Adult onset Diabetes
Panel recommends easing restrictions on ROSIGLITAZONE despite concerns about cardiovascular safety. (JAMA July 17, 2013 Vol 310 #3)
Sadly, late stage adult onset diabetes remains under treated with oral hypoglycemics. At the least oral hypoglycemics are too little too late. Diabetes remains under diagnosed and under treated leading to multiple other problems and early fatalities. The interaction between diabetes and obesity insidiously compounds the problem. Diabetes causes obesity and obesity causes diabetes.
Until legislators put the common good ahead of their fast food lobbyests and get sugars out of the packaged food supply, our only defence against the out of control epidemic of diabetes and obesity stems from early detection and agressive treatment.
Unfortunately the current standard limits detection of diabetes to fasting blood sugar tests, and initial treatment to oral hypoglycemics. Juvenile diabetes is another matter, but protocals call for adult diabetes that does not respond to first line hypoglycemics to be treated by adding more powerful oral hypoglycemics. This polocy based on so called best evidence codifies the too little too late axium of treatment.
Early detection and early treatment will greatly reduce the mortality and morbidity of adult diabetes, but fasting blood sugars detect the disease long after the disease has damaged other organ systems. The damage results from the high osmotic pressure acompaning higher glusecose levels, like a storm front moving throughout the vascular system and extracellular fluid compartment damaging basement membranes and connective tissue.
In order to get a handle on the control of adult diabetes and obesity too, one needs the concept of pre-diabetes to catch the disease before it mets the current criteria for diagnosis. A hemaglobin A1c will help with an earlier detection. HbA1c measures the glucose on red blood cells. Red blood cells have an average life of 120 days in circulation; therefore, testing today measures the average high points of circulating glucose over that time span. The follow up diagnosis of pre diabetes might beter be with a 5 hour glucose tolerence test.
Interestingly, the first signs of diabetes seen in the clinic often include arcus senilis, A-V nicking, obesity or polyuria. Such is a testimony to our lack of rational preventive medicine guidelines.
The patient can often reverse pre-diabetes with diet and exercise. Failing that one might better turn to small doses of regular insulin before meals rather than oral hypoglycemics. Patients want a pill in order to perpetuate a denial of the disease or a denial of their obesity. The only way to overcome that resistance is by education. Here again the advertising by the drug companies for mor powerful and more toxic oral hyperglycemic medications works against us. If the physician believes in tight control and is passionent about it, that entheusiasm and passion can be transmited to the patient.
Most endocrinologists and many internists urge treatment of adult onset diabetes with regular insulin or equivalent. Not the long acting kind but fast acting physiological insulin before meals.
I learned this technique and philosophy over fifty years ago in medical school. Why is knowledge forgotten? That may be another question. To the point, my clinic diagnosed pre diabetes and treated it aggressively with diet and exercise. HbA1c at frequent intervals identified early advances in the disease. We were very successful with the pediatric subcutaneous fine needle attached to thin tubing and a push button fountain pen like measured delivery device.
Patient compliance depends on patient education and an agreed upon strategy to protect vital organs and extend life expectancy. Life style changes come easy when you have a needle in place as a reminder. It works.
With regard to the oral hypoglycemics, some have a use, but most are the promotion and advertising product of drug companies valorized by lobbying and tainted publications -- and yes the protocols of best evidence as well. Again early diagnosis is the key. Modern medicine lacks sufficient emphasis on diagnosis.
Sadly, late stage adult onset diabetes remains under treated with oral hypoglycemics. At the least oral hypoglycemics are too little too late. Diabetes remains under diagnosed and under treated leading to multiple other problems and early fatalities. The interaction between diabetes and obesity insidiously compounds the problem. Diabetes causes obesity and obesity causes diabetes.
Until legislators put the common good ahead of their fast food lobbyests and get sugars out of the packaged food supply, our only defence against the out of control epidemic of diabetes and obesity stems from early detection and agressive treatment.
Unfortunately the current standard limits detection of diabetes to fasting blood sugar tests, and initial treatment to oral hypoglycemics. Juvenile diabetes is another matter, but protocals call for adult diabetes that does not respond to first line hypoglycemics to be treated by adding more powerful oral hypoglycemics. This polocy based on so called best evidence codifies the too little too late axium of treatment.
Early detection and early treatment will greatly reduce the mortality and morbidity of adult diabetes, but fasting blood sugars detect the disease long after the disease has damaged other organ systems. The damage results from the high osmotic pressure acompaning higher glusecose levels, like a storm front moving throughout the vascular system and extracellular fluid compartment damaging basement membranes and connective tissue.
In order to get a handle on the control of adult diabetes and obesity too, one needs the concept of pre-diabetes to catch the disease before it mets the current criteria for diagnosis. A hemaglobin A1c will help with an earlier detection. HbA1c measures the glucose on red blood cells. Red blood cells have an average life of 120 days in circulation; therefore, testing today measures the average high points of circulating glucose over that time span. The follow up diagnosis of pre diabetes might beter be with a 5 hour glucose tolerence test.
Interestingly, the first signs of diabetes seen in the clinic often include arcus senilis, A-V nicking, obesity or polyuria. Such is a testimony to our lack of rational preventive medicine guidelines.
The patient can often reverse pre-diabetes with diet and exercise. Failing that one might better turn to small doses of regular insulin before meals rather than oral hypoglycemics. Patients want a pill in order to perpetuate a denial of the disease or a denial of their obesity. The only way to overcome that resistance is by education. Here again the advertising by the drug companies for mor powerful and more toxic oral hyperglycemic medications works against us. If the physician believes in tight control and is passionent about it, that entheusiasm and passion can be transmited to the patient.
Most endocrinologists and many internists urge treatment of adult onset diabetes with regular insulin or equivalent. Not the long acting kind but fast acting physiological insulin before meals.
I learned this technique and philosophy over fifty years ago in medical school. Why is knowledge forgotten? That may be another question. To the point, my clinic diagnosed pre diabetes and treated it aggressively with diet and exercise. HbA1c at frequent intervals identified early advances in the disease. We were very successful with the pediatric subcutaneous fine needle attached to thin tubing and a push button fountain pen like measured delivery device.
Patient compliance depends on patient education and an agreed upon strategy to protect vital organs and extend life expectancy. Life style changes come easy when you have a needle in place as a reminder. It works.
With regard to the oral hypoglycemics, some have a use, but most are the promotion and advertising product of drug companies valorized by lobbying and tainted publications -- and yes the protocols of best evidence as well. Again early diagnosis is the key. Modern medicine lacks sufficient emphasis on diagnosis.
posted by Clancy Hughes | 8/02/2013 11:18:00 AM
0 Comments:
Post a Comment
<< Home