Diabetics - Are The Drugs Killing Us?

[grumpy_old_retired]

Background: A Type II diabetic for over 30 years. A 3 pack a day smoker for over 50 years (recently cut to 1 - 1 and half a day). Have been using Glucophage for over 30 years, Amaryl 6mg for the past 10 years w/Glucophage 2550mg. Average glucose readings have been in the range of 223 to 350. Approximately 3 months ago a doctor decided I needed to start taking Ramipril 10mg and Simvastatin 20mg. Recently went to doctor who decided I needed to ADD Actos to my drug diet. All these recommendations were based on NO analysis of overall health condition over a period of time. I went home and told myself "Enough".

Back in 1998 I put a spreadsheet together to record all my blood test results - Glu, Hb1Ac, Trig, BUN, etc. (approx 49 results). Since 1998 I have done blood testing in 2002, 2003, 2004, and two times in 2007. Except for Glucose every other test was well within Normal ranges. In fact, some of the tests showed lower values than in 1998. So, when the doctor decided I needed to ADD to my DRUG list I showed him the results of all my previous blood tests. He WAS NOT interested!

Doctor's apparently base their decision on current readings. They may or may not ask if you ate anything after midnight. My own analysis shows that if I eat anything AFTER 6 PM the night before the test, the test results will in most cases show a higher reading. Drinking a cup of coffee before the AM blood test is a definite no-no - It raises the Blood Pressure. So a doctor sees the results of the AM test and right away wants to ADD or have you start taking DRUGS.

Over the past 10 years I have put in many thousands of hours (no joke) of internet research into Diabetes and Heart Disease. I have read many Studies, Opinions, and Assumptions regarding the various drugs used to control diabetes. What I learn is that many of the Studies were Funded by the Drug companies trying to peddle their respective drugs. Diabetics and Heart Disease patients are nothing but "guinea pigs" to the drug companies using doctors, clinics, hospitals, etc. as their surrogates. After-all, how else are the drug companies going to make their "billion dollar" a year profit. Many (non-Surrogate) renown doctor's and others have formed the same opinion - we are "guinea pigs" for the Drug Companies.

The DRUGS are killing us - NOT the disease. The doctors want to keep ADDING more and more DRUGS on top of what we are already taking. UNLESS we are already on deaths doorstep DRUGS do not seem to be the answer. To clarify - I am not a doctor and have never worked or been associated with the medical field.

So what is the answer? I do not advocate that anyone (Type II diabetic) reading this to take the actions that I have taken. We are all individuals. We DO NOT have the same genes, cells, etc. We are not copies of one another therefore what may work for one individual may not work for another. BUT, isn't it amazing that doctor's give all of us Normal ranges of everything and tells us that we must fit into that Normal range!

That said, I have tested my glucose levels periodically for over 10 years. Over the past 3 months I have been doing daily (no exception) blood glucose and blood pressure checks. What I found was my drugs are NOT WORKING. ADDING more drugs on top of what I was taking was not the answer for me. So I STOPPED taking all the drugs. Nothing drug related goes into my body.

I then started 5 a-day blood glucose and blood pressure readings. During my initial 5 days off the DRUGS, the glucose levels ranged between 220 and 350 - Look familiar! The same readings when I was taking the drugs. The blood pressure readings is what amazed me! They were all lower than what they were when I was taking the Drugs to control the heart - before 157/93 down to 138/79.

I had to do something about the blood glucose. All of my research pointed out (by doctors and others NOT SURROGATE to the drug companies) that EXERCISE was the key to the Glucose Levels and Blood Pressure - NOT DRUGS. So I bought a Treadmill and started walking at a speed of 2 KM per hour for 15 minutes a day increasing to 30/45 minutes a day after 10 days. After 30 days my range of Blood Glucose has been as low as 118 to a high of 190. My heart rate has dropped from 157/93 to 125/65. I eat whatever I want within reason (and I mean anything) BUT I limit the AMOUNT (Volume) at each sitting. Stay away from all the Chips, Donuts, Ice Cream, candy bars, i. e., THE VERY bad stuff.

Is this the answer for everyone? Certainly not. But when I see on this forum the number of people with diabetes and the numbers of drugs that they are taking I feel that there must be a better answer. Whether you NEED to take the drugs because you feel you have no alternative is a decision that each individual has to decide for themselves.

In Conclusion: Ever wonder why in 1930's, 40's, and 50's Type II diabetes was pretty much unheard of! Then the 60s come along and all the pre-packaged manufactured foods high in every conceivable additive! Saturated fats, trans fats, etc., etc. Again, billions of dollars have been made off us "guinea pigs". We eat everything that is thrown at us! No wonder diabetes is on the rise worldwide. No wonder obesity is on the rise worldwide. We buy and feed ourselves all this crap and then wonder why, years later, we have diabetes or are obesite. Ok, yes, Type II diabetes (we have a working Pancreas) is hereditary (??) but we can control it without all the drugs that we are taking - MY opinion. Diabetes is like Aids - it is not the disease that is killing us, it is the results or complications of the disease. So why treat the disease AND the complications - Heart Disease - by ADDING more DRUGS! Doctor's (DRUG company surrogates) tell us that Cholesterol and Triglycerides are very bad for us and we need to take DRUGS to lower them. While non-Surrogate doctors will tell you that Cholesterol and Triglycerides are not bad for us and that not everyone's body handles Cholesterol and Triglycerides the same. Some people are prone to have high Cholesterol. So, what came first - the chicken or the egg!

Sorry for this very long post BUT I had to find some way to vent my anger at the doctor who wanted to ADD more drugs to my already overloaded body. Ever wonder why some people have headaches, upset stomach, pain in the lower extremities, pain in the chest, etc.!!

Have a nice day.

[Trevor]

Look, doctors are taught to prescribe daily drugs (and butchering surgery) to get rich whilst slowly killing people and ruining their quality of life. Cures come from nutritional therapy -- no money in it for the medical mafia and their big-pharma sidekicks -- so they push highly-lucrative patented drugs instead. Their media lackeys make sure they keep the real truth VERY quiet!

Diabetes :

You need to read <snip> otherwise the drugs will cause gout and slowly kill you, possibly losing limbs in the process.

Eat raw honey, raw fat, raw meats, raw tuna, salmon, avocado & other recommended raw foods. It will take 2 years to regenerate the pancreatic cells sufficiently and wean your body off the insulin. This will take a highly-disciplined radical change-of-diet, but do you want to live or not?

Edited November 30, 2007 by Jai Dee
Spam links deleted - please see the forum rules

[Mobi]

I won't say too much, as I do have a lot of sympathy with the OP's view point.

I too am a very long term insulin dependant diabetic, with coronary disease, an enlarged prostate, and glaucoma, (to name but a few), and at the last count, I take 10 different meds a day - excluding my insulin shots. This amount of medication bothers me too, and I would love to have a n independent medical expert ( if there is such a thing) review all these meds and see if there isn't any way I can cut some of them out.

However, having said that, I'm afraid the glucose readings quoted by the OP are way above acceptable, safe ranges. He says "as low as 118" as though 118 is good!! Normal readings for non diabetics are 7-110 upon waking and 70 -140 after meals. Anything over that means you are diabetic and long term high glucose readings will cause permanent damage to your organs and extremities, and almost certainly shorten your life span and quality of life.

OK, I am disturbed with the amount of medication I take, but for the most part I manage to keep my glucose levels where they should be, and my blood pressure under 140/80.

And of course exercise, and sensible eating to keep the heart strong and the weight down will be very beneficial, but I'm not sure it's the total answer.

[Sheryl]

While I certainly agree with Grumpy that the doctor he refers to did not act appropriately, I take serious issue with generalizing from that to all doctors.

It is very well known that diet and other life-style factors (exercise etc) are major risk factors for type II diabetes and also that the trend towards sedentary living, processed foods etc is a large factor in the increase in the prevalence of this disease. Well known, proven in scientific studies, and thoroughly accepted by the mainstream medical profession.

It is also accepted, mainstream medical practice to provide people with type II diabetes or signs of its future onnset with this information and with counselling on nutrition. And to manage mild cases of Type II diabetes with dietary and life style modifications alone, using drugs only if these alone are not effective.

If a doctor fails to do the above, far from being part of some universal medical conspiracy, he or she is acting against established medical practice. Change doctors.

That said, post #2, in addition to making sweeping and unjust generalizations about the medical profession as a whole, contains some potentially dangerous advice.

It is certainly good to consume fresh fruits and vegetables, and highly processed foods are indeed best avoided by everyone and absolutely should be avoided by people with type II diabetes or risk factors for it. However the diets mentioned in post #2 are extreme and have not been proven to "cure" anything.

The drugs used to treat diabetes -- of which there are a number of different ones -- have side effects, as all drugs do, but they are well tolerated by most partients and cwhen used correctly under medical supervision ertaionly do not kill people or cause them to loose limbs -- diabetes does that. The drugs used to treat diabetes are usually effective in controlling the disease and preventing death, loss of limbs etc. Of course, they do have drawbacks, and it is much better to control the disease through diet and life-style changes where-ever possible. .

It is not possible in all cases, however. Some people do need to take these drugs to keep their diabetes under control and reduce the substantial risks that uncontrolled diabetes poses to life and health. They should also, of course, try to eat a healthy diet, and inform themselves thoroughly of the potential side effects of the medications they take.

Drug companies, being drug companies, do indeed promote...drugs. That is their field. Dcotors and other health professionals, however, are not members of any kind of global conspiracy and are trained to do more than prescribe drugs, especially for conditions like diabetes where the connection to diet and life-style are well proven. That some fail to do this or do it poorly reflects upon them as individual practitioners, not on some overall "conspiracy" or servitude to the pharmaceutical industry.

Lastly, should not confuse type II diabetes, in which the cells of the pancreas are capable of producing insulin but fail to do so sufficiently, with type I in which the pancreas is unable to produce insulin altogether. The latter condition requires insulin and is largely genetic. The former, although there is often a genetic predisposition, is heavily affected by dietary habits, can often (but not always) be prevented through appropriate diet and life-style, and in mild cases can be treated through dieatry modifications, weight loss and exercise alone. In cases where these measures do not suffice, oral medications are usually sufficient (they are completely ineffective in Type I diabetes), although a minority of patients will require insulin.

[grtaylor]

Whilst being admitted to Bumrungrad for an operation, not in any way related to diabetes, I was given blood checks. My glucose level was around 140, and I was warned that I had to modify my life-style and eating habits, otherwise I ran the risk of becoming diabetic. As a result of changing my diet, and doing a small amount of exercise, I lost 12 kilos in 6 months, and my glucose levels came down a lot.

My point is saying all this is that, as far as I could see, the doctors gave me every possible bit of advice to AVOID me having to take drugs, rather than the scenario some people here have suggested. . . . .

Edited November 30, 2007 by grtaylor

[grumpy_old_retired]

While I certainly agree with Grumpy that the doctor he refers to did not act appropriately, I take serious issue with generalizing from that to all doctors.

It is very well known that diet and other life-style factors (exercise etc) are major risk factors for type II diabetes and also that the trend towards sedentary living, processed foods etc is a large factor in the increase in the prevalence of this disease. Well known, proven in scientific studies, and thoroughly accepted by the mainstream medical profession.

It is also accepted, mainstream medical practice to provide people with type II diabetes or signs of its future onnset with this information and with counselling on nutrition. And to manage mild cases of Type II diabetes with dietary and life style modifications alone, using drugs only if these alone are not effective.

If a doctor fails to do the above, far from being part of some universal medical conspiracy, he or she is acting against established medical practice. Change doctors.

That said, post #2, in addition to making sweeping and unjust generalizations about the medical profession as a whole, contains some potentially dangerous advice.

It is certainly good to consume fresh fruits and vegetables, and highly processed foods are indeed best avoided by everyone and absolutely should be avoided by people with type II diabetes or risk factors for it. However the diets mentioned in post #2 are extreme and have not been proven to "cure" anything.

The drugs used to treat diabetes -- of which there are a number of different ones -- have side effects, as all drugs do, but they are well tolerated by most partients and cwhen used correctly under medical supervision ertaionly do not kill people or cause them to loose limbs -- diabetes does that. The drugs used to treat diabetes are usually effective in controlling the disease and preventing death, loss of limbs etc. Of course, they do have drawbacks, and it is much better to control the disease through diet and life-style changes where-ever possible. .

It is not possible in all cases, however. Some people do need to take these drugs to keep their diabetes under control and reduce the substantial risks that uncontrolled diabetes poses to life and health. They should also, of course, try to eat a healthy diet, and inform themselves thoroughly of the potential side effects of the medications they take.

Drug companies, being drug companies, do indeed promote...drugs. That is their field. Dcotors and other health professionals, however, are not members of any kind of global conspiracy and are trained to do more than prescribe drugs, especially for conditions like diabetes where the connection to diet and life-style are well proven. That some fail to do this or do it poorly reflects upon them as individual practitioners, not on some overall "conspiracy" or servitude to the pharmaceutical industry.

Lastly, should not confuse type II diabetes, in which the cells of the pancreas are capable of producing insulin but fail to do so sufficiently, with type I in which the pancreas is unable to produce insulin altogether. The latter condition requires insulin and is largely genetic. The former, although there is often a genetic predisposition, is heavily affected by dietary habits, can often (but not always) be prevented through appropriate diet and life-style, and in mild cases can be treated through dieatry modifications, weight loss and exercise alone. In cases where these measures do not suffice, oral medications are usually sufficient (they are completely ineffective in Type I diabetes), although a minority of patients will require insulin.

Hi Sheryl:

As I stated in my original tirade! I was angry when the doctor told me I needed to start taking Actos without the benefit of checking past results from blood tests. And according to medical studies, Actos is not much better than Advandia. Also looked at forums of people taking or were taking Actos and these people were not at all happy about the adverse reactions. I will believe what a lot of people say about their experiences before I will believe another doctor's recommendation.

As stated, I have spent many thousands of hours researching diabetes and heart disease. What I found in every Study, whether diabetes or heart disease, is that NOT ONE Study took into consideration (at least Not mentioned) the diet habits, the volume or quantity of food, type of food, the amount of exercise, if any, that the people in the Studies availed themselves. Many of the Studies, not all, stated that the company manufacturer of the drug PAID for the study. Secondly, NOT ONE study makes reference to adverse effects above a 10 or 15 percentile. Why is that? I have had adverse effects from drugs (medicine) that I had taken previously, some very disabling, but when you review the adverse effects of the drug, my adverse effects are not mentioned. How many people in these studies have severe adverse reactions to drugs that are not reported. When I mentioned my adverse reactions to drugs, the doctor stated that you "are nuts" - my words - those reactions are not LISTED reactions. So, I guess I was dreaming when 3 drugs had me crawling around on the floor because I could not stand up and partially blind as well as other adverse effects for several hours while I waited, in pain, for the drug to wear off.

When I stated that many of the doctor's are surrogates of the drug companies marketing their specific drug, those were not my words. These are words from doctor's that are not now, but may have been in the past, surrogates of drug companies.

Yes I find a lot of fault with doctors not taking their patients seriously. Not just doctors here but also back in the USA. I have been on Glucophage for over 30 years. Not one doctor has told me that "it may not be working anymore"! Doctors want to add MORE drugs on top of what we are already taking. Surely there must be a way to determine if one drug has outlived it's usefulness? I have also been taking Amaryl for over 10 years. Has this drug also outlived it's usefulness? How do I determine if one drug works and another does not? That is why over a month ago I stopped taking any drugs. I am taking one at a time for 10 days to try and find out if the drug is working before checking the next one! Is this the proper way to check the usefulness of a drug? I don't think so but what other alternative do I have. Like Mobi says, how do we no when a drug is no longer working? In all my research I have been unable to find a "usefulness period" for a specific drug.

After eliminating drugs from my diet I started back walking as this was very helpful in the past and appears to be helping me today while I TEST my drugs effectiveness. Not the proper way to do it but neither is Adding and Adding more drugs on top of what we are already taking IF some of the drugs are not working.

Do you know of a better solution? I do not like doing what I am doing BUT I also do not like continually adding more drugs to my growing list.

I have read many of your opinions throughout this forum and value them tremendously. There is no doubt that your background provides us "novices" with very valuable and mostly accurate information. Thank You.

[Sheryl]

Grumpy, I thoroughly agree that the doctor in question's approach wasn't sound. My issue was with generalizing that to all doctors.

When you say that none of the studies you have found look at diet I assume you are talking exclusively about clinical drug trials, since there have been literally thousands of studies looking at diet and diabetes.

Clinical drug trials are required in order to get a drug approved for use and, of course, the drug companies who develop the drugs are responsible for paying for them. In addition, drug companies also often sponsor research looking at new uses or dosing regimens for drugs already approved.

I don't understand your reference to adverse effects above a 15 percentile. Clinical trials are required to report all adverse effects seen, in both the drug and placebo groups, along with incidence. Even effects found in only 1% of patients, and even effects found just as often in the placebo group, are reported. In addition, drug companies are (at least in the US and I imagine most developed countries) required to keep track of "post marketing" adverse effects, that is to say, effects reported after the drug has come on the market, even if they may not have been caused by the drug itself, and one can easily find detailed reports of all such reported events for any drug.

All that aside, though, back to your dilemma. The better way you ask about would be to find a doctor who specializes in diabetes and cardiovascular disease, has a sincere interest in his or her work, has a conservative approach to the use of medication and treats the patient as a partner in decision-making, and them to work on establishing an optimal regimen for yourself under that doctor's supervision. I'm all for people taking their health into their own hands but diabetes is a serious condition as is cardiovascular disease which I gather you also have, and doing what you are doing on your own is just too risky.

. If any of the readers on this forum have a doc they are happy with, perhaps they could post the info or PM grumpy; also if you search this forum there have been past threads on diabetes which may give some names.

I can't give any firsthand recommendations but based purely on qualifications the following look good:

Bangkok Hospital

http://www.bangkokhospital.com/App/doctorp...&Lang=en-US

(US Board Certified)

http://www.bangkokhospital.com/App/doctorp...&Lang=en-US

http://www.bangkokhospital.com/App/doctorp...&Lang=en-US

(Did a fellowship on Clinical Nutrition)

Bumrungrad

Dr. Chorthip N. Phattanasri - US Board Certified and did a fellowship in clinical nutrition in the US; also has expertise in managing hyperlipedemia as well as diabetes

Dr. Poj Tannirandorn - US Board Certified; expertise in hypertension as well as diabetes

Dr. Apichati Vichayanrat - US Board certified; a professor of medicine at Mahidol Univ

Dr. Varaphon Vongthavaravat - US Board Certified and an Asst Professor

Bangkok Nursing Home Hospital

Dr. Chichitr Plengwithaya - US trained

Dr. Sompongse Suwanwailakorn - US trained; professor at hulalonghorn

It may take some time and trial and error to find the right doctor for you, but it is well worth it as your problem is a chronic one. Suggest you just make appointments with some of the above and tell them flat out that you are looking for a doctor to help manage your diabetes long term and would like to know more about their particular philosophies/approaches. In other words, interview them. Any who take offense at that approach you can cross off the list straight away.

Good luck, and please let us know the name of any docs you are favorably impressed with as their are quite a few TV members with diabetes.

[grumpy_old_retired]

Grumpy, I thoroughly agree that the doctor in question's approach wasn't sound. My issue was with generalizing that to all doctors. OK! Agree, too harsh. Not all doctor's are like that. BUT too many are!

When you say that none of the studies you have found look at diet I assume you are talking exclusively about clinical drug trials, since there have been literally thousands of studies looking at diet and diabetes. Correct - clinical drug trials. And I agree again, many trials have looked at diet and exercise BUT not in conjunction with the taking of drugs to learn the benefits of taking a specific drug along with diet and exercise. The trials generally state that WHEN diet and exercise does not work THEN take such and such drug.

Clinical drug trials are required in order to get a drug approved for use and, of course, the drug companies who develop the drugs are responsible for paying for them. In addition, drug companies also often sponsor research looking at new uses or dosing regimens for drugs already approved. I should have been more specific. Correct - I was referring to the clinical studies.

I don't understand your reference to adverse effects above a 15 percentile. Clinical trials are required to report all adverse effects seen, in both the drug and placebo groups, along with incidence. Even effects found in only 1% of patients, and even effects found just as often in the placebo group, are reported. In addition, drug companies are (at least in the US and I imagine most developed countries) required to keep track of "post marketing" adverse effects, that is to say, effects reported after the drug has come on the market, even if they may not have been caused by the drug itself, and one can easily find detailed reports of all such reported events for any drug. In this regard I was referring to a statement that has been made by several doctor's that NOT ALL adverse reactions to drugs are shown in the studies. The drug companies do not want to report all the adverse effects of their drugs. I have taken many medications that have caused some very severe reactions. In reviewing the side effects of the drug(s), the side effects I experienced were not listed. And, when a doctor that prescribes the drug tells me I 'am nuts' then I have no respect for that doctor. This has happen on several occasions.

All that aside, though, back to your dilemma. The better way you ask about would be to find a doctor who specializes in diabetes and cardiovascular disease, has a sincere interest in his or her work, has a conservative approach to the use of medication and treats the patient as a partner in decision-making, and them to work on establishing an optimal regimen for yourself under that doctor's supervision. I'm all for people taking their health into their own hands but diabetes is a serious condition as is cardiovascular disease which I gather you also have, and doing what you are doing on your own is just too risky. I live 'way up' north and have not found a doctor that specializes in diabetes related problems. It would be great if I lived in Chiang Mai where I could probably find the doctor I need. Just too far to drive weekly or monthly. I do appreciate you taking the time to compile the following list. It might be advantages to me to visit Bangkok for a complete and thorogh evaluation. I will seriously consider do this.

(EDIT: Trying to figure out how to switch between 'Red' and 'Black' - without succsess) SORRY for all the Red

. If any of the readers on this forum have a doc they are happy with, perhaps they could post the info or PM grumpy; also if you search this forum there have been past threads on diabetes which may give some names.

I can't give any firsthand recommendations but based purely on qualifications the following look good:

Bangkok Hospital

http://www.bangkokhospital.com/App/doctorp...&Lang=en-US

(US Board Certified)

http://www.bangkokhospital.com/App/doctorp...&Lang=en-US

http://www.bangkokhospital.com/App/doctorp...&Lang=en-US

(Did a fellowship on Clinical Nutrition)

Bumrungrad

Dr. Chorthip N. Phattanasri - US Board Certified and did a fellowship in clinical nutrition in the US; also has expertise in managing hyperlipedemia as well as diabetes

Dr. Poj Tannirandorn - US Board Certified; expertise in hypertension as well as diabetes

Dr. Apichati Vichayanrat - US Board certified; a professor of medicine at Mahidol Univ

Dr. Varaphon Vongthavaravat - US Board Certified and an Asst Professor

Bangkok Nursing Home Hospital

Dr. Chichitr Plengwithaya - US trained

Dr. Sompongse Suwanwailakorn - US trained; professor at hulalonghorn

It may take some time and trial and error to find the right doctor for you, but it is well worth it as your problem is a chronic one. Suggest you just make appointments with some of the above and tell them flat out that you are looking for a doctor to help manage your diabetes long term and would like to know more about their particular philosophies/approaches. In other words, interview them. Any who take offense at that approach you can cross off the list straight away.

Good luck, and please let us know the name of any docs you are favorably impressed with as their are quite a few TV members with diabetes.

My problems with doctor's started over 40 years ago when a doctor told me that I need to go into the hospital to have a skin graft placed over the end of a thumb that I had sliced off with a mechanical slicer (slicing tomatoes). His nurse, standing behind him, was shaking his head NO. I told the doctor I would think about it. When the doctor left the room the nurse told me I did not need a 'graft'. Just come in every day and I will clean it. After a week my thumb was fine.

Many other times I have been prescribed drugs for conditions that had no correlation to the sickness that I was experiencing at the time. I am allergic to many drugs and when I point out the allergies I have been told many times that the effects you are experiencing are unfounded. Do I believe the doctor or my body and what it is experiencing. My greatest fear is having to go into a hospital, given drugs, and experiencing (allergic reactions) pains because of the drugs that I am given and not be in a condition to explain.

Then there are doctor's (Thailand) that have prescribed medications to my wife and son when sick. I review all drugs on the internet before I allow them to take them. By the way, almost always there are 5 drugs involved! In one particular case, a drug given to my son was not to be used by anyone under the age of 12 because the drug has been known to cause 'heart stoppage'. He was 7 at the time. Several other times certain drugs interacted severely with other drugs perscribed.

I have followed very closely the experiences of many forum members experiencing the same problems with diabetes. The same drugs that these members are taking to control diabetes, cholesterol, heart problems, etc. I am also taking. MY original 'beef' was and still is, how are we to no when one drug stops working BEFORE adding other drugs? How are we to determine when one drugs is no longer working and another drug does work? If all we do is ADD and ADD, we are putting money into the pockets of drug companies with no benefit to us!

Again, thank you for taking the time to read and reply to these ridiculous questions. Sorry to say that I will continue to question what a doctor prescribes to me because I have no faith that a doctor 'really' cares what they are prescribing to their patients.

(EDIT: Sorry for all the RED - tried to fix without success)

I will not waste everyones time by reply further. It is apparent that all diabetics in Thailand are happy with their care and do not question the care given. I wish I felt the same way.

Edited December 7, 2007 by grumpy_old_retired

[Sheryl]

Grumpy,

I thoroughly agree that people should question all medications given to them and thoroughly inform themselves of the action, side effects etc of all medications they take. Also agree that over-prescription is very much a feature of "Thai-style" medical care. And many Thais equate good care with being given a large number of different drugs, thereby perpetuating this. However, it is quite possible to find good doctors practicing medicine by international standards in Thailand. They are, unfortunately, heavily concentrated in Bangkok. I know it's a long trip, but you really would do well to invest in it and find a suitable doctor there. Once stabilized it would not be necessary to come in that often. You can have your primary doc write out follow up instructions, including lab tests, for a local hospital to follow.

As a nurse I have certainly seen my share of very bad doctors, they do exist although I don't think they are in the majority. You seem to have met up with a disporortionate number.

It is important to chose a doctor with care and take the time and trouble to research his/her qualifications first.

I am constantly amazed at how few people do this. People who would not think of buying a car without researching a bit on make and model, will just walk into a hospital or clinic and see whomever. Likewise, people who would gladly travel long distances to get to a fine beach or exceptional restaurant, sometimes balk at having to travel to see a top specialist. I'm not implying this is true of you, just using this occasion to re-iterate a point I have made many times in the past:

Nobody cares as much about your health as you do, and nothing in life is as important as one's health. Invest in it accordingly. Choose a doctor as carefully, and with as much research, as you would chose a house or other major investment.

Regarding the issue of adverse reactions, all adverse effects noted in clinical studies are, by law, published. If a drug company fails to do this they may lose their license and face other serious legal consequences. However, initial drug trials are conducted on maybe a thousand people or so. And exclude people with other medical problems and on other medications in order not to confuse the results. There are good reasons for this but inevitably once a drug is on the market, being taken by tens or hundreds of thousands of people or more -- people with all sorts of other problems, other medications, different genetic make up etc, inevitably additional adverse effects occur. These should always be reported to the drug companies, who are required to keep track of such "post marketing" events and include them in their future literature.

This is one of the reasons (in addition to cost) why I favor use of older, tried and true, preparations over new variants unless there is really an obvious advantage to the newer ones. the longer a drug has been on the market, the better known are all of its side effects including ones that may occur only very rarely.

As for allergies, there is no drug to which it is impossible to be allergic. Allergies to some drugs are more common than others, but it is possible to be allergic to anything. And the manifestations of allergy can vary greatly among individuals.

[dr_Pat_Pong]

Thank you for an interesting and cogent thread.

[ignis]

Hi Grumpy

Don't forget if you go for a test smoking a cig before will show higher blood pressure........ I Needed a medical Certificate last year.

As for the blood pressure test........ do they use those new things ?? ask to be tested with the old ones in a metal box and they have to pump up........ they did one of these tests, with the new thing = they said I had high blood pressure... strange as I take tablets for low blood pressure........ they then went to find a old pump up tester = I had low blood pressure... they then got 4 different 'new sort' and tested me again every one showed I had high blood pressure, they found another 2 old testers and tried again = I had low blood pressure.!!! so they said my blood pressure was normal

I have type 2 diabetic and still use [Thai version] the prescription I had from my Dr in the UK in 2003, I have never had any test here, a couple of months back the blood sugar went very high no idea why at the time, but now is back to a low level, [new tablets were different + 1/4 strength]

In UK the Dr’s tell you to have a checkup every 6 months last one was over 4 ½ years ago and other than that little problem with the wrong pills, all appears fine..

[grumpy_old_retired]

Grumpy,

I thoroughly agree that people should question all medications given to them and thoroughly inform themselves of the action, side effects etc of all medications they take. Also agree that over-prescription is very much a feature of "Thai-style" medical care. And many Thais equate good care with being given a large number of different drugs, thereby perpetuating this. However, it is quite possible to find good doctors practicing medicine by international standards in Thailand. They are, unfortunately, heavily concentrated in Bangkok. I know it's a long trip, but you really would do well to invest in it and find a suitable doctor there. Once stabilized it would not be necessary to come in that often. You can have your primary doc write out follow up instructions, including lab tests, for a local hospital to follow. As soon as my evaluation of current drugs is completed - are they or are they not working - then I will arrange an appointment in Bangkok.

As a nurse I have certainly seen my share of very bad doctors, they do exist although I don't think they are in the majority. You seem to have met up with a disporortionate number.[color="#FF0000"][/color]Once again I do agree. There are good and bad doctor's everywhere.

It is important to chose a doctor with care and take the time and trouble to research his/her qualifications first.Kinda hard to do in Thailand!

I am constantly amazed at how few people do this. People who would not think of buying a car without researching a bit on make and model, will just walk into a hospital or clinic and see whomever. Likewise, people who would gladly travel long distances to get to a fine beach or exceptional restaurant, sometimes balk at having to travel to see a top specialist. I'm not implying this is true of you, just using this occasion to re-iterate a point I have made many times in the past:

Nobody cares as much about your health as you do, and nothing in life is as important as one's health. Invest in it accordingly. Choose a doctor as carefully, and with as much research, as you would chose a house or other major investment.

Regarding the issue of adverse reactions, all adverse effects noted in clinical studies are, by law, published. If a drug company fails to do this they may lose their license and face other serious legal consequences. However, initial drug trials are conducted on maybe a thousand people or so. And exclude people with other medical problems and on other medications in order not to confuse the results. There are good reasons for this but inevitably once a drug is on the market, being taken by tens or hundreds of thousands of people or more -- people with all sorts of other problems, other medications, different genetic make up etc, inevitably additional adverse effects occur. These should always be reported to the drug companies, who are required to keep track of such "post marketing" events and include them in their future literature.Please read the following posting.

This is one of the reasons (in addition to cost) why I favor use of older, tried and true, preparations over new variants unless there is really an obvious advantage to the newer ones. the longer a drug has been on the market, the better known are all of its side effects including ones that may occur only very rarely.Agree with the older drug seniario. Well tested over many years and still "Appear" to work for me.

As for allergies, there is no drug to which it is impossible to be allergic. Allergies to some drugs are more common than others, but it is possible to be allergic to anything. And the manifestations of allergy can vary greatly among individuals.

The following are "Just a Few" extracts from papers and articles that I have read. Although there are a few drugs in this category, I have to wonder how many more there are that are Unreported! I have been and continue to be very concerned regarding the multiple (different) categories of drugs that we are required to take to control diabetes and other conditions! NO controlled studies to indicate whether it is SAFE to use multiple drugs together at the same time! What are/will be the long term effects! The reason for my topic - Diabetes - Are The Drugs Killing Us?

Avandia - was approved for the treatment of Type-2 Diabetes in the U.S. in 1999. To date, more than six (6) million people worldwide have taken the drug, and Avandia generates approximately $3.2 billion in annual sales for its manufacturer. However, on May 21, 2007, The FDA’s Safety Alert follows a study released on the same day, which will appear in the June 14, 2007 issue of the New England Journal of Medicine. This type of study, known as a ‘meta-analysis’, evaluated forty-two (42) separate studies comparing patients using Avandia (rosiglitazone) to patients who were not using Avandia. This study concludes that patients taking Avanida (rosiglitazone) face a 43% increased risk of heart attack, and a 64% increased risk of dying from heart related ( cardiovascular) disease.

Reports of diabetes drug’s side effects triple

The sudden spike is a sign that doctors probably were unaware of the drug’s possible role in their patients’ heart problems and therefore may not have reported many such cases in the past, several experts said.

It also shows the flaws of the safety tracking system and suggests that a better one might have detected a potential problem before the drug had been on the market for eight years.

Reporting a drug’s side effects is voluntary, and only a crude indication rather than a scientific measure of how many problems patients are actually having. The FDA relies on this unenforced system once a drug is on the market. Critics say it leads to haphazard oversight in which problems can be missed because doctors don’t connect the dots between a drug and symptoms they see in an individual patient.

FDA Scientist Graham Calls Glaxo Avandia Trial Useless

World-renowned cardiologist Dr Steven Nissen and statistician Kathy Wolski of the Cleveland Clinic posted a study online on May 21, 2007, to warn the public that the diabetes drug Avandia (rosiglitazone) increased the risk of heart attacks by 43% and the risk of death from cardiovascular causes by possibly 64%. Dr Curt Furberg, a health policy professor at Wake Forest University, and University of Washington epidemiologist Dr Bruce Psaty, wrote an accompanying editorial in the NEMJ urging regulatory action by the FDA. "During the market life of rosiglitazone," they wrote, "tens of millions of prescriptions for the drug have been written for patients with type 2 diabetes." "Insofar as the findings of Nissen and Wolski represent a valid estimate of the risk of cardiovascular events," they noted, "rosiglitazone represents a major failure of the drug-use and drug-approval processes in the United States." "Indeed," they said, "at the time of approval of rosiglitazone, the evidence from 26-week studies of expected health benefits was at best mixed." The doctors were no doubt referring to the FDA's review of the clinical trials in 1999, by Dr Robert Misbin, who noted Avandia's adverse effects in an April 2, 1999 report that specifically warned that the "increase in body weight" and "undesirable effects on serum lipids [cholesterol] is cause for concern."

The same day that the Nissen report appeared online, the FDA issued a pubic health alert stating: "Safety data from controlled clinical trials have shown that there is a potentially significant increase in the risk of heart attack and heart-related deaths in patients taking Avandia." However, in the same alert the agency began a clear campaign of damage control for Avandia maker GlaxoSmithKline and said, "other published and unpublished data from long-term clinical trials of Avandia provide contradictory evidence about the risk of ischemic cardiovascular events in patients taking Avandia." But as it turns out, some of the "contradictory evidence" referred to was Glaxo's own analysis of an ongoing company sponsored clinical trial called RECORD that is basically useless, according to FDA scientist Dr David Graham.

FDA and Drug Approval Overview

Vioxx was one of the most widely used prescription drugs in the world and, for many, it may have been a killer. The Food and Drug Administration (FDA) is supposed to guarantee the safety of the medicines we take, but some say it may have disregarded warnings from its own scientists about this looming public health disaster. NOW's BAD MEDICINE explores the drug approval process and talks with FDA whistleblower, Dr. David Graham, who reveals how his FDA managers tried to silence him and quash evidence that indicated Vioxx was unsafe.

Despite many successes, drug approval at the Food and Drug Administration (FDA) is subject to gaps, internal tensions, and conflicts of interest. Recalls of drugs and devices and studies demonstrating advantages of older drugs over newer ones highlight the importance of these limitations. The FDA does not compare competing drugs and rarely requires tests of clinical efficacy for new devices. It does not review advertisements before use, assess cost-effectiveness, or regulate surgery (except for devices). Many believe postmarketing surveillance of drugs and devices is inadequate. A source of tension within the agency is pressure for speedy approvals. This may have resulted in "burn-out" among medical officers and has prompted criticism that safety is ignored. Others argue, however, that the agency is unnecessarily slow and bureaucratic. Recent reports identify conflicts of interest (stock ownership, consulting fees, research grants) among some members of the FDA’s advisory committees. FDA review serves a critical function, but physicians should be aware that new drugs may not be as effective as old ones; that new drugs are likely to have undiscovered side effects at the time of marketing; that direct-to-consumer ads are sometimes misleading; that new devices generally have less rigorous evidence of efficacy than new drugs; and that value for money is not considered in approval.

Thanks again Sheryl for your kind explanations.

Edited December 9, 2007 by grumpy_old_retired

[geriatrickid]

Some obvious good advice about exercise and proper diet. Such a no brainer but we all forget that sometimes the simplest measures give the best results.

One of the reasons doctors prescribe drugs too quickly is that 1) Patients want fast results and 2) patients won't follow instructions to change diets, stop smoking etc.

But back to the OP, question when you go in for your annual measurements, like a benchmark, do you spend the whole day at the hospital?

My friend has kept himself in pristine shape. He goes in for his annual testing for almost a full day. They give him those solutions to drink, they take measurements, he does some exercise, they measure again, feed again etc. Is your testing along those lines? They changed his insulin supplier as well (I never realized that one can develop a resistance to certain formulas.) There's another guy I work with, who just lets his diabetes slide and he's on all sorts of meds and he hasn't done the full day testing regimen.

[ChiangMaiAmerican]

When I worked in my profession back home I spent a lot of years treating and educating non-compliant diabetics. I usually got involved after the patient began developing complications. From my observation Actos can cause more problems than it solves. My mother, a retired RN and another relative, a retired physician both had negative experiences with Actos. My mother had to develop liver problems before she would listen to me and discontinue the medication. She recovered quickly after it was stopped. Metformin (Glucophage) on the other hand is an old drug that continues to work well. When metformin first hit the market the sales of insulin dropped by approximately one third if my memory serves me correctly. This was attributed to the use of metformin by type II diabetics. As Sheryl pointed out, this would not work for type I diabetics because they lack the capacity to make insulin. Metformin does not increase the amount of insulin in the body like the older sulfa based diabetes drugs do. It alters they way your body absorbs and stores glucose.

The biggest problem I had in managing diabetics was educating them to the point they were willing to make the necessary lifestyle changes. Excercise is one of the keys to effective management of blood sugar. I have seen exercise with diet alone control type II diabetes but you still need to monitor your blood sugar a few times a week. Diet is another. Its not just processed sugar that creates the problem but carbohydrates. Fats are a serious problem since as a consequence of diabetes blood vessels develop plaques at a rate faster then the non-diabetic population. Smoking is definately a no no. Nicotine is a vasoconstrictor. Diabetic blood vessels are already at high risk for narrowing. That is why they prescribe cholesterol lowering medication. Properly prescribed medication is also part of the picture.

If you want to play Russian roulette with diabetes then go ahead. If you are lucky you will die quickly. Diabetics with poorly controlled disease commonly develop ulcers and osteomyeletis (bone infections). Once they develop osteomyeletis the toe, foot or leg is amputated not necessarily in that order. Diabetes also affects the nerves and the eyes. Diabetic retinopathy causes blindness. Loss of feeling in the body extremities is common. If you have an active sex life leave your diabetes untreated and that will disppear too. Uncontrolled diabetes eventually, if other complications don't get them first, leads to gastroparesis. The nerves in the intestinal track no longer work properly. Food no longer moves through the system and the patient experiences severe pain. I have seen people scream and cry because of the pain. They vomit at nearly every meal. It is not a way I would prefer to have my life end.

Diabetes is not a minor problem that can be ignored. I had a close friend who developed type II diabetes in his mid forties. For a time I was able to convince him to manage his disease. Then he found a new girl friend that thought he out to be able to smoke, drink and eat anything he wanted to. At 49 he began losing toes. At 50 he was being treated for another round of osteomyelitis when he had a massive heart attack and was one. The girlfriend was devestated when he was gone. Such a waste. He was a very talented businessman who might have enjoyed a full span of life had he managed his disease.

Edited December 14, 2007 by ChiangMaiAmerican

[Prakanong]

A good source if info on what Clinical Trials are actually running - thiese are posted after the Protocol has IRB Approval

http://www.clinicaltrials.gov/

GSK did set up a clinical trials register before the Avandia problems but now due to that it is more important that pharma share all data which many of them are doing such as this one here

http://ctr.gsk.co.uk/welcome.asp

As Sheryl alludes to it is oftem the PMS (post marketing studies) which identify longer term safety problems with medications - in the regulatory clinical trials all adverse effects may not come to light and that is why long term safety follow up's take place as well as PMS - drugs would never get to market if they had to be trialled for ever - in a way they are though with PMS which many countries require - in this region Korea and Philippines demand this very strongly

I do sympathise with the OP and Dr's trying to over mdicate. I just had it myself and he was told in no uncertain terms he was wrong. I then consulted my GP oplus my best pal at work who is a very senior Oncologist working a novel therapeutic vaccine for cancer - they both told me I did not need medication at all and the Dr was totally wrong (not often you get medical professionals coming right out and saying it)

In my case he was up-selling - trying to make a lot more money than he would get paid for my heaslth screening from my company

I think in many other cases it is like Sheryl say's - patients want immediate results, many think if they do not get medication then the Dr is bad and sometimes Dr's are lazy and just go for the easiest solution for themselves.

Do not be afraid to question your Dr - learn a lot about your conditions and the latest treatment and research. It just so happened a clinical trial that I had been asociated with very recently had put the quack I saw in his place and he was 10+ years out of date!

[ChiangMaiAmerican]

This on Actos is from the US FDA . The US FDA already pulled Rezulin but this one remains. Things may change after the next election there and a neutral FDA administrator is appointed.

General Precautions with Actos:

• Actos is in the same class of drugs as Rezulin, which has been associated with rare but serious liver injury, including liver failure leading to transplant or death. Because the liver safety profile of Actos is not fully determined yet, your doctor will do blood tests that evaluate your liver before starting you on Actos. These blood tests should be repeated every two months for the first year, then regularly after that.
  
• Call your health care provider right away if you develop nausea, vomiting, stomach pain, a feeling of tiredness or having no energy, loss of appetite, dark urine, or jaundice (yellow coloring of eyes and skin). These may be the symptoms of liver problems.
  
• Patients who experience an unusually rapid increase in weight or retain fluid (edema) or who develop shortness of breath or other symptoms of heart failure while on Actos should immediately report these symptoms to their health care provider.
  
• When taking Actos with insulin or certain other oral diabetes medicines, there is a risk of your blood sugar becoming dangerously low. Ask your health care provider about symptoms of low blood sugar, conditions that make low blood sugar more likely, and what to do if you get it. Make sure to explain to family members.
  
• If you are a woman who has not reached menopause but have not had menstrual periods; you may become pregnant unless you use an effective method of birth control. Actos, like other drugs in this class, may cause insulin resistant women to start ovulating again.
  
• Women should tell their doctor if they notice any changes in their monthly menstrual cycle.
  
• During periods of stress on the body, such as fever, trauma, infection, or surgery, your medication requirements may change; contact your health care provider promptly.
  

http://www.fda.gov/cder/consumerinfo/druginfo/actos.HTM

Edited December 14, 2007 by ChiangMaiAmerican