March 5, 2016
You may disagree with me and that is your right, but I do not like most oral medications used for type 2 diabetes. Why? The side effects and the side effects that are still being exposed. Yes, many of the newer drugs are still unproven and new side effects are still becoming known.
Other than Metformin, I would not touch any other medications with a ten-foot pole, other than insulin. I made a decision some time ago. Metformin, which the doctors have now stopped me from using a few months ago, I will stay on injected insulin. This works well for me and by using Dr. Bernstein's 'law of small numbers' my insulin units are starting to decrease.
I did get to the 5% club about six months after diagnosis. At diagnosis HbA1c of above 13 and average blood glucose meter readings above 250 mg/dl, I was very worried about what I was going to be able to do on a couple of oral medications. Fortunately, my doctor was not afraid of insulin and about three months later, after a discussion on insulin, I was moved off the oral medications to both Lantus and Novolog. I have tried a few of the other insulins which the VA moved me to, but did not have great management. I then needed to have a discussion with the VA doctor about moving back to the first two insulins where I have remained.
Think about it, most type 2's beta cells are not up to the job, how can so many people with type 2 diabetes remain injected insulin free? Most do not have great blood glucose numbers, yet most doctors refuse to prescribe insulin and now if the patients cannot manage their diabetes with dietary changes, they will need to change doctors to obtain the insulin they desperately need.
When the majority of clinicians and supporting paraprofessionals realize the oral diabetes medications are not doing the job of diabetes management, we will start making some progress against the epidemic of obesity and the management of diabetes more effectively.
Think I am blowing smoke, why are so many of our support group members so willing to change away from oral medications to insulin. When they see the blood glucose readings for many of our members and the HbA1C numbers below 6.0%, they start asking questions. Yes, most of the members not using insulin are using low carb, high fat way of eating, but having problems with fasting blood glucose levels and A1c levels above 6.5%. All but four members are under 7.0% and presently no one is over 7.4%.
Presently, only two members are off all diabetes medications and Sue's husband is on metformin and hoping to get back off that if he is able.
Our members have different backgrounds and have been on many of the different diabetes oral medications. Most have been on a sulfonylurea and a second medication from metformin to other injectables. Most are tired of the oral medication side effects and are asking many questions about insulin. Allen, Barry, and Ben are receiving most of the questions.
March 4, 2016
When is comes to the elderly, too many have polypharmacy, me included. Diabetes also adds to the medications. In the elderly, the problem can become severe because of the risk of harm from medication side effects. The CDC states that every year, 177,000 older adults visit the emergency room for medication problems. This is not a great thing to happen to the elderly and it is unknown how many deaths happen because people cannot reach the emergency room.
Polypharmacy is often a burden for the elderly because of the cost of medications. Often a decision needs to be made between medications and food and a medication prescription is not filled as a result. In addition, real hassles occur for many of the elderly in timely taking their medications during the day, especially if they have too many medications. This often can make a chronic condition become worse and lead to doctors failing to realize that the patient has not been able to take all medications as directed.
The point to remember for many of the elderly is that doctors are taught to prescribe medications and often it may be a case that some medications need deprescribing. Research has documented that inappropriate prescribing of medications is common. A careful medication review will often identify medications that are marginally useful or no longer necessary, but you may not get such a review unless you request it.
For more information:
- MedStopper.com (Pharmacist-created online resource designed to help with deprescribing)
Number 8 of 8 blogs.
March 3, 2016
Isolation and loneliness are problems for people with diabetes and the elderly. I admit I have not blogged about this topic, as I have not felt isolated. However, lately some of my health problems are starting to make me withdraw from interaction with others. I do have a wife that can make life funny at times and since she also has type 2 diabetes (treated with metformin at present), we do have some tense discussions about my health.
Both isolation (not having a lot of social contact with others) and loneliness (the feeling of lacking social connection) have been linked to declines in physical health. A 2012 study found that 43% of older adults reported feeling lonely; over the next 6 years, they were more likely to lose physical abilities or die. Loneliness and isolation have also been linked to decreased immune function and greater risk of depression. I have not felt depression and feel fortunate that my positive attitude has prevented depression, as type 2 diabetes can be a strong risk for depression. In the past, I have had minor bouts of depression, but they have not lasted more than a week to 10 days.
The elderly who live alone or have been bereaved are at particular risk, especially if health problems are interfering with their ability to get out. But, even people who are in proximity to others, such as family caregivers or seniors residing in a facility, may suffer from feeling lonely.
Studies have found that certain psychotherapies, including mindfulness, can help reduce feelings of loneliness and even inflammation in the body. However, another study found that isolation seems to be a stronger risk factor for premature death than loneliness, so it’s important to relieve social isolation as well. Arranging more social contact usually helps. It’s also vital to address any health concerns (including fear of falling, incontinence, or pain) that may be keeping a senior from getting out and socializing.
For more information:
Number 7 of 8 blogs.
March 2, 2016
Surveys suggest that about 50% of all adults aged 65+ experience bothersome pain every month, often in multiple parts of the body. Persistent pain is linked to decreased social and physical activity, depression, and taking worse care of one’s own health. Pain can also be a sign of a new health problem that needs attention or a chronic problem that’s being inadequately managed.
Pain can and should be treated with non-drug approaches whenever possible. Studies have found that pain can often be lessened through certain types of psychotherapy, exercises or physical therapy, and many other treatments. Treatment with medication may still be necessary, especially for short-term purposes or in combination with other treatments. Bear in mind that many over-the-counter pain medications (such as Advil and Motrin) are non-steroidal anti-inflammatory drugs (NSAIDs), which are risky for older adults when used chronically or in high doses.
People with type 2 diabetes often have neuropathy pain and this should not be treated with NSAIDs. Excellent blood glucose management does more to lessen the pain and will over time greatly reduce the pain. There are other medications that will help more than NSAIDs.
For more information:
Number 6 of 8 blogs.
March 1, 2016
This is one topic I have not written much about, but it does affect the elderly. Having chronic difficulties controlling one’s bladder is a common problem for older adults, and tends to get worse with aging. It affects both men and women, although it may have different underlying causes, such as prostate enlargement in men. It is often embarrassing, can cause seniors to restrict their social or physical activities, and has been linked to depression.
Incontinence comes in different “types,” each of which can have different causes. Correctly identifying the type and causes is key to effective treatment. Finding suitable pads or underwear to manage leaks can also make a big difference. They are definitely not all equal, and doctors have little idea which is best. Remember that medications to treat bladder spasms are usually quite anticholinergic, hence risky for brain function. To help a doctor evaluate incontinence, it’s helpful to log your symptoms in a voiding diary for 3 days prior to the appointment.
For more information:
Number 5 of 8 blogs.
February 29, 2016
People with type 2 diabetes are more susceptible to depression. Although healthy older adults have lower rates of depression than the general public, depression is still a common problem that is easily missed. It’s more common in those who are struggling with illness, involved in caregiving, or socially isolated. It’s important to spot and treat depression, as this is key to better quality of life and greater involvement in social activities. It can also enable older adults to better manage any health problems they have, such as chronic diseases, type 2 diabetes, or pain.
One important sign of depression in seniors is “anhedonia,” which means one stops enjoying activities that used to bring pleasure. If you notice this in an older person, or yourself, it’s important to get help. Studies show that medication and psychotherapy are generally equally effective in mild-moderate depression, but non-drug treatment often isn’t offered unless you ask. Among medications, the selective serotonin reuptake inhibitors (SSRIs) sertraline and escitalopram tend to have fewer side effects and drug interactions. Avoid paroxetine (Paxil) as it is anticholinergic, which means it dampens brain function.
For more information:
- Pharmacological Treatment of Depression in the Elderly (review article written for family physicians; walks the reader through a nice real-life example)
Number 4 of 8 blogs.
February 28, 2016
Memory concerns often cause anxiety for older adults and their families. They may, or may not, reflect decreases in thinking abilities.
This is when evaluation helps by providing a more objective measure of whether a person is cognitively impaired, and to what extent. Even more importantly, evaluation can uncover treatable causes of decreased brain function, such as medication side-effects, thyroid problems, and a variety of other problems, which are common in older adults. Remember that diabetes has a link to Alzheimer's disease.
People are often reluctant to have memory concerns evaluated because they are worried that it could be Alzheimer’s disease or another dementia. They also may believe that “nothing can be done.” It can help to tell people that we can often find ways to improve a person’s brain function, either by identifying and treating an underlying health problem or by encouraging the activities that promote brain health.
For more information:
Number 3 of 8 blogs.