ArcaMax

DEAR DR. ROACH: I am a healthy 63-year-old woman. I walk or do the elliptical four to five times per week for 30-40 minutes, and I also do strength training at the gym three times per week. I eat most of my meals at home, and I eat mostly healthy -- daily salads, fruits, fish and chicken. Although I do go out to eat on weekends and enjoy some snacking, I am maintaining a 30-pound weight loss since 2018 and weigh 149 pounds at 5 feet, 7 inches.

In November 2022, my A1C came in at 5.7%, and my glucose level was 124 mg/dL (although I had not fasted for those tests). My endocrinologist was very concerned about prediabetes. For the next few months, I was very rigid about my eating, and my A1C has varied from 5.3% to 5.8% most recently. I really cannot maintain the rigid diet that got my A1C down to 5.3%, but I still eat mostly healthy.

I have an appointment with my endocrinologist next week, and I know he will suggest medication based on our previous conversations. My questions are: Should I start taking medication to lower my A1C? Is there damage being done to my body from a slightly elevated A1C? If I wait and monitor my A1C, at what level would I need to start medications? All my other labs are normal, and my cholesterol levels are excellent. -- D.P.

ANSWER: Prediabetes is most commonly defined as an A1C between 5.7% to 6.4%, so you are still in the prediabetes range, despite what sounds like an excellent diet and exercise regimen. I advise my patients not to feel guilty about not being able to get their blood sugars into the perfect range; it's just not possible for some people.

Your endocrinologist's goal will be to prevent you from getting to diabetes, which is most commonly diagnosed by an A1C of 6.5% or higher on two occasions. While medications are sometimes used to help achieve this, a healthy diet and regular exercise was found to be more effective than medicine. Of course, a combination of a continued careful diet (one that you can maintain) and regular exercise would be more effective than either alone.

The decision to take medicine is up to you. If there is damage from your A1C of 5.8%, it is likely to be minimal. The most common A1C goal for a healthy 63-year-old with diabetes is 7.0%, and you are well below this.

DEAR DR. ROACH: My mother-in-law had a herpes simplex virus (HSV) infection and now wants to kiss my newborn. She says that once the cold sores have crusted over, it's no longer contagious. When would you say an HSV infection is no longer contagious? -- D.G.

ANSWER: Cold sores are most commonly caused by herpes simplex virus 1. In adults, cold sores are a nuisance, but in a newborn, HSV-1 infection can be devastating with complications including skin, eye and mouth disease. Especially feared is an infection of the meninges (meningitis) and brain (encephalitis). Disseminated disease, where the virus spreads, is incredibly dangerous.

All babies are at risk for HSV infections. When a baby is born to a mother who's never had HSV, the newborn has no protection at all. For this reason, keeping family members with symptoms of HSV infection away is critical.

The stage where the sores are crusted over is not adequate time. The child's grandmother should wait until there are no lesions at all and no symptoms, which usually takes about two weeks.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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