Diabetes Management: Myths and Medication Options

Myths about Diabetes

My husband is currently 30 years old and was diagnosed with diabetes at the age of 27.
He has been managing it with traditional Chinese medicine, taking it four times a day (morning, noon, evening, and before bed).
However, his post-dinner blood sugar levels are around 350 mg/dL.
After exercising for half an hour post-meal, his blood sugar two hours later is about 250 mg/dL, and his fasting blood sugar in the morning ranges from 130 to 160 mg/dL.
I came across a report online about a new blood sugar-lowering medication called NovoNorm, which is used to control postprandial blood sugar levels.
I would like to ask the physician the following questions:
1.
Given my husband's condition, is his blood sugar control inadequate? Should he switch to oral medications?
2.
If he switches to oral medications, will it lead to a situation where the longer he takes the medication, the higher the dosage required, potentially overstimulating the pancreas to the point of losing its function and necessitating insulin injections?
3.
What are the potential side effects of taking NovoNorm?
4.
Do traditional Chinese medicines have no side effects at all?
5.
If he takes oral medications, can he also use traditional Chinese medicine (for kidney health) without any conflicts? How long should he wait between taking oral medications and traditional Chinese medicine?
6.
We reside in Kaohsiung City; could you recommend a specialist physician?
Thank you to all the physicians for your assistance.

Xie, 20~29 year old female. Ask Date: 2002/06/26

Dr. Chen Changxun reply Internal Medicine

1.
At the age of twenty-seven, it is essential to determine whether the diabetes is type 1 or type 2.

2.
Currently, Western medicine has made significant advancements, and side effects are minimal, with the primary concern being hypoglycemia.
NOVONORM belongs to the third generation of sulfonylureas, which have even fewer side effects.

3.
Insulin injections are now predominantly genetically engineered, making them very safe and convenient.

4.
In healthy individuals, postprandial blood glucose should not exceed 200 µg/mL; a postprandial level of 350 is too high.
Generally, oral medications are administered thirty minutes before meals to control the peak blood glucose level one hour after eating.
In type 1 diabetes patients, short-acting insulin may be used for multiple injections.

5.
Please consult a nearby endocrinologist for a detailed examination.

Reply Date: 2002/06/26

More Info

Managing diabetes effectively requires a comprehensive understanding of the condition, its treatment options, and the potential implications of various therapies. Your husband's situation, characterized by persistently high postprandial blood sugar levels, indicates that his current management strategy may not be sufficient. Here’s a detailed response to your questions based on the latest medical knowledge.

1. Is his condition well-controlled? Should he switch to Western medicine?
Based on the blood sugar readings you provided, it appears that your husband's diabetes is not optimally controlled. A post-meal blood sugar level of 350 mg/dL is significantly above the recommended target, which is generally below 180 mg/dL two hours after eating. The fasting blood sugar levels of 130-160 mg/dL also suggest that better control is needed. While traditional Chinese medicine (TCM) can be beneficial for some individuals, it may not always provide the necessary blood sugar control for everyone. If lifestyle modifications and TCM are not yielding satisfactory results, it may be prudent to consider Western medications, which have been extensively studied and proven effective in managing diabetes.

2. Will switching to Western medication lead to increased dosages and potential insulin dependence?
Concerns about escalating medication dosages and the eventual need for insulin are common among patients. However, the goal of diabetes management is to achieve optimal blood sugar control while minimizing the risk of complications. Medications like Metformin, which is often the first-line treatment for type 2 diabetes, work by improving insulin sensitivity and reducing glucose production in the liver. If your husband requires additional medications, such as GLP-1 receptor agonists or SGLT2 inhibitors, these can help manage blood sugar without necessarily leading to insulin dependence. Insulin therapy is typically reserved for cases where oral medications are insufficient, but it is not an inevitable outcome of starting medication.

3. What are the side effects of NovoNorm (repaglinide)?
NovoNorm, or repaglinide, is a medication that stimulates the pancreas to release more insulin in response to meals. Common side effects include hypoglycemia (low blood sugar), which can occur if meals are skipped or if the medication is taken without adequate food intake. Other potential side effects may include weight gain and gastrointestinal issues. It is essential to monitor blood sugar levels closely when starting this medication to avoid hypoglycemic episodes.

4. Do traditional Chinese medicines have side effects?
While many people perceive TCM as natural and therefore safer, it is essential to recognize that herbal remedies can also have side effects and interactions with other medications. Some herbs may affect liver or kidney function, and others may interact with Western medications, potentially altering their effectiveness. It is crucial to consult with a healthcare provider knowledgeable in both TCM and Western medicine to ensure safety.

5. Can Western medications be combined with TCM? How should they be spaced?
Combining Western medications with TCM can be beneficial, but it requires careful management to avoid interactions. It is generally advisable to space the doses of Western medications and TCM by at least two hours to minimize any potential interactions. Always discuss any combination of treatments with a healthcare provider to ensure that they are safe and effective together.

6. Can you recommend a specialist in Kaohsiung?
While I cannot provide specific names, I recommend seeking an endocrinologist or a diabetes specialist in Kaohsiung. You can look for clinics or hospitals that have a diabetes management program, as they often have multidisciplinary teams that include dietitians, diabetes educators, and endocrinologists who can provide comprehensive care.

In conclusion, it is crucial for your husband to have a thorough evaluation by a healthcare professional who can assess his diabetes management plan and make necessary adjustments. Effective diabetes management often involves a combination of lifestyle changes, medication, and regular monitoring of blood sugar levels. Encourage your husband to maintain open communication with his healthcare provider to find the best approach tailored to his needs.

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