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One Pill At a Time

Jan Chait

July 30, 2013

Which is a better way of treating people with Type 2 diabetes: Starting with one medicine and adding more, or starting with multiple medicines and lowering doses or subtracting meds?

I’m a proponent of beginning with multiple medicines that target different areas, getting the blood glucose down, then lowering doses and/or subtracting medicines. I blogged about this in 2008, but had previously written about it in 2004, based on an interview with California-based endocrinologist Allen B. King, who calls the method “Blast and Taper Fast.”

King explained that it takes more medicine to bring a high blood glucose level down than it does to maintain a normal level.

Depending on the person’s fasting blood glucose after undergoing a two- to six-week period of increased activity and eating changes, he hits them with up to three different medicines. And if their glucose isn’t down to normal levels in two weeks, they’re on insulin.

Wow! Your glucose is coming down. In fact, you’re doing so well the doctor is taking medicines away or, at least, lowering the doses.

Now let’s go to the United Kingdom, where researchers looked at the records of 81,573 people with Type 2 diabetes. Records were in the UK Clinical Practice Research Datalink. Findings were published online in Diabetes Care on July 26. You can read an article about it here. If you have a subscription to Diabetes Care, you can read the original.

Those who had an HbA1c of 7% at baseline had to wait a median of 2.9 years for doctors to add a medicine. By then, their HbA1c was an average of 8.7%. (Median means that half had a lower number and half had a larger number.) It took more than seven years for them to be put on insulin.

Because Type 2 is progressive, treatment needs to be more aggressive as time goes on.

“A substantial proportion of people remain in poor glycemic control for several years before intensification with oral antidiabetes drugs and insulin,” the authors were quoted as writing.

Anyway, and so it went. Sometimes the times and HbA1c results were a little less, sometimes a little more. Doctors waited as patients’ control got worse, putting them at higher risk for diabetic complications.

Researchers were quoted as saying that a

protracted period of poor control can have adverse effects; the follow-up data from the UK Prospective Diabetes Study (UKPDS) have demonstrated the beneficial legacy effect of good glycemic control early in the course of Type 2 diabetes, potentially conferring protection against, or delaying, long-term diabetes complications.

I believe this also makes the case for Type 2s checking their blood glucose. If you see your numbers going up, you can let your doctor know.

Your doctor isn’t the one who feels like crap because of high numbers. Your doctor isn’t going to get retinopathy, kidney disease, neuropathy, have limbs amputated or any of the other, many, diabetic complications. (Remember: Diabetes only affects the parts of your body that have blood flow.)

Insurance and Medicare cover strips if you have a prescription. I didn’t know that in the beginning, nor did my doctor, and I paid out of pocket. You can get store brand meters and strips at places like Walmart and Walgreens. The meters don’t have the bells and whistles the newer ones have, but they work.

You can get a good snapshot of how your numbers are running by checking only two times a day. On one day, check before breakfast and before dinner. The next day, before lunch and at bedtime. Keep alternating.

Occasionally, check two hours after you take your first bite of a meal. I told a man to do that after he said his glucose was about 130 mg/dl every time he checked — every Saturday when he woke up. The next time I saw him, he was in shock. He was from India. I knew he probably ate a lot of rice.

OK. Get yourself educated. Check your BGs. Don’t let your doctor wait to intensify your treatment if your numbers indicate you need more oral medicine or insulin. You haven’t done anything wrong: It’s that darned Diabeastie rearing its ugly head. Again.



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