For most people, a bad shoe day means a blistered heel or painful arch that goes away quickly. But for people with diabetes, poor footwear can trigger serious problems, such as foot ulcers, infections, and even amputation.
Foot problems aren't inevitable, though. Ralph Guanci learned the hard way to pick his shoes with care and to stick with wearing them because they're good medicine for his feet.
Guanci, 57, a businessman in Carlisle, Massachusetts, was diagnosed with type 2 diabetes 25 years...
“The first principle is to make life as easy and therapy as effective as possible,” says Daniel Einhorn, MD, medical director of the Scripps Whittier Diabetes Institute in La Jolla, CA. “We want to choose therapies that people can easily live with.”
What Your Doctor Will Consider
There are several types of diabetes medicines. They all control your blood sugar, along with a healthy lifestyle.
If you need more than one diabetes drug, that's called combination therapy. Your doctor will pick medicines that work well together. "Today we have a variety of drugs that work in very different ways, so combinations can be especially effective," Einhorn says.
In addition to metformin, some people also take insulin or other drugs, which may be pills or shots. Your doctor will consider whether you're comfortable giving yourself an injection, so let him or her know how you feel about that.
“Some patients are fine with injectable medications. Others will do anything not to have to give themselves injections,” says Eleftheria Maratos-Flier, MD, professor of medicine at Beth Israel Deaconess Medical Center in Boston.
Your doctor will also consider other things, including your weight and the pros and cons of each type of drug, so your treatment plan is tailored to meet your needs.
“There is no single best combination for all patients,” Marina Basina, MD, an endocrinology professor at Stanford University. “And over time, we often have to change the regimen if patients stop responding to a certain drug or develop side effects.”
Choosing the best diabetes therapies is as much an art as a science. The American Diabetes Association publishes annual treatment guidelines. Leading professional groups also release recommendations.
“But the field of diabetes treatment is changing so fast that some guidelines may be out-of-date almost as soon as they’re published,” Maratos-Flier says. “The only way to find the best therapeutic regimen is through trial and error. There’s almost no way to know in advance how patients will respond to a given medication or combination of medications.”
To make sure your combination therapy is on track, work with your doctor to watch your blood sugar levels.
“The sooner you bring blood sugar levels down to normal, and the better control you have over time, the less likely your diabetes is to progress,” Einhorn says.
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