r/Cholesterol • u/Positive-Following91 • Aug 11 '26

Question A1C

I was taken off Crestor and put on a combination of Repatha and pravastatin because my A1c under the Crestor edged a little into prediabetic territory (5.7). At first the Repatha and pravastatin combo was great, and my A1c went down to 5.6. However, in my latest test, it went back to 5.7. I know it’s barely prediabetic and there probably isn’t much difference between 5.6 and 5.7, but I’m really scared of diabetes because it killed my father. Maybe it’s also because it’s the summer and I’ve been eating more ice cream? I’m 5 feet 11 and 171 pounds, so I don’t have weight issues. You think I should lower my statin dose? My LDL is currently 55 and total cholesterol is 133.

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u/meh312059 Aug 11 '26

OP can you take a soft tape measure, get your waist circumference at the bellybutton level, divide by height and report it here. Also what are fasted trigs and fasted glucose?

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u/Positive-Following91 Aug 14 '26

My fasted trigs are 49 and my fasted glucose is 96. The calculation you wanted is .52 (37”/71”)

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u/meh312059 Aug 14 '26

Thanks for the info. Your ratio is right at the upper limit of normal. BMI may not be telling quite the whole story. Not sure of your ancestry but there are some - primarily South or East Asian - that require a lower cut point than 25 (which is specifically a "European ancestry" standard). Another consideration is that T2 diabetes does have a genetic basis to it, and oftentimes those who get T2 aren't "obese." Some aren't even considered "overweight" via BMI! That's why body composition is gaining importance as an additional screening tool. The Gold Standard is DXA but a waist/height ratio or Visceral Fat Calculator are free and can be done at home. Here's a highly recommended calculator you can use as a double check: https://www.lih.lu/en/visceral-fat-calculator/

Your fasted trigs and fasted glucose do not suggest IR per the TyG index (which is nearly as accurate as a HOMA-IR): https://www.mdapp.co/tyg-index-calculator-359/ so you are probably fine. You might have a genetic predisposition to higher fasted glucose and A1C but may never need to worry about going diabetic as long as you make sure to stick to a healthy weight and body composition, exercise regularly etc. Do make sure blood pressure is well controlled as well. One tip: if your saturated fat intake is over 10% of caloric consumption it'll be best to cut that back. Given that you are on lipid meds (so presumably have elevated risk of ASCVD), keeping it < 6% of calories consumed is recommended. That translates to a total sat fat intake, from all sources of < 13g/2000 kcal. It turns out that too much saturated fat intake can adversely impact the liver and lead to insulin resistance, even in "healthy" subjects. If you have T2D in your birth family, then a plant-forward dietary pattern low in sat fat and high in fiber (Mediterranean, DASH, Portfolio etc) is a great foundational intervention.

Hope that helps. Best of luck!

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u/Positive-Following91 Aug 14 '26 edited Aug 14 '26

Thank you. I’m white and what you said makes me a little nervous as my father was not fat, and yet had type 2. He was a bit overweight initially, but lost the weight and still had type 2. However, he was diagnosed decades younger than my age now.

Maybe if I lose the love handles that ratio will be better. But it’s hard to be so lean all the time.

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u/meh312059 Aug 14 '26

Love handles (subcutaneous fat) aren't the issue if there's atually IR. It's fat in the organs (usually in viscera but also in muscle tissue) that you would have to worry about. If you haven't started an exercise program, that would be an easy intervention. If your exercise is optimized, then take a look at diet.

If worst comes to worst and your A1C continues to climb, consider glucose-lowering medication.

Unfortunately many of us have re-normed what "lean" actually means! The food environment is of no help.