Why won’t some people use diabetic maintenance meds?

MargaretYakoda

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?

TwistedSassette

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!

MargaretYakoda

TwistedSassette wrote: »

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.

TwistedSassette

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.

Lietchi

MargaretYakoda wrote: »

.

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.

Or they might not be as numerous as you think. I can't recall seeing people advocate not using meds (but I have seen people suggest how to try a dietary approach, mostly for pre-diabetics), but diabetes isn't a subject I'm particularly attentive to.

MargaretYakoda

TwistedSassette wrote: »

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.

drmwc

Anecdotal evidence:
My diabetes reversed without medication. On diagnosis, my doctor wanted to give me metaformin. I asked to 3 months to try a diet first. At the time of diagnosis, my hemoglobin 1AC was 50 mmol/mol (diabetes starts at 48). Three months into my diet it had fallen to 36 (pre-diabetes starts at 42). It is now 32. As a side benefit, I had borderline high BP. I went on medication for this, but now my BP is typically the low end of the normal range and I no longer take the medication.

Peer reviewed evidence:
I based my diet on an article I read in New Scientist, which was based on a paper by Roy Taylor in the Lancet. 15 kgs is the magic number for weight loss, and once that has been achieved, remission is possible depending on if the pancreatic beta cells are permanently damaged or not. In a clinical trial, 50% of those in it achieved remission through diet.

I failed to find the exact article I was after, but here is a similar one:
https://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/Translating aetiological insight into sustainable management of T2D.pdf

This is Professor Taylor's website, which is a treasure trove of information and has links to peer reviewed arrticles:
https://www.ncl.ac.uk/magres/research/diabetes/reversal/#publicinformation

His book (only published after my diet, but I enjoyed nonetheless):
https://www.amazon.co.uk/Life-Without-Diabetes-definitive-understanding/dp/1780724098/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=&sr=


Edited to add:
I found the Lancet article here:
https://core.ac.uk/download/pdf/327360094.pdf

MargaretYakoda

Thank you for these. It’s helpful.

I’ll read them tomorrow.

kshama2001

MargaretYakoda wrote: »

TwistedSassette wrote: »

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.

This thread is missing context. Would you please post links to these threads where you've seen this?

lynn_glenmont

MargaretYakoda wrote: »

TwistedSassette wrote: »

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.

Or they read your OP as asking for peer-reviewed articles on why people don't use diabetes maintenance drugs (i.e., is it money?, is it lack of access to medical care? is it bad side-effects? etc.), not peer-reviewed articles on hypothetical arguments against the medication.

paperpudding

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

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

kshama2001

MargaretYakoda wrote: »

TwistedSassette wrote: »

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.

Were the advocates of avoiding all diabetic maintenance medications posting here in Debate? If not, that would explain it. Many posters don't come to this forum.

Still waiting for links for where you saw these posts.

nooshi713

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

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

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.

autobahn66

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.

This is frankly dangerous and deviates significantly from all national health guidance.

While diet and exercise are excellent, and for some people will result in a substantial change in HbA1c over time, there are many circumstances where this is just inappropriate:

Urgent presentations with diabetes: hyperosmolar hyperglycaemic states or other states of dehydration associated with diabetes.

Presentations with ongoing renal, eye or nerve disease: the injury to these is a function of hypergylcaemia, not insulin resistance. Any mechanism of dropping blood glucose is important to limit progressive irreparable damage.

There are also lifestyle and personal factors to consider. If someone goes into their diabetes with no consideration of weight loss as an important part of their life then they are unlikely to benefit from this as the treatment of their diabetes. Indeed the dropout rate of studies which used weight loss or calorie controlled diets is quite high, and that is in a selective clinical trial setting, not day-to-day practice. Mobility, access to services, finances are all major inhibitors to a weight loss and exercise only approach.

Your personal experience is not evidence. It should not be used to inform care of patients. Prompt glycaemic control is important in certain circumstances and a weight loss approach can be used in parallel. Otherwise it is totally reasonable to trial without pharmaceutical therapy, but reviews should still be undertaken to ensure appropriate response.

Furthermore, those people who develop T2DM and then put it into remission have shown themselves to be vulnerable to insulin resistance (which is substantially a function of genetics). As age and pancreatic function progress, and perhaps weight is regained, they need to be aware that their glycaemic control is likely to slip backwards, and blood glucose lowering medications may be recommended once more (again to reduce the long term risks of going blind, losing a leg, or ending up on dialysis: they don't tend to make people feel particularly good).

pamperedlinny

I have been pre-diabetic since my 20s and type 2 diabetic since early last year.... I'm 38. I don't have the articles or links on hand. I can say from personal experience I took Metformin for approximately 15 years and suffered digestive side effects the entire time. It was horrible. When I began refusing to take it any longer my doctor tried to get me to take multiple different medications except the co-pays without meeting my deductible were so high that I literally could not afford the drugs.

Thankfully, I was able to really buckle down and get my numbers under control with diet and exercise but it is so hard to stay on plan enough to keep my numbers stable. However, I am not the only person I know that literally can not afford the medication. Metformin often has a zero co-pay when other meds have crazy high prices. I would have been more open to medication if it was affordable but since it is not my only other option was diet and exercise.... because I refused to continue on a medication that made my digestive issues insane and where I couldn't go anywhere without a change of clothes "just in case"

Obviously, if you can control your numbers with diet and exercise that is the best solution. However, there will always be people who have out of control numbers even while doing everything right but can not afford the medication. Also, not all diabetes are the same. There are actually many types of diabetes and what type you have can also affect what works and what does not.
https://www.diabetes.co.uk/diabetes-types.html

autobahn66

pamperedlinny wrote: »

I have been pre-diabetic since my 20s and type 2 diabetic since early last year.... I'm 38. I don't have the articles or links on hand. I can say from personal experience I took Metformin for approximately 15 years and suffered digestive side effects the entire time. It was horrible. When I began refusing to take it any longer my doctor tried to get me to take multiple different medications except the co-pays without meeting my deductible were so high that I literally could not afford the drugs.

Thankfully, I was able to really buckle down and get my numbers under control with diet and exercise but it is so hard to stay on plan enough to keep my numbers stable. However, I am not the only person I know that literally can not afford the medication. Metformin often has a zero co-pay when other meds have crazy high prices. I would have been more open to medication if it was affordable but since it is not my only other option was diet and exercise.... because I refused to continue on a medication that made my digestive issues insane and where I couldn't go anywhere without a change of clothes "just in case"

Obviously, if you can control your numbers with diet and exercise that is the best solution. However, there will always be people who have out of control numbers even while doing everything right but can not afford the medication. Also, not all diabetes are the same. There are actually many types of diabetes and what type you have can also affect what works and what does not.
https://www.diabetes.co.uk/diabetes-types.html

I still find it scary to imagine a healthcare system that functions like that: to be unable to afford the best medications for your individual needs is crazy. Here in the UK it's not a free-for-all (for example there are criteria for getting an insulin pump if you are T1DM) but at least all options are on the table...

A great point about the multiple types of diabetes: and there is definitely even more variability in response to medications or diet within those groups. Diabetes is an extremely personal illness, and we have limited tests for real-time pancreatic function or for reliable insulin sensitivity.

nooshi713

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.