Diabetes meds questioned due to insulin resistance and weight
DEAR DR. ROACH: My husband is an over-the-road truck driver, and he is 68. He has been on metformin for a long time, and I have been reading that this medicine does not help bring down blood sugar. He is also using human insulin two times a day.
What I want to know is if there's a better medication for him to take? I think he is gaining weight from insulin resistance, since he is getting a bigger belly, and his primary care physician doesn't seem to care about the issue, even though I have brought it to his attention. -- Anon.
ANSWER: Metformin is considered the best initial treatment for most people with Type 2 diabetes, due to its long history and excellent safety profile. There are also a large number of studies that found that the long-term outcomes are better for people taking metformin than they were with the other drugs that were available at the time the studies were done. It is true that metformin by itself is unlikely to cause the blood sugar to get too low, but it certainly reduces high blood sugar very well. Unfortunately, by itself, it is often not enough to control blood sugar.
Medication alone is not the best treatment for Type 2 diabetes. Regular exercise and a healthy diet are critical parts of a diabetes treatment plan. When these aren't enough (and regular exercise is very difficult for professional drivers), many diabetes experts will choose a different type of medication now -- when before insulin was the best option.
I worry about insulin in a truck driver because it may cause the blood sugar to get too low. Another problem with insulin (and medications that cause the body to release more insulin, such as glyburide) is that these tend to worsen insulin resistance and promote weight gain (especially around the belly, where it is most associated with heart disease).
Although we do have drugs that work directly for insulin resistance, drugs in the GLP-1 agonist class (such as liraglutide and semaglutide) have been shown to reduce the risk of heart disease in those who are at high risk. These also promote weight loss, but the main point is that they protect against serious complications.
I certainly don't have enough information to recommend a particular medicine for him, but getting a second opinion from an expert in diabetes is a prudent step at this point, in my opinion.
DEAR DR. ROACH: I am a 76-year-old female and have had alopecia since I was 5. I also take Synthroid. When I was receiving one of my COVID shots, I was asked if I had an autoimmune disease. I said I didn't have the faintest idea. Later, I heard that alopecia was an autoimmune disease, instead of the usual saying, "No hair, no reason, no cure." My questions are: How do I know if it is? And why was it important to know for the shot? -- L.J.K.
ANSWER: Alopecia is a general term for hair loss, and several kinds of alopecia are thought to be autoimmune in nature, with the body's immune system attacking the cells that grow hair. Most cases of thyroid disease are autoimmune as well. People with one autoimmune disease are at a higher risk for others.
The COVID vaccine may be less effective in some people with autoimmune diseases when they are taking medicines to suppress the immune system. Further, when vaccines were in short supply, those with immune system diseases were at a higher priority to get the vaccine. Now, however, there is no reason for you to take the COVID vaccine differently from anyone else.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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