When people with type 2 diabetes could take a pill instead of insulin to help us control our diabetes, smiles must have appeared on many faces. The pill was tolbutamide, and in the mid-1950s it became the first of the sulfonylurea class of drugs.
But that was more than half a century ago. Meanwhile, we now have choices of pills we can use. In fact, we now have nine other classes of oral diabetes medication plus several combinations.
The sulfonylureas force the beta cells in the pancreas to pump out the insulin that our body makes there. That’s why we call these drugs insulin secretagogues. For years many of us have been concerned that they will eventually burn out whatever beta cells we have left.
About a dozen years ago I voiced this suspicion to Edward S. Horton, who was then the director of clinical research at the Joslin Diabetes Center in Boston. In reply he told me that we have no evidence for this belief.
“You are not whipping the beta cells to death,” he said. “There is evidence that the beta cells do fail gradually over time. But there is no evidence that drugs hasten the process. I know that it is a popular conception that people have, but it is not true.”
Almost all of us who have diabetes have to struggle with our weight. So, wouldn’t it be easier with a formal weight loss program?
Probably not, according to the results of a presentation to the Fourth International Congress of Behavioral Medicine in Washington, D.C. The National Weight Control Registry just brought this unpublished study to my attention.
The National Weight Control Registry is the largest prospective investigation of long-term successful weight loss maintenance. It tracks the progress of more than 5,000 people who have lost a lot of weight and have kept it off for a long time. I am one of those people whom it tracks.
Actually, I don’t consider that the registry’s standards are all that high. To join you only have to show that you have lost at least 30 pounds and have kept it off for at least a year.
With all the emphasis on how we check our blood glucose levels using all the new meters that we can choose from, many of us who have type 2 diabetes forget or never learned why we check our levels. Anyone who has type 1 diabetes has to know why he or she checks as do those type 2s who uses insulin. Those of us who inject insulin check their levels so they can take more if their levels are too high or take a glucose tab or something similar if they are too low.But three-fourths of all type 2s don’t take insulin. Some of them still use the first oral medication, one of the sulfonylureas that can cause hypos, a level below about 70 mg/dl. Then they too will need to take something like a glucose tab to bring their level back to normal.
The overwhelming majority of all people who have diabetes rarely if ever get hypos. So why should they go through the trouble of checking their blood glucose? What can they do with that information?
If our doctors and nurses ever told us why, most of us have forgotten by now. As a result, a lot of people with diabetes don’t bother at all any more with blood glucose checks.
That’s a shame, because even people who don’t use insulin or one of the sulfonylureas, can benefit from checking if they do it at the right time.
The most right time is after eating a big meal, especially one that has a substantial amount of starch in it. Nothing raises our blood glucose level as much and as fast as starch — the stuff in potatoes and grains and grain products, like bread, bagels, pizza, or anything made from wheat flour.
Here is a copy of a letter — with the author’s name and other identifying information redacted out — about anecdotal evidence that medical marijuana might help some complications of diabetes.
The person who wrote me has a better memory than I do. I don’t remember corresponding with him before, but he remembers that when I used marijuana I was addicted to it. It got to where I had to be high all my waking hours. My correspondent is also quite correct in writing that I would not be a good candidate for medical marijuana, except as a last resort.
The jist of what he wrote follows:
If you are one of the 600,000 Americans who take Avandia, you need to see your doctor right away. That’s only a small fraction of the 24 million of us here who have diabetes, but anyone who now takes it has an important — and perhaps a life-saving — decision to make.
The U.S. Food and Drug Administration just pulled the major diabetes drug Avandia (rosiglitazone) from the U.S. market — with two exceptions. This government agency responsible for drug safety and efficacy says that people with diabetes who are already on Avandia can keep on using it. But the FDA will let us take it only if we and our doctors swear that they have tried every other diabetes drug and that they and their doctors know how risky Avandia is for their heart.
The FDA’s decision also affects two drugs that combine Avandia with another drug. These are Avandamet, which is Avandia and metformin, and Avandaryl and glimepiride, one of the sulfonylurea drugs.
One study indicates that between when the FDA approved Avandia in 1999 and last year more than 47,000 Americans needlessly suffered heart attacks, strokes, or heart failure — or died. Still, the FDA’s decision yesterday will let people keep on taking Avandia. And the agency admitted that implementing its decision can take months.
The FDA had previously withdrawn our access to drugs years after the agency approved the them. Think thalidomide, which the FDA approved in the late 1950s and pulled in 1961 after mothers who took it gave birth to many children with tragic birth defects. Think too about the diabetes drug Rezulin, which the FDA approved in 1997 and withdrew 11 years later after about 400 people with diabetes died from liver failure. Rezulin and Avandia are two of the three drugs in the same class, the thiazolidinediones. The third member of this drug class, Actos, still appears to be safe.
So the FDA’s decision yesterday leaving a loophole was a strange one. Even more unusual was its coordinated announcement with European drug regulators. Well, they coordinated the timing of the announcement, which was highly unusual and perhaps unprecedented. But the European Medicines Agency took Avandia totally off the market there.
The world has a controversial Cleveland Clinic cardiologist to thank. A meta-analysis led by Dr. Steven Nissen that the New England Journal of Medicine published three years ago exposed Avandia’s dangers to people with diabetes.
With the FDA’s action yesterday the second shoe dropped. To mix a metaphor, if you take Avandia the ball is in your court now.
This article is based on an earlier version of my article published by HealthCentral.