Diabetes Demands a Triad of Treatments
Oral Drugs continued...
Product labeling recommends that doctors
start patients on lower doses to combat the flatulence problem.
"Although the lowest effective dose is 25
milligrams three times a day with meals, some physicians are starting patients
on just 25 mg daily to minimize this side effect," Misbin says.
The newest drug, Rezulin, was well-tolerated
in clinical studies. The most commonly reported side effects were infection,
pain and headache, but these occurred at rates comparable to those in the
placebo-treated patients. The drug should be prescribed with caution in
patients with advanced heart failure or liver disease.
Some diabetes experts report that when it
comes to prescribing initial therapy for Type II diabetics, some doctors tend
to follow a "treatment of laziness" -- for example, prescribing SFUs if
they perceive difficulties in the patient's ability to change dietary habits or
"Sometimes, patients with diabetes are
treated with drugs when it's not really necessary," Misbin says. "Oral
pills should be used in Type II diabetes only when diet and exercise are not
effective. It's very common for overweight patients who lose weight to lower
their own blood sugar levels and come off the medicines. The problem is that
it's very difficult to get patients to lose weight."
So, the bottom line in diabetes control still
hinges on patients' ability to manage the disease themselves. "I don't know
of a chronic disease in which the person who suffers from it is so responsible
for its management," says ADA president Cryer. "The patient has to
become an expert regarding their own diabetes."
Although drug treatment makes a difference to
many diabetics and their quality of life, Cryer adds that current diabetes
treatments are still "not ideal." He hopes that continuing research
will someday find the answer to the diabetes dilemma.
Blood Glucose Monitoring Devices
For millions of Americans with diabetes,
regular home testing of blood glucose levels is critical in controlling their
"The most near-normal glucose patterns
you can get will have a terrific long-term impact on how well people with
diabetes do," says Steven Gutman, M.D., director of the division of
clinical laboratory devices in FDA's Office of Device Evaluation. But he adds,
"Tight control isn't easy because it requires multiple glucose
For many years, diabetics relied on home
urine glucose testing to monitor blood sugar levels. But the method was not
without drawbacks. Monitoring glucose levels via the urine is problematic for
several reasons: First, blood glucose concentrations above which glucose
appears in the urine vary widely among individuals, so the tests are not very
reliable. Second, factors such as fluid or vitamin C intakes can influence test
results. And third, negative tests can't distinguish between normal, low, and
moderately high blood sugar levels.