Should I Take Medication for Diabetes? Exploring Treatment Options

Is medication necessary?

I have been diagnosed with diabetes for a year and a half.
During this time, my fasting blood sugar levels have ranged from 140 to 160 mg/dL, and my postprandial blood sugar levels have been between 180 and 200 mg/dL.
My HbA1c levels are between 7.0% and 7.3%, total cholesterol is 220 mg/dL, triglycerides are 173 mg/dL, my weight is 70 kg, and my blood pressure is 120/80 mmHg.

Doctor 1 believes that with an HbA1c of 7.0%, I do not need medication and can manage my condition through diet and exercise, with follow-up every three months.
On the other hand, Doctors 2 advocate for early medication treatment since I have been diagnosed with diabetes, starting with a low dose and not stopping the medication.

I followed Doctor 1's advice for six months, then switched to following Doctors 2 for another six months, during which I took medications including Glucomine, Actos, Glucobay, and Glusafe.
While on these medications, I experienced discomfort such as increased heart rate, gastrointestinal issues, polyuria, fatigue, increased appetite, and a weight gain of 7 kg.

I returned to Doctor 1, who still believes that I do not need medication and can manage my condition with diet and exercise, with follow-up every three months.
However, I am concerned about delaying treatment and potentially needing higher doses of medication in the future.
I am hesitant to return to Doctors 2 and use my body as a test subject for different medications.

What should I do now? Thank you.

Karen, 30~39 year old female. Ask Date: 2005/06/12

Dr. Yang Hongzhi reply Internal Medicine

Generally, a hemoglobin A1c level below 7.0% is considered acceptable, while a level above 8.0% necessitates intervention.
Since your level is currently between these two thresholds, you can try to enhance your diet and exercise as non-pharmacological treatments.
However, if you are still unable to lower it to below 7.0%, medication should be considered.
There are many options available for medication, and there should be a suitable one for you.

Reply Date: 2005/06/12

More Info

Managing diabetes effectively requires a comprehensive approach that includes medication, lifestyle changes, and regular monitoring. Given your situation, where you have been diagnosed with diabetes for a year and a half, and your blood sugar levels and HbA1c readings indicate that your diabetes is not optimally controlled, it is crucial to consider your options carefully.

Understanding Your Current Situation
You mentioned that your fasting blood sugar levels range from 140 to 160 mg/dL, and postprandial levels are between 180 and 200 mg/dL. Your HbA1c levels of 7.0 to 7.3% suggest that your blood sugar has been consistently above the target range. The American Diabetes Association recommends an HbA1c target of less than 7% for most adults with diabetes, but individual goals may vary based on age, health status, and other factors.

Your total cholesterol and triglyceride levels are also elevated, which can increase the risk of cardiovascular complications associated with diabetes. Additionally, you reported experiencing side effects from the medications prescribed by the second group of doctors, including increased heart rate, gastrointestinal discomfort, fatigue, and weight gain.

Medication Considerations
1. Consultation with Healthcare Providers: It is essential to have open communication with your healthcare providers. Since you have received differing opinions from two sets of doctors, consider discussing your concerns about medication side effects and the potential for disease progression. A unified approach from your healthcare team can help you make informed decisions.

2. Medication Options: The medications you mentioned—Glucomine (likely a form of glimepiride), Actos (pioglitazone), Glucobay (acarbose), and Glusafe—are commonly used to manage blood sugar levels. Each has its mechanism of action and potential side effects. For example, Actos can lead to weight gain and fluid retention, while Glucobay may cause gastrointestinal issues. If you experience intolerable side effects, it may be worth discussing alternative medications or adjusting dosages with your doctor.

3. Lifestyle Modifications: Regardless of medication, lifestyle changes are crucial. A balanced diet low in refined sugars and high in fiber, combined with regular physical activity, can significantly improve blood sugar control. Consider consulting a registered dietitian who specializes in diabetes management to create a personalized meal plan.

4. Monitoring and Follow-Up: Regular monitoring of your blood sugar levels and HbA1c is essential to assess the effectiveness of your treatment plan. If you choose to manage your diabetes without medication, ensure you have a structured follow-up plan with your healthcare provider to monitor your progress.

Addressing Concerns About Delayed Treatment
Your concern about delaying medication and potentially needing higher doses in the future is valid. Diabetes is a progressive disease, and early intervention can help prevent complications. If lifestyle modifications alone do not yield satisfactory results, medication may become necessary.

Recommendations
1. Seek a Second Opinion: If you feel uncertain about your current treatment plan, consider seeking a second opinion from an endocrinologist or a diabetes specialist. They can provide insights into the latest treatment options and help tailor a plan that suits your needs.

2. Educate Yourself: Understanding diabetes and its management can empower you to make informed decisions. Resources such as the American Diabetes Association and diabetes education programs can provide valuable information.

3. Consider a Comprehensive Approach: If you decide to continue with lifestyle modifications, ensure you are also addressing other risk factors, such as cholesterol levels and blood pressure, through diet, exercise, and possibly medication if necessary.

In conclusion, managing diabetes is a multifaceted process that requires collaboration with healthcare providers, adherence to treatment plans, and a commitment to lifestyle changes. Your health is paramount, and finding a balance between medication and lifestyle management is key to achieving optimal diabetes control.

Similar Q&A

Understanding Diabetes Treatment Options: Medication vs. Lifestyle Changes

Hello Dr. Lee, My basic information is as follows: I have a family history of diabetes and was diagnosed with diabetes two years ago, with a fasting blood sugar of 113 and an HbA1c of 7.1 at that time. My weight was in the 80s (kg). Since then, I have been managing my condition ...

Dr. Li Jian reply Internal Medicine
1. Lifestyle modifications combined with medication management yield better results; relying solely on diet and exercise to control blood sugar is more likely to fail. Having medication assistance makes it easier to achieve targets. 2. If significant weight loss can be achieved...

Effective Medications for Managing and Treating Diabetes

I would like to confirm which medications can control or treat diabetes. Thank you.

Dr. Guo Qinghui reply Internal Medicine
There are quite a few medications available for the treatment of diabetes. Please refer to Chapter 8, Sections 5, 6, and 7 of the diabetes course on this digital health platform, or visit a healthcare facility for more information.

Should Diabetic Patients Rely on Insulin or Oral Medications?

My mother has had diabetes for over ten years. In December of last year, her doctor recommended insulin injections to control her blood sugar. After the New Year, she did not take insulin for about two weeks, and her blood sugar levels were 148 postprandial and 118 preprandial. T...

Dr. Guo Qinghui reply Internal Medicine
Diabetic patients need to maintain their blood glucose levels within a certain range to delay the onset of complications. The use of insulin or oral antidiabetic medications to control blood sugar each has its advantages, disadvantages, and limitations, and is also related to the...

Managing Diabetes: Diet Tips, Insulin Effects, and New Treatments

1. I would like to know what dietary choices are best for managing diabetes. 2. Does long-term insulin injection have adverse effects on the body? 3. Are there better treatment options available for diabetes now?

Dr. Yang Guojun reply Internal Medicine
1. Avoid consuming high-sugar foods such as sugary beverages, and increase physical activity. 2. Insulin is a substance that the body naturally produces, making it essential for the treatment of diabetes, and it does not have adverse effects. 3. There are now many new oral medica...