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JoeD42
Total Posts: 24
Registered on: ‎11-10-2011

Which is better, meds or no meds?

Hi there,

 

If you are able to control the BG level with a very strict diet and exercise, would it be better to stay off the meds.?  

 

 The reason why I ask is because if there is a cure someday one would need to preserve any remaing beta cells they have left.  

 

So does taking the meds help to preserve the remaining cells you have left or or does it kill the rest of em off?

 

thanks for your help.

alan_s
Total Posts: 14,395
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Registered on: ‎10-30-2009

Re: Which is better, meds or no meds?

To answer the question in the topic:

 

Q: Which is better, meds or no meds? A: Whatever works for you. The goal is to avoid, delay or mitigate diabetes complications, not to avoid meds.

 

However, I prefer to aim for that goal using meds if, and only if, I cannot achieve it by reasonable lifestlyle choices.


The reason why I ask is because if there is a cure someday one would need to preserve any remaing beta cells they have left.  

 

So does taking the meds help to preserve the remaining cells you have left or or does it kill the rest of em off?


Nobody really knows the answer to that. I work on the presumption that is best to err on the side of caution until they do. I wrote a longer response here: To Medicate - Or Not?

 

 

Cheers, Alan, Type 2, d&e metformin 2000mg, Australia.
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: It Must Be OK - It's Sugar-Free! Wrong!)
Born Under a Wandering Star (Latest: Flying Alitalia from Morocco to Rhodes)
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morrisolder
Total Posts: 10,432
Registered on: ‎11-28-2009

Re: Which is better, meds or no meds?

The most important thing is to maintain good control of blood glucose numbers. If that can be done with diet and exercise alone, fine, but if medications or insulin is needed to accomplish that, it is more important to have good numbers than to remain med free.

 

A number of studies have shown that taking meds does not seem to affect the rate at which beta cells wear out.

 

But not treating high glucose numbers does force the body to produce high levels of insulin and that can progress to wearing out the beta cells that produce that insulin.

 

Here is one discussion of how that happens.

Morris

Diagnosed Type 2, with an A1c of 11.4 in 2003; averaging a 5.0 A1c since then with diet, exercise and Glipizide XL + meds for blood pressure and cholesterol. 
A bit dated, but scroll down on this page if you want to know more ...


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powerwalker2
Total Posts: 5,403
Registered on: ‎11-02-2009

Re: Which is better, meds or no meds?

[ Edited ]

JoeD42 wrote:

Hi there,

 

If you are able to control the BG level with a very strict diet and exercise, would it be better to stay off the meds.?  

 

 The reason why I ask is because if there is a cure someday one would need to preserve any remaing beta cells they have left.  

 

So does taking the meds help to preserve the remaining cells you have left or or does it kill the rest of em off?

 

thanks for your help.


I agree with Alan and Morris that the most important thing is good blood glucose control.  But, in answer to your first question, I'd say that "if you are able to control the BG level with a very strict diet and exercise", you may not need meds.  At least, for a while.  Maybe for many years.  When I was controlling with just diet and exercise for 11 years, I saw no need for meds, and neither did my doctor.  My numbers were good for a long time that way, and my A1cs were around 6 most of the time.  I am still using diet and exercise, but also metformin as a supplement.  It has helped keep my A1c down, but only about half a percentage point.  Do what you can, and when you can.  Whatever you need to do.  What does your doctor say?  How are your numbers?  What is your overall plan?

Nancy ~ T2 since '98 ~ 16 yrs ~ D&E 11yrs ~ treadmill, elliptical, bike 15-20 minutes 3x/day (including evening), dumbbells/resistance training, small portions heart-healthy high-fiber/low-fat fuel/carb-counting, 500mg Glucophage XR x4, 2.5mg Glucotrol XL x6, 6000IU Vit. D/day ~ RHR 53 ~ A1cs mainly between 5.9-6.9 av. 6.5
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sam_43
Total Posts: 83
Registered on: ‎10-10-2011

Re: Which is better, meds or no meds?

Dear Alan

I am a D2 diagnosed in 2006 with a FGB of 136 and A1C of 7.3% .At first, I kept my blood sugar in check with exercise and diet. I was successful initially and my A1C fell

to 5.7% after three months. I was able to carry on like this for nearly two years with my quarterly  A1C  never crossing 6.3 %. However, this was too good to last and I

had to go on medication -2x500 mg Metformin daily .I am continuing with the life style changes I initiated just after diagnosis . My A1C which i test every three months

or so hovers between 5.9 and 6.3 %. I am confident that I can reduce my BG and A1C quite a bit if I were to add a Sulfonyl urea to my medication. Is it worthwhile doing

this taking into account stuff like Glucostoxicity, betacell burnout, secondary failure etc  with the hope of protecting my betacells so that they can live to fight another day?

What is the trade off ? Is it a short term versus long term issue?

 

Me endo is not in favour of the idea because he feels that Sulfonylureas are potent drugs that I do not need at present. I think he  ,like most of the medical profession

is scared of hypoglycemia. His target tBG levels for me are FBG of < 100 and postprandial of <150. Presenty I am able to maintain these levels ,more or less.

 

Any advice would be thankfully welcomed

 

sam

alan_s
Total Posts: 14,395
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Re: Which is better, meds or no meds?


I am a D2 diagnosed in 2006 with a FGB of 136 and A1C of 7.3% .At first, I kept my blood sugar in check with exercise and diet. I was successful initially and my A1C fell to 5.7% after three months.

 

I was able to carry on like this for nearly two years with my quarterly  A1C  never crossing 6.3 %. However, this was too good to last and I had to go on medication -2x500 mg Metformin daily .

 

I am continuing with the life style changes I initiated just after diagnosis . My A1C which i test every three months or so hovers between 5.9 and 6.3 %. I am confident that I can reduce my BG and A1C quite a bit if I were to add a Sulfonyl urea to my medication.


First, I'll repeat that I am a diabetic, not a doctor so what follows is purely a personal unqualified opinion.

 

With an A1c of consistently 6.3% or less I would need a substantial reason to add a medication before I had exhausted a review of my menu and exercise regimen. If I had some diabetes complications such as one of the 'opathies that might change my opinion, but I doubt it.

 

Whatever their possible benefits there are no side-effects-free medications. I would need something more than the situation you have decribed to add the sulf. Or anything else.


Is it worthwhile doing this taking into account stuff like Glucostoxicity, betacell burnout, secondary failure etc  with the hope of protecting my betacells so that they can live to fight another day?
What is the trade off ? Is it a short term versus long term issue?
Me endo is not in favour of the idea because he feels that Sulfonylureas are potent drugs that I do not need at present. I think he  ,like most of the medical profession is scared of hypoglycemia. His target tBG levels for me are FBG of < 100 and postprandial of <150. Presenty I am able to maintain these levels ,more or less.

The jury is still out on whether insulin stimulators cause beta cell burnout. On the other hand, there is no research AFAIK indicating that adding a sulf will cause improved beta cell longevity.

 

On balance, I agree with your endo. Not because of hypo fears but simply because I believe the med is not necessary in the situation as you describe it. And I don't take unnecessary meds or prophylactyic meds; I only take those for which I, or my doctor, can see a demonstrable personal need.

 

Just my opinion.

Cheers, Alan, Type 2, d&e metformin 2000mg, Australia.
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: It Must Be OK - It's Sugar-Free! Wrong!)
Born Under a Wandering Star (Latest: Flying Alitalia from Morocco to Rhodes)
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morrisolder
Total Posts: 10,432
Registered on: ‎11-28-2009

Re: Which is better, meds or no meds?

I won;t presume to answer for Alan, but will share my thoughts on this, Sam, since I have thought a lot about this.

 

Sulfonylureas are pretty powerful, in the same way that insulin is--they very directly bring blood sugar levels down by putting more insulin into your system, and thus do have the danger of hypoglycemia as their biggest downside.

 

Aside from that, whether they make sense for you  depends on your personal brand of diabetes. If, for example, you are unable to produce enough insulin, sulfonlylureas cannot magically produce it for you. In that case you would need  insulin. Your current numbers, however suggest you probably are not in t hat category.

 

If you are not having any issue producing enough insulin, then lack of insulin is not an issue, and a sulfonylurea is unlikely to help all that much.  Where it would be most useful would be if you are totally capable of producing enough insulin, but somehow just don;t do it. Basically your pancreas is not turning on, and in that situation  a sulfonylurea can effectively trigger insulin production that otherwise is lacking.

 

Speaking from personal experience, neither metformin nor Avandia did very much for me at all, and it wasn;t until I added Glipizide that suddenly I had numbers lower than you currently have, quite normal numbers. I stopped the other meds and my numbers did not change. For me the issue was precisely what the Glipizide was addressing. And after more than 8.5 years I have not only dropped the other meds, but also reduced the Glipizide i am taking twice. And my numbers have stayed just fine--my latest A1c at 5.2 was the highest in about 18 months.

 

For me there has never been a hint that I am in any way "burning out" my beta cells. Although I have read lots of internet opinions warning me of that I have never found a doctor who thought that might occur to me.  Yes that I might need insulin some day, but not as a result of Glipizide, but of the normal progression of diabetes. Well, if that is happening, it is very slow. I always wondered why beta cells have to be different than muscles, which when you use them, grow.

 

I found this discussion of the issue a while back and still find it convincing...  The author is pretty well known as a diabetes expert.

 

One more thought--beta cells do burn out when forced to overwork by large insulin resistance over a long period. But when  following a relatively low-carb diet, stimulating the normal production needed to metabolize carbs may not have that effect.

Morris

Diagnosed Type 2, with an A1c of 11.4 in 2003; averaging a 5.0 A1c since then with diet, exercise and Glipizide XL + meds for blood pressure and cholesterol. 
A bit dated, but scroll down on this page if you want to know more ...


alan_s
Total Posts: 14,395
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Re: Which is better, meds or no meds?


I found this discussion of the issue a while back and still find it convincing...  The author is pretty well known as a diabetes expert.

Thank you Morris.

 

I owe a debt to Charly; one of the wisest writers I encountered on usenet. Thanks for reminding me and for the link to that post. I haven't seen much to change that detailed response since 2003.

Cheers, Alan, Type 2, d&e metformin 2000mg, Australia.
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: It Must Be OK - It's Sugar-Free! Wrong!)
Born Under a Wandering Star (Latest: Flying Alitalia from Morocco to Rhodes)
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TopperH
Total Posts: 73
Registered on: ‎08-18-2011

Re: Which is better, meds or no meds?

Read the precautions and side effects on some of the diabetic medications (actos, byetta, etc.).  Common sense will then tell you it is better to not take some of these meds if you don't have to.  Common sense also says if you can't get good BG control without meds, then it is probably better to use some meds to get good BG control.  Yes, I am not taking any meds now and am just controlling my BG with diet.  I think that is way better than where I was last year eating carbs and taking 4 meds.  The side effects of 3 of these are pretty scary if you ask me.  These are all choices we have to make, but you should use some logic in those choices.  You can't be blind to the effects of your choice.  That is my opinion anyways.  

_____________________________________________________________________________
Type 2 Diabetic Since 2007 -> 7.2 A1C when diagnosed

Used 4 meds (Metformin, Lantus, actos, byetta) until 8/2010 -> 5.9-6.0 A1C consistently

Doing low carb diet since 8/2010 to control my Diabetes (actos only) -> 5.4 consistently
No more actos since 10/04/2011 - drug free now
lizzylou
Total Posts: 13,847
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Registered on: ‎10-31-2009

Re: Which is better, meds or no meds?


JoeD42 wrote:

Hi there,

 

If you are able to control the BG level with a very strict diet and exercise, would it be better to stay off the meds.?  

 

 The reason why I ask is because if there is a cure someday one would need to preserve any remaing beta cells they have left.  

 

So does taking the meds help to preserve the remaining cells you have left or or does it kill the rest of em off?

 

thanks for your help.


Hi Joe,

 

My answer is similar to the other ones, the aim should be good BG control with or without medication depending on your condition (and here's where I differ) and your lifestyle choice.

 

Yes, this is your life and your choice.  If you can live with the level of "very strict diet and exercise control" that's necessary to maintain your numbers long-term, then by all means go for it. 

 

If however you find yourself constantly "falling off the wagon" because the diet is too strict for you to maintain, then in my opinion it's better to seek a little help from medication because nothing will burn your beta cells out faster than high numbers.

 

As far as I'm concerned every person must make realistic decisions for themselves.  I'm not the moral police and it's no ones place to make judgments on anyone else's choices.  Just because something works for me doesn't mean that everyone should have to deal in the same way. The world is full of individuals with free will and most have the ability to make choices for themselves after being fully informed and aware of the alternatives.

 

In case you hadn't noticed this is one of my "soap box" issues. :smileywink:  I think often we give the impression around here that if you have to eat super low-carb because you're body can't handle more than that, you should just suck it up and do that instead of seeking some help from medication.  My position is that each person has to decide what they can reasonably live with and the real goal is to get and maintain good numbers.  Granted this will always involve carb control to some level, there are different choices, not just one.  There are also different levels of how a person's body functions to consider as well.  If you can't see well without glasses would you debate whether your eyesight would get worse if you wear them?

 

Lizzy

Knowledge is Power!





Here's some useful links, click on the titles


Testing 101
 
 All About Carbs

Resources For The Un-insured and Discount Medicine and Equipment

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Lizzy's Blog
for lots more