetes (DMII) - the small vessels in the person’s brain became inflamed.

That sounds like a credible referral source. But of course, once the door closes and the doctor-patient encounter begins, no one besides those two knows what does or doesn't happen. It can be hard for patients to assess whether the doc is or isn't seeing and doing everything that they should because they may have no frame of reference for comparison.

Primary care doctors usually provide written instructions for follow-up actions patients are suggested to do.

Thanks. Yes, I would hope (expect) that a competent internist would give the patient some direction or instructions. You cannot just send a pre-diabetic patient home and hope they read up or figure things out on their own (assuming they are even well enough and cognitively competent enough and motivated to do so).

Although it is an hour drive, the friend could go to a Boston area teaching hospital. But often one ends up with residents. Mixed bag.

A primary care Dr. who specializes in geriatric patients would be appropriate, I think. I consider myself fortunate that mine does, since I'm over 65 now.

Thanks, CarolB. He nor I know anyone to ask about who is/ might be good. The friend/patient is not the most compliant, aware, attentive, responsive. He is often recalcitrant.

Sigh.

I think you've gotten good advice here.

I just wanted to mention that for some people metformin has some distressing gastrointestinal side effects both unpleasant and embarrassing. I'm wondering if that happened to your friend?

In any case I agree that he needs more information and direction, and he doesn't seem to be getting that.

Thanks, Lily. No side effects. He was taking his AM fasting Blood glucose measurements with one of those OTC kits and because the readings were usually something like 105 108 he thought that was close enough to normal (I think ”normal” would be < 90 or 99),

he suggested to the nurse practitioner that he stop taking the metformin. DUH. He can be increasingly obdurate. <——— is that a symptom of dementia, DM, old age of lame brain?

From articles I’ve recently read about metformin and prediabetes, it seems that his taking that medication, exercising, getting good sleep and nutrition (grains, complex carbohydrates) might go a long way towards helping him stay free of developing DM II.

Now please read about a relationship between Metformin and Vitamin B-12 deficiency. Read the effects of B-12 deficiency and you might see some familiar things.

I have an elderly friend who also went to a medical practice which I felt was doing very badly by her. They seemed to have a revolving door for doctors as she was constantly seeing a different doctor who was unfamiliar with her (very complicated) medical history and would make ad hoc changes in her treatment regime which were not in her best interest.

I had myself once one to one of their doctors (it was the only practice in our small town and I did not have to time to drive over to the next town where my usual practice is) and was very dissatisfied, having presented with three issues and being told "Oh, it's just one of those things" and being dismissed within five minutes of my sitting down.

Even though I constantly urged my friend to seek a different practice, she was very stubborn and would not. She had tried my excellent practice but was not happy with them because the doctor she saw looked at her funny, or something. She is quick to see and to take offence where there is none.

Sadly, there may be nothing you can do to help your friend if he digs his heels in. As an adult, he can make his own decisions, even if they are wrong.

Since the numbers are pretty borderline, perhaps the doctor wants to get a better idea of where he really is when he gets lab work done again, and will put him back on the medication if necessary. Having too low a blood sugar can cause real problems, too.

The CDC promotes a National Diabetes Prevention Program featuring an entire year of weekly and monthly learning sessions, both live and remote, lifestyle coaches and support groups to help people get themselves on a healthier track. Maybe this approach will appeal to your friend. https://coveragetoolkit.org/about-national-dpp/ndpp-overview/

Thanks again, everyone. Good reassurance and food for thought.

Matthias — thanks for the heads up. He only took it for perhaps 4 or 6 months. I found a link https://medicine.net/news/Gynaecologyandobstetrics/What-You-Should-Know-About-Metformin-and-Vitamin-B12.html

I suggested he might want to consider taking a multivitamin (but isn’t the thinking that multivitamins can just make expensive pee?)

He seems to eat decently, not picky. Fish, poulry, limited red meat, some ham (nitrates, nitrites), yogurt, fruit, real oatmeal. Maybe not many leafy greens.

Also, should men take vitamin D3? That Centrum Silver has 1000 IU of vitamin D3.

I take 2000 IU daily per doctor’s recommendtion, but now cannot recall why. (Maybe it improves calcium absorption?)

I also want to prevent DMII. My A1c was 5.1 a few months ago, so I guess that’s okay, but I want to stay aware and on top of things. Lately I have partaken of Hershey bars with almonds. I think my memory might be losing ground 🤔