April 6, 2014

Are Non-Insulin Type 2's Over Medicated?

I ask this question because I feel that the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) are over medicating people with type 2 diabetes that are not on insulin. They are doing this because many doctors do not stay current with insulin and many doctors are afraid of insulin.

This is why many patients are complaining about their doctors stacking one oral medication on top of another oral medication. Some doctors will prescribe up to four or more different oral medications. Many doctors don't even realize the side effects of doing this and many just follow the ADA and AACE and continue adding oral medications.

It is true that some individuals are able to do this without medical drug conflicts, but many become confused and even have episodes of hypoglycemia and other health problems because of this uninformed stacking of oral medications.

Another aspect that concerns me is the fact that the Food and Drug Administration (FDA) has not approved many of the oral diabetes drugs to be used in some combinations. Some combinations are relatively safe for many individuals, but unsafe for other individuals. Yet doctors continue to prescribe these unproved combinations willy-nilly and when patients have problems, blame the patients.

Even the AACE algorithm shows adding medication on top of medication. All show oral medications and recommend them before insulin for type 2. Some recommendation is made for insulin when HbA1c is above a certain level. However, many doctors do not even consider this.

The doctors do not know insulin or how to administer it. They are literally afraid of hypoglycemia and therefore keep pushing oral medications. Some doctors will use insulin as a threat and tell the patient they are failing to manage their diabetes on oral drugs. Most patients realize the need for insulin before their doctors do and are castigated for asking about or for insulin.

What are patients to do? Under the new insurance, if you can call it that, the number of doctors is limited and finding another doctor that knows insulin is very tricky. This said, I would still recommend trying to find another doctor that will work with insulin. Even a doctor that is some distance away may be a better choice for your diabetes health. Talking to your insurance company for a recommendation is still a good policy.

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