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

[mysorian]

The patient is diabetic with HbA1C >6.7%. Otherwise, he is healthy with cholesterol within US standards. Why would the doctor not recommend some diabetic medication to control his blood sugar?

 

[CatsFive]

The patient is diabetic with HbA1C >6.7%. Otherwise, he is healthy with cholesterol within US standards. Why would the doctor not recommend some diabetic medication to control his blood sugar?

I was 56 (7.3%) at diagnosis and was given an appointment with a dietician. All medications have side effects, they have to be balanced against the benefits. Many people here has started with a higher HbA1c than 6.7% and come down to pre-diabetic levels through diet or diet & exercise.

 

[mysorian]

Doctors have a standard procedure to recommend or not diabetic medicine. What is the standard for recommending medicine?

 

[EllieM]

Doctors have a standard procedure to recommend or not diabetic medicine. What is the standard for recommending medicine?

I would suspect that it varies by location (country), and by patient's age and other conditions.

eg my 93 year old T2 father is in the UK and used to be on gliclazide before he adopted a low carb diet. He then went medication free for a couple of years but then got put on metformin when his hba1c went up to 54mmol/mol (7.1%)

 

[JoKalsbeek]

The patient is diabetic with HbA1C >6.7%. Otherwise, he is healthy with cholesterol within US standards. Why would the doctor not recommend some diabetic medication to control his blood sugar?

Maybe because medication has side effects, and diabetes type 2 will progress and require more and more medication if there is no lifestyle change? Change diet to low carb and there is less chance of diabetic complications, remission is a possibility, no medication required.

That said, my mom was put straight on insulin when she was in the hospital and developed steroid-induced diabetes, but then, she was going to die and anything she did eat was a win, because food had lost all flavour for her by then. The little joy she derived out of eating the wrong things was a matter of more-power-to-her. It really does depend on a whole lot of factors... How long will the patient yet live, quality of said life, odds of remission/complications etc... And not in the last place, how enlightened is the GP in question, as most will just write a scrip and wish you luck, which isn't the best method, really.

Does that help at all?

 

[mysorian]

Maybe because medication has side effects, and diabetes type 2 will progress and require more and more medication if there is no lifestyle change? Change diet to low carb and there is less chance of diabetic complications, remission is a possibility, no medication required.

That said, my mom was put straight on insulin when she was in the hospital and developed steroid-induced diabetes, but then, she was going to die and anything she did eat was a win, because food had lost all flavour for her by then. The little joy she derived out of eating the wrong things was a matter of more-power-to-her. It really does depend on a whole lot of factors... How long will the patient yet live, quality of said life, odds of remission/complications etc... And not in the last place, how enlightened is the GP in question, as most will just write a scrip and wish you luck, which isn't the best method, really.

Does that help at all?

Strange but true. My diabetes has not progressed at all from 1997 to 2021. I suffered a heart attack which required stents. The condition was diabetic, but the Cholesterol was within the USA standards.
A good piece of advice for people with borderline cholesterol and diabetes is to raise the bar Cholesterol.

 

[CatsFive]

Doctors have a standard procedure to recommend or not diabetic medicine. What is the standard for recommending medicine?

The 'standard procedure' depends on what country you are in, and in some cases how up-to-date the doctor is. Medicine isn't static, in the UK NICE guidelines are reviewed from time to time.

These are the current ones:

Overview | Type 2 diabetes in adults: management | Guidance | NICE

www.nice.org.uk

You have to read quite some way down before you get to recommendations about medication.

 

[pinkjude]

Maybe because medication has side effects, and diabetes type 2 will progress and require more and more medication if there is no lifestyle change? Change diet to low carb and there is less chance of diabetic complications, remission is a possibility, no medication required.

That said, my mom was put straight on insulin when she was in the hospital and developed steroid-induced diabetes, but then, she was going to die and anything she did eat was a win, because food had lost all flavour for her by then. The little joy she derived out of eating the wrong things was a matter of more-power-to-her. It really does depend on a whole lot of factors... How long will the patient yet live, quality of said life, odds of remission/complications etc... And not in the last place, how enlightened is the GP in question, as most will just write a scrip and wish you luck, which isn't the best method, really.

Does that help at all?

Hi, How did you manage to reverse yours?

 

[JoKalsbeek]

Hi, How did you manage to reverse yours?

I went low carb. I responded badly to metformin, so I went looking for a workable alternative, and the glucose meter told me low carb was effective. And it has been, these past 7 years. https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html is basically what I did, though I had to change around some things due to food sensitivities.

Hope that helps.
Jo

 

[jomar_uk]

I went low carb. I responded badly to metformin, so I went looking for a workable alternative, and the glucose meter told me low carb was effective. And it has been, these past 7 years. https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html is basically what I did, though I had to change around some things due to food sensitivities.

Hope that helps.
Jo

Thank you!

I’ve bookmarked your blog as it’s pretty good advice.
Sorry to hear your mum got T2 the way I did via steroids.

Kind regards, JoMar. (I’ll use this instead of John (and Marian ) in future

 

[KennyA]

The patient is diabetic with HbA1C >6.7%. Otherwise, he is healthy with cholesterol within US standards. Why would the doctor not recommend some diabetic medication to control his blood sugar?

In my case, because the patient (me) refused metformin and controlled his blood glucose via diet.

 

[mysorian]

In my case, because the patient (me) refused metformin and controlled his blood glucose via diet.

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.

 

[EllieM]

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.

While I would agree with your definition, you've got to look at the reason someone becomes T2 in the first place. If it's weight gain, that is often caused by excess (also known as healthy by some dieticians) carbs, so reverting to a high carb diet may reverse the weight loss and remission. On the other hand, if the T2 was caused by steroids or other medication, I guess there is more hope of genuine remission?

(DIsclaimer, not T2 and not a doctor, so my opinion doesn't bear much weight).

 

[CatsFive]

In my case, because the patient (me) refused metformin and controlled his blood glucose via diet.

The doctor did recommend metformin!

 

[AndBreathe]

The doctor did recommend metformin!

Metformin isn't a life or death medication, so recommending it is just that; a recommendation.

There are a plethora of reasons individuals will pass on Metformin - some to do with their relationships with the small room, and some just don't want medications, where there is any credible alternative. Some like it because they believe it has additional benefits, relating to heart or other aspects of their health, or that it aids weight loss, and some like it because it is a simple gateway to free prescriptions.

It is rare Metformin would not be an option in the future, to someone deciding not to accept that recommendation at that time.

 

[CatsFive]

Metformin isn't a life or death medication, so recommending it is just that; a recommendation.

There are a plethora of reasons individuals will pass on Metformin - some to do with their relationships with the small room, and some just don't want medications, where there is any credible alternative. Some like it because they believe it has additional benefits, relating to heart or other aspects of their health, or that it aids weight loss, and some like it because it is a simple gateway to free prescriptions.

It is rare Metformin would not be an option in the future, to someone deciding not to accept that recommendation at that time.

All true, I was being pedantic

 

[HSSS]

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.

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.

 

[AndBreathe]

All true, I was being pedantic

That's usually my role .

 

[Robbity]

The patient is diabetic with HbA1C >6.7%. Otherwise, he is healthy with cholesterol within US standards. Why would the doctor not recommend some diabetic medication to control his blood sugar?

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.

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

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!...

 

[Outlier]

I consider myself "well controlled" because I will always be diabetic but I can keep my bloods in the non-diabetic level by managing my diet. If I were to eat like a non-diabetic person, even if a "healthy" diet the way I used to, the BG readings would soon creep up.

Hippocrates............. "let your food be your medicine....."