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Why won’t some people use diabetic maintenance meds?
Replies
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My GOALS for my patients are the same I set for myself.
FBS < 100
A1c < 5
Fasting insulin < 5
HDL > 75
TG < 75
My approach:
Healthy Atkins diet
Fasting
Low intensity exercise
Improve sleep
Reduce stress
No meds. No tricks (ACV, cinnamon, berberine, etc).
The patients you admit you cherry pick.
Which definitely skews your results.9 -
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neanderthin wrote: »
None. It's total BS. Atkins (LCHF) CURES heart disease. Pritikin (low fat) CAUSES heart disease.
I have SEVERAL patients (myself included) who demonstrate REAL and SIGNIFICANT reductions of coronary artery obstructions on our Coronary CT Calcium scans.
You guys pass around a lot of cute "bro science".
I actually understand, study, and DO this stuff. With great success I must add.
I would like to see the peer reviewed meta analysis journal article that makes this conclusion.7 -
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"Have you got any peer reviewed journal articles that support your claim that Atkins cures heart disease?"
Yes I do. I'll show you mine if you show me yours.
Have you any peer reviewed journal articles saying a low fat diet cures heart disease?
You are the one making the claim.
I am politely asking for a citation or two.
Since you are an MD, I assume you’re up on the literature? More so than a disabled, retired, relatively low income and thus unable to afford access to expensive journals, individual like myself.
*edited by a MFP moderator7 -
"There are loads of folk with T2DM with absolutely no pancreatic function left: how is diet going to fix them when they cannot produce insulin?"
or in the private healthcare sector where I work.
So it's a charlatan then?
Also you lost a fraction of your diabetes there Dr DM1.5...
What a joke.
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autobahn66 wrote: »
To be fair, there are many causes of diabetes.
DM1.5 is a real thing.
https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/expert-answers/lada-diabetes/faq-20057880
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I would never go to a doctor who disregards all standards of care ( in all countries, US diabetic recomendations aren't different from other countries) and has some maverick idea that he/she knows better than all other standing knowledge.12
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paperpudding wrote: »I would never go to a doctor who disregards all standards of care ( in all countries, US diabetic recomendations aren't different from other countries) and has some maverick idea that he/she knows better than all other standing knowledge.
But how would someone know?
Like, a recently diagnosed T2D patient makes an appointment with a doctor their buddy raves about. They go in. Get checked out. Get told stuff that doesn’t come close to standard of care…. How would that patient know it’s not standard care?
Or, perhaps worse, get told with a brusk bedside manner that it’s too late and there’s no hope for them.
That’s a real problem.
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To be fair, the American standard of care is pretty poor and leads, on average, to terrible outcomes. ADA considers “well controlled” diabetes to be an a1c under 7 which essentially means you’re at an average bg which is continually cooking your nervous system, which is borne out by the high rate of amputations, strokes, blindness, kidney failure, and heart disease. They are okay with postprandial glucose up to 180 which is frankly not okay.
I love my metformin, consider it a wonder drug. Met plus exercise and diet and I eat pretty much whatever I want within limits and have an a1c of 4.7. I’m sure I could do okay without the met, but it’s an appetite suppressant among other things, prevents dawn phenomenon which I have a problem with, and rich people have been paying their doctors to prescribe it as an anti-aging drug. I have no side effects so why wouldn’t I take it?
BTW @tsazani and I have opposite experiences in many ways. For example high intensity exercise spikes his glucose, whereas it lowers mine, not only in the short term but for about 48 hours afterwards. Different diabetics at different points in their disease react differently. When he says he prescribes only low intensity exercise to his patients, and tells them to avoid “no pain no gain” types of workouts, that tells me that he’s only looking at one type of patient and ignoring ones like me. This proselytizing absolutist approach ignores actual patients and their actual differences.14 -
MargaretYakoda wrote: »autobahn66 wrote: »
To be fair, there are many causes of diabetes.
DM1.5 is a real thing.
https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/expert-answers/lada-diabetes/faq-20057880
Absolutely.
But these are the exact people who could never succeed on a diet only approach: they have an autoimmune disease that progressively destroys their islet cells. So to say that they manage this with diet just must be a lie.2 -
autobahn66 wrote: »MargaretYakoda wrote: »autobahn66 wrote: »
To be fair, there are many causes of diabetes.
DM1.5 is a real thing.
https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/expert-answers/lada-diabetes/faq-20057880
Absolutely.
But these are the exact people who could never succeed on a diet only approach: they have an autoimmune disease that progressively destroys their islet cells. So to say that they manage this with diet just must be a lie.
I don’t disbelieve Tsazani when he describes his own experience.
My issue is the one big hammer that gets swung hard at everything that even remotely looks like a nail. While simultaneously disregarding every other diabetic or prediabetic who isn’t exactly like him.
There are different causes of diabetes.
So the approach for each one should be different. And each individual is different too.
Tolerances for various medications.
Ability to adhere to a strict diet regimen.
Ability to exercise.
BG getting elevated after different activities. Or foods….
It’s almost like there are as many ways to approach a diabetic treatment regimen as there are diabetics.
In my opinion.
Also? Cilantro tastes like soap.7 -
rheddmobile wrote: »To be fair, the American standard of care is pretty poor and leads, on average, to terrible outcomes. ADA considers “well controlled” diabetes to be an a1c under 7 which essentially means you’re at an average bg which is continually cooking your nervous system, which is borne out by the high rate of amputations, strokes, blindness, kidney failure, and heart disease. They are okay with postprandial glucose up to 180 which is frankly not okay.
I love my metformin, consider it a wonder drug. Met plus exercise and diet and I eat pretty much whatever I want within limits and have an a1c of 4.7. I’m sure I could do okay without the met, but it’s an appetite suppressant among other things, prevents dawn phenomenon which I have a problem with, and rich people have been paying their doctors to prescribe it as an anti-aging drug. I have no side effects so why wouldn’t I take it?
BTW @tsazani and I have opposite experiences in many ways. For example high intensity exercise spikes his glucose, whereas it lowers mine, not only in the short term but for about 48 hours afterwards. Different diabetics at different points in their disease react differently. When he says he prescribes only low intensity exercise to his patients, and tells them to avoid “no pain no gain” types of workouts, that tells me that he’s only looking at one type of patient and ignoring ones like me. This proselytizing absolutist approach ignores actual patients and their actual differences.
Yup.
On this we definitely agree.
A current irritation I have with the VA is that they are completely unconcerned with my husband’s A1C, which was 6.7 last time I remember. (Down from an all time high of almost 12, which was one huge reason I took over all his meds and diet choices in the early days of me being his caregiver)
I want to push for a CGM for him. I can monitor it with my phone. Which would be great for both of us. But I don’t think they’ll go for it.
My own GP was happy (gobsmacked, actually) that I got mine down to 5.7 in June (down from 9.2 in February) and when I suggested I could probably get it even lower she gave me the stink eye. Which doesn’t bode well. But if I can show her I am able to get it lower without a lot of hypoglycemic episodes, maybe she’ll soften.
We’ll see…
I’d love to try a CGM, but since I am not using insulin my insurance company won’t pay for one. And anyhow, I have a rotten nickel allergy, and until someone makes a sensor that doesn’t have nickel, or until Apple comes through with a skin surface CGM? I’m stuck with the finger prick.
And I am going to say it one more time.
Cilantro tastes like soap.1 -
MargaretYakoda wrote: »paperpudding wrote: »I would never go to a doctor who disregards all standards of care ( in all countries, US diabetic recomendations aren't different from other countries) and has some maverick idea that he/she knows better than all other standing knowledge.
But how would someone know?
Like, a recently diagnosed T2D patient makes an appointment with a doctor their buddy raves about. They go in. Get checked out. Get told stuff that doesn’t come close to standard of care…. How would that patient know it’s not standard care?
Or, perhaps worse, get told with a brusk bedside manner that it’s too late and there’s no hope for them.
That’s a real problem.
Well, diabetic recomendations are not secret - like anything else, a person could look them up and if their doctor is completely out of sync with them, that would be a huge red flag to me.7 -
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@tsazani Saw a few of your posts and love what your style is....seems to go along with what I was reading from Dr Fung/Obesity Code. I was wondering what your opinion was on how often should one do a 24-72hr fast?2 -
Getting back to the original topic.
I remember a gentleman who had a heart attack at about the same time my husband did. So, about five years ago.
Similar age to my husband (early 70’s) and less fit, but not by much.
He absolutely believed everything “Big Pharma” did was a ploy to get money out of people. He was adamant that herbs and probably stuff like cinnamon and turmeric were adequate to control his blood sugar.
These statements were made during group cardiac rehab classes.
Spoiler alert: those herbs and spices were not adequate. And whatever diet regimen he tried, which was very low carb (I know because he also was against any carbs) was not a miracle cure, because he didn’t last long after those classes.3 -
SherryRueter wrote: »@tsazani Saw a few of your posts and love what your style is....seems to go along with what I was reading from Dr Fung/Obesity Code. I was wondering what your opinion was on how often should one do a 24-72hr fast?
I would strongly encourage you to follow the advice of your own healthcare team. And, of you are diabetic or pre-diabetic, follow the diet advice of the ADA. Which can include keto, if that’s your thing.7 -
@MargaretYakoda good question. When I googled diabetes med adherence on scholar a number of studies popped up.
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MargaretYakoda wrote: »And I am going to say it one more time.
Cilantro tastes like soap.
No, don't stop! People need to know this.
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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.
so for you, and your hand picked clients that works. and thats fantastic. But there are many people who can not, or will not make changes to their diet or exercise. for ... whatever reason. Sometimes valid reasons, sometimes not. Or those that do make those changes, but those changes are not ENOUGH to lower their numbers into an acceptable range that makes medications unnecessary.
Blanket statements that essentially say 'this is the one and only way and all other ways are garbage' ESPECIALLY coming from someone who CLAIMS to be a Physician do nothing to give any credibility to you as a professional.
That's my two cents on that particular matter.
That said, I do feel that more people should (assuming no physical limitations) make more of an effort to take control of their health issues through diet and exercise. But I also wish that more people would do so BEFORE issues, other than simply being overweight, arose. Is it possible I had high blood pressure and blood sugar before I began losing weight? Certainly. I know I did not when I was pregnant, and I was certainly in the morbidly obese category then, too (pregnancy weight not included lol). But by the time I had lost (give me a second to think how much it would have been at that point ) roughly 100 pounds and had my first physical since beginning to lose weight, all of my labs were in the normal ranges. not everyone is that fortunate.
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Didn't see this until now. For an admin I will do this. Google any of these physicians. Enjoy. And welcome to OUR side.
1. Richard K. Bernstein, MD
2. Jason Fung, MD
3. Peter Attia, MD
4. Robert Cywes, MD
5. Robert Lustig, MD
6. David Ludwig, MD
"You are the one making the claim.
I am politely asking for a citation or two.
Since you are an MD, I assume you’re up on the literature? More so than a disabled, retired, relatively low income and thus unable to afford access to expensive journals, individual like myself."
*edited by a MFP moderator
Quote
I note you have provided zero peer reviewed journal articles.4 -
I am a t2 diabetic. I think MOST of what doctors talk about, concerning diabetes is not helpful.
I was on max doses of Metformin for years.. 1000 g 2x a day, plus Amaryl.. refused even basal Insulin for years, but they said they couldn't give me larger dosages.. even though I had an A1C over 12, and 400-500 mg/dL was normal.
A major issue was they had me eating lots of carbs.. better carbs, but MORE carbs. I used to eat a ton of meat, plus pizza, sweets, pop etc. The switched me to cereal, milk, sandwiches/subs, rice/pasta, vegetables.. and my BG levels went UP.. I ate a lot less meat.. still do.
What changed was finding the Atkins book in 2010. It helped me understand what causes high blood sugar.. carbs. Now you still want carbs which don't spike blood sugar much.. I don't think you NEED them, but you WANT them.. who doesn't like some veggies?
Low carb is manipulating your blood sugar through diet. I was off ALL diabetes meds from late 2010-2016. A1C was 5-5.5 every 3 months. Stopped testing blood sugars regularly.. diet was doing the job.
Until it wasn't. I got stricter, and stricter, and eventually found myself in a place where the option was not eating, or eating off plan.. so I ate off plan.. A1C was fine the next time I got tested... so the next time I felt like I wanted to look normal when dining out with friends, I said.. why not have some pie?? It took 9 months, until my A1C was up to 5.8, and my doctor asked what was changing.. I said.. I'm indulging every 2-3 weeks now, but I have it under control. I'll become stricter.. said the diabetic.
I started cheating more and more, until I switched to.. I'll get back on track TOMORROW. A1C went back up to 9-10. I dropped it a few times to 8, then back up.
At the end of 2017, after a year of high A1C's, I went on Januvia. Then Glimiperide, and still hovered at 7-8. At the end of 2019, I agreed to use basal Insulin at night. My pills have been dropped to a minimum, and my doctor is hesitant to drop them, but maybe in 3-6 months.. my A1C was 6.2, and I am getting low blood sugars now.. back on my low carb diet. Insulin will be the last to go, she says, and I really think it works the best. My morning BG was 78 mg/dL.. which is fine. I tend to get low blood sugars during the day every so often. I'd like to get back off the pills. Maybe Insulin eventually.
I think that diet CAN manage your Insulin.. BUT.. the diet necessary is not one we eat. Maybe if we ate less carbs from the start, and healthier carbs, we could eat 120-150 grams a day, and never damage our pancreas, and diabetes wouldn't be the problem it is, but that isn't reality.. we have a disease, and you have TWO ways to deal with it.. diet, which hasn't been our strong point. Despite the knowledge of WHAT can make my blood sugars low, without meds.. no thanks to my doctors.. it still isn't something many people can stick to permanently. I think 6 years in a row was pretty good. I hope to do it again, and be off meds. I like the food, that isn't the problem.. I am. I like carby foods, and sometimes I will indulge, and that's OK, in rare circumstances, but if we start indulging too often, high blood sugars resume.
If you are NOT managing your blood sugars.. getting numbers over 120 mg/dL.. then you SHOULD be on meds.. OPTION 2. The goal is good numbers consistently, and if I can do it with diet, AWESOME, but if not, you should use meds. High blood sugar is deadly.
I think a lot of people say you don't need meds, but fail to say IF you have it under control with diet.
I would change the SAD to a moderate carb one.. limit sweets, grains etc.. focus more on legumes, nuts, seeds, cheeses, non-starchy veggies ( lots of these ), with occasional fruits, more berries, less bananas/grapes.. more of the ones which spike blood sugar less. these are natures desserts.
I would also change the " diabetic diet " to be closer to Keto.. 5% carbs/75% fat/20% protein, even stricter on the foods.. almost exclusively non-starchy vegetables, meat, eggs, and fats. Water.
I think that would greatly diminish the amount of diabetes we have, and people adjust in a few weeks. They would be fine having 120 grams of carbs a day, and manufacturers would follow suit.
In the end though, not everyone is going to follow the right plan for them. They will eat food which spikes their blood sugar, despite all the warnings, and all the info. They simply want some potato salad. We all do that sometimes.. hopefully very rarely, but many do it regularly.. which is why we are diabetics, right? Expecting us to now eat a healthy diet, just because not doing so will kill us? Get real!!
THAT is why we have meds. They are miraculous, and allow someone trying, but not doing good enough, to mitigate the damage.. they assist you in lowering blood sugar. If you can't control your diabetes with diet.. TAKE THE MEDS!!!
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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.
I believe that the person advocating that all diabetes meds suck, specifically insulin, has been banned now. He professed to be a doctor. More like a quack.
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