Click here for the Health Tip link.
Q: My doctor told me I need to take drugs for something he calls pre-diabetes. After reading your tips on the pharmaceutical industry, can you give me any advice on whether or not I need to take them?
A That’s a great question because it exemplifies how doctors let themselves off the hook by reaching for a prescription pad. Generally, most pre-diabetics are overweight and maybe diabetes runs in the family. You carry your weight in your midsection. Your primary exercise is lifting a fork and you do like your refined “white” carbohydrates.
Here’s what happens: Whenever we eat, our blood sugar (glucose) rises and in order to move the glucose molecule into our cells, where it’s used for energy, the pancreas, a gland safely tucked behind your intestines, produces the hormone insulin.
In pre-diabetes, this entire response system becomes fatigued. The cells receiving glucose become resistant to the insulin (insulin resistance) and the pancreas responds by going into overdrive and producing more insulin (hyperinsulinemia). In time, the system finally breaks down, blood sugar starts to rise, and the “pre-diabetes” of hyperinsulinism and insulin resistance changes to diabetes, which is high blood sugar.
The prescription drug for pre-diabetes is metformin, which works by reducing insulin resistance. Later, when you develop diabetes, a second drug is added that literally flogs your pancreas to make more insulin. When the action of these two meds starts to fail (you can only flog so much before the system collapses altogether), your doctor gives up and you start taking injections of synthetic insulin.
Pre-diabetes is considered a risk not only because it can lead to diabetes but also because it increases your risk of developing heart disease. Doctors do know that most prediabetes can be reversed without medication. What’s needed is a highly motivated patient committed to some major lifestyle changes. When your doctor looks at your health records and is reminded of all the times she said “You need to lose weight” and yet your weight steadily rises, she figures you’re not going to get religion at this stage of your life and writes you a prescription.
Hard work is indeed required. You must get your weight down to a number appropriate to your build and height. You must begin a daily exercise routine and say goodbye to sugary foods, anything containing high fructose corn syrup, and also foods that act just like sugar in your body–“white” carbohydrates prepared with refined white or wheat flour such as pasta, any non-whole grain bread, and most breakfast cereals. Eat a diet of fruits and vegetables along with lean protein and whole grains, including brown rice and oatmeal. Here’s a link that can help.
Taking metformin, which does work, is not a wrong choice, but it can lull you into a false sense of security (“Now that I’m covered with metformin. I’ll have another piece of pie.”). Most people end up steadily increasing their metformin dose until it loses effect. At that point your doctor will add another diabetes drug and then another until finally she says, “Looks like we’ve got to switch you to insulin.”
David Edelberg, MD