7 Things Your Health Team Don't Tell You
Why was I not told that before? It’s a question many of us with diabetes have asked ourselves at some point.
The amount of information about diabetes we’re given can vary quite substantially from one doctor to another and there are some key points about diabetes that patients are commonly not made aware of.
Medication side effects
Before you are prescribed a new medication, your doctor should make you aware of the side effects or at least direct you to read the side effects in the patient information leaflet, enclosed with the medication, before starting treatment.
However, it is not uncommon for doctors to omit this and, as a result, some of the side effects of medications may come as a surprise.
Some examples of what people have noted as side effects they wish they’d been made aware of before starting treatment include:
- Statins can sometimes bring on muscle aches, memory loss and increased blood glucose levels
- Sulphonylureas can, in some cases, cause severe hypoglycemia
- Some blood pressure medications, such as ACE (angiotensin-converting-enzyme) inhibitors and ARAs (angiotensin-II receptor antagonists), may reduce kidney function
- Most antidepressive medications have weight gain as a side effect
- Many medications can lead to decreased sex drive or increase the risk of impotence
Type 2 diabetes need not be progressive
Many medical textbooks list type 2 diabetes as a progressive disease so it is not a surprise that many doctors inform their patients that their type 2 diabetes will steadily get worse over time. Some doctors may even go so far as telling patients that they will inevitably require insulin within a few years.
Whilst in many cases type 2 diabetes does indeed grow in severity over the years, a significant number of clinical studies have shown that the symptoms and severity and type 2 diabetes can be reversed to a significant extent.
Losing weight, taking more physical activity and adopting a very low calorie or low carbohydrate diet have all been shown to be effective ways to reduce dependence on diabetes medication and to reduce or eliminate symptoms of hyperglycemia.
Whilst type 2 diabetes certainly can progress, with adequate support and commitment, patients can hold back the progression of diabetes.
The benefits of low carb
The NHS advises people with diabetes to maintain a relatively low fat diet and many doctors and dietitians advise people with diabetes to consume plenty of starchy carbohydrate at each meal.
What very few health practitioners tell diabetes patients is that low carbohydrate diets have been shown to be significantly more effective than low fat diets towards helping people to achieve improved diabetes control in all of the main types of diabetes.
In addition, research has also shown low carb diets to be more effective at achieving weight loss and more effective at achieving improved markers of heart health than low fat diets.
Carbohydrate is not the only nutrient that raises blood glucose levels
All people with diabetes that are put on insulin are told that they need to be aware how carbohydrate affects their blood glucose levels.
Very few patients, however, are made aware that protein and even fat, to some extent, can raise blood sugar levels. Whilst the blood glucose raising of effect of protein and fat is significantly less than the effect of carbohydrate, many people on insulin, particularly those with type 1 diabetes, can often be left puzzled why blood sugar levels may be surprisingly high a few hours after having a protein or fat based meal.
If you are experiencing high blood glucose between 3 and 6 hours after a high protein or high fat meal, it is worth considering the effects that protein and fat as a possible cause. Discuss your results with your health team if you need more help in understanding your blood glucose results.
There are other types of diabetes
Most people in the UK will be diagnosed as type 1 diabetes, type 2 diabetes or gestational diabetes. However, there are other types of diabetes which are sometimes overlooked.
The International Diabetes Federation (IDF) notes that a form of type 1 diabetes that develops in adults, known as Latent Autoimmune Diabetes of Adulthood (LADA), is estimated to occur in 10% of adults diagnosed with diabetes between the ages of 30 and 50.
Another form of diabetes which may sometimes go overlooked by doctors is diabetes MODY, a form of diabetes caused by a single genetic mutation. There are a number of different forms of MODY and in some cases people with MODY may be incorrectly diagnosed as having either type 1 or type 2 diabetes.
If there is significant doubt over which type of diabetes you have, your doctor can perform specific diagnostic tests to confirm your diabetes type.
Sometimes exercise can raise blood sugar levels
All people with diabetes should be told that exercise can help with lowering blood glucose levels. Whilst this is usually true, it is not so often mentioned that some forms of exercise can actually result in a rise in blood sugar levels for some patients.
We should stress that exercise is beneficial for health but it is useful to be aware of when exercise can lead to a rise in sugar levels particularly if unexpected highs following exercise lead to confusion over how best to control your sugar levels.
One of the main causes of high sugar levels following exercise is if you do short bursts of exercise, for example sprinting.
A short burst of exercise can, in many people, cause the body to release stored glucose from the liver into the bloodstream in anticipation of further exercise. If you intend to exercise for an extended period of time, this raise in blood sugar can be helpful, however, if you only take part in a short duration of exercise, the rise in sugar levels will not be so helpful.
So, if you have previously been confused as to why high sugar levels occur following exercise, the above explanation may provide an answer.
If you are frequently getting higher than intended sugar levels after short bursts of exercise, consider extending your exercise to include a period of lower intensity exercise such as walking or jogging.
There are other forms of metformin available
Metformin is the most commonly prescribed drug for treating type 2 diabetes. Side effects within the first few weeks of taking metformin are common and metformin’s reputation for causing flatulence, particularly when patients start taking the drug, has seen the medication become nicknamed ‘metfartin’ amongst many members of the diabetes patient community.
Whilst the side effects will usually wear off to a large extent in most people, in other people, uncomfortable side effects may persist over a longer term.
For these people, an alternative form of metformin, called extended release metformin, can prescribed. Extended release metformin has benefits in that the side effects are less pronounced than with regular metformin.
If you’re wondering why doctors don’t tell many patients that the extended release version exists, it’s because this version is more expensive than the regular version.