A1: Rick,
She has severe Insulin resistance. I would check a one and two hour post meal glucose along with an insulin level just to make sure her pancreas is indeed functioning. with such an elevated A1C and high post prandial glucose she needs to cut the refined carbs out of her diet and if possbible -- if she is not too ill -- do some weight resistance exercise daily. She may need something to enhance her insulin receptors such as Metformin. (stay away from Avandia/Actos).
The usual micronutrients like chromium polynicotinate 800mcg-1000mcg, with alpha lipoic acid 600mg to800mg, Vanadium and so on can help.
If her pancreas is not really working post prandially, she probably should go on some insulin...BUT, still reduce or eliminate all refined carbs. Stick to lots of green veggies, nuts, seeds, eggs, lean meats, berries, and some whole grains based foods depending on her 2 hour post prandial responses to these. Get off potatoes, fruit juices, sugars, wheat flour foods, corn starch, white rice, et cetera.
If she needs insulin, then she needs to see someone competent to initiate this. (It really sounds like she'll need insulin as her baseline blood glucose levels are too high.) I prefer a split dose of Lantus insulin for long acting basal insulin, along with shots of regular (fast acting) insulin before meals. all of this needs to be closely monitored and she will need lots of instruction on how to do this. That is why I say a competent doctor. By the way, once she starts getting on a proper low glycemic diet and loses weight, her need for insulin will probably go down. However, I should add, that adding Insulin without eliminating the refined carbs in her diet, will only make her gain weight. INsulin is a storage hormone.
She needs to start losing weight as the obesity will make her insulin resistance and diabetes worse. Hence the lower carb diet and exercise. My suspicion is that her diet has been horrible for decades and high in refined carbs and she has not had much exercise. (if you pump in the glucose and stay inactive, you are following the blue print of the pre-hibernating bear, and will convert all of this to triglycerides and store it around the waist/belly area. No fat cheetahs on Natl. Geo! They're carnivores and no carb eaters. )
Ron Manzanero,MD
http://www.aimmd.comAustin, TX
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