• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

Dr Jason Fung on T2 Diabetes and Drugs

Every GP and nurse should be reading this article along with everyone with T2.

A lot of the health issues come from insulin resistance not high BG. Most drugs improve the BG while making the insulin resistance worse.

And this is why I intend to keep taking Metformin even when my blood tests start to show me as “normal”…… (I don’t get the side effects from Metformin unlike some people.)

I expect that within a few years SGLT2 inhibitors (Farxiga) will be added to Metformin as being the only drugs that are proven to reduce long term risk of stokes and heart attacks (for people with T2) while also helping to control BG.

The first drugs company to truly understand how Metformin works and produce a drug that works in the same way without the side effects may get very rich.
 
I so agree. Why use Gliclazide to stimulate the pancreas to produce more insulin without knowing how much the pancreas is already producing? People are drowning in insulin and gaining weight if they continue to eat to their medication, which is what the NHS seems to want us to do. No wonder it is seen as progressive.
 
I have often wondered why so many overweight T2s are on long-term insulin and/or sulfonylurea when the highest priority is weight reduction together with Metformin to reduce insulin resistance and possibly markedly reduce the need for much or even any medication. This is why I'm so keen to make sure the diagnosis of Type is correct and also keen on the c-peptide test as it shows how much insulin you are actually producing. It's obvious from many posts on the forum that GPs often just guess what medication e.g. if Metformin doesn't work then add Gliclazide and then insulin regardless of the patient in front of them, their weight, their diet and whether they have high or low natural insulin.
 
An interesting article.
So, Fung agrees with my decision that staying on Metformin is actually beneficial, and rushing to be med free may not actually be the diabetic's holy grail?
 

They are guessing, yes, but they are told to do this by NICE. Diet and exercise first if the HbA1c is low enough. Metformin if it isn't. When that doesn't work, Gliclazide. When that doesn't work, something else. Then as a last resort insulin. There is no mention of how much natural insulin they have.

https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management-2

 
It is the side affects which help me with my IR. It changes my tummy fat so I can exercise the fat cells off.
Like the pill. The side affects are infertility.
Another drug without side effects wouldnt work half as good! I feel.
Metformin gave me the chance to have 2 wonderful boys by solving my infertility in pcos which is IR related too.
I wish people didn't get craps and loose tummy on it too.
 
Thankgod my gp past me back to endocrologist instead. I've received so much support from their dept. additional to meds.
 
I think the name “Type2” does not help and the NHS should start to measure insulin levels at health checks and treat the condition of “Insulin Resistance” as we all know it is a big risk factor for strokes, high BG, heart issues, dementia etc.

If someone is overweight with the fat on the middle it is very likely the issue is “Insulin Resistance” and a low carb diet is the best option, but yet my GP says “low fat”! I tend to think that Metformin should be offered to everyone with Insulin Resistance even if their BG is normal.

I expect some people who are labels Type 2 are closer to being “half a Type1”, e.g they are producing a level of insulin that is lower than a “normal person”, for some reason other than fat clogging up the system.

Maybe DNA testing will let us be classified into more useful groups allow GPs to give the same meds to everyone in a grouping….
 

I was lucky, but I don't normally react to meds too badly.
But I do wonder, how long do people give it?
It took me over a year to reverse my diabetes, and it was a major disruption to my life.
A year well spent though.
As to metformin, can you take metformin and Imogen?
Can you spend a month getting accustomed to it?
(not easy, but it's a month against a life)
Diabetes isn't "pop a pill and carry on", it's a life changer.
 
douglas99 said:
An interesting article.
So, Fung agrees with my decision that staying on Metformin is actually beneficial, and rushing to be med free may not actually be the diabetic's holy grail?
Click to expand...

Or of course it could also be that having a low HbA1c without meds means you wouldn't be susceptible to diabetes-related death or heart attack in the first place. Without insulin resistance you are far less likely to have these problems.
 
Daibell said:
This is why I'm so keen to make sure the diagnosis of Type is correct and also keen on the c-peptide test as it shows how much insulin you are actually producing.
Click to expand...
This is why I was so disappointed to be refused a C-Peptide test by both GP and diabetic specialist who did however order a Gad test.
 

Rapid weight loss on a very low calorie diet (Newcastle Diet) is by far the best option for "middle fat"
 
bulkbiker said:
Or of course it could also be that having a low HbA1c without meds means you wouldn't be susceptible to diabetes-related death or heart attack in the first place. Without insulin resistance you are far less likely to have these problems.
Click to expand...

Could be, but I'm just going with what Fung actually says in the article.
You've met Fung, maybe you can ask him if his article is misleading?
 
As soon as SGLT2 inhibitors (Farxiga) have been in use for long enough for any long term side effect to be know, I think they should replace Gliclazide on the NICE flow chart, maybe even alongside Metformin without waiting to see if the Metformin works on its own.

I also think it may be worth offering Metformin and Farxiga to anyone that commits to “low carb training” without first waiting to see if diet and exercise works. Offer a small reward to anyone that controls their BG well enough for come off them, rather than wasting 3 months before they are started.

I think self monitoring of BG can be such a big motivator that it should be standard, but how do we stop people just writing down the number, without thinking about it and taking action when needed? Just having the Low Carb Training being led by people who have proved it works would be a great ideal.

I think most people with Type2 could turn it round, provided it is not left for many years to damage their organs.
 
douglas99 said:
Could be, but I'm just going with what Fung actually says in the article.
You've met Fung, maybe you can ask him if his article is misleading?
Click to expand...

"Metformin was considered separately from insulin and SUs in sub study UKDPS 34. Overweight type 2 diabetic patients were randomly assigned to either metformin or diet control. Metformin lowered the A1C from 8.0% to 7.4%. This was good, but not as good as the results with the more powerful insulin and SU medications.

Metformin reduced diabetes-related death by a jaw-dropping 42% decrease and the risk of heart attack by a whopping 39%. Metformin performed far superior to the insulin/ SU group despite the weaker blood glucose effect. Something was protecting the organs, but it had nothing to do with the blood glucose lowering effect. The specific type of diabetic medication used made a huge difference. Metformin could save lives, where SUs and insulin could not."

Is the exact quote..I'll let others decide if he says what you think or not. By the way he is a Dr so would be only polite to address him with his correct title.
 
douglas99 said:
Rapid weight loss on a very low calorie diet (Newcastle Diet) is by far the best option for "middle fat"
Click to expand...

Not convinced as too many people go back to their old ways…… Hence I think controlled carbs (say under 100g) should be the first angle of attract getting people eating in a way they will be happy with for the rest of their life’s. Then and only then use intermittent fasting or Newcashle Diet.

Asking people to do something that lots of people fail at is a bad option, but even if people fail to get down to low carb levels they are very likely to have learned to avoid the worse foods.
 
douglas99 said:
An interesting article.
So, Fung agrees with my decision that staying on Metformin is actually beneficial, and rushing to be med free may not actually be the diabetic's holy grail?
Click to expand...

I think it depends also on why people want to be meds free. I wanted to be meds-free, so that I'm not tethered to a pharmacy, however often I would have to replenish any medication.

Of course, not one of us knows how long we might be able to maintain our status quo, but if it is important enough to the individual and they weigh up the risks v benefits, then they are making an informed decision. The decision made may just not be uniform across all who make it for themselves.
 
I agree with @ringi - people need to see a fast successful result at the beginning - and then when they get 'stuck' move on to something a bit more 'hardcore' - and 600 calories a day is definitely hardcore. I've struggled with it twice and its horrible.
 

Yes, it seems the difference between diet control and Metformin is fairly clear.
I'll stay on Metformin.

Post edited by mod to remove a comment which broke Forum Rules 1, 2 and 12
 
Last edited by a moderator:
You must log in or register to reply here.
Menu
Log in
Register
Cookies are required to use this site. You must accept them to continue using the site. Learn More.…