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Diabetes Medication

Diabetes Without Drugs

All drugs have side effects, some worse than others. Yet one of the cornerstones of diabetes management along with diet, weight control, and exercise, is to take insulin or one of the many diabetes medications that our doctors routinely prescribe.

People with type 1 diabetes have no choice. They have to take insulin. But the great majority of us have type 2 and mostly take one or two or even three different pills for our condition.

Some of these pills are clearly safer than others. For example, none of us take Rezulin any more, now that it killed at least 63 people. That was a dozen years ago so I wouldn’t be surprised if you forgot about Rezulin or never heard of it, but half a million of us were using it when the U.S. Food and Drug Administration recalled it.

Six years later Avandia became even bigger than Rezulin, earning GlaxoSmithKline $2.5 billion that year. Not so many of us take Avandia now that studies show that it raises the risk of heart attack by 43 percent.

Recently, yet another diabetes drug, Actos, seems to be life-threatening. Already banned in parts of Europe because it may cause bladder cancer, the FDA says that doctors should be cautious when telling us to take Actos. “The benefits of blood sugar control with pioglitazone,” it says, “should be weighed against the unknown risks for cancer recurrence.”

Even the diabetes drug that the most people with type 2 diabetes use can’t be completely safe. Metformin carries what the FDA calls a “black box warning.” Named for the black box that usually surrounds the warning, it means that the drug may cause serious adverse effects. Metformin’s black box warning says that lactic acidosis is a rare result of taking metformin, but when it happens it can lead to death half of the time.

I took my chances with metformin until February 2006. That’s when I took an even bigger chance.

In 2005 I had written here about the “Worst Diabetes Pills,” citing the sensible advice of Public Citizen’s Health Research Group not to use most pills until seven years after they came on the market. The only exception they made was for breakthrough drugs that were much better than anything else.

When I stopped metformin to take a chance on Byetta, I was gambling on a drug that had come on the market less than a year earlier. Even now the Health Research Group’s cautious waiting period is not quite over.

I had assumed that Byetta was indeed a breakthrough drug. Our subsequent experience with it seems to bear out this assumption. But some researchers are concerned that the GLP-1 medications, including Byetta and Victoza, might cause pancreatitis and pancreatic cancer.

I seem to have lucked out with Byetta. But I’m not much of a gambler with my money, much less with my health.

When a good friend of mine who is also a wise Certified Diabetes Educator encouraged me to manage my diabetes without drugs, I accepted the challenge. In December 2007 I stopped taking any diabetes drugs.

Since that time I have been able to control both my blood glucose level and my weight. I did it by chosing the only alternative that I knew at that time, following a very low-carbohydrate diet. It’s still the only way that I know to manage diabetes without drugs.

In the past four or five years I’ve written again and again about new studies showing the benefits of a low-carb lifestyle. But now I can report a new study on the flip side of the coin.

A study that the BMJ (formerly the British Medical Journal) published recently shows just how dangerous the side effects of diabetes drugs are. The study is a meta-analysis, one that combines the results of several studies to more powerfully estimate the real effect of something. In this case that something is the diabetes drugs that most of us take.

The BMJ editors thought that the article is so important that they made the full-text free online. You may want to read through its dense, scientific language for yourself. Here is a taste from the concluding paragraph: “The overall results of this meta-analysis do not show a benefit of intensive glucose lowering treatment on all cause mortality or cardiovascular death. A 19% increase in all cause mortality and a 43% increase in cardiovascular mortality cannot be excluded.”

Note that the meta-analysis reviewed studies of intensive glucose-lowering treatments. Still, as the authors point out, “It is paradoxical to propose intensive glucose lowering treatment when available drugs have no proved intrinsic efficacy.”

Does this mean you should throw away your pills? I would never give that advice. Instead, I urge as many of us as possible to use the safest diabetes drugs that we can and only as a temporary measure. When you and your doctor agree that you are managing your diabetes well enough with your diabetes drugs, you can then become drug-free with the only alternative that works.

This article is based on an earlier version of my article published by HealthCentral.

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  • Ken at

    David is right, there are a lot of diabetics that manage their type 2 diabetes very well with carb restriction alone. The game the doctors play is to get you to eat diets far beyond what you can handle as far as carbs go and then give you drugs to try to make up for it, and usually they don’t. Carb restriction should be the first thing people try, and a lot of people think they do low carb but could benefit by trying even lower.

  • Joan M Parker at

    Your article and the responses are helpful. I am presently taking Metformin 750mg A day and Onglyza 5 mg a day. I do experience a lot of diarrhea, however I am willing to put up with it. Is there a safer oral drug on the market than Onglyza? I was taking Byetta for a short while, however was too nauseated. I would appreciate any information.

    • David Mendosa at

      Joan, you really have to increase your dose of metformin very slowly. See http://www.mendosa.com/blog/?p=1261.

      Metformin is probably the safest oral drug for people with diabetes. If you follow a very low-carb diet, you probably don’t need to take any other drug with it. And in fact you will then be able to go off metformin too.

  • cindy at

    Thanks David i will try that. Many thanks!

  • Ken at

    When you start getting complications like foot problems then your body is telling you that you need to fix this now. This is how I discovered I had diabetes, and at that point with nerve damage you can’t fool around. I’ve been treating this for over 3 years now and I’m still not all better yet although I’d say probably 80%.

    To fix this we need to attack this on several fronts, the first of course is to manage blood sugar better, that’s one that just about everyone is aware of. It’s not just the blood sugar though it’s also reducing lipotoxicity from excess insulin, basically your cells are being poisoned by both too much sugar and too much fat, and this is why a low carb diet is so helpful, it reduces both blood sugar and insulin levels and this should be the goal.

    Quite a few people with diabetic damage are hip to things that reduce glycation, which is the way high blood sugar damages us, there are no prescriptions for this as they are limited to pain management but someone mentioned alpha lipoic acid, that can be helpful, benfotiamine is even better. Then you want to support the healing process and in particular correct any deficiencies, things like making sure you are getting optimal amounts of vitamin E, mixed tocopherols that is, just taking the alpha form may do more harm than good actually, as well as things like B12 and magnesium which are both critical for nerve health.

    Supplements are indeed drugs but they are natural ones, nature provides us a whole medicine chest of great things to use, big business has fashioned mutant versions in order to be able to obtain the monopolies they need to make huge amounts of money, no matter that they are far more dangerous and no matter if they make the condition worse over time, more dangerous and more side effects represent greater profit opportunities to sell people something else to treat the side effects, and making diseases worse is perfect actually, from a profit standpoint that is.

    People may choose a vegan or vegetarian diet, that actually might be more challenging to manage blood sugar with, it’s all about experimentation and it’s probably best to keep an open mind and not be too exclusionary here 🙂

  • cindy at

    I also take iodine lugols 5% and vitamin D forgot to mention them. My D was low at one time and I got cancer. It has been 7 years since then.

  • cindy at

    I was around a 7 the last check of A1C, My blood sugar is from 160 to 230 but it is wierd. My sugar gets up after eating for hours even on meds. I tried metformin and can’t take it. Glyduride is what I have now, but I have been hearing bad reports on this drug recently. I always thought the shots were the end of the line at the worst. Lots of people report higher sugar than me so I am not there yet I don’t think. Rather do it with food. A smoothie either veggie or fruit makes my sugar go up. They are saying vegan or frutarian makes sugar normal, but not sure how they get it to work. The whole diet thing is a mystery to me.
    Vegetarian is all carbs and no meat. I have tried every diet at one time or another. I am afraid to put anything in my mouth these days. Ha! Ha! Am happy if you found the right path. It isn’t obvious to some of us. I take alpha lipoic acid, C
    a Multivitamin, the bitter mellon is a plant,
    used in other countries as a food and for blood sugar regulation I think. Anyway if they have ued it I have tried it and asked about the berberine at the health food store and they had never heard of it.

    • David Mendosa at

      Your A1C level is better than I though you would report, Cindy. In this case, I highly recommend that you manage your diabetes without any drugs. The way you can do that best is to reduce the amount of carbohydrates to very few, about 50 grams or less per day.

      • nancy karabinos at

        Can you suggest a good low carb diet I can follow that I can find in line? Thank you

  • Sharon at

    My husband has diabetic foot pain which has been eliminated by eating more carefully, taking alpha-lipoic acid, and vitamin B complex. He bought these supplements at Walmart.

  • cindy at

    I have been going around in circles trying to control my sugar without meds. I feel better without the meds but am starting to have foot problems because my sugar is too high. You have done what I am trying to do. Where did you start?? I have tried many things including bitter mellon, gemma sylvestre intermittent fasting,juicing, but can’t find berberine yet. Ideas appreciated so much. Desperate!!!!!

    • David Mendosa at

      If you have foot problems, Cindy, your blood glucose level is indeed far too high. But in fact some the things that you tried are actually drugs. Supplements are drugs that haven’t been tested and aren’t standardized. That’s not what I wrote about at “Diabetes Without Drugs.” When we manage our diabetes, we manage our A1C level so that it remains below 6.0. The only ways to do that are three, and a very low carbohydrate diet is by far the easiest and safest (the other two ways are bariatric surgery, which is recommended only when you get up to the level of being morbidly obese, and a crash diet that is essentially a starvation one of 600 calories per day).

      But to your question about where I started: it was actually with a diabetes drug, now that I reflect back on it. I switched from metformin and a sulfonylurea to the first of the GLP-1 receptor agonists (Byetta) for a couple of years. While that actually had only a small effect on my A1C level, it had a great effect on my weight, and I was able to get down to a normal BMI level for the first time in years. At the same time I began to eat much lower in carbohydrates than ever before. Then I realized that I could safely follow a very low carb diet, so I stopped the Byetta in 2007. I did have some craving for some carbs for a while but that is long gone.

      In your case, I don’t necessarily suggest that you go on a very low carb diet now. This depends on how high your A1C level is. Who knows what the cutoff point is, but if it is, let’s say, above 9.0, you need to bring it down quite quickly because it is doing a lot of damage to your body, some that you can feel in your feet and much that isn’t apparent yet. I would in this case that you use insulin injections until you have reduced your A1C level substantially. But otherwise you need to consider whether you are committed to following a very low carb diet for your health. It will definitely bring your blood glucose level down to normal.

      Be well,

  • Ken at

    Here’s my take on this. The issue with these drugs isn’t just the side effects, it’s that their benefits are only fairly short term.

    So with Januvia for instance this elevates a hormone called GLP-1 which plays a role in blood sugar control, which sounds good on the face of things.

    However, what happens is that this hormone is given too much to do and as is the case generally with anti-diabetic hormone related therapy, it’s elevated to unnaturally high levels. This not only causes mutations in the pancreas, we also become resistant to the hormone fairly quickly, then it doesn’t work so well anymore. Along the way we’ve become resistant to our own GLP-1 as well, which we can recover from but this is just a mess, left with pancreatic tumors, which seem to be present in all cases of incretin therapy, as well as mutant islet cells which are both alpha and beta, and the last thing we need as diabetics is more glucagon being secreted by more alpha cells.

    So if one can manage this naturally then this is well worth considering I would think, I personally feel that conventional medical approaches, including insulin therapy with T2D, are designed to produce short term improvements but lead to an acceleration of the progression of the disease. That’s diabetes though as they say.

    Metformin doesn’t do this by the way and might be the only anti diabetic that doesn’t worsen the disease over time, but you’re limited by how much you can take due to potential side effects.

    As time goes on I feel more and more that gut health plays a bigger and bigger role, and this is hormone related as well, I’ve been focusing ecen more on things like probiotics, and things that improve the gut lining like colostrum and glutamine, and I’m finding that working pretty well for me. Hippocrates had it right I think when he understood the importance of the gut to our health and todays’ diet just ravages that really, especially all those grains, unrefined included, leaky gut is at epidemic levels, and we wonder why we are getting sicker every year.

  • Lisa at

    Thanks for the helpful information! My doctor has me on 4 metformin a day, and is wanting to add Januvia, but I am hesitant. I would like another way. I am a fairly new type 2 diabetic, a little over 2 years now. So I am still learning a lot and do not like the terrible side effects that most of these medicines may and have caused for others.

  • Ken at

    Lisa, we have studies with either berberine monotherapy and combined with metformin and both have produced similar results to metformin monotherapy. One of the issues why you need to watch the dosage of metformin is, aside from the side effects, you don’t want to elevate lactic acid too much. Berberine doesn’t do this though. I’ve no idea why anyone in the know would ever take metformin actually, it’s inferior to berberine in many ways.

  • Lisa at

    What is Berberine and can you take it while on Metformin?

    • David Mendosa at

      Berberine is an herbal supplement, Lisa. Some people take it, but I don’t know if it helps or hurts.

  • Ken at

    There are a lot of different supplements that can be helpful to some degree, although the benefits tend to be slight compared to prescriptions in most cases. However, the effects are cumulative, meaning the benefits can be stacked and the sum total can be impressive. Berberine on the other hand is right up there with any anti diabetic and is what I have found the most success with by far personally.

  • Sharon at

    What supplements do you recommend to control diabetes?

    • David Mendosa at

      Most people with diabetes can benefit from taking some magnesium, iodine, and vitamin D, Sharon.

  • Ken at

    One of the key tools that gets left out in these discussions generally is the benefits of taking more natural substances to help manage this. It’s not just diet and exercise vs. adding prescription drugs. There are many things that we can take which by themselves help a little but in combination can be even more effective than drugs.

    I’m 52 and I’ve always managed my own health care and in fact the first prescription I ever had in my life was for metformin which they give everyone these days once they diagnose you. I did try taking it but it made me pretty sick. So I turned instead to a strategy of using diet, exercise, and a number of supplements which have been shown to help.

    I’ve always been a supplement nut and now that I have diabetes this has really inspired me to see what the potential really is here. I’m inspired by stories of folks who have successfully reversed this through just diet and exercise although in this situation we need to be as proactive as we can and not just rely on big diabetes to direct our lives for the sake of their enormous profit.

    This is a work in progress three weeks into it but I’ve seen good results so far and the goal is to look to manage it this way before having to resort to drugs. I’m fully confident though that I will succeed here.

  • oubuti at

    I’m a type1 on novomix insulin and metformin tablets my blood sugar levels is reduced an I’m thinking of stoping ma medication. Is it advicible?

    • David Mendosa at

      Hard to say. Is your A1C below 5.0 yet? In any case this is a decision you and your doctor have to make.

  • km at

    In starting I found it difficult to reduce my sugar level without insulin. but Later after consulting SB Group , my life changed. I myself is type1 diabetes and my brother is type 2 diabetes. My brother has managed to stop 2 tablets for diabetes. But he is still on SB Herbal medicine which consist of all bitter tree leaf powder. My insulin is not reduced but sugar level has been reducing. I’m keeping my finger crossed . Hoping to reduce insulin unit soon. herbal medicines give good impact on pancreas.

  • Steve Parker, M.D. at

    You reminded me about phenformin, a drug in the same class as metformin. It was withdrawn from the U.S. market in 1978 due to excessive cases of lactic acidosis.

    I agree with you, David, that low-carb eating can help people with diabetes avoid drug toxicity. Not in all cases, but many.