I'm going to write some boring stuff about my history, but start with some rather firmly worded stuff about the need to make aggressive changes now.
8.5 is not merely unsatisfactory. It is dangerous. Anything over 6.5 is a serious issue, and you need to be back down to 6.0. There are subtle types of damage being done to lot of your body. Eyes, nerves, kidneys, blood vessels, ticker, and more. You will be more prone to various infections, too. By the time you notice them, you will have serious problems that will destroy your quality of life. You're being compelled to move to satisfy your wife's desire to see the grandkids etc - if you don't change the path on which you are traveling with the utmost aggression, you will not be able to enjoy the kids, even assuming you are alive. Go to youtube, and find the R. Lee Ermey/Full Metal Jacket introduction to boot camp. Apply that mindset to the changes you need to make.
The diabetic education class is a critical first step. Good for you, and as you note, you should have gone to it at the first indication. Due to my introduction to diabetes, I didn't know what I didn't know. The class was vital. Try like heck to have your GP refer you to a good endocrinologist as suggested above. The specific knowledge is good for you. Exercise is vital. I se you have some significant issues that limit your ability to engage is some forms of exercise, so a good rehab therapist and athletic trainer if you can find them (most MDs know jack about exercise physiology) who can help you find something you can do is a great investment. My guess is that walking in a pool (easier on your joints) might be in your future. Let's make sure you understand this: the things you have to do will require serious changes in your mindset, your life, and your allocation of money. If you are not willing to do this, plan on writing your will and checking out ASAP, or on having a miserable remainder to your life.
Why do I have such a vigorous attitude? My own history. I have written about it in a couple of settings, and will try to combine the S&W forum safe parts of it. Some was written to my siblings to educate them and their kids (themselves all adults); some in a PM exchange on another forum.
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Shorter version: I do pretty well with the BG and everything else, partly because I am so active. It probably saved my life when I was discovered to have developed diabetes (June 2008) as a result of the prednisone I was on for a few months. 3.5 days on my backside with IV insulin and stuff - a 676 BG causes some major panty bunching among medics. My A1C at that time was 13.1 or so. I've been 6.2 or less, usually 6 or less, for 4.5 years now. For unknown reasons, the glomu-whatever (filters in the kidneys) had gotten too open and I was not processing protein, just pissing it out. The prednisone at pretty high doses for 4 months were needed to shrink them. Unfortunately, that is a stress test for the pancreas, and if you have the latent tendency, it will soon suck to be you.
The prednisone made me gain weight (35-ish pounds in about 6 weeks) AND get weak. FML. As the BG got higher, I become very prone to muscle cramps during exercise, so instead of using the exercise bike for 60 hard minutes, at about 22 minutes I had opposing muscles lock up. Painful. FML again. When I groused to the doctor and wanted to see if we could transition off the Prednisuck, they did some blood draws. One was over 400, which meant jack to me, but I did not even have any of the side effects. 2 were ok, the 4th was the 676. I was in the hospital and on IV insulin, plus a bolus to start, an hour after the doctor called. I started the diabetic education right away the first morning in the hospital. After 3.5 days I got out, and I don't recall ever getting below 200 while I was there. I was too used to being active.
When I went to the education class the day after release, they were advocating this starvation diet (maybe 1800 calories/day, when I would lose weight at 3K under normal conditions) and at least 30 minutes of walking as exercise (which is maybe what I would do with the dogs, prior to the real exercise). Most of the folks in the class were on the slow motion suicide by lifestyle plan. This was followed by the clot and all that crud, discovered that day. (I seemingly clotted as a result of laying on my butt in the bed, which may have been BG related.) 31 hours of not getting out of bed in the hospital except I refused to dump in a bedpan and have some poor stranger have to wipe my furry butt. 4 more days total, leaving me at 8 in an 11 day period. The two sets of diet restrictions meant I could only eat unrestricted amounts of meat and cheese. Hello cholesterol and pravstatin. FML cubed.
Several people smarter than I have told me the vast majority of people who experienced that would have croaked - like 95%, and only my lifestyle carried me. I was annoyed and inconvenienced. I have some tangential damage/after effects, like the last 10 pounds of the 35 are just refusing to come off. I had a herniated belly button due to the weight gain, leading to surgery. FML(4th). My vision already sucked; there was a little more damage that is hard to tell from the effects of age on a guy who started wearing glasses at 7 and was at or worse than 20/400 most of his life. There is a little additional nerve damage, not much, and some other hormonal/adrenal crud.
Considering what it could have been, no real complaints. The diabetes is dealt mostly by diet and exercise, with some metformin. I wear a 50-52 coat with < 38 trousers at 6'1 and 230, which is a pain in itself since that means nothing on the rack is close to fitting. It would be worse if I were in better shape! I am also a pharmacopea. My list of scrips is annoying, but not as bad as someone who really let themselves go for 40 years. I have a lot of affection and respect for the two specialists, whom I saw so much that I did not see my primary for over 2 years.
To the sibs: I've been doing some research about this since my predisone induced blood sugar issues, and more since I learned that mom has diabetic tendencies, specifically high BG. As I learned enough more to have new questions, I inquired of my endocrinologist. In sum: I think we are all at a higher risk because of genetics. This means that each of you (and your kids) need to be aware of the risk, means of monitoring, and risk reduction protocols.
In essence, those like me who end up developing type 2 as a result of the use of the steroid (prednisone), are already prone to the problem. My doctor described it as essentially a failed stress test for the pancreas. I suspect that some symptoms I had, such as occasional calf cramps on the exercise bike, were preliminary indications. That was likely a result of elevated blood sugar because unlike running, I needed to eat something or become far too hungry to continue. The good news is that because of my relatively aggressive exercise program, I was merely inconvenienced by all the things that happened.
I only survived it because of my lifestyle, and roughly 95% would have died. I should have been comatose, or at least convulsing. The BG level I had was well over 5X the presumed top of normal BG, and my A1C (the real issue) was WAY past the diabetic threshold. The nurses on my floor told me that I looked too healthy to be there. Well, goody.
I suspect that the kidney issue that resulted in being prescribed the prednisone to address the filter issue may have been related to diabetic symptoms, too. All together it means I don't get to improve my life insurance in any meaningful way. All of these things interrelate and mean I have some real interesting (in both breadth and number) prescriptions, in part because of the increased risk of other problems (blood pressure being the big one).
SO: the real point is that all of you (and your kids) may be well advised to pay a little more attention to diabetic symptoms and indicators than most other members of the population. I think that there is enough here to answer a question about "family history of diabetes" in the affirmative. The problem then becomes being an informed consumer. I did not know the extent of my ignorance when this all started. Like most people who are not diabetic or did not know of their risk, I did not have any incentive to know what any of this all meant.
First: the BG # one gets from a finger stick test is simply a moment in time, like a snapshot. Unless you have some really odd # that gets medical attention, it is not useful information. What you really want is the A1C. It essentially provides a more long term impression, showing your average BG over a period of months. (This is a CRUDE over-simplification.) For good info, see
A1C and eAG: American Diabetes Association®. I strongly recommend that you get this test done at every physical, not less than once a year, if you can persuade your doctor. It also takes a finger stick, and about 5 minutes to process. If you are at or above 6.5, you need to start taking action. 7 is considered diabetic. When I was hospitalized, mine was over 13 - and if you look at the chart on that web page, you'll see it does not go that high! (My A1C for the last 4 years has ranged between 5.8 and 6.2.) I can control this largely by diet and exercise, as once I weaned off the prednisone I had less trouble with the insulin production and uptake. I do take some pills (metformin), but most of the control is personal.
When I started the education classes, I was aghast at what they considered appropriate exercise, until I considered the population in my class. The level is so low (work UP to 30 minutes/day of walking) as to be laughable, IMHO - generally less than the normal walking of the dogs before exercising! They also had me on what was essentially a starvation diet, because they were not used to an active person. That took some fixing.
The importance of exercise is two-fold. The first part is obvious - the more exercise, the more you use the sugar in your blood. That's simple. The other part, however, is that exercise improves/increases uptake of insulin at the cellular level. That means if you have limited insulin production, as I do and you are at risk for, what is there is used better. I have lost a lot of tolerance and recovery ability in the last few years, which I think is mostly age related, but may overlap with the illness(es). It's pretty hard to do a minimal CV workout (40 minutes at >80% of MHR, when I used to do an hour or more) followed by serious weights. I do what I can. Losing the last 10 pounds of what I gained with the prednisone has also been ugly. The first 25 came off in about 8 months.
I was lucky. An insurance physical caught the kidney issue, leading to the scrutiny. My lifestyle carried me through this. My doctors, frankly, are outstanding. Because I had one squared away specialist (nephrologist), I got connected to one of his colleagues (the endocrinologist) whom he holds in high regard. They work together and coordinate well enough that I call them co-conspirators. I did not even see my primary care doctor for the first 2 years or so of this, as they saw me so often they took care of all my medical needs while I was there. I can’t say enough good about them. Good insurance helped.
Since I have ridden through this, about as well as I can, and we also have the indicators from mom’s symptoms, you should make use of this experience for your own benefit without going though all the fun I did. My vision, never good, is a little worse; I have a few small nerve problems; other things have been impacted a bit. Don’t let yourselves get too far in to a problem by failing to learn from my experience and upgrading your self monitoring. One of the things I have seen since my first diabetic education is that most people are HORRID consumers of medical care. They don’t know what they don’t know, they are too apathetic to inquire of and work with their doctors, and then often too lazy to make use of the information. It’s crazy to see some of the people who do not listen to my doctors, and it is obvious they don’t. Why bother going to the doctor then?
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Back to the specifics again. I am a needle sissy. I HATE doing blood draws, getting shots, and all that. So what? I did the insulin thing for about 10 months as they weaned me off the prednisone (on something else now for that issue, which maintains control over it). Insulin is watery and thin, so the needles are not obnoxious. I had one shot daily of ... something I don't recall, and then an adjustable pen with about 250 units of insulin that I injected with meals after I did the carb math. Even while in the hospital, I insisted on learning to do my own, since I was going to have to. Compared to the blood thinners (and when I started it was IV Heparin, oral Coumadin, and injected Lovanox), easy. Lovanox was like shooting gear lube into my belly blub. Hated it, but it was only a week. I have some other endocrine damage and give myself another shot 3X/month. Big needle, and I live 180 miles from the clinic, so I do it at home. Also thick, think enough to try to push the plunger back up if I don't hold it.
I take Metformin ER, 1000 2 X daily with food. (Regular metformin made colonoscopy prep seem fun; take the ER.) For me, with diet and exercise, it works. I prioritize exercise over almost everything else that is optional in life. My wife and I don't go to movies much, most other social silliness is rare (maybe 1 event a year at most), etc. My dad got 10 good years of life after his first chest pains that would have been fatal if he had not lost weight and started exercising at 42 or so, and I have been to enough autopsies that I know what matters. You are at this moment, not able to do without insulin. Suck it up, and do what you gotta do. It's the only body you will ever have, and if you don't start doing what you need to, the costs will be awful. I went to a DOA about a year before I retired on a guy who was not all that old, but spent 30+ years dying from all of his diabetic issues and side effects. Multiple amputations, open heart surgery, and a generally bedridden horrid life. No thanks.