Diabetes Self-Management Blog

I apologize in advance. I don’t want to keep writing about American medicine’s obsession with drugs. I’m tired of reporting on how the system’s drug addiction hurts people with chronic conditions. You might be tired of reading about it, too.

But they just won’t stop! The medical establishment keeps putting out dangerous pro-drug misinformation. The latest misleading study comes from William Duckworth, MD, and colleagues at the Phoenix VA Health Center. As in last year’s ACCORD study (see my take on that here), Duckworth found that “Intensive glucose control did not reduce cardiovascular events in patients with previously diagnosed Type 2 diabetes.”

Duckworth defines “intensive control” as the American Diabetes Association’s guideline of a 7.0% HbA1c. He believes an HbA1c of 9% is the best many older people can do. He recommends focusing on lowering cholesterol and blood pressure instead.

There’s only one glaring problem with this advice. When the authors say “intensive control,” they mean “control with drugs.” They notice that giving people four or five drugs to lower blood glucose doesn’t help reduce cardiovascular risk, so they question the point of lowering it at all! There is no mention of self-management or any self-care activities. And just how do they recommend lowering cholesterol and blood pressure? Of course, with even more drugs!

Treating Symptoms, Ignoring Disease
Well, OK. I agree that we shouldn’t obsess about HbA1c or any particular number like weight or cholesterol. Health is about more than numbers. I’ll even admit that blood pressure might be the most significant of these numbers. But the point is that high cholesterol, blood sugar, and blood pressure are not diseases. They are all symptoms of the same disease, which goes by many names, insulin resistance and metabolic syndrome being the most common. This disease is caused, at least in part, by our social environment, with the three main causes being: too much stress, not enough physical activity, and too much unhealthy food.

And as I say in my books, you can’t treat these environmental causes with drugs. You can treat them with self-management, and drugs can help with that. But when you start piling on more and more medicines, the side effects rapidly start to outweigh the benefits. And drugs can’t make people active. They can’t reduce stress, and they can’t help us find and eat healthier food.

Why Blame Drug Companies?
See last week’s blog entry, “Too Many Drugs,” about the effects of polypharmacy, the scientific name for overprescribing. Sometimes people bring polypharmacy on themselves by consuming too many over-the-counter drugs. More often, we are pushed into, or even forced into taking more drugs.

For example, did you know that the standard doses for many drugs are much higher than most people need? Drug companies test drugs at high doses because they are more likely to show a beneficial effect and win FDA approval. (A lot of this information comes from the book Overdosed America by John Abramson, MD.) Then those doses become standard, which means the companies sell higher quantities of drugs. The problem is that most people, especially older people (who take the most drugs) can’t handle these higher doses. They get far more side effects and drug reactions and spend far more money than they would if they received lower doses.

New drugs are marketed not so much as cure-alls as “prevent-alls.” We are supposed to take them even if we’re not sick to prevent getting sick later. The statin (cholesterol) drugs are the prime example. They are supposed to prevent heart disease, but at least one long-term study showed that overall health and mortality didn’t change much for study subjects.

Another example is the class of drugs called “bisphosphonates,” used to prevent osteoporosis. This class includes the once fabulously profitable drug alendronate (brand name Fosamax). Now it turns out that they may cause cancer. A recent letter in The New England Journal of Medicine by Diane Wysowski, PhD, of the FDA says that, since 1995, the FDA has received 23 reports in which people taking Fosamax developed esophageal tumors. Typically, two years lapsed between the start of the drug and the development of esophageal cancer. Eight people died, she reported.

Fosamax (which has now gone generic) has also been reported to increase irregular heartbeats in women who take it. (Women, remember, who aren’t even sick. They’re just “at-risk.”)

The point isn’t that drugs have no place in healthy living. It’s that many drugs are dangerous, expensive, and have nasty side effects. It’s that self-management comes first. Of course, most people who read this blog may know that already, so keep up the good work. And I promise not to write about this again for a while.


  1. Dear david.

    A HA1c of 9% great. My brother’s was lower and he had severely gangreened feetand that was not caused by cholesterol.

    It is also possible that if you keep your blood sugars in the normal range most of the time and do a bit of exercise that all the rest falls into place for most people.

    Not always true, rare individuals like a collegue of mine had sky high cholesterol because of genetic predisposition. But somehow his parents lived to be very old. He was very disturbed and nervous all the time and you wonder if that had more to do with his heart attack than the cholesterol.

    Posted by CalgaryDiabetic |
  2. Sorry Dr Duckworth, my body trumps your study.

    I was diagnosrd high cholesterol at the same time of my diagnosis with type 2 diabetes. Since I was going to change my eating habits, I declined the cholesterol meds in favor of waiting to see what the change in diet would do.

    My 2nd hbA1c was in normal ranges (I was using insulin for that as well as the dietary changes) and SO WAS MY CHOLESTEROL. High blood sugars and high triglycerides go hand in hand.

    After losing some weight and maintaining my diet, I’m no longer using insulin but my cholesterol levels have REMAINED in NORMAL levels.

    Posted by Ephrenia |
  3. I would like to know the science behind why fat is harder to lose for a diabetic. I am having very little luck finding the scientific reason for this. I am recently diagnosed with Type 2 and am having an awful struggle even though I try to stay at 1200 to 1400 calories per day and am carefully watching carbo intake.

    Also, your magazine (which a friend sent me) showed a link between metoprolol (Toprol XL)and higher glucose. How much higher? I have been on these beta blockers (mostly Toprol and now metoprolol) for about six years. Would these pills have caused my present problem? They were started because of rapid heart beat (due to thryroid disease) but at the time I did not have high blood pressure (I do now).

    I have one more question. Is there a correlation or have any studies been done linking statin drugs to higher glucose levels? I have stopped my statin pills for six weeks and my glucose is down, although I have also been dieting.

    Any information you can give me will be much appreciated. Sincerely, Frances Anderson

    Posted by Frances Anderson |
  4. Hi Frances,
    I don’t really think it’s true that weight loss is harder for people with diabetes. It’s hard for everyone. People with type 2 tend to have slower metabolisms; they tend to be “energy-savers.” So the important thing is to get moving. See this blog -http://www.diabetesselfmanagement.com/blog/David_Spero/Fitness_in_Ten_Minutes_a_Day

    The toprol quite likely is a major cause of your problems. Studies show beta blockers increase risk of diabetes by 50%. See if you can find a way to get off them. Check this link: http://www.dailymail.co.uk/health/article-403973/Beta-blockers-increase-diabetes-risk-50-cent.html

    There is one study linking a statin drug to increased glucose levels. It was significant, but they need to do more research. (Statins are hard to criticize - it’s kind of like attacking the Pope.) Here’s the abstract - http://www.ncbi.nlm.nih.gov/pubmed/16733297

    Hope this helps. Try to get more physical activity.

    Posted by David Spero RN |

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