Diabetes Demands a Triad of Treatments
Oral Drugs continued...
Metformin is also contraindicated in patients
with liver dysfunction. "It should be used only in healthy patients, and
it's not for the elderly," Misbin says.
Precose is less effective but usually safer
to use than Metformin, he points out. Precose's one major side effect is
flatulence. Precose stops, or delays, absorption of carbohydrates and in doing
so delivers glucose and other carbohydrates, which cause gas, Santiago
explains. "Flatulence can occur when the drug is used at high doses, but
this can be reduced by beginning the drug at a low dose and going up... a
'start-low, go-slow' approach."
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.