Effectiveness of Drugs for Type 2

[Indy51]

A couple of sobering links:

An article (from a malpractice and patient safety blog) on "The Emerging Scandal of Dangerous Diabetes Drugs":
http://www.protectpatientsblog.com/2015/01/the_fdas_role_in_dangerous_dia.html

A video lecture on Metformin - The Case of Exaggerating Both Benefits and Harms:

I captured a slide from the video presentation - it paints a fairly dismal picture of how effective Type 2 drugs are:

 

[ButtterflyLady]

Quite right, there are side effects and risks to consider with any medication. I've read up on diabetes drugs at Blood Sugar 101 and it's not encouraging. That website is pretty positive about metformin though. And insulin, depending on the way it is used.

I like metformin, but I think if someone has a bad reaction to it there's no shame in discussing with your HCP about stopping.

Taking medication safely is a case of weighing up the pros and cons, and keeping up to date with new information. Some of the meds I take for non-diabetes conditions cause side effects that are problematic for me, but it's a trade off against the effects of the illness that I'm trying to treat. I try to keep an open mind.

 

[mikej1973]

Quite right, there are side effects and risks to consider with any medication. I've read up on diabetes drugs at Blood Sugar 101 and it's not encouraging. That website is pretty positive about metformin though. And insulin, depending on the way it is used.

I like metformin, but I think if someone has a bad reaction to it there's no shame in discussing with your HCP about stopping.

Taking medication safely is a case of weighing up the pros and cons, and keeping up to date with new information. Some of the meds I take for non-diabetes conditions cause side effects that are problematic for me, but it's a trade off against the effects of the illness that I'm trying to treat. I try to keep an open mind.

Blood sugar 101 is just a rehash of other studies pointing out possible worst case scenarios and is frequently quoted here as rule and quoted incorrectly. Jenny ruhl to be fair makes no claim the site does anything but that. However the phrase "studies show this may be the case" is to be found through all her links.

It's a valuable site but it is just a lot of possible worst case scenarios that many in this community take as law.

 

[ButtterflyLady]

Blood sugar 101 is just a rehash of other studies pointing out possible worst case scenarios and is frequently quoted here as rule and quoted incorrectly. Jenny ruhl to be fair makes no claim the site does anything but that. However the phrase "studies show this may be the case" is to be found through all her links.

It's a valuable site but it is just a lot of possible worst case scenarios that many in this community take as law.

I disagree. I've read several of the studies she links to and they do say what she says they say. The risks she refers to such as pancreatic tumour proliferation or heart disease, for example, are real. Many people find that when they try some of these drugs, they experience the worst case scenario side effects. IMO it's better to be informed about these things than to stay in the dark about them.

 

[mikej1973]

I disagree. I've read several of the studies she links to and they do say what she says they say. The risks she refers to such as pancreatic tumour proliferation or heart disease, for example, are real. Many people find that when they try some of these drugs, they experience the worst case scenario side effects. IMO it's better to be informed about these things than to stay in the dark about them.

I didn't day she disagreed with the findings. The studies themselves tend to be more pessimistic than others and tend to not have firm conclusions. I haven't read all of them. And won't disagree on the drug ones as I don't need drugs. However the studies on what level blood sugar does what type of damage are all inconclusive.

The website is a good resource. It isn't a panacea and shouldn't be the sole resource for a diabetes management plan. In terms of drugs the balance is controlling blood sugar vs side effects. That impacts everyone differently, and people's own view on where on that spectrum they fall is down to the individual. All of the drugs mentioned have their role. I don't think any empirical study can determine the risk vs reward of those drugs because everyone is different.

 

[ButtterflyLady]

I didn't day she disagreed with the findings. The studies themselves tend to be more pessimistic than others and tend to not have firm conclusions. I haven't read all of them. And won't disagree on the drug ones as I don't need drugs. However the studies on what level blood sugar does what type of damage are all inconclusive.

The website is a good resource. It isn't a panacea and shouldn't be the sole resource for a diabetes management plan. In terms of drugs the balance is controlling blood sugar vs side effects. That impacts everyone differently, and people's own view on where on that spectrum they fall is down to the individual. All of the drugs mentioned have their role. I don't think any empirical study can determine the risk vs reward of those drugs because everyone is different.

I haven't spent much time focusing on what level blood sugar does what type of damage, as I just aim for under 7.8 and hope for the best. I don't use the website as my sole resource. I approach it skeptically like I do all information.

IMO the side effects and long term risks of all diabetes drugs except metformin and basal/bolus insulin outweigh the benefits by a little or a lot. I accept that for some people, metformin and insulins can't be tolerated. I don't see a role for drugs like Victoza and Forgixa that seem to be a nightmare for many people. I've had more than enough UTIs and thrush infections to last a lifetime. Those who report no concerning side effects can't be sure there aren't serious illnesses developing in the background. For me, the anxiety would outweigh any benefits.

Medicine can't be practised on the basis of everyone being different and no research information being reliable. The available studies indicate areas of concern for either certain groups or anyone who takes a given drug. I wish I could be more positive about these drugs but what I have read (in a range of places) I find compelling enough, and concerning.

Fortunately in most cases I believe that T2 can be controlled without drugs. I think there is a role for insulin where people are unable to sufficiently reduce carbs or body weight.

 

[Brunneria]

Thanks @Indy51 plenty of food for thought there.

Loved his info on the relative effectiveness of metformin at different dosages. Good stuff!

I also found his representations of the different risks very useful.
Just wish he had compared the glucose levelling effect of the drugs too. But then, so much depends on dosage, that wouldn't have been possible.

 

[ButtterflyLady]

Thanks @Indy51 plenty of food for thought there.

Loved his info on the relative effectiveness of metformin at different dosages. Good stuff!

I also found his representations of the different risks very useful.
Just wish he had compared the glucose levelling effect of the drugs too. But then, so much depends on dosage, that wouldn't have been possible.

IIRC from what I've read, many of the drugs have really good glucose reducing effects. Which is why HCPs are so keen to suggest them.

I imagine that in general a HCP wants the patient to try the drug and if they say too much about side effects and risks the person may be put off. I'm a bit different to the usual patient though, I want a lot of information and I'm usually pretty keen to try a drug unless I'm really concerned about side effects and risks. Maybe it's because I'm on multiple drugs that my doctors are now as cautious about it as I am. Adding a new drug can really upset the apple cart for me.

 

[mikej1973]

I'm a bit different to the usual patient though, I want a lot of information and I'm usually pretty keen to try a drug unless I'm really concerned about side effects and risks. Maybe it's because I'm on multiple drugs that my doctors are now as cautious about it as I am. Adding a new drug can really upset the apple cart for me.

In other words your stance is about YOUR risk vs reward. Paracetamol can be a killer. I take allopurinol. Side effects include death, coma, male breast enlargement!! It's tiny risk but it is a risk. I was happy to take it. You're not happy to take that risk and that's great, but most of the drugs in that presso reduce blood sugar and the Nhs fda and whoever else approve those drugs knowing a lot more about the side effects and implications than you or I.

Diabetes management is individual. Like you 7.8 is my only indicator if whether things are good or bad in real time. Keeping spikes to less than 2mmol etc is overkill and based on no science at all. But how other people do it is down to them. The same applies for drugs. With the proviso I don't take any and my opinion may change if I need to!

 

[andcol]

A little thought experiment... are these drugs that lower the glucose levels but not improve overall outcome actually being overshadowed by the hyperinsulinemia that raised glucose sufferers exhibit.

What we are missing is the relative effects on the end point percentages for those that return their insulin levels back to normal and not their glucose per se...

I knew about the increase from 1gm to 2g of metfarting and it not providing much benefit at all. I think if you do some digging there is very little difference from 0.5g to 1g doses. That is probably why they are happy to reduce doses relative to kidney function. So all in all I conclude that they are over-dosing for very little benefit.

Unfortunately (or fortunately depending on your point of view) I couldn't even handle 500mg (normal of slow release) without my body going into melt down with it. Whether it was the drug or its combination with lifestyle changes as well I do not know. I do know as soon as the drug was stopped the symptoms disappeared., but may be going back to old lifestyle would have allowed me to have managed met... Unwilling to find out.....

 

[ButtterflyLady]

A little thought experiment... are these drugs that lower the glucose levels but not improve overall outcome actually being overshadowed by the hyperinsulinemia that raised glucose sufferers exhibit.

What we are missing is the relative effects on the end point percentages for those that return their insulin levels back to normal and not their glucose per se...

I knew about the increase from 1gm to 2g of metfarting and it not providing much benefit at all. I think if you do some digging there is very little difference from 0.5g to 1g doses. That is probably why they are happy to reduce doses relative to kidney function. So all in all I conclude that they are over-dosing for very little benefit.

Unfortunately (or fortunately depending on your point of view) I couldn't even handle 500mg (normal of slow release) without my body going into melt down with it. Whether it was the drug or its combination with lifestyle changes as well I do not know. I do know as soon as the drug was stopped the symptoms disappeared., but may be going back to old lifestyle would have allowed me to have managed met... Unwilling to find out.....

I think it's pretty clear that you were one of those people whose body can't tolerate metformin. Fortunately the drug isn't necessary

 

[Indy51]

And a very entertaining blogpost from Dr Jason Fung on the current ADA recommendations (I do wish he'd stop using the "cure" word though):

https://intensivedietarymanagement.com/treatments-that-cure-type-2-diabetes-t2d5/

He definitely doesn't agree with Jenny Ruhl on the subject of insulin being a good idea for some Type 2's.

 

[ButtterflyLady]

And a very entertaining blogpost from Dr Jason Fung on the current ADA recommendations (I do wish he'd stop using the "cure" word though):

https://intensivedietarymanagement.com/treatments-that-cure-type-2-diabetes-t2d5/

He definitely doesn't agree with Jenny Ruhl on the subject of insulin being a good idea for some Type 2's.

I didn't find it entertaining. I tried, I really tried to give him the benefit of the doubt and to hear what he had to say. But I just don't think he understands that some T2s can use insulin effectively and prevent complications and disease progression. For sure, those T2s who pay no attention to carbs or even diet in general, and rely on tablets, then injectables, then insulin, then more insulin, are not doing it right. But to claim that everyone who uses any insulin at all is in the same category as these people is wrong.

If a T2 is unwilling to cut carbs, then they are better off on basal/bolus MDI variable dose insulin than they are with BGs in the teens for the next 5 years, which will definitely lead to complications. For those unwilling to low carb, insulin can normalise BGs and prevent complications.

The fact that Fung uses the word "cure", and uses it often, shows that he doesn't understand diabetes management. A bariatric surgery patient is not cured. Something like 50% of them go right back to overeating and become diabetic again.

I'm sure he's a great nephrologist, and he's really enthusiastic about low carbing, which is great.

 

[Indy51]

In an ideal world where people were taught to use it properly (like Dr Bernstein's patients), it may be of benefit. But most patients aren't taught or prescribed it in the manner Jenny Ruhl would like it to be. It takes a very savvy patient (like Jenny Ruhl) to deal with correctly. She is definitely not a typical Type 2 patient being prescribed insulin; nor are Dr Bernstein's patients.

The reality is more like this:

http://care.diabetesjournals.org/content/32/suppl_2/S270.full
http://www.ncbi.nlm.nih.gov/pubmed/23372169

 

[ButtterflyLady]

In an ideal world where people were taught to use it properly (like Dr Bernstein's patients), it may be of benefit. But most patients aren't taught or prescribed it in the manner Jenny Ruhl would like it to be. It takes a very savvy patient (like Jenny Ruhl) to deal with correctly. She is definitely not a typical Type 2 patient being prescribed insulin; nor are Dr Bernstein's patients.

The reality is more like this:

http://care.diabetesjournals.org/content/32/suppl_2/S270.full
http://www.ncbi.nlm.nih.gov/pubmed/23372169

Yes, very true. Using insulin in the way the ADA or NHS does it for T2s can be disastrous. The doses are far too high, leading to weight gain and the health effects that come from that. And I imagine that many of the people who use it in this way are already obese and may have hypertension and high LDL and triglycerides.

It's interesting that the recently updated NICE guidelines for T1 recommend everyone is on basal/bolus MDI insulin. I hope the same follows through next time the T2 guidelines are updated. It won't fix the wider problem but it might improve things for those people who use it wisely.

When I think of T2s like those in the studies above, I think of those husbands and partners that are referred to on the forums as being obese, sedentary, and eating whatever they like and just injecting the insulin to cover it. Which is about the worst way to do it.

 

[Indy51]

When I think of T2s like those in the studies above, I think of those husbands and partners that are referred to on the forums as being obese, sedentary, and eating whatever they like and just injecting the insulin to cover it. Which is about the worst way to do it.

Reminds me of a neighbour as well - his stomach has got so big that he has that pregnant belly issue - his muscles have split apart. I dread to think what will happen to him eventually