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Why won’t some people use diabetic maintenance meds?

MargaretYakoda
MargaretYakoda Posts: 2,997 Member
Peer reviewed articles only, please.

I am seeing more than a few people on these forums who report regularly having blood glucose above 200, and who are insisting on not using maintenance medications for diabetes.

I don’t get it. Obviously diet and exercise are also key factors. But glucose levels that high are not safe.

What gives? Is there any real science behind avoiding metformin or other diabetic maintenance medications?
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Replies

  • MargaretYakoda
    MargaretYakoda Posts: 2,997 Member
    I don't have any articles for you (I'm not sure if it's something that has been clinically studied), but anecdotally these medications come with a whole swag of side effects that can make life hell.

    I am insulin resistant (thanks PCOS) and was prescribed Metformin but after sticking with it for a while (over a year), my endocrinologist agreed that it was not worth me taking it any longer since I didn't tolerate it well. I had extreme digestive issues, and my lab results showed no marked improvement in insulin sensitivity. Essentially, it just didn't work for me. I now take inositol which is a natural supplement, have zero side effects, and my labs are much improved.

    My husband is T2 diabetic (though normal weight), and he was also prescribed Metformin recently. He took it for around 6 months before discovering that it was the cause of his extreme lethargy (he accidentally forgot to take it one morning, and had an incredible amount of energy, but the next day after taking it again, he was as lethargic as before). His labs appeared normal, but being barely able to function is not worth living that way. He contacted his GP and was switched to another medication which has been much better, but again not without its side effects (like an extreme hypo event this week).

    I think that there are a number of factors at play, in general. Obviously we all know that sustained high glucose levels are not safe for the body (though I imagine many people don't actually know WHY that is). But it's not necessarily something tangible for the person, as in, they don't physically feel the effects of that high BGL. So if the given medication causes the person to feel worse than they did before (even if they're "better" on the inside), then there will always be some hesitancy just based on perceptions. There is also a matter of pride and not wanting to be on medications for the rest of one's life (I can manage this myself, I don't need big pharma, you know the type!).

    Also a lot of doctors actually encourage their patients to attempt to control/reverse their T2D through diet & exercise before turning to medication - I know this was the case for my mother in law, she wanted a prescription and her doctors wanted to see if she could control it unmedicated first. Add to that, when doctors just prescribe Metformin by default, and it has a huge amount of side effects, and a lot of doctors basically just tell people to deal with it rather than finding another medication that actually makes the patient feel better, it makes people hesitant to continue with the treatment and they avoid going to their doctor. I don't know how common this is, but I do know that it does happen, anecdotally!

    Agreed that side effects can be a problem.
    I am lucky that the metformin doesn’t seem to do anything for me but help lower my BG, and make me fart a bit more.

    That said, what I’m asking about is people who are saying all such meds are bad.
    There are some here who not are saying that someone needs to switch to a different medication. They’re saying all diabetic medications are bad. And I’m just not understanding what the logic is in that.

    I thank you for this response. The fact that after a number of days this is the only response tends to indicate that the advocates of avoiding all diabetic maintenance medications may not have much to back up their point of view.
  • MargaretYakoda
    MargaretYakoda Posts: 2,997 Member
    I must admit I haven't seen anybody saying that diabetes meds are bad! That is a shock. They are literal life-savers for some, especially where the diet & exercise isn't able to control it.

    I’ve seen some. And it’s especially puzzling to me. Which is why I posted this question. And so far no one has chosen to explain it.

    And I agree. These meds are an absolute life saver. Especially when paired with diet and exercise.
  • MargaretYakoda
    MargaretYakoda Posts: 2,997 Member
    Thank you for these. It’s helpful.

    I’ll read them tomorrow.
  • paperpudding
    paperpudding Posts: 9,302 Member
    In my experience of working in a medical centre, I do not see doctors against non medication management - if people can control their diabetes with diet alone then that is great
    But if not, then carrying high blood sugars is not something that should look be left unmedicated - and Australian guidelines calls for metformin as first line
    If that that is not enough or the patient cannot tolerate it ( ie gets side effects) you move on to other medication options

    I have not come across a reluctance to use oral medication when needed

    ( a reluctance to progress to injecting yes but for different reasons)
  • paperpudding
    paperpudding Posts: 9,302 Member
    I thank you for this response. The fact that after a number of days this is the only response tends to indicate that the advocates of avoiding all diabetic maintenance medications may not have much to back up their point of view.


    I am not such an advocate and could of posted my above reply sooner - but did not because you asked for peer reviewed studies only, not observational or anecdotal experiences
  • nooshi713
    nooshi713 Posts: 4,877 Member
    Many reasons im sure including some listed above already. Some are just anti-medication period. They don’t like taking anything or are in denial about their diagnosis or don’t think it is a big deal. Others don’t want any side effects or try one medication and then give up and won’t try anything else.

    It is ideal if a patient can control their disease through diet and exercise but in my experience many can’t or won’t implement the lifestyle changes necessary. It seems many are more inclined to take medications than change their lifestyle. Regarding side effects, it seems to me that most side effects are not as bad as being on dialysis, losing toes or whole limbs to amputation, bad infections, heart attacks, strokes, and blindness that eventually occur in many uncontrolled diabetics.
  • xrj22
    xrj22 Posts: 218 Member
    This does not apply to me, so just conjecture. Some people want to avoid meds for a while to give diet and exercise a try first. Depending on their numbers, this is often a safe and reasonable step. Then I think there are a few people who are just opposed to meds, but I think that is rare. I think you would have to ask the individuals, because reasons could be very particular to that person.
  • neanderthin
    neanderthin Posts: 10,261 Member
    Like a few have already said. Medication is to control the symptom not the root cause. Diet is an attempt to control the root cause, can't blame people for that imo.
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  • MargaretYakoda
    MargaretYakoda Posts: 2,997 Member
    tsazani wrote: »
    NO T2D meds! Zip. Zero. None.

    They are ALL tricks or force (insulin) to get / make your liver and muscles take in more glucose.

    I'm an internal medicine physician. TODAY I advise against ALL T2D meds. T2D is reversed by DIET and good SLEEP. I try and get my patients to get rid of their meds. If they can. It's not easy. Patients don't realize that their IR (insulin resistance) is KILLING them SLOWLY. Meds just mask the problem.

    When I ate the SAD diet and did "no pain no gain exercise" I was overweight (highest BMI = 29.5) and diagnosed with type 2 diabetes in 2005 (highest A1c = 6.7). Same thing with my patients. Fatter and sicker taking more and more meds. My T2D meds WERE Metformin and Victoza. I also took 3 meds for blood pressure. one med for high cholesterol, and one med for inflamed prostate.

    Then I REDISCOVERED Atkins. Since following a HEALTHY (i.e. real food) Atkins diet my T2D is reversed (A1c + 5.1) and I'm at my ideal (HS graduation) weight (BMI = 23.5). I no longer NEED or TAKE those SEVEN medications.

    My husband’s T2D was caused by exposure to a defoliant, not lack of exercise or poor diet.

    I am not sure how this advice would help him. I don’t think it would.
  • lorib642
    lorib642 Posts: 1,942 Member
    I have not seen those posts, but I am guessing, besides from side effects and cost, it is a desire not to be dependent on medication. Or, like people who don’t finish antibiotics because they feel better. They may be in denial of the illness. I am just guessing. Here is an article on medication adherence

    https://medcitynews.com/2021/08/the-behavioral-economic-challenges-of-medication-adherence/

    I take metformin and do experience gi distress. My dr lowered the dosage which helps. I just was taken off of januvia. I would love to be able to control it by diet alone. I just don’t see that happening. Never thought of not taking my meds.
  • nooshi713
    nooshi713 Posts: 4,877 Member
    nooshi713 wrote: »
    tsazani wrote: »
    NO T2D meds! Zip. Zero. None.

    They are ALL tricks or force (insulin) to get / make your liver and muscles take in more glucose.

    I'm an internal medicine physician. TODAY I advise against ALL T2D meds. T2D is reversed by DIET and good SLEEP. I try and get my patients to get rid of their meds. If they can. It's not easy. Patients don't realize that their IR (insulin resistance) is KILLING them SLOWLY. Meds just mask the problem.

    When I ate the SAD diet and did "no pain no gain exercise" I was overweight (highest BMI = 29.5) and diagnosed with type 2 diabetes in 2005 (highest A1c = 6.7). Same thing with my patients. Fatter and sicker taking more and more meds. My T2D meds WERE Metformin and Victoza. I also took 3 meds for blood pressure. one med for high cholesterol, and one med for inflamed prostate.

    Then I REDISCOVERED Atkins. Since following a HEALTHY (i.e. real food) Atkins diet my T2D is reversed (A1c + 5.1) and I'm at my ideal (HS graduation) weight (BMI = 23.5). I no longer NEED or TAKE those SEVEN medications.

    I don’t believe you are a physician because no physician worth anything would give this dangerous and horrible advice! None of the doctors I work with would endorse this message and we see diabetic patients daily.

    Totally agree.

    also anyone can say "I am a physician" - like we have seen many posts on this forum saying " I am a scientist" followed by extremely unscientific claims

    Yes, weight reduction, if one is over weight, can reduce some people's need for type 2 diabetic meds and BP meds, sometimes to less than before, sometimes to nil.

    They are still diabetic though - just now diet controlled.

    and in the meantime or if that is not successful, it is still important to reduce blood sugars - carrying high blood sugars leads to complications and is not something to leave untreated

    I see diabetic patients regularly too, working in a medical practice - yes, I know I could just be saying that too- but national guidelines of all countries support what I am saying.

    True! No one is saying don’t make lifestyle changes. His advise is downright dangerous and irresponsible. It goes against the standard of care and all accepted guidelines too.
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