What medicines do you take to control Type 2 DM?

[namaha]

With reference to the poll which we had recently on usage of medicines to manage our Type 2 DM ( healthunlocked.com/diabetes.... ), it is observed that members are using various kinds of medicines as prescribed by our physicians, when we fail to lower our blood sugar by diet, exercise and life style changes ... While the medicines are designed to manage our conditions, some of us may encounter some possible side effects. I thought of giving a brief summary on management of type 2 DM and possible side effects from usage of medicines some of which are anecdotal and some are evidence based...

(1) Mild to moderate DM type 2 can be managed with Life style change, diet and exercise and without medicine as can be seen from the poll.... Some members have successfully adopted to a particular diet, exercise, life style to control type 2...

(2) People those who can not manage with diet , exercise , life style change , resort to Metformin which seems to be very popular among members and is supposed to be the safest of all with least side effects , though long term usage could lead to depletion of vitamin b12 level... You should be watchful and if required, you may have to take B12 Methylcobalamine tablets after consultation with your doctor.

Metformin is basically an insulin sensitiser which mainly acts on liver to stop glucose production and it also acts at cellular level. It also seems to help in reducing weight if he is an obese type 2..

But in case someone is a thin type 2 with BMI of 20 and below and wanting to add few kilos , he may find it difficult to put on weight with Metformin..If required such persons may consult with their physician to minimise Metformin and take some other alternate drugs....

(3) Obese type 2's with high circulating insulin level and strong IR can always manage his Type-2 DM with weight reducing plans with suitable diet, exercise, life style, IF..

Medicines may not be required...

If some obese type 2's are taking insulin secretagogues like Sulphonylurea, he may like to review his drugs after consultation with his physician.. no need to whip the pancreas, if he already has enough circulating insulin in his blood .

(4)Some members who take Sulphonylurea must find out if he really needs the drug... He may need it if his pancreas does not produce enough insulin...especially low weight /very Low BMI are possible candidates for low insulin levels...

(5) People taking DPP4 inhibitor/ SGLT 2 must be aware that the drugs are comparatively new. In fact Galvus Vildagliptin is not yet approved by USFDA... Though many European and Asian countries have approved...

DPP4 inhibitors in high dose in some cases seem to have caused a dangerous skin disease called Bullous pamphigold.

SGLT2 is being mainly prescribed for obese type 2. It helps clearing the blood sugar through kidney and urine. Though it helps reducing weight and Carries no CV risk, but very notorious in creating urinary tract infection due to persistent presence of sugar in urine...please remain alert..

(6) Pioglitazone is being taken by some members. While it is an old drug and highly effective in fighting insulin resistance... But at high doses it has a plethora of side effects in few % of people... It was banned in many countries , but the ban was lifted by the protest from patients and doctors since they found it is a very effective medicine at low doses to fight IR and also reactivating Beta cells....

(7) Some people who take Injectable insulin, if they are obese , recently it was seen that few people after reducing their weight substantially, they were able to switch from injectable Insulin to oral insulin secretagogues... Unbelievable but true.. But needs to be reproduced with many such people under expert Medical supervision....

Similarly , nowadays some medical experts are advising injectable insulin for type 2 , even though these can be managed with Sulphonylurea. In their view , insulin injectables if properly dosed with reference to carbs counting , it is safer than oral medicines. They say oral medicines needs to be metabolised in body which in process can cause metabolites which can lead to various side effects ..

Anyway, any kind of medication if taken in high doses / excessively could lead to side effects with some people- some possible side effects known and some others could be unknown...it is always better to keep the doses to minimum by combining with suitable changes in life style, diet and exercise...

Disclaimer: The above post is for information only..Always consult your physician before changing your medical plans..🙏

[sandybrown]

I am plan (1).

[namaha Administrator in reply to sandybrown]

Dear Sandy

Good that you have been able to manage your conditions with Lifestyle, Diet & exercise.......

However, to avoid diabetic complications, you may please keep an watch on the following 4 Vital Parameters:

(1) Hba1c below 6.5

(2) IR as measured by HOMA-IR below 1.5

(3) Beta cell status as measured by HOMA -B minimum 60%.

(4) Body inflammation under control with hsCRP- C Reactive protein below 1mg/L

If any one or more of the above 4 vital parameters are out of range, then you may need intervention !

Good luck !

[sandybrown in reply to namaha]

Thanks. In UK, NHS do not do 2,3,4 checks. 1 blood test,eye test and foot test. I an appointment in December, will ask questions.

After watching online videos I always fine contact details and send emails. Last evening I received a response on HbA1C numbers!!!

Now I have to wait for my latest blood test. at the end of the month .

I talk to people in the gym diabetic group on their life style and medication. Some people even with medication have high HbA1C numbers.

On the insulin course there is a discussion going on at what level of A1C, insulin should start !!, very interesting. Will give more information in mid Dec.

Only time will tell.

[namaha Administrator in reply to sandybrown]

Dear Sandy

On test serial number 2 & 3 , you need not have to undergo any specific test....

HOMA IR & HOMA-B can be computed from fasting blood sugar and fasting insulin....

HOMA IR=(FIXFG)÷ 405

HOMA B=(360XFI) ÷(FG-63)

Where FI= Fasting insulin in uIU/ml.

FG= Fasting blood glucose in mg/dL

Especially if you are not taking any medication, you must check your fasting insulin even if NHS does not do it, you must check it privately at regular intervals. .

HsCRP is also a simple blood test low cost..

With regards to blood glucose control and DM management : Diet , Exercise and life style all the three are of primary importance and medicine is only an add-on i.e secondary...

You can not ignore the primary 3 things and medicine may only helps as a last mile help if required...

The most important thing is MONITORING your HBa1c, Fasting /PP, Fasting insulin & hsCRP at regular interval.

Unfortunately , people tend to ignore either one or more of the elements once they find some improvements and then they allow it to go back to the undesired conditions.....

[Hidden]

Thanks namaha this is well thought out and topical so will be interesting combined with the polls.

Jerry. 😊

[Activity2004 Administrator]

Fantastic job, namaha !😀👍 Thank you for posting it for everyone.

[rnpath]

an excellent upto date review of the present scenerio. i have come across few complications with gliptins use,such as constipation,polyps of intestine and chronic pancreatitis.precipitated by practicing dhanurasan.

[namaha Administrator in reply to rnpath]

Dear rnpath

Yes, Gliptin's are a new class of drugs being widely prescribed by doctors...

You should avoid high doses of DPP4 inhibitor ...

After consulting with your doctor , you may like to get a substitute...

[namaha Administrator]

Dear Pippa999

Appreciate your participation in the discussion..

I think all the members live with a lot of optimism and sharing with each other's experience during this journey to cure their conditions..

Your post is really interesting and it only validates our discussions/ polls we are having...( You may please read our recent posts and the discussions)

(1) There is a clear way forward for obese type-2 to go in to remission by reducing weight through diet , exercise ,IF- and in fact a lot of our such members have already achieved this feat..

(2)The only challenge is for the thin type 2 ... Where they have no weight to lose !

They are already lean and thin... Bony without muscles...can you imagine of 45-47 kg weight with 19-20 BMI.

They can not afford to lose weight further ... They badly need to add few kilos ....

75% of World diabetes are obese / over weight... 25% are such lean type...

Thin type 2's are characterized by low extremely low insulin secretion as contrary to high insulin levels with obese / overweight Type-2's...

These thin type 2 with low insulin levels are to be treated in a different way...

[barani19 Administrator]

Thanks a lot for sharing this comprehensive information namaha

[rogbert]

i take novomix insulin 3 times a day i am trying to lose weight but find it impossible sometimes especially on hypo days but have lost 5 stone since 2014 my dose has gone down from 80 units a time to 30

[namaha Administrator in reply to rogbert]

Yes , it is possible for an obese DM , by reducing weight one can reduce insulin dose.

In fact there are instances people by reducing weight have switched over from Injectable insulin to Oral drugs namely Sulphonylurea or other Insulin secretagogues.

[namaha Administrator]

The way forward for thin type 2's is to get their fasting blood insulin level checked and if it is low say less than 5 uIU/ ml and find out his Beta cell status by the furmula HOMA B as discussed above and then it makes sense to consult his Physician and should take a Sulphonylurea and though with a suitable diet such as Low carb and exercise , he can minimise his dose .

[gangadharan_nair]

I take Human Mixtard injection twice daily (10 units in the morning and 10 units in the evening) to control type 2 diabetes. I am suffering from nonalcoholic cirrhosis and liver cancer (HCC). So my doctor advised me not to take anti-glycemic pills as it will adversely affect my liver.

I am aged 82 years with diabetic history of nearly 30 years.

Links:-

en.wikipedia.org/wiki/Diabe...

[namaha Administrator in reply to gangadharan_nair]

Dear Gangadharan

Great Going at 82👍. May God Bless you !

When one has declining beta cell function, Nowadays the trend is that many endochrinologists are directly advising injectable insulin even though there is a scope for oral insulin secretagogues....

In their view, injectables are safer than oral drugs since most of the oral drugs either act on the liver or needs to be processed by liver....putting the liver under stress...

The only issue with injectables are a bit of inconvenience and of course chances of Hypo unless it is properly dosed depending upon the intake of carbs...

Any way wish you best of luck

🙏