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Do any traditional or nonprescription remedies for diabetes really help control blood sugar? If so, which ones do you recommend?

There are a number of nonprescription remedies that are known to be effective at lowering blood sugar. In fact, one of the most frequently used and established treatments for diabetes, metformin, was derived from the traditional knowledge that the leaves of the French lilac plant reversed the symptoms of diabetes in some patients. This fact had been known to Europeans for more than 200 years before its eventual isolation and chemical modification to the medication that we now use. Other nonprescription remedies that have been found to be effective to varying degrees include cinnamon (it appears that the cinnamon stick itself must be used rather than powdered cinnamon alone), the herb gymnema sylvestre (gurmarbooti, gurmar), raw walnuts, bitter melon, and some compounds of the metals chromium and zinc. The beneficial effects of these are generally mild and can be more effective in some people with diabetes than in others, as is also the case for prescription medications. There is generally little down side to trying some of these supplements, as long as the glucose level is carefully monitored and conventional medications are also taken if they are needed. Since these remedies are not labeled or approved by the Food and Drug Administration for this use, there is no specific standardization for their formulation, which can therefore vary widely between manufacturers. Sometimes, exaggerated claims may be made for their effectiveness while at the same time a disclaimer is offered acknowledging that such compounds are not intended to diagnose or treat any disease!

One of the most frequently used and established treatments for diabetes, metformin, was derived from the traditional knowledge that the leaves of the French lilac plant reversed the symptoms of diabetes in some patients.

Are there any medications prescribed for other conditions that can improve or worsen my diabetes?

Yes, there are a number of medications used to treat other conditions that can affect your blood sugar control. Most of these effects are small, but can be quite dramatic, such as the effect of certain types of steroid medications. Examples of various drugs and how they can affect your blood sugar are shown in Table 5.

Table 5 Examples of Medications in Common Use That Can Affect Blood Sugar

Medication

Usual Use

Effect on Sugar

Amount of Effect

Antiretroviral drugs (some)

HIV/AIDS

++

Antidepressants (some)

Depression

++ to +++

Carvedilol

Blood pressure

↓ or ↑

+

Estrogen

BCP, menopause

+ to ++

Etanercept

RA, SLE, psoriasis

++

Losartan

Blood pressure

+

Niacin

Cholesterol

+ to ++

Octreotide

Various

↑ or ↓

+

Pentamidine

Infection

↓ but later ↑

+ to ++

Pentoxifylline

Arterial disease

+

Pseudoephedrine

Colds & allergies

+

Ramipril

Blood pressure

+

Steroids

Inflammation

+++

Thiazides

Blood pressure

+

Abbreviations: HIV: human immunodeficiency virus; AIDS: acquired immune deficiency syndrome; BCP: birth control pill; RA: rheumatoid arthritis; SLE: sytemic lupus erythematosus.

I hear that there are seven different types of pills for diabetes novo. Is there a preferred order in which to try them and can they all be combined?

The various types of medications for diabetes are illustrated in Table 4 (Question 41). While there is no right or wrong order in which to try them, there are certain important principles that guide the use of diabetic medications. Important examples of these principles are effectiveness, safety, avoidance of weight gain, avoidance of low blood sugar, avoidance of side effects, long-lasting effectiveness, smallest number of pills required per day, lowest cost, and lack of interaction with other medications being taken by the patient. The overriding principle is that treatment must be tailored to the specific needs of each individual patient. Thus, while no medication can be said to be right for every patient, there is almost always a medication or combination of medications that can be used in each individual patient. Decision making is further complicated by the cost structure of your medical insurance company's drug formulary. Thus, while a certain pill may be more or less desirable from a medical perspective, the cost may factor significantly into the decision as to whether to use it and this can differ among various insurance plans.

Although many and complex factors must be taken into consideration, certain generally accepted patterns of practice have evolved among those caring for people with diabetes. Metformin is often the drug of first choice because it is inexpensive, does not cause weight gain (it may cause a modest weight loss), and does not cause low blood sugar. However, it has certain side effects and cannot be used in patients who have various medical problems, such as liver and kidney disease or some forms of serious lung and heart problems. After metformin, the sulfonylureas are often used frequently, even though they can cause both low blood sugar and weight gain. However, they are generally very inexpensive. If this were not the case, sulfonylureas would probably be used much less often than they are and will probably be less and less used as the cost of safer alternative pills comes down over time. The newer class of pills known as DPP-IV inhibitors (e.g., sitagliptin) is very safe, convenient, and fairly effective, and does not cause weight gain or low blood sugar, but is more costly. The thiazolidinediones (TZDs or glitazones) are effective and do not cause low blood sugar, but they can be associated with weight gain and fluid retention and should not be used in people with, or at high risk for, heart failure. They are also expensive. The latter two types of pills therefore remain second line when cost is an issue. Other types of pills such as the meglitinides and the alpha-glucosidase inhibitors have their place in the management of diabetes, but are also usually not first-line drugs. Table 6 shows an example of a common order in which diabetes pills can be used when considerations of cost are set aside.

Although many and complex factors must be taken Into consideration, certain generally accepted patterns of practice have evolved among those caring for people with diabetes.

These classes of pills can be used in most combinations. Not all of these combinations are specifically approved by the Food and Drug Administration, but many are. The only classes of medication that have been specifically shown to be no more effective when combined together than when used alone are the sulfonylureas and the meglitinides, since they both work through a similar mechanism to release insulin, although they activate it in different ways.

Table 6 Example of an Order in Which Oral Antidiabetic Drugs Can Be Tried

Medication

Choice

Reasons(s)

Metformin

1st

Potent, no weight gain, no hypoglycemia, inexpensive

DPP-IV-I

2nd

Mid-potent, no weight gain, no hypoglycemia, very few side effects, can he used with liver or kidney disease

Pioglitazone

3rd

Potent, durable effect, no hypoglycemia, cholesterol benefits, heart protective

Meglitinides

4th

Potent, rapid effect, less hypoglycemia

Sulfonylureas

5th

Potent, rapid effect, inexpensive

Acarbose

6th

No hypoglycemia, no weight gain

Colesevelam

7th

No hypoglycemia, no weight gain, cholesterol benefits

Note: This table does not take into account potential reasons why one or other drugs may not be suitable for a given patient. Treatment decisions must be tailored to the needs and for the safety of the patient. This is an example only.

 
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