Should I Take Diabetes Medication? Navigating Treatment Options

Do I need to take medication?

In the morning, my fasting blood sugar is around 140, and my HbA1c is 7%.
Therefore, my doctor said I could manage without medication, just by controlling my diet and exercising, and I should return for regular check-ups every three months.
Later, I went to another hospital, and the doctor told me that I am already a diabetic and must take medication daily.
He prescribed Actos for me, but every time I took the medication, I experienced polyuria, which I did not have before.
So, he switched my medication to Glucomine, which resolved the polyuria, but I started having frequent bowel movements and an increased heart rate, with a pulse over 100 beats per minute.
He said that a regular pulse over 100 is not a concern.
Later, he changed my medication to Glucobay.
While taking this medication, I did not feel much difference, but after some time, my fasting blood sugar increased to around 170.
I am unsure whether this increase is due to the medication or other factors, and now I don't know what to do.
Should I switch to another hospital and see a different doctor? Should I stop taking medication and focus on diet and exercise? Or should I return for a follow-up and consider changing my medication again?

Karen, 30~39 year old female. Ask Date: 2005/03/01

Dr. Guo Qinghui reply Internal Medicine

Currently, the fasting blood glucose level is around 170 mg/dL, which requires treatment.
The methods include dietary control, exercise, and medication.
For dietary management, it is essential to consult a nutritionist to deepen the understanding of dietary control.
Engaging in physical activity for at least one hour each day, such as walking or doing household chores, can help expend energy.
If overweight, a more aggressive approach is necessary.
Regarding medication, since individuals may respond differently to various drugs, any discomfort experienced after taking medication should be reported to the physician, who will address the situation accordingly.
Additionally, if there are other health conditions (such as hypertension or hyperlipidemia), it is important to inform the physician so that they can manage those issues as well.

Reply Date: 2005/03/01

More Info

Navigating diabetes treatment can be quite challenging, especially when faced with conflicting advice from different healthcare providers. Your situation highlights the complexity of managing diabetes, particularly when it comes to medication, lifestyle changes, and monitoring blood sugar levels. Let's break down your concerns and explore the best course of action.

Understanding Your Condition
You mentioned that your fasting blood sugar is around 140 mg/dL and your HbA1c is at 7%. According to the American Diabetes Association, a diagnosis of diabetes is made when fasting blood glucose is 126 mg/dL or higher, or when HbA1c is 6.5% or higher. Therefore, it appears that you fall into the category of having diabetes, which is why one physician recommended medication while another suggested lifestyle management alone.

Medication vs. Lifestyle Management
1. Medication Necessity: The decision to start medication often depends on various factors, including blood sugar levels, symptoms, and individual health conditions. If your blood sugar levels are consistently above target ranges, medication may be warranted to prevent complications associated with uncontrolled diabetes. However, if you can maintain your blood sugar levels through diet and exercise, some healthcare providers may opt for a non-pharmacological approach initially.

2. Medication Side Effects: You have experienced side effects from different medications, including Actos (Pioglitazone), which can cause weight gain and fluid retention, and Glucomine (a combination of Metformin and Glimepiride), which can lead to gastrointestinal issues. Glucobay (Acarbose) is generally well-tolerated but can cause gastrointestinal discomfort as well. It’s essential to communicate these side effects to your healthcare provider, as they may need to adjust your treatment plan.

3. Monitoring Blood Sugar: It’s crucial to keep track of your blood sugar levels regularly. If you notice that your fasting blood sugar has risen to 170 mg/dL after starting Glucobay, this could indicate that the medication is not effectively controlling your blood sugar or that other factors (such as diet, stress, or illness) may be influencing your levels.

Next Steps
1. Consult Your Healthcare Provider: Before making any decisions about changing medications or stopping them altogether, it’s advisable to have a thorough discussion with your healthcare provider. They can help you understand whether the changes in your blood sugar levels are due to the medication or other lifestyle factors.

2. Consider a Diabetes Specialist: If you feel uncertain about the advice you’ve received, seeking a second opinion from an endocrinologist or a diabetes specialist may provide clarity. They can offer insights into the latest treatment options and help tailor a plan that suits your specific needs.

3. Lifestyle Modifications: Regardless of medication, lifestyle changes play a critical role in managing diabetes. Focus on a balanced diet rich in whole grains, lean proteins, healthy fats, and plenty of fruits and vegetables. Regular physical activity is also vital; aim for at least 150 minutes of moderate exercise per week.

4. Regular Monitoring: Continue to monitor your blood sugar levels and keep a log of your readings, medications, diet, and any symptoms you experience. This information can be invaluable for your healthcare provider in making informed decisions about your treatment.

5. Patient Education: Educate yourself about diabetes management. Understanding your condition can empower you to make informed decisions about your health and treatment options.

Conclusion
Managing diabetes is a multifaceted process that requires collaboration between you and your healthcare team. While medication can be an essential part of treatment, lifestyle modifications are equally important. If you are experiencing side effects or have concerns about your current treatment plan, do not hesitate to seek further evaluation and guidance. Your health and well-being should always be the priority, and finding the right balance between medication and lifestyle changes is key to effective diabetes management.

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