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Diabetes Medication

Deprescribing Diabetes Drugs

Do you wonder why your doctor keeps telling you to take more and more drugs to manage your diabetes? Many people with diabetes take three or even more prescriptions for it every day.

A new article in the BMJ, which is the journal of the British Medical Association, reviewed the case of a British man who has had diabetes for 14 years and wondered if his stomach upset problems might be from the drugs he was taking for diabetes, cholesterol, high blood pressure, and coronary artery disease. He “asked if he could cut down on any if they weren’t all needed,” but didn’t want to jeopardize his diabetes control.

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In the article by Doctors David Unwin and Simon Tobin, “A patient request for some ‘deprescribing’” they reported what happened next. They felt that “none of his drugs is essential — they have all been prescribed to reduce his risk of cardiovascular events and the complications of diabetes, not to treat an actual disease.” They appreciated that a better diet and more exercise were alternatives to the drugs.

He Stopped Taking All His Medicine

When he stopped taking every one of his drugs with the support of his doctor, this man began following a low-carb diet and lost more than 35 pounds and his A1C dropped from 6.9 to 6.2. “Despite eating more eggs and lots of full fat Greek yoghurt, and stopping statins” his LDL cholesterol and triglycerides both improved. He feels “much younger again.”

You can read the full case study online by getting a free trial subscription to BMJ, as I did. But for me, the responses were even more interesting. As I write, comments from 29 people from around the world, many of them from doctors and nurses, are free online. I am heartened that each of them support deprescribing diabetes drugs in favor of a low-carb diet.

The New Concept “Deprescribing”

Strangely, deprescribing is such a new concept in medicine that the word doesn’t appear in any of the dictionaries I consulted. Deprescribing is the entire process of stopping to take a medication, writes Dr. Emily Reeve at Australia’s University of Sydney. It “is more complicated than just not renewing a repeat prescription, or simply telling a patient not to take that medication anymore.”

She has written more about deprescribing than anyone else. PubMed includes links to nine of her articles on deprescribing. I have been in correspondence with her, and she sent me six of them relevant to this article.

Another Australian, Dr. Michael Woodward, wrote the first article about deprescribing in 2003, but, as one of Dr. Reeve’s articles points out, only eight articles published before 2013 even mentioned deprescribing. Even now, “cessation of a medication is the most common recommendation following a formal medication review,” she writes,  “yet it is the least likely to be enacted.”

The Risks Can Outweigh the Benefits

Isn’t it sad that our doctors have been prescribing more and more drugs for uncounted years and yet only recently have they began to think about how to get us off them when we don’t need them or they do more harm than good? Different studies show that 20 to 60 percent of elderly patients are taking at least one drug “where the potential risks associated with use outweigh the potential benefits.”

The older we get the greater the problems we have with drugs. As we age there tends to be an increase in the number of our medical problems and consequently an increase in the number of drugs we take. That’s associated with everything from malnutrition and falls and fractures to hospitalization and institutionalization, Dr. Reeve writes.

More Drugs = More Interactions

Studies in Canada show that nearly two-thirds of seniors take five or more classes of drug, according to a report last year by the Canadian Institute for Health Information. More than one-quarter of them were taking 10 or more drug classes. More drugs means more potential for serious interactions.

Both the benefits and the risks of a drug change with time. We may get less benefit as we develop tolerance to a drug.

Many of us have begun to question the benefits of the diabetes drugs we were taking. Because of my concern about the side effects of all drugs, I have been following a very low-carb diet since 2007, as I have written. Many of us now know that the diabetes drugs than many of us take are too risky and that we can manage our diabetes even better without them. Could you do that too?

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

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  • Julie at

    I am 5’5″ and have been eating low carb since Sept. 2015 and my post meal numbers have not exceeded 115. I have lost from 107 to 98 lbs over the year that I limited my grains – the last four months I don’t eat any grains. I exercise regularly with weights and walking. However, my a1c has gone up over a 1 1/2 years from 5.7 to now 6.0 when checked at the end of Dec. My doctor wants me to try Tradjenta to lower my a1c. I don’t want to do medication but I don’t want to harm myself with these numbers either. Please share your opinion and advise.

    • David Mendosa at

      The good news for you, Julie, is that you have a doctor who really cares about your blood glucose level. Most doctors would be delighted with a 6.0 A1C level, which some people consider to be a normal level. You are doing the right things and your level is probably going up (I say “probably” because this is close to the margin of error). The one question I do have for you is what you BMI is. If it is above 25 and even if it is above 23, you might want to work out with your doctor that you will focus for a while at least on getting it down there.

  • Davo at

    There needs to be a better explanation if possible of which is the preventative medication. There is a need for you to mention this in your article.

  • Bob Douglas at

    David. Where is the best place to find low carb. diabetes meal plans. Are there any good sites you could refer me to,?

    • David Mendosa at

      Dr. Bernstein gives a lot of information about this in his book “Dr. Bernstein’s Diabetes Solution.” I have also written many articles recommending for or against certain foods and telling what I eat.

  • Chris Jones at

    Hi David, I still have a print-out in a file of an article on Chana Dal by Rick Mendosa dated 1998.

  • John Wilkinson at

    Thank you Rick, um I mean David. You have kept me informed for a lomg timr. Keep up the great work.

    • David Mendosa at

      You are welcomed, John. You must have indeed been following me for a long time to remember that I used to be named Rick.

  • Vishwa at

    Thank you David, nice expression of the current status with people having Diabetes for some good time. Even in my experience any recommendation for treatment through medication, looses its ability through drug resistance and the trial abuse the body and specially gut flora.

    According to Ayurveda, managing Diabetes is more based on wholestic approach involving exercise, food habits, keeping mind calm, stress free life, good sleep and to a lessor extent depend on drugs, thus reducing the side effects.

  • Marcus Valdes at

    I deprescribed my insulin (Lantus and Novolog) about a month ago. For the last 8 weeks, I have eaten a low carbohydrate diet and introduces walking/running about 3 days per week for an hour at a time. I have also recently introduced intermittent fasting (usually only skipping dinner in the evening). In 8 weeks I have taken my A1C from 8.5 to 7.5. I have lost 21 pounds with relative ease. The most fascinating diabetes information I have come across recently has been from Dr. Jason Fung (on YouTube).

    I feel 100% better already but still have a lot of work to do. It is made easier by the increased energy that I already feel.

    • David Mendosa at

      Congratulations, Marcus! Actually, you almost certainly reduced your A1C level even more than the test shows. That’s because there is a sort of delayed reaction because the measured level reflected your average blood glucose over approximately the past 3 months.

  • Chris Jones at

    I “cured” my mother’s lack of appetite and diarrhoea. I asked the doctor if it was necessary to take Metformin. They reviewed her medication and she is still on quite a cocktail of drugs but not Metformin. Some of those drugs will be necessary but I’m sure she would have a better quality of life without the others.

    It seems to me that (UK) doctors are under time pressure and need to treat patients as median in a spread of possible situations with exceptional situations ignored. By prescribing the standard solution they run less risk of being accused of being liable for making the wrong decision.

    I was told “We don’t recommend you do the 5:2 fasting diet” since I have Type 1 diabetes. Generally that is good advice for the population of Type 1 diabetics as a whole but it insults those with a good HbA1c who could benefit greatly. I “deprescribed” that advice and I have lost a stone and stopped taking blood pressure tablets.

    I stopped taking statins a couple of years ago. I said to the doctor “taking the population of people with heart disease do they tend to be people with high heart rates or low heart rates?”. My low heart rate meant that I didn’t have a typical risk and I argued that I didn’t need to be prescribed in a typical way.

    I think that finding ways to identify atypical cases would greatly help in deprescribing and I wonder if artificial intelligence would help in identifying individuals who would benefit.

  • Arun at

    Sir William Osler, a Canadian physicist of the nineteenth century is supposed to have said, “One of the first duties of a physician is to educate the masses not to take medicine”.
    Of course, he may not have been right in all respects for the situation today. But the fact is with our present day perception that ” there is a pill for every ill” we seem to have lost sight of our own inborn capacity to fight various illnesses. It is high time we question the benefits of many of drugs we take, and be really thankful for doctors who deprescribe some after careful thought.

    • David Mendosa at

      Thank you for your comment, Arun. I knew that Osler was a famous physician, but didn’t know that he said those wise words or that in fact he was a Canadian. Since he became famous in the the States, I thought that he was an American.