12) DIABETES MEDICATIONS
a) Introduction
The most important "diabetes" medications are not actually diabetes medications. By far the most important medications for anyone with type 2 diabetes are medications which lower the cholesterol and which lower the blood pressure, so called "heart" medications. It has to be remembered that 75% of all type 2 diabetes patients die from heart disease and that "diabetes" drugs do not affect heart disease very much. As a matter of fact some diabetes medications actually increase the incidence of heart disease if the weight is allowed to increase or the person eats too much carbohydrate. If an individual with type 2 diabetes doesn't take a diabetes medication they will have an increase in blood sugar diseases ("microvascular disease" or "small blood vessel disease") which affects the "quality of life" by causing blindness, kidney failure, neuropathy, impotence and cognitive decline. The type 2 Diabetes will also progress faster. But taking these diabetes medications typically will not directly affect the "killer", namely heart disease. Insulin medication is the notable exception. If a person is insulin dependent they have to take insulin, otherwise they will probably die relatively quickly and suffer enormously in the process.
There are hundreds of blood pressure medications and several good cholesterol lowering drugs and we won't list them here. Most individuals with diabetes should be on these drugs. One surprising statistic to keep in mind, the only drugs which have been proven over and over again to actually extend life expectancy in individuals with type 2 diabetes are cholesterol lowering drugs and blood pressure lowering drugs!
It is also important to understand that lifestyle changes (weight loss, exercise and diet) are more important than medicines in preventing the progression of type 2 diabetes. For instance Glucophage (metformin) demonstrated a 31% reduction in three-year incidence of development of diabetes in people with pre-diabetes. While this is impressive, the lifestyle change portion of that same trial demonstrated a 58% reduction in diabetes progression. This study was the "Diabetes Prevention Program Research Group", a very well done study on individuals with pre-diabetes.
Because medications shunt blood sugar into fat cells, medications tend to increase weight, increase insulin insensitivity, increase blood pressure and increase heart disease and morbidity. The ACCORD study was stopped when the group taking more medication had significantly higher mortality rates than the group taking lower amounts of medications. In this study, 27.8% of the group taking more medication gained more than 22 pounds while only 14.1% of the group taking less medication gained more than 22 pounds. The British UKPDS and the Australian ADVANCE studies found no difference in mortality with diabetes medications while the VADFT study found a statistically insignificant increase in mortality with medication. The University Group Diabetes Program (sulfonylurea) and the Avandia Meta-analysis found statistically significant increase in mortality with medication or increased medication. If a person is on diabetes medication, they have to control their weight.
It puts the the type 2 diabetes patient between a rock and a hard place. If they take the diabetes medication and don't keep their weight low, they risk dieing earlier. If they don't take their diabetes medication, they risk kidney failure, blindness, impotence, nerve damage, Alzheimers, and senile dementia. So taking the medication while losing weight is the best option by far.
Current Chapter: 12) DIABETES MEDICATIONS
a) Introduction
b) Diabetes Medications
c) List of Potential Medications
d) Insulin Injections
e) Blood Sugar Testers
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