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Treatment Options for Diabetes

Program: Taking Care of Diabetes and Avoiding Complications
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Andrew Schorr:

So doctor, I’ve always heard that there are sort of pillars of diabetes care. So there’s exercise. There is monitoring of course. There is appropriate weight control, and then there are medications. Now let’s face it, in our culture we’ve sort of gotten to the point where we think there’s a pill for everything, and we don’t always take responsibility for our health, and then we go to someone like you and say, ‘Give me a pill, give me a prescription, fix me.’ But it sounds like you’re saying well there are medications that can help. They can’t really do the heavy lifting. The patient has to do that.

Dr. Choudhury:

Yes. Most diabetic who are obese will improve with lifestyle modifications just like Rick has done. Yes you’re right. I mean most people don’t want to do that. They don’t have the time to exercise. They don’t have the time to look at their diet and eat healthy foods. They are eating on the run all the time, not eating regularly, and so eventually the easiest way to get the glucose under control is by taking medications for these people.

As Rick mentioned there are some medications that can sometimes cause some weight gain, so what we tell our patients when we put them on diabetes lowering medications is there are some pills that may cause weight gain, so we really do want you to do your part too, which is once again exercise and diet restriction so that way diabetes is controlled not just by increasing doses of medications.

Andrew Schorr:

All right, let’s talk to somebody who maybe has not gotten to the point that Rick had who was able to make a big change and then see the benefit of that, but they’re trying. So what would be medications, the array of medications, and I don’t mean by name but the types that might be used? For instance we were talking about the heart. Would many people with diabetes be wise to have; if their blood pressure is up, which it might be, or their cholesterol/triglycerides are out of whack, which it might be; that they would have those medications as well as what we think of as diabetes medicines?

Dr. Choudhury:

Yes, these three issues that I mentioned before; blood glucose, blood pressure, and cholesterol; all go together, and it is just expected that someone with high blood glucose will have high cholesterol, and most of these patients will also have high blood pressure. So not just treating glucose but treating blood pressure as well as cholesterol is very important.

Again the studies have shown that strict glucose control does prevent certain complications of diabetes like eye complications, which we call retinopathy, kidney problems that we call nephropathy. Strict glucose control does prevent these complications. Prevention of heart attack and stroke is also helped by glucose control, but also very important for prevention of heart attack and stroke is the control of cholesterol and blood pressure. So all three need to be controlled well.

Andrew Schorr:

Let’s talk about some of the risks. Now Rick, I mentioned about your children and your grandchildren, and you and I are both 59, and we want to live a long happy life and enjoy our families. Did you have a vision or a fear at some point that if you didn’t control your diabetes you wouldn’t be around for all that?

Rick:

By all means and even more so with my wife with all the weight she had on I got to thinking you know something’s got to change or we’re not going to be around to enjoy the kids and the grandkids.

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