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The treatment of diabetes has changed dramatically over the last year and some doctors are harming their patients by not keeping up with the latest guidelines. The United Kingdom Prospective Diabetes Study (UKPDS) showed that tight blood sugar control can prevent blindness, deafness, heart attacks, strokes, kidney failure, amputations, impotence, burning foot syndrome and other complications of diabetes.

The primary goal of treating diabetes is to get the blood test HBA1C to normal. When you eat, your blood sugar level rises. If it rises too high, sugar sticks to cells and can never get off. Sugar stuck on cells is converted to a poison called sorbitol that destroys the cells. This is what causes all the complications of diabetes. If a diabetic can keep HBA1C in the normal range, he is no more likely to suffer the horrible side effects of diabetes than a person who is not diabetic.

The first rule is to avoid the foods that cause a high rise in blood sugar. Second, the doctor must do a blood test called C peptide to see if person can produce insulin. If the C peptide is above 1, that person's pancreas makes insulin and the odds are overwhelming that the person should not be on insulin. Nobody should take insulin unless he needs it, because insulin constricts arteries to cause heart attacks and it also causes obesity. If a person has a normal C peptide, signifying that his body makes insulin, he should not be put on insulin.

If his HBA1C is above 6.5, signifying that his diabetes in out-of-control, he should be put on other drugs. Glucophage (metformin) is taken before meals to prevent blood sugar levels from rising too high after meals. Actos makes the cells more sensitive to insulin so less insulin is required. Other drugs to cause the pancreas to make more insulin. Most doctors start with all three types of drugs, strict dietary control and an exercise program. As the HBA1C blood test returns to normal, the drugs are removed one at a a time.

If a diabetic cannot be managed with these three drugs, the doctor should add the exciting new injectable LANTUS insulin that is given at night and lasts for 24 hours. If you are a diabetic and your HBA1C is not below 6.2, you may want to get a second opinion on your management because you are at high risk for serious side effects such as a heart attack, stroke, blindness, deafness, kidney failure, impotence or burning foot syndrome. See report #D222.

Combination therapy with insulin and oral agents: optimizing glycemic control in patients with type 2 diabetes mellitus. Diabetes - Metabolism Research and Reviews, 2002, Vol 18, Suppl. 3, pp S77-S81. H YkiJarvinen. Univ Helsinki, Dept Med, POB 340, Helsinki, FINLAND

Checked 8/9/05

May 19th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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