September 3, 2006

A Good Time to be Diagnosed?

There's plenty to depress us in the diabetes news. The ADA continues to pander to the snack food and drug companies. Medical researchers who are funded almost entirely now by drug companies continue to publish research so poorly designed a freshman can see the flaws in the design and statistical analysis. But even so, when I compare the situation now to what it was when I was first diagnosed in 1998, there are a lot of reasons to be optimistic. Here--listed in no particular order--are a few of them.

1. Doctors are Finally Prescribing the Right Drugs. When I was diagnosed in 1998, the only drug available for people with Type 2 diabetes in the U.S. that wouldn't damage their health was insulin--which most doctors would not prescribe until the patient had already developed life-ruining complications like nerve pain and kidney damage. Now we have metformin, arguably the best drug ever invented for people with diabetes because it reduces insulin resistance, enables weight loss, and after many years of use in Europe appears to have a safety profile no other drug can beat. Just this past month the ADA's last-to-get-on-the-bandwagon" "Experts" recommended that doctors use metformin followed by insulin instead of the traditional sulf drugs (Amaryl, Glipizide, Gliclazide, etc) which probably burn out beta cells and have been shown to increase the incidence of heart attacks.

[NOTE: An alert reader tells me that Metformin was, in fact, available in the U.S. in 1998, but if it was, my doctors sure weren't aware of it. The first time any one suggested I use it was in 2001. In 1998 I knew one person who was on Avandia as part of a drug trial, but most people who were taking oral drugs that I knew were taking sulfonylurea drugs.]

2. New Classes of Drugs are Appearing Which Don't Make you Fat and Dead. In the bad old days doctors routine prescribed Sulfs and Avandia/Actos, both of which make you fatter and do bad things to your heart. Avandia/Actos also turn out to occasionally cause blindness--via retinal edema. But the new class of drugs which is just emerging cause weight loss and, so far, show no evidence that they worsen heart disease. Byetta, the first of these, is already on the market and Januvia is coming, along with several other versions. These incretin hormone mimic drugs don't work for everyone, but for those for whom they do work, they work very well.

3. Insulin Pills that Work are in Human Trials. A pill from an Israeli company, Oramed, is being tested in humans. It looks like it might actually do what no insulin today can do--enter the liver and allow the body to release insulin quickly in response to incoming food, rather than release at the very slow speed of injected and inhaled insulins. It has been tested in a small group of people, and it worked for them.

The limitation on this pill looks to be that it cannot deliver very high doses of insulin, but for people in the EARLY stages of Type 2 diabetes or those, like me who are not insulin resistant but don't produce enough insulin, they could be the "Magic Bullet" we've all been waiting for. An oral insulin spray is also in testing which might be helpful, too, though it probably shares with inhaled insulin the property of not being able to be administered in a carefully controlled dose.

More on the insulin pill is available here

4. Some doctors ARE getting it. The AACE (American Association of Clinical Endocrinologists), unlike the ADA's elderly and reactionary Expert Committee, continues to revise downward the blood sugar targets they suggest for their patients. An increasing numbers of endos and even some family doctors are urging their patients to cut way back on carbohydrates to achieve better control, too.

Not everyone in the medical community is ignoring the findings of the multi-million dollar WHI study that showed that low fat diets are worthless for preventing heart disease and not everyone ignores the many studies that show that carb restriction improves both blood sugar and cholesterol profiles for people with diabetes.

Which doctors are most likely to recommend low carb diets? Those who themselves have diabetes! And beyond them, those whose patients have shown them how well they work by bringing their A1cs down from 10 or 12% to the 5% range.


Anonymous said...

i wish i could find these trials for the insulin pill by oremed.
i get no benefit from actos and am probably going to disregard my doc's advice on taking it. all it is money down the drain and i don't like the potential for heart problems. no weight gain for me, tho.

Anonymous said...

i have to agree--they are getting the message, albeit slowly to those of us who want to avoid all the complications if we can.
my endo and i spent 45 minutes!! going over my meds and results and debating the pros and cons of each, determining in the end to move slowly but aggressively to bring glucose readings as close to normal as possible without lows and affirming low carb and avoiding the post prandial spikes (confirmed! as the most important from all the latest research) at all costs.

Anonymous said...

Notice--if you know anyone Blind that takes the Drugs-Actos or Avandia-Please spread the word
In Jan 2000 I was prescribed 15 mil per day Actos-in a few months it was raised to 25 mil per day-in Oct 01 it was raised to 35 mil-in Aug 01 I had a light stroke in NOV 01-vision got very blurry.
My Dr sent me to a Dr of Ophthalmology, Tulsa, OK-the Dr stated, we can fix this, you got to me in time. We started Lasers, 3 treatments in left eye & one treatment in right eye, vision got worse. Now I had Cystoids Macular Edema. Shots in the eyes 2 in right & 4 in left of Kenalog.
About July 03 my medication was changed from Actos to Avandia. Since Kenalog can worsen cataracts, I had cataract surgery on left eye Dec 24th 03-it was wonderful I could hardly waite to get right eye done. Jan 04 we done cataract surgery on right eye--My vision was 20-20-BUT-only for a few days!! The swelling had come back.
On Jan 6th of this year I was watching the local evening news-they stated the F D A has put out a warning on the drug Avandia-in research, Actos & Avandia have some of the same ingredients --Could my problem be the medication?
I stopped taking Avandia on Jan 7th-I watch my blood sugar well & it is better since I stopped taking Avandia All the things that were being done to my eyes was all in vain as the drug was causing such swelling.
My vision is getting better by the day since I stopped taking, Avandia. Now my problem is all the lasers, shots & work that has been done to my eyes in trying to fix a problem I did not have.
Pat Kelly
453515 Creek Ave.
Afton OK 74331
Ph & Fax 918-782-4840
If you feel you have been harmed by these drugs Contact
Norman & Edem
Oklahoma City, Oklahoma
phone (405)272-0200
(866) 272-0201 (Toll Free)
fax (405) 235-2949