We live in a time of extremes, and nowhere is this more obvious than in the health and wellness worlds, where new guidance seems to be released on an almost daily basis contradicting earlier advice and new fads promising to help us achieve perfect health come and go with the seasons.
But as trends rise and fall, one thing about wellness remains constant: Our bodies perform best with moderation and balance. For years, a common source of confusion in diabetes advice has been whether to start medicines early or hold off as long as possible. There are proponents on both sides of the debate, and people with diabetes often avoid starting medication due to a perceived stigma (along with concerns about potential side effects or financial impacts).
But while many hold off on starting diabetes medications, this can have a number of negative health effects. In fact, for many reasons, waiting to start could be the biggest mistake we make in managing our diabetes. Here are some of the reasons to adopt medicines as part of your diabetes management regimen sooner rather than later.
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The time following a diabetes diagnosis can often be full of confusion and conflicting opinions, but this is also a prime time for motivation and hope for improvement. People who are newly diagnosed have already taken positive steps and made the good decisions to get checked out, have lab work done, talk with their doctors, and make a plan to improve. Adding a medication at this time can make the most of this positive forward movement. Keeping up the momentum makes reaching goals easier.
However, many times both prescribers and patients start with the mindset of, “If lifestyle change efforts don’t work, then we will start medication.” But lifestyle change can be very difficult, and it is not always enough to achieve optimal management. A few months later, the patient may be struggling and may even avoid follow-up appointments because they fear they will be judged harshly for not reaching goals that may have been unreasonable to begin with. It may be months or more before they go back to their provider, having not met their goals and now feeling defeated. They may be depressed or in denial.
In this scenario, starting medication is no longer a helpful continuation of forward movement but rather a desperate attempt to stop the backward slide or even perceived as a punishment for “not doing well enough.” Starting medication soon after diagnosis can avoid this situation, instead maintaining positive momentum and leading to feelings of empowerment.
Preserving pancreatic function
There is research showing that, for many people, type 2 diabetes is a progressive disease. Elevated blood sugar puts a strain on the pancreas as it attempts to produce more insulin to bring these levels down. This strain may damage or “burn out” the insulin-producing beta cells, so they can’t make enough insulin to meet the body’s needs. Blood sugar levels then rise further, and the cycle of pancreatic cell function loss continues.
Beta-cell loss means that when medications are started, they may not work as well. This, in turn, means that higher doses will be needed, which increases the risk of side effects. However, if medications are started earlier, they can ease the strain on the beta cells, so the cells maintain more of their function. This means lower doses will be needed to achieve healthy blood sugar levels. There are even studies indicating that starting medications sooner can allow for the regeneration of damaged pancreatic cells in those with type 2 diabetes. Starting insulin sooner has additionally been shown to have a benefit in helping maintain low levels of pancreatic insulin production, which is extremely valuable in reducing the risk of long-term complications and the incidence of severe low blood sugar.
Discussing with your prescriber what medications you can use to help you lower your blood sugar without putting additional strain on your pancreas can be a very helpful step in diabetes management from the very first day.
Medication does not have to be forever
Diabetes is a condition that we can directly impact and improve with our efforts, and starting medication sooner can sometimes also mean stopping it sooner. Initiating medications early can help bring blood sugars into a healthy range quickly. At the same time, efforts can be made to adopt healthy lifestyle adjustments, such as meeting with a nutritionist to plan out a healthful diet, increasing physical activity to help tone muscles and improve insulin sensitivity, and working slowly and steadily toward weight management.
These lifestyle changes can be made all while the medication is working in the background to help control blood sugar and reduce the risk for complications. Better-managed diabetes will also lead to more energy, a more positive outlook, better vision, a sharper mind, and more, all of which can make it easier to adopt the lifestyle adjustments. And as those lifestyle changes are put in place, there may even be a decrease in the need for medications.
This is all to say that diabetes medications can often serve as temporary supports while a person’s new lifestyle is “under construction.” This is how a building is repaired: Supports are put in place to keep things safe and allow for quicker progress. Lifestyle and weight management goals can be reached more quickly and safely with the support of medications, which then can possibly be reduced or removed as the other changes are put into action.
Jumpstarting weight-loss efforts
Weight management is often a crucial piece of diabetes management, but weight loss is tough to get started, and it takes time to see the results reflected both on the scale and in blood sugar levels. However, medicines in two drug classes — SGLT2 inhibitors (Steglatro, Invokana, Jardiance, Farxiga) and GLP-1 agonists (Trulicity, Bydureon, Ozempic, Victoza, Adlyxin, Byetta) — have been shown to reduce appetite and increase feelings of fullness, both of which can be very helpful for both blood sugar and weight management. SGLT2 medications also work by increasing the excretion of glucose in urine, which releases excess calories and may help with weight loss.
Reducing the risks of other conditions
While medications all have associated side effects, when it comes to diabetes drugs, these effects are not always bad. In fact, some medications have side effects that can help us reach other health goals. For example, the SGLT2 and GLP-1 medications discussed above have been shown to have health benefits beyond blood sugar reduction, including reductions in blood pressure and lowered risks for heart disease, congestive heart failure and heart-related hospitalizations.
The role of medications
We should not rush to medications as a quick fix, and it is important to recognize that diabetes increases the risks for other health conditions, even with well-managed blood sugar. In caring for your health, the choice should not be between medication or lifestyle management. Indeed, lifestyle changes such as improving weight management, increasing physical activity and eating a healthy diet can help reduce the risk of issues like cardiovascular disease, stroke and cancer.
Aim to find a healthy middle ground where lifestyle and medication can work together to get you to the healthiest version of yourself. Don’t let making medication your last resort be the first mistake you make in managing your diabetes.
Want to learn more about diabetes drugs? Read the “Diabetes Medicines” series from certified diabetes educator Amy Campbell, covering insulin, metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors, alpha-glucosidase inhibitors, bile acid sequestrants and dopamine receptor agonists, and non-insulin injectable diabetes medications.