Low doses of diabetes pills don't cut it
By Landis Lum
By Landis Lum
Q. I have diabetes and just read that many doctors are not adequately treating their patients. How can we tell?
A. At a June 10 meeting of the American Diabetes Association, four studies found doctors were not pushing doses of medicines high enough to fully protect their patients.
Diabetics have three times more strokes and heart attacks than those without diabetes, along with higher risks for eye, nerve and kidney damage and for gangrene of the feet. But the high blood sugars, cholesterols and blood pressures that can lead to such complications are silent — no tiredness, headache or anything. And folks hate taking pills when they feel fine. Most diabetics are on five, six or more pills a day. But when I explain that these will reduce their chance of waking up paralyzed one morning or of going on dialysis, and that the effectiveness of natural products is unproven, they get the point.
Office blood pressures should be reduced to less than 130 over 80 to reduce diabetic complications. This often takes two to three drugs if three months of lifestyle changes don't work. Home pressures are five points less, so if they're consistently above 125 over 75, this can lead to strokes or dialysis. Do let your doctor know. Go to www.dableduca tional.com/sphygmomano meters/p_devices_2_sbpm_ua.html to find a blood pressure machine that's accurate. The cuff bladder width should be at least 40 percent of the arm circumference, so big patients will need wider cuffs — otherwise, the pressure will read too high. Don't record measurements taken the first day you buy it, as these are inaccurate.
All diabetics older than 40 should be on a statin drug to lower cholesterol, even if cholesterol is normal. The goal should be an LDL (bad) cholesterol below 100, and maybe even lower. Those under age 40 who have other risks like smoking or a close relative with early heart disease may also need statins. And if you qualify for a statin, ask your doctor if you should also take a baby aspirin a day to further reduce strokes and heart disease.
Know your A1C level? It reflects average blood sugar over the past three months, and should be less than seven to reduce damage to kidneys, eyes and nerves. To reduce A1C, lose weight if overweight. Increase daily physical activity to get your body to respond to diabetes pills and attain a lower A1C — for example, walk an extra 10 minutes twice a day. Start insulin if your A1C remains above seven. Increase to two or three shots a day if needed. By checking your pressures and sugars at home, you can help your doctor help you to live long and prosper.
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or write firstname.lastname@example.org. This column is not intended to provide medical advice.