A single research report that found risks in one of the medications that we take to control our diabetes would warrant our attention. But when three separate studies find serious side effects from all our major drugs, the time is right for us to reconsider how we control our blood glucose levels.
Most of us think of our diabetes drugs, diet, and exercise as the three basic ways we do that. But drugs come first. Maybe they should come last, at least for all of us with type 2 diabetes, who unlike type 1s have a choice.
Since March 10, studies have called into question the side effects of metformin, the glitazones, insulin, and the sulfonylureas.
First, came a report in the Proceedings of the National Academy of Sciences. The study suggested that when the elderly use metformin alone they might eventually get Alzheimer's disease. This is bad news, because metformin is by far the most commonly prescribed medication and is otherwise extremely safe.
The study found that taking insulin along with metformin counteracted that effect. But few people take that combination. And they found the effect only in the elderly, but with luck we will all be elderly some day. And these results are certainly preliminary. There are based on a study of rat's brains, and with luck our brains work differently.
Next, came a study in the April issue of the American Journal of Ophthalmology of the glitazones -- Actos and Avandia. A study of about 170,000 people with diabetes found that taking one of the glitazones is "modestly associated" with macular edema. If untreated, it can lead to blindness.
But the researchers hadn't yet finished finding problems with our diabetes medications. The April 15 issue of JAMA: The Journal of the American Medical Association reported that older people are more likely to have dementia after they had experienced one or more episodes of severe hypoglycemia. These findings came from a long-term study of more than 16,000 people.
The study found that compared with people taking insulin were more likely to have severe hypos than those on other drugs. But the sulfonylureas and the rarely prescribed Prandin can also cause hypos.
Except for Byetta, this just about covers the medications that most of us rely on to control our diabetes. While in 2007 the Food and Drug Administration found 30 reports of pancreatitis among people taking Byetta, that is a very small percentage of those people taking it. And in fact it is a smaller percentage than found among people with diabetes in general. Full disclosure: I own some stock in Amylin, the company that developed Byetta.
Because every drug has its side effects, it's no wonder that more and more people ask me about natural treatments for diabetes.
"Because my A1C is 6.8, my doctor wants to put me on metformin," a woman just wrote. "I'm scared."
"I noticed that you do not have anything on natural products for the control of diabetes," one young man wrote me last week. "Do you not believe in them?"
Earlier, a correspondent wrote that she doesn't want any medications that "shake down" her pancreas. She wanted to use alternative herbs instead.
“But complementary and alternative medicine is a medication,” Dr. Laura Shane McWhorter replied when I passed on that comment. She is a professor at the University of Utah’s College of Pharmacy and the author of Complementary & Alternative Medicine (CAM) Supplement Use in People with Diabetes: A Clinician’s Guide.
“Many people believe that these products are not drugs," she told me, "but they have pharmacological ingredients.” She added that, for example, we got both metformin and aspirin originally from herbs.
Those alternative herbs haven't been tested nearly as much as prescription medicine. They generally aren't standardized either.
But we do have one natural choice that's well tested and has no side effects. It is a very low-carbohydrate diet. Regular readers will remember that I have written many articles here about the reasons for and advantages of this means of controlling our diabetes.
I don't recommend that you or anyone with type 2 diabetes stop taking their prescribed diabetes medication when your A1C level is above 6.0 or 7.0. Especially now in light of these three new studies, the only medication that I can comfortably recommend to bring your A1C level within that range is Byetta.
But then carefully consider that you can totally relying on a low-carb diet -- as well as exercise. After years of taking many different diabetes drugs, I know from my own experience that a very low-carb diet combined with regular exercise is both the safest and the most effective way to control my blood glucose level.