Drug Treatments for Diabetes 2

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Topics from the book,
Managing Diabetes 2

Normal Foods Cause Diabetes
Importance of Diet Revision
Coping with Diet Change
Exercise is Best Medicine
Consequences of Diabetes 2
Oral Medications
Insulin
Monitoring Diabetes
Diabetes and CV Disease
Sugar and other Carbohydrates

Drug Options

Standard medical treatment protocols for Diabetes 2 always mention "lifestyle changes" and then quickly proceed to medication options. While diet is sometimes mentioned , the critical, decisive importance of diet revision and exercise is not emphasized and in practice, diet revision is often neglected in favor of drug treatments.

Drug treatments of Diabetes 2 do not have a good track record. The main problem is the false belief that a drug or combination of drugs can rescue an individual from a disease-causing lifestyle. While there are benefits to be had with the newer medications, a diabetic should learn expert self-management skills and exercise all the therapeutic and preventative options available before considering drugs.

The most negative aspect of medication is that a drug prescription may be taken to mean that the patient is passive, dependent and has been excused from making all the important changes that will preserve body parts and ultimately save his or her life. If the drug is taken as permission to postpone or forego the vitally important changes in food choices, eating behaviors and exercise, then the prescription has done a great disservice.

Drugs to Lower Blood Sugar

Our perspective is that the drug treatment of diabetes is lacking in convincing long-term efficacy and there are an number of important concerns about side effects and long-term adverse effects. Oral medications should not be considered as primary treatment. MDs tend to be drug prescribers and do not teach self-management skills.

There is also uncertainty about the different mechanisms at work in diabetic patients and the selection of medication is not based on solid foundation of understanding who benefits from what pharmacological interventions. The current choice is between a group of drugs which improve glucose clearance from the blood but do not raise insulin levels and another group of drugs (sulphonylureas) which increase insulin secretion. A drug which would restore the function of insulin sounds like a good idea. A single, ideal drug with long-term benefits may never be found since there are likely to be many different mechanisms behind the failure of insulin to work properly and the dietary and environmental determinants of this failure are likely to be multiple and very potent.

Medical treatment plans often give lip service to the life-style changes that are required to control this disease and seldom are realistic about the difficulties encountered by anyone who attempts major diet change. Medical treatment plans also are unaware of or underestimate the intensity of habitual eating patterns and the compulsive eating aspect of the diabetic experience. Drugs are prescribed as soon as a patient fails to achieve diet control and often provide a false of security that the problem is being handled. Drug-taking patients continue to eat too much of the wrong food and exercise too little.

We realize that the task of changing and then controlling eating behaviors long-term is not an easy one. The task is to realistically assess your own eating behaviors, understand what has to change and then recruit the necessary resources to make this change.

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According to the National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Public Health Service.

"Oral diabetes medicines, or oral hypoglycemics, can lower blood glucose in people who have diabetes, but are able to make some insulin. They are an option if diet and exercise don't work. Oral diabetes medications are not insulin and are not a substitute for diet and exercise. Although experts don't understand exactly how each oral medicine works, they know that they increase insulin production and affect how insulin lowers blood glucose. These medications are most effective in people who developed diabetes after age 40, have had diabetes less than 5 years, are normal weight, and have never received insulin or have taken only 40 units or less of insulin a day. Pregnant and nursing women shouldn't take oral medications because their effect on the fetus and newborn is unknown, and because insulin provides better control of diabetes during pregnancy.

There is also some question about whether oral diabetes medications increase the risk of a heart attack. Experts disagree on this point and many people with noninsulin-dependent diabetes use oral medicines safely and effectively. The Food and Drug Administration (FDA), the agency of the Federal Government that approves medications for use in this country, requires that oral diabetes medicines carry a warning concerning the increased risk of heart attack. Whether someone uses a medication depends on its benefits and risks, something a doctor can help the patient decide.

The purpose of oral medications is to lower blood glucose. Therefore, the person taking them must eat regular meals and engage in only light to moderate exercise, to prevent blood glucose from dipping too low. Medications taken for other health problems, including illness, also can lower blood sugar and may react with the diabetes medicine. Therefore, a doctor needs to know all the medications a person is taking to prevent a harmful interaction. Lowering blood sugar too much can cause hypoglycemia with symptoms such as headache, weakness, shakiness, and if the condition is severe enough, collapse. Oral diabetes medications usually don't cause side effects. However, a few people do experience nausea, skin rashes, headache, either water retention or diuresis (increased urination), and sensitivity to direct sunlight. These effects should gradually subside, but a person should see a doctor if they persist. For reasons that aren't always clear, sometimes oral diabetes medications don't help the person for whom they're prescribed. Investigations are under way to learn why this happens."

Managing Diabetes 2

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