Diabetes drugs given 'too soon'

[IndianaGreen]

Source: BBC News

Diabetes drugs given 'too soon'

Page last updated at 10:30 GMT, Saturday, 7 March 2009

One in three people with type 2 diabetes are given medication too soon, instead of being urged to eat better and do more exercise, a study suggests.

A study of 650 people in south west England found 36% were put on tablets within a month of being diagnosed, a Diabetes UK conference heard.

But guidelines recommend first trying lifestyle changes to control diabetes.

A Department of Health spokeswoman said medication helps people to "manage their condition".

The Royal College of GPs agreed diet and exercise should come first.

More than 400 people a day are diagnosed with type 2 diabetes in the UK.

Read more: http://news.bbc.co.uk/2/hi/health/7930007.stm

[Warpy]

1. I disagree with this wholeheartedly

because it's essential to get that blood sugar down ASAP.

Lifestyle changes happen slowly and a lot of people aren't willing to make them. When and if those changes occur, the drugs can be tapered off and a lot of people can stop taking them entirely.

Since there is no crystal ball to tell docs which people are going to take it seriously enough to work hard to control it and which would rather live the way they've always lived and take their chances, it is simply good medicine to treat the high blood sugar in both groups and change things accordingly.

Diabetes II is serious. It has all the complications associated with Type I, albeit they occur a little more slowly. It needs to be treated as quickly as possible to minimize these complications. If patients go on to control their blood sugar with diet and exercise and can quit taking the drugs, that is great.

[wickerwoman]

22. The drugs make lifestyle changes much more difficult though.

Once patients go on the drug to lower blood sugar it becomes almost impossible for them to lose weight even when they do start eating better and exercising.

Pretty much everyone else in my family has diabetes which meant when my mom was diagnosed she was super vigilant, lost thirty pounds and so far hasn't had to start the drugs. Because she has lost weight and feels better, she is even more motivated to continue the lifestyle changes. If she had started the drugs straight away, she wouldn't have been able to lose the weight.

If I were a doctor, I would give patients the option to lose weight (depending on how serious the blood sugar problem was) and if, after a month or so, they weren't able to do it, push the drugs. It seems more dangerous to me to get people dependent on the drugs and unable to lose weight... the drugs should only be a stopgap until people are ready to make serious lifestyle changes.

[Warpy]

27. What if your mom hadn't lost the weight?

Most people don't. Starting the drugs and getting that blood sugar down is essential. People like your mom would be motivated to get off the drugs, some of which have unpleasant side effects.

Please don't make the rules for everybody because your mother was an exception.

[goclark]

29. My mom is 90 and weights 108 lbs. she works with a Fitness

Trainer 3 days a week. He comes to the house, walks her and has her do lite exercises.

When she was declared Diabetic 25 years ago, she weighed 135 lbs.

Later in the thread I spoke about my wondering if she can ever get off of the drug.

Her level is generally 98 - 110 all the time.

[wickerwoman]

30. That's why I said "depending on their blood sugar level"

and the only "rule" I made was that doctors should give patients more credit and give them a fuller picture of what's possible with lifestyle changes vs. drugs.

My mom's doctor strongly recommended that she go on drugs but if she had, she wouldn't have been able to make the lifestyle changes that she did.

I'm not "making rules", I'm pointing out that it's a bit more complicated than a simple "take drugs now and sort out your life later".

In her case, watching her sister-in-law die after numerous amputations and blindness and dealing with her husband's poorly managed diabetes and the poorly managed diabetes of her two brothers, sister and another s-i-l and nephew gave her the knowledge of the disease and the motivation to handle her own case differently. But when she walked into the doctor's office they didn't bother to learn about or take into account any of that. They just assumed that no one can change and pushed drugs.

My dad went straight on drugs and tried lifestyle changes but because of the drugs he couldn't lose weight so he lost all motivation, said fuck it for years, and now has significantly lower quality of life and will never be able to get off the drugs.

[Dorian Gray]

32. I agree and disagree

I was exhibited pre-diabetic symptoms when I started up with my yearly exams. When I got all my numbers back, I was shocked into action. (High Cholesterol, good cholesterol low... bad cholesterol high... BP skyrocketing, etc.)

I think that doctors should keep up with their patients and try to encourage them to eat well and exercise. If they refuse to change, then yes.

One of the reasons I turned my life around (started eating well and exercising) was to avoid the need for meds if I came down with diabetes.

And happily, now, I'm in perfect health.

But, I agree with you that most people are unwilling to make good choices due to a number of reasons. And if diagnosed with diabetes, it is important for them to keep their blood sugar regulated. Watching my mother in law struggle with all the diabetes related problems while refusing to make any dietary changes (fried foods for almost every meal, and she's never met a fruit, vegetable or whole grain that she's liked), I realize that many other people are like her.

[grilled onions]

2. It;s Just The first Step

Many doctors get their patients to take a diabetic class and it's there that dietary changes are taught and hopefully used. If they insist on eating as they did the meds won't work well. The meter numbers tell the story. When I was diagnosed I immediately was put on meds as well as an intensive class. Ironically while the blood sugar numbers went down the cholesterol med numbers went up indicating that the cholesterol was not just a diet issue. I am now on cholesterol meds as well. Hopefully my next fasting will show lower numbers.
Yes those numbers need to get down fast and many have no idea there numbers are dangerously high. Meds aren't given too soon but they should never be expected to do all the work. Patients have a huge responsibility to exercise,watch what they eat and check those blood sugars.

[kimmerspixelated]

3. I'm no expert,

but from what I've read in alternative medicine, the first step, other than diet and exercise, is to take herbs that replenish, and nourish or rejuvenate the pancreas. When insulin via drugs are introduced to the body, the pancreas thinks it doesn't have to make insulin anymore so it quits working to do it. Setting up a lifetime of insulin shots, does nothing to help the pancreas at all.

[grasswire]

6. what herbs are those?

Do tell.

[Lost in CT]

13. They are magic herbs from the land of your going to die anyway just quicker and more natural.

[elias7]

31. Alternative medicine: two problems

First, claims are made that are testable but never are formally tested. And second, gross misrepresentations of traditional medicine foster mistrust of the whole industry.

The FDA would be breaking the law if it allowed a company to market a drug without thorough testing, yet you state that alternative medicines exist which can replenish the pancreas. This would be an easily testable hypothesis. In pre-diabetes, the islet cells have a blunted release of insulin in response to meal. In diabetes, that response becomes completely lost. Give me a study that shows these medicines rejuvenate the pancreas (measure post-prandial insulin levels) and you're on to something. Maybe Wyeth will by the rights to Cottonwood extract or Jericho root, call it Rosiglitazone, test it exhaustively, then allow the public to try it.

There is no analogue to insulin in oral form. Metformin inhibits release of glucose stored in the liver, easing the burden of the pancreas. The glitazones increase the ability of muscle, fat and other tissues to absorb glucose from the blood, also easing the pancreatic burden. Sulfonylureas coax the islet cells of the pancreas to produce more insulin, as does a newer class of drugs that you take before meals.

The combination of drugs, diet, exercise, renal protective meds, blood pressure meds and cardiovascular risk factor reduction all work to preserve the pancreas as long as possible, though it does eventually burn out (rather than stop working from underuse as you suggest).

If people had any idea of sheer volume of research and information out there, the huge numbers of people in the various medical fields working on countless aspects of this problem, I don't think they would be so quick to dismiss traditional medicine in such a contemptuous manner. Similarly, if people had any idea how little research and ongoing work goes into the production of alternative medicine, as well as how grossly misrepresentative the claims are, they'd realize that the bulk of info out there is really a big scam. The underlying principles are sound-- rejuvenate and replenish this or that organ-- but they're utilizing some old folk knowledge or chinese knowledge or other form of healing from earlier cultures, and morphing it into snake oil.

In my opinion, the alternative medicine industry is criminal as it markets dubious, though wonderfully named, chemicals as healing agents, while proffering all kind of misinformation.

Do you really believe that pounds and pounds of spackle cake our intestines? Ask someone who knows, like a gastroenterologist who looks at the insides of bowels all day...

[BanzaiBonnie]

8. I was put on a regimen of eating 2 T flax seeds (ground)

and 2T sunflower or pumpkin seeds daily + the fish oil caps to increase my intake of omega 3 oils. We'll see in the next blood test if that has caused my good cholesterol to show higher.


Both my husband and I have eliminated MOST of the refined sugar in what we eat. I'm working on taking in no more than 15 grams a day. I use stevia, maple syrup and agave syrup for sweeteners.

We're both feeling immensely better for it.

[CAG]

4. The "diet and exercise" thing is given only lip service by physicians

because 1) there is a general perception (which is probably and unfortunately correct) that these genuine changes occur rarely and 2) big pharma drug reps and their "expert" speakers bureau physicians from academia push the drugs over the big steak dinners

[Psephos]

5. Docs couldn't care less about steak dinners

They're motivated, like everyone else, by having to expend less effort to get a result. It's far easier to write a script than to figure out a plan tailored to a Type II patient's psychology and physical capabilities, along with all the follow-up on reinforcement and accountability.

Most doctors are less concerned about money (which is usually plentiful enough) than they are about time. Time is the true incentive of the professional class. Not getting sued is right up there, too.

[CAG]

11. We're both correct. By "steak dinner", thats only one of several ways

the drug companies spend billions marketing to physicians; if it didn't work, they wouldn't do it.

[TexasProgresive]

12. Actually few will do the diet and exercise is why the docs

turn to drugs.

[Abq_Sarah]

17. Doctors known the probablility

Of compliance is very low. There are ways to either reduce or eliminate dependence on drugs for Type II but most people just won't do it.

[KalicoKitty]

21. The diet and exercise has definitely helped me!

I was diagnosed in September with type II diabetes. My doctor recommended the diabetes education classes, which I attended. I also met with a dietician. My doctor also recommended more exercise. I have been going to the gym three mornings a week and eat a healthy diet. I have lost twenty pounds and feel great. My blood glucose is now where it should be. I have learned to stay away from the carbs, which were always my weakness!

[cannabis_flower]

7. However..

at least in the case of Glucaphage (Metformin) there are studies that say the drug can actually prevent or delay diabetes from occuring. I am taking it even though I am just prediabetic. I have Polycystic Ovarian Syndrome which leads to diabetes usually.

[KT2000]

9. A plan that worked

When my sister was diagnosed with Type II Diabetes she was put on some drugs, and sent to a class. The instructors were a nutritionist, an orthopedic surgeon, and endocrinologist, and an ophthalmologist.
There was no doubt in her mind that she risked losing her legs, eyesight and kidneys if she did not take it seriously. She was off the meds and in control through diet and exercise ASAP.

My brother and brother-in-law were also diagnosed. They each had an appointment with a nutritionist who talked to them like they were children. They are both still on meds and do not think it is a serious condition. Well, actually BIL just had a stroke so he is taking it more seriously.

[Epiphany4z]

10. as a type 2 diabetic,,,i can tell you

the life style change takes a bit of time...and high blood sugar #s make it twice as hard to make the needed life style changes....you are tired and cranky alot when your numbers are off...it is easier to eat the crap you shouldn't eat and dam hard to get up and exercise when your so tired lifting you head off the pillow can be a chore...so there is something to be said for starting on meds rite off...without the meds I don't know if I could have gotten the umpf to get my butt in gear...

[Egnever]

20. Exactly right!

the begining months are especialy hard there is a lot to learn and any help during that period is welcome IMHO.

[Ms. Toad]

14. That's all well and good -

but my spouse's numbers were 3-400 at diagnosis, and the FIRST nutrition/lifestyle class our health care covered was six months from the date of diagnosis. The doctor's lifestyle diet changes were - Don't go nuts, just be careful. You don't have to deny yourself a piece of graduation cake once in a while (our daughter was graduating from high school in a few months.) Exercise.

I researched and a fair amount of information - but it was critical to get the numbers down quickly - not more than six months (by the time she learned what lifestyle changes should be made had a chance to work).

The real kicker is that even when she managed to get into the class, their advice was geared to people who were overweight. She did lose about 20 lbs in the process - but she was in the normal weight range to start - they had very little advice for people whose diabetes is not weight related (about 10%). . . and even for people with weight problems, the advice to "count carbs" doesn't go very far for people who don't recognize what foods are carb heavy, and aren't given guidelines as to limitations on carbs. I can count to gazillion - but if the limit is 100 I haven't done myself much good.

[ellenfl]

15. my doc put me on metformin because my blood sugar

was 106 . . . one time. my NEW doctor and i are going to take me off the pills and see what happens . . . my idea, of course. i still have to lose some weight and i do still have high cholesterol (genetics). the only good thing is that metformin has been around a long time so any side effects (like death) have already been worked out . . . and it's $4/month. regardless, i am getting off those pills and working on making some adjustments to my diet.

oh, and i have not been diagnosed with diabetes and i have NONE of the symptoms. i am told i'm pre-diabetic but isn't everyone, potentially? what does that mean, anyway? i'm also pre-hearing loss and pre-death, technically.

ellen fl

[Abq_Sarah]

18. If you are overweight

Have crappy blood lipid results and your blood sugar is running a little on the high side, they may consider you prediabetic because you could be showing signs of insulin resistance which will lead to Type II. Has your doctor ordered glucose tolerance tests?

[ellenfl]

24. no gtt. my prior doc was a pill pusher. it's why

i got a new doctor. btw, my sister does everything right, health wise, and she periodically has blood sugar over 100 . . . in fact she tells me she has had slightly high sugar for the last 8 physicals. we both have genetically high cholesterol and apparently blood sugar, as well. no way she is pre-diabetic . . . and i don't think i am either. my doc could have worked with me on nutrition but chose instead to put me on metformin.

ellen fl

[Abq_Sarah]

26. Weight is a strong indicator

For Type II but you can be thin and still have high blood sugar levels. There was a story in Men's health about a year ago called The Thin Man's diabetes.

I was pre-diabetic with horrible blood lipids, borderline blood glucose levels and high blood pressure 8 years ago at age 38. I was about 20 lbs over optimal weight. My doctor wanted me to take statins and metformin because my father had his first heart attacks at age 42. Instead, I completely changed my diet and now have normal blood sugar levels, excellent lipid profile and normal blood pressure. The catch? I can't eat sugar anymore. If I keep my carbohydrate level low, everything's fine. For me, low carb was an acceptable alternative to pills, pills, pills. I understand some people either can't or won't make that change so they need to do the best they can.

[goclark]

23. My Mom was declared Diabetic 20 yrs ago. She is 90

and every morning I take her Diabetic Numbers.

I kept asking the Dr. was she still diabetic because her numbers are rarely over 108.

He said yes, she is still a Diabetic.

Finally he said, anything over 128 and I must give her the pill.

In 8 months she has reached it one time.

She lost 25 lbs. over those years and I believe that is a major factor.

[Ms. Toad]

25. You might want to see if her doc will run an

HA1C. It is essentially a look-back over blood sugar over the past few months. As long as it is below 7 my mom's doc does not require her to take metformin. (I think most doctors have gone to 6.5 - and it doesn't catch spikes, which are also hard on the system dangerous)

As to taking it (I am assuming metformin) for blood sugar over 128 on any given day - it isn't an immediate acting medicine, so it is sort of pointless to take one pill. If your mom needs it she should be taking it regularly, not just on the days she goes over 128.

Disclaimer - I'm not a doctor or a diabetic, just married to one, grew up with half dozen type I diabetics, and my grandfather, mother, and uncle are diabetic.

[goclark]

28. Thanks for the information ~ we really have to be our own

doctor ultimately because it is getting more and more difficult to know what to believe with all the Pharma ads dancing around our TV all day long.

And we constantly have to watch the Pharma reps dancing into the doctor's offices while patients sit there waiting to be seen.


I believe you and I will ask him about giving her that test and again thanks so much for the advise.
Edit to add: I came to live with my Mom in 2001 and she was on 11 medications a day.

One by one, I kept asking the doctors why she needed this and that and I kept reading all the side effects( and she had many)and listening to people.

Seven years later she had her 90th birthday and she only takes her high blood pressure medication -- 1 pill a day.
For 90 yrs young that's pretty good.

[espiral]

16. re:

I wonder whether the pharmacos always make sure that they choose low-carb health foods when they swing by the clinic with those complimentary catered lunches and such?

[Egnever]

19. There is a lot of misinformation on diabetes.

coming from all corners. This article misses the mark IMHO the drugs should be used in conjunction with diet and exercise. The damage from diabetes comes from the pressure on the cells caused by high blood sugar and the idea that remaining high while trying to change ones lifestyle immediately is ok is silly.

Type 2 is very tricky because the islet cells are still producing insulin and it can be very sporadic. obviously limiting carb intake and paying attention to glycemic indexes is key to decent control but it is a very hard line to walk and any treatment that helps, especially in the beginning while people educate themselves on the disease, should not be frowned upon.