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Wednesday, November, 25, 2009
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Shedding Light on the Co-morbidities of DiabetesThe Complications of Having Rheumatoid Arthritis and Diabetes

Welcoming Welchol

David Mendosa
David Mendosa
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Medical Journalist Living with Diabetes and Author of Fitness and Photography for Fun, www.mendosa.com/fitnessblog

After earning a B.A. with honors from the University of California,...

David Mendosa

Wednesday, May 20, 2009
View All of David Mendosa's Posts
A year ago the U.S. Food and Drug Administration approved a new drug to treat type 2 diabetes. But few of us ever heard of it. Until now. Studies presented at the annual convention of the American Association of Clinical Endocrinologists in Houston on Friday finally caught our attention. The senior...
  1. nothing new under the sun
    frankenduf
    Wednesday, May 20, 2009 at 04:11 PM

    indeed, Joslin has been lobbying for quite some time for expanding use of bile acid sequestrants as an ancillary treatment for DM- there is actually another independent benefit from BAS in DM, but i forgot the mechanism! :(- my only beef with this post is the claim that metformin does not cause wt. loss, therefore categorizing it along with Januvia- metformin does, in fact, cause wt. loss, via decreased appetite, and lipolysis via decreased insulin levels:

    http://content.nejm.org/cgi/content/abstract/333/9/550

    Reply
    re: nothing new under the sun
    David Mendosa
    Wednesday, May 20, 2009 at 04:15 PM

    Dear Frankenduf,

     

    I also thought that metformin could cause a little weight loss. But I quoted Dr. Handelsman to the contrary. In any case, the effect is minimal.

     

    Best regards,

     

    David

    Reply
    re: re: nothing new under the sun
    Gretchen Becker
    Thursday, May 21, 2009 at 08:57 AM

    It's my understanding that metformin alone won't make the pounds melt off with no effort, but it can help you lose weight if you're also doing diet and exercise. I know someone who had been trying to lose weight for years, with no success. She was finally Dx'd with type 2 and given metformin and was then able to lose 60 pounds and is now normal weight. However, she continues a very strict diet and walks or runs for an hour every day.

     

    She said she simply couldn't lose without the metformin.

     

    To me this is similar to David's weight loss on Byetta. It helped, but he probably wouldn't have lost the weight if he'd spent his days on a lounge chair watching football games and drinking beer.

     

    I know someone else who says that without metformin, she'll pack on pounds when she eats carbs.

     

    Of course, both of these examples are annecdotal.

     

    I'm sure Dr. Handelsman has a reason for his conclusions. But his interview was arranged by the drug company that is selling Wellchol, and one should evaluate his comments in that light.

     

    I took another bile acid sequestrant a long time ago, and it caused severe constipation. I now have diverticulosis and wonder if the BAS was a contributor to that, so I tend to run in the other direction when someone suggests a BAS. However, Welchol isn't supposed to have this effect.

     

    Allison Goldfine, who wrote the introduction to my T2 book, had an article on Welchol here.

    Reply
    re: nothing new under the sun
    Anonymous
    Wednesday, May 20, 2009 at 06:07 PM

    metformin did NOT lead to either appetite or wgt loss for me but to increase of both.  nor did it help control BG but did cause extreme gastric distress and insufferable fatigue. I will never touch it again. 

    Reply
  2. LDL
    Rabbi Hirsch Meisels
    Wednesday, May 20, 2009 at 08:22 PM

    High LDL is not part of the metabolic syndrome. Low HDL is.

    Reply
    re: LDL
    frankenduf
    Thursday, May 21, 2009 at 03:42 PM

    well, it more likely is:

    http://www.americanheart.org/presenter.jhtml?identifier=4756

    perhaps your emphasis is to imply that low HDL is associated with increased morbidity/mortality than high LDL, but that point would be subsumed by the double whammy of concurrent high LDL/low HDL which is precisely why this metabolic syndrome is so dangerous

    Reply
    re: re: LDL
    Rabbi Hirsch Meisels
    Thursday, May 21, 2009 at 05:50 PM

    My emphases was that the official description of Metabolic syndrome includes low HDL, but does not include high LDL. Metabolic syndrome has official criteria to what it includes, and high LDL is not one of them. Having a pattern of small LDL particles usually is seen in people who have metabolic syndrome, but it also is not officially the criteria for the diagnosis.

    Reply
  3. It's a little-used drug, so far
    Steve Parker, M.D.
    Monday, June 01, 2009 at 10:04 PM

    In case anyone is searching for additional information on the drug, note that it is colesevelam, not colesevemal.

    I haven't seen the drug used much in Arizona (where I live), particularly not for diabetes.  This might be related to 1) it adds a layer complexity since it cannot be used for diabetes as a single agent, and 2) it interferes with absorption of many other drugs.  Many people with diabetes are taking mutliple drugs.

     

    Statins are the market-leaders for cholesterol lowering because there are data that they reduce cardiovascular disease and death rates, not just lower cholesterol levels.  Welchol can't make that claim. 

     

    -Steve Parker, M.D.

    -http://diabeticmediterraneandiet.com

    Reply
    re: It's a little-used drug, so far
    David Mendosa
    Monday, June 01, 2009 at 10:50 PM

    Dear Dr. Parker,

     

    Thank you for pointing out my typo. I just fixed it.

     

    Best regards,

     

    David

    Reply
    re: re: It's a little-used drug, so far
    Steve Parker, M.D.
    Tuesday, June 02, 2009 at 11:18 AM

    Thank you, David, for bringing this drug to my attention.  I try hard to stay up to date, but hadn't heard of this one, or had forgotten about it.

     

    By my count, we now have 10 classes of drugs to treat type 2 DM.  When I started my medical career over two decades ago we only had three. 

     

    I appreciate all you do for people with diabetes. 

     

    -Steve 

    Reply
    re: re: re: It's a little-used drug, so far
    David Mendosa
    Tuesday, June 02, 2009 at 11:54 AM

    Dear Dr. Parker,

     

    Ten is my count too, and I list, describe, and link them at http://www.mendosa.com/drugs.htm

     

    In the U.S. before 1995 when the FDA finally approved metformin, the only classes of drugs that we had to control our diabetes were insulin and the sulfonylureas. And in at least one respect both of them made it HARDER for us to control our diabetess because they cause us to gain weight.

     

    Best regards,

     

    David

    Reply
  4. Welchol side effects
    Mayumi
    Tuesday, June 16, 2009 at 05:01 PM

    The side effects of this drug appear to be minimized.  I am intolerant of statin drugs, so my Doctor suggested Welchol.  I was supposed to start with 2 capsules twice a day.  Wanting to be cautious, I started with 1 capsule twice a day.  After five days I have such severe muscle pain and overall body weakness that I stopped taking the drug.  It makes me wonder how many Doctors would recommend Welchol if they were in this kind of pain?

     

    Mayumi

    Reply
    re: Welchol side effects
    Anonymous
    Thursday, July 09, 2009 at 04:13 PM

    My dr. just prescribed Welchol because I am also intolerant of statin drugs.  He said that Welchol has almost no side effects.  I will err on the cautious side myself, but am disappointed that you had muscle pain and/or weakness with this drug also.................it makes me not want to start it, but I will give it a try. 

     

    You're right - I wonder how many physicians would endure the horrible muscle pain that a lot of patients experience on statins.  Incredibly, I was told at first to take a Motrin every day..............like that would help!  Good luck in your search for a remedy that will help you.

    Reply
    re: re: Welchol side effects
    Anonymous
    Friday, October 23, 2009 at 11:53 PM

    I have only been on this drug for 2 days but i have not had any bad side affect and i am taking 3 pills 2 times a day I have diareah almost daily and so far havent had it in the 2 days so far i like it but only time will tell, i am on tricor and metformin

    Reply
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