Why would a doctor not recommend diabetic medicine to a healthy diabetic patient?

mysorian · Aug 19, 2023

HSSS said:
That sounds more like a definition of cure to me. Most of us consider ourselves well controlled rather than cured, whether that by dietary control or medication. The official definition of remission is a hba1c below diagnostic levels maintained without the use of medication. Nothing about being able to achieve that without any kind of effort.

As to why no medication was recommended, it’s increasingly recognised that dietary control is more effective at reducing blood glucose levels than many of the more mild medications they usually begin with and hasn’t got the same side effects they risk. It also increasingly appears that it addresses the root causes better than medication does, ieinsulin resistance, so the patient doesn’t deteriorate over the years and possibly suffer the associated complications in the same way as one on medication will almost invariably do. Perhaps the dr is enlightened about these issues. Did the dr offer any guidance what to do? If they weren’t heading immediately to medication some constructive advice on lifestyle really would help rather than leave the patient in a limbo of no action whatsoever.

If the various health-related public services are really interested in getting a handle on blood sugar control in the general populace, they should spread awareness by making it easy or even free to get continuous glucose monitoring even for short periods of time. People may be eating the wrong food, or eating undefined quantities, or improperly timed consumption, and many other variations of eating habits. Single prick measurements should be used only for checking the glucose in events that may require immediate attention. I have experimented with CGM, and I believe every morning one prick for the last 20 years has not helped even a bit. I know I could have evened out glucose if I had had CGM. What a waste of resources and energy in using the expensive and painful finger pricks!

HSSS · Aug 19, 2023

mysorian said:
If the various health-related public services are really interested in getting a handle on blood sugar control in the general populace, they should spread awareness by making it easy or even free to get continuous glucose monitoring even for short periods of time. People may be eating the wrong food, or eating undefined quantities, or improperly timed consumption, and many other variations of eating habits. Single prick measurements should be used only for checking the glucose in events that may require immediate attention. I have experimented with CGM, and I believe every morning one prick for the last 20 years has not helped even a bit. I know I could have evened out glucose if I had had CGM. What a waste of resources and energy in using the expensive and painful finger pricks!

Singing to the choir here about education and facilitation of monitoring.

I agree once a day fingerpricks are next to useless but that doesn’t mean fingerpricking is completely. Doing it before and after meals looking to emulate normal reactions by adjusting intake is incredibly useful and how a huge number of those in this forum that achieved remission did so. Kind of a poor man’s cgm, except not exactly cheap. And fingerpricking shouldn’t be painful done right.

KennyA · Aug 20, 2023

mysorian said:
How can one determine if he or she is in real remission? I would say true remission is when you do not seriously try to limit carbs. Otherwise, it is controlled remission.

Ah - there has been international agreement on what "remission" is to be defined as - this paper has the details: https://link.springer.com/article/10.1007/s00125-021-05542-z

The agreed definition is where we are - my practice a few years back used a much tougher definition - one year of HbA1c 42 or under without any glucose-related medication.

Remission to me doesn't imply not being diabetic - it is mainly absence of symptoms. I am still diabetic and I think I will always be diabetic. What you're describing is possibly more equivalent to a "cure" - ie that you could eat carbs as a major part of your diet and not see raised blood glucose levels and other symptoms.

Grant_Vicat · Aug 20, 2023

Robbity said:
I've been able to reduce my diabetic glucose levels to pre-diabetic/near normal, which I'm now maintaining by diet alone. I believe my diabetes was triggered in part by eating an unnaturally (and probably unhealthy) high carbohydrate diet, which my body ended up unable to cope with. Reverting to a lower carb diet - a somewhat stricter version of what I'd always eaten previously for around 70 years - has enabled me to maintain these lower glucose levels for nearly 10 year now, and going by my results my GP eventually decided I could manage without diabetic medication.

For me, limiting carbs is more about eating sensibly (diabetes or not!) rather than "controlling remission", and lower glucose levels are simply one of several benefits of my doing so.

There's no real necessity at all to stuff our faces with the (often) huge quantities of carbs we've been conned into believing that we should consume, as our bodies use both carbs and fats as fuel. Since we only require around 120-130g glucose (either converted from carbs or generated by our livers) for certain brain functions, we can use fat for our main source of energy - or only source as our carnivore members can confirm!...

It astonishes me how fish and chip shops (they are by no means alone!) will serve enough chips to equal 100gm of carbohydrate, even if you specify a small portion. I don't blame the general public for not being aware of what they are stuffing into their faces. Small psychologically suggests healthy. I know the Government want to control what we eat, but in theory they would be better off informing us what small should look like. Then we might be closer to "Nothing in excess". The best diabetic education I have had is how to recognise a single portion of carbs. I still do this and my weight has not changed sice at least 1978.

mysorian · Aug 21, 2023

Everybody likes potato chips (potato fries) and potato crisps and a few care or now they could be not so good after all for some.

Daphne917 · Aug 21, 2023

KennyA said:
Ah - there has been international agreement on what "remission" is to be defined as - this paper has the details: https://link.springer.com/article/10.1007/s00125-021-05542-z

The agreed definition is where we are - my practice a few years back used a much tougher definition - one year of HbA1c 42 or under without any glucose-related medication.

Remission to me doesn't imply not being diabetic - it is mainly absence of symptoms. I am still diabetic and I think I will always be diabetic. What you're describing is possibly more equivalent to a "cure" - ie that you could eat carbs as a major part of your diet and not see raised blood glucose levels and other symptoms.

My practice has only just decided that I am in remission despite having a non diabetic Hba1c for approx 10 years.

Deleted member 527103 · Aug 21, 2023

mysorian said:
If the various health-related public services are really interested in getting a handle on blood sugar control in the general populace, they should spread awareness by making it easy or even free to get continuous glucose monitoring even for short periods of time. People may be eating the wrong food, or eating undefined quantities, or improperly timed consumption, and many other variations of eating habits. Single prick measurements should be used only for checking the glucose in events that may require immediate attention. I have experimented with CGM, and I believe every morning one prick for the last 20 years has not helped even a bit. I know I could have evened out glucose if I had had CGM. What a waste of resources and energy in using the expensive and painful finger pricks!

Great idea if you have unlimited funds for the CGM and training.
Whilst many of us on this forum are able to lear how to use a CGM and get value from it, we are a small subset of the diabetes population. Many may not have the ability or interest or confidence to use tech such as a CGM.
I still read threads from people who use their CGM to avoid pricking their finger and that is it: they look at the number before they eat and look at it 2 hours later with no interest in what happens between or afterwards.
In a country such as the UK with government funded healthcare, a decision needs to be made about the best return on investment. In a country such as USA where most healthcare is funded by insurance, the individual (or their employer) needs the money to fund the insurance.

HSSS · Aug 21, 2023

mysorian said:
Everybody likes potato chips (potato fries) and potato crisps

Actually I don’t and never did.

Why would a doctor not recommend diabetic medicine to a healthy diabetic patient?

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Why would a doctor not recommend diabetic medicine to a healthy diabetic patient?

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