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Thursday, September 23, 2010

To Medicate - Or Not?

Quite often type 2 diabetics appear on forums that I read announcing that their goal is to become medication-free or to avoid needing insulin.

Although that sounds like a good goal, and for some individuals it may be, I think they may be confused about the true goal. To me the true goal is to delay or defer the terrible complications of diabetes for as long as possible; preferably to a date about ten years after I die in my sleep as a very old man.

I do not fear medications. If medications are needed to achieve my true goal I will take them. I added metformin a few years back for that reason. However, and it is a very important however, I will use them if, and only if, reasonable application of diet and exercise cannot achieve the desired result. There is an enormous difference between fearing medications and having a healthy and informed respect for the full implications of adding drugs to our bodies.

In my opinion medications should be used to complement a healthy lifestyle, not to attempt to compensate for an unhealthy lifestyle. If the diabetic's circumstances are such that further changes in lifestyle are unreasonable, impossible or not capable of producing the same benefits as medication, then medications are appropriate and valuable. But, if that is not the case, medications may be adding to their problems instead of solving them. Nor am I in favour of prophylactic medication, prescribed because some study somewhere showed a statistical benefit for some people. I'm interested in the effects on me as an individual, not a percentage of a study group who may or may not represent me.

There are no side-effects-free medications. As with all things in life a risks-benefit analysis is needed when considering adding medications or insulin.

I am unapologetically selfish about testing of new drugs. When new medications appear, often with lots of fanfare and research papers supported by the manufacturer of the new wonder drug, I have decided to wait for a decade or two of human experience before I will add that to my regimen. I will let others be the human guinea pigs over that period unless there is an urgent need that no other course of action can meet. Selfish? True. But sensible.

The history of many drugs makes salutary reading. First the euphoria, then the glowing reports, then the doubts, then the reaction. Some recent relevant cases for the drugs commonly prescribed for type 2s include the statins, Byetta, Avandia, Actos and even insulin. All may be beneficial to a large number but have significant risks for minority. The difficulty is knowing whether you are in the majority or the minority in advance. Nothing is risk-free.

Medications should not be feared. They are a valuable tool for us - but they should be respected and used only when needed.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter