Diabetes: Concerns About Medication and Testing

Re-examination for Diabetes Mellitus

Hello Dr.
Chang, I would like to ask about diabetes.
Two months ago, my father had a blood test at a general clinic, and the doctor informed him that he has diabetes (the blood test report indicated a fasting blood glucose level of 200).
He immediately started insulin injections and medication.
In the first month, my father monitored his blood sugar levels and found them to fluctuate, with fasting levels around 100 to 130.
After informing the doctor, the doctor increased the medication dosage and the insulin injection amount (from 10 to 12 units).
In the second month, my father's fasting blood glucose levels dropped to around 70 to 100.

Now, the concern is that my father feels that the initial blood test at the clinic was done without proper preparation, and he was not following any dietary restrictions.
He was shocked to be told he has diabetes and is reluctant to accept it.
Now in the third month, my father does not want to continue taking medication or insulin and wishes to wait a while before getting retested at Chang Gung Memorial Hospital.

I would like to ask the doctor if stopping medication and insulin for one month would have serious implications for the progression of his diabetes.
Essentially, the family does not oppose my father going for a retest at Chang Gung, and we all understand that he likely has diabetes, as evidenced by the high readings from his home blood sugar tests.
However, my father believes that only by getting retested will he accept the diagnosis and be willing to take the medication.
We are just very concerned that stopping the insulin and medication for a month could lead to a rapid deterioration of his condition.
Thank you, doctor.

Xiao P, 30~39 year old female. Ask Date: 2013/07/31

Dr. Zhang Guoji reply Internal Medicine

1.
Patients with diabetes who abruptly stop their medication are at risk of hyperglycemic complications, which can severely lead to hyperglycemic hyperosmolar state.
Therefore, do not discontinue or adjust medications without medical advice.
2.
HbA1c (glycated hemoglobin) testing is now available, which reflects the average blood glucose levels over the past three months.
A result greater than 6.5 indicates diabetes and is considered a very objective test.

Reply Date: 2013/07/31

More Info

Understanding diabetes and its management is crucial, especially when it comes to medication adherence and monitoring blood sugar levels. Your father's situation raises several important points regarding diabetes diagnosis, treatment, and the implications of discontinuing medication.

Firstly, diabetes is diagnosed based on specific blood sugar levels. In your father's case, a fasting blood sugar level of 200 mg/dL indicates diabetes, as per the American Diabetes Association (ADA) guidelines. This diagnosis can be surprising, especially if the individual does not exhibit typical symptoms of diabetes, such as increased thirst, frequent urination, or unexplained weight loss. It is important to understand that diabetes can sometimes develop without noticeable symptoms, which is why regular screening is essential, particularly for those with risk factors such as family history, obesity, or sedentary lifestyle.

Regarding your father's treatment, it is common for healthcare providers to adjust medication dosages based on blood sugar readings. The fluctuations in his blood sugar levels, ranging from 70 to 130 mg/dL after medication adjustments, suggest that the treatment is having an effect. However, the concern about stopping medication is valid. Discontinuing diabetes medication, whether it be insulin or oral hypoglycemics, can lead to a rebound effect where blood sugar levels may rise significantly. This is particularly concerning if he has been diagnosed with diabetes, as uncontrolled blood sugar can lead to serious complications over time, including cardiovascular disease, neuropathy, kidney damage, and eye problems.

If your father decides to stop his medication for a month, it is likely that his blood sugar levels will increase, potentially leading to hyperglycemia (high blood sugar). This could worsen his overall health and complicate his diabetes management in the long run. It is crucial to communicate to him that diabetes is a chronic condition that requires ongoing management, and that medication is often a necessary component of that management.

If your father is hesitant to continue his current treatment regimen, it would be beneficial for him to discuss his concerns with his healthcare provider. A thorough discussion can help address his fears and misconceptions about diabetes and its treatment. Additionally, if he is considering a re-evaluation of his condition at Chang Gung Memorial Hospital, it is advisable to do so while continuing his current medication. This way, the healthcare team can assess his condition accurately without the confounding factor of medication withdrawal.

In the meantime, lifestyle modifications such as a balanced diet, regular physical activity, and weight management can also play a significant role in managing diabetes. These changes can help improve insulin sensitivity and lower blood sugar levels, potentially reducing the need for medication in the long term. However, these should complement, not replace, prescribed medications unless advised by a healthcare professional.

In summary, while your father's desire to confirm his diagnosis through further testing is understandable, it is crucial that he does not stop his medication without medical guidance. The risks associated with uncontrolled diabetes are significant, and maintaining a dialogue with his healthcare provider will ensure that he receives the best possible care tailored to his needs.

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