“When does medication start for diabetes?”

Your blood sugar is in a range where treatment should be started. If you are overweight you can start with diet and regular aerobic exercise. Otherwise, you can start with medication. Treatment is usually begun when blood sugar level is above 130.

Fasting (pre-breakfast) blood glucose levels above 126 mg/dL are diagnostic of diabetes mellitus. You should be making an effort with diet and exercise (and weight reduction) to achieve a fasting blood glucose between 80 and 120 mg/dL. If these lifestyle changes are not sufficient in realizing goals, we would begin with medications. Your doctor will decide on the proper time to begin with medication and a selection will be made from many available options depending on your situation.

I would start immediately. Anything that decreases the stress on the pancreas, so that less insulin is needed on a daily basis, will preserve the insulin secreting cells. Metformin is a cheap and great choice.

This depends on whom you see. The new guidelines for the American Association of Clinical Endocrinology would recommend treatment of a pre diabetic to prevent the patient from becoming an actual diabetic.

140 is not borderline. It is full Diabetes. I start meds at a fasting sugar of 126 or higher. Sometimes even earlier. It takes at least 5 years of poor sugar control for fasting sugars to rise that much since the first sugars to rise are usually the after-meal sugars in the pre-diabetes stage.... fasting sugar elevations mean a great deal of pancreatic insulin production has already been lost.

If diet and exercise not helping to lower fasting blood sugar < 110.

Medications like Metformin along with Diet and Exercise are shown in studies to slow down progression of DM

It is a discussion that needs to happen between you and your doctor. If you are someone who is at high risk for type 2 diabetes and diabetes related complications depending on your family history or life style .. medical therapy should be initiated as a means of prevention. Metfomin is the best drug of choice. Of course the main stay is always the diet and life style changes. Data is clear that with 5-7% of weight loss one can prevent progression of Pre diabetes to diabetes without medical therapy.

Well the good news is you don't have "borderline" diabetes. The bad news is you have Diabetes. First of all "borderline diabetes" is an obsolete term we don't use anymore. The term for an early state of diabetes today is Pre-diabetes. Here are the criteria FBS <100 normal, FBS 100-126 Pre-diabetes, FBS >126 Diabetes Mellitus. So with a FBS of 140 you are beyond pre-diabetes and have diabetes. Start treatment now. 1) get advice on diet and exercise (we call it life style change 2) start medication. 3) Get a good education course on diabetes 4) get a HbA1c test if not already done. At this level of blood sugar, most physicians would just start Life Style change. I would do that but add the medication metformin. This drug has been in use for decades and has few side effects, control BS, & is generic so is very cheap. Its time to start so see your Dr. & get going before it gets worse as it will without working to keep blood sugar as near normal as possible.