Lowering blood sugar

“Who cares?”, says Nortin Hadler. I’m sure a few endocrinologists would take issue with that:

I have practiced medicine for 40 years. I have never prescribed a pill to lower blood sugar. I still see no reason to do so. If I am disadvantaging my patients, it’s to a trivial degree at most. However, I know I am sparing them known and unknown hazards.
And I won’t let you measure my blood sugar or the measure of its persistent elevation, the hemoglobin A1c. I don’t care, and I won’t care till there is compelling science that something meaningful can be done if it is elevated.

Comments

Anonymous
Dare I say perhaps he is right? Perhaps this is the solution to our health care woes. Just how DID my grandparents survive into their 90′s without modern medicine? They were farmers, got plenty of exercise, and raised and prepared most of their own food. They ate eggs, angus beef, raspberries, and cottage cheese. They didn’t have diabetes or hypertension. Who knows about their lipid profile? All I do know is that nobody had angina or a heart attack. They died of things like cancer and “old age”. So here I am, my lipid profile out of whack since age 20, now on a statin with better “numbers”. My borderline blood glucose and A1C have forced me into an exercise regimen, despite the fact that I am not overweight and have no familial risk factors. So what gives? Was it all the mac and cheese or the ramen in medical school? Or was it the fast fried food on call? Perhaps the sleepless nights and perpetual caffeine infusion? No, maybe it is too much Nutrasweet…All I do know is that just maybe Dr.Hadler is on to something. After all, the doctors who lived the best lifestyles I have observed lived up right to the end, whether that was the acute MI, stroke, or aggressive pancreatic cancer. None lingered and few had regrets. If you add up the months and years patients with chronic but asymptomatic disease spend in our offices, as well as the dollars spent, and instead let the patients have this time and money to live it up, I suspect when all is said and done it would be a better bargain for many.
Mike
WHAT ARE YOU TALING ABOUT???????
Because your grandparents survived without medicine, no one need smedicine??? OY, you’re as bad as my patients! All I get is “Hey Jim Fixx died when he was 40, so I should just eat whatever the hel I want”
How mnay studies does one need to see about lipid lowering and fewer MI and prologned survival, or blood pressure, etc.??
I just dont know what to say.
I’m speechless.
Anonymous
He didn’t say “no one” and he did say he takes a statin. Did you read the original post/link? Many physicians neglect themselves, particularly in a preventative sense. If it doesn’t cause a symptom, they don’t worry about it. And when it does, ignore it until it is really bad or chronic. In the meantime keep on working, your patients need you!
I suspect doctors as a group have an incredibly low personal utilization of health care resources.
Megan
Apparently this guy has never heard of the DCCT. Ah well, what’s the DCCT matter if you’re not an endocrinologist, right? /sarcasm
Anonymous
Mike, the first poster was in his 20ish with no family risk factors for heart desease and he was put on statin. What was exactly his 10-year absolute risk of heart attack? Would you care to tell us what is (in absolute risk reduction) the chance he’ll benefit from statin use? And while we are at that could you show some studies of benefit for primary prevention in this low-risk group?
If the guy’s risk of heart attack is under 10%, why was he put on statin in the first place? Is this evidence-based medicine?
Mike
The original poster isnt talking about his “absolute risk reduction”. He summarizes his various metabolic problems, and then ponders whether he should “live lif to the fullest”, like the other doctors he knows. And I love how he laments he’s been “forced into an exercise regimen”.. as if that was a BAD thing!
If anyone has a crystal ball out there and knows which patients are going to benefit from hypoglycemics or statins, and which won’t, PLEASE SHARE IT WITH US!!! Otherwise, guidelines and advice are all we have. If you choose to advise someone to “live it up”, then more likely than not you’re doing the patient a disservice. I’ve seen enough diabetics with amputations, dialysis, blind, etc living their life in the hospital, and I KNOW they would do better on meds (obviously not a cure and in concert with diabetic diet and exercise).
Anyway, who says he is at low risk? I havent seen his chart.
Anonymous
Mike, I know you don’t have a crystal ball, but you can predict someone’s 10-year risk of heart attack. I agree, though, that complaining about “being forced into an exercise regimen” is ridiculous; especially since his grandparents who lived life to the fullest got plenty of exercise.
At the same time, the original poster said that 1) he has no family risk factors for heart desease 2) he is not overweight. Does it sound like someone whose 10-year risk of heart attack is in double digits?
This is from a slim athletic woman, btw, with no diabetes, low sugar and normal blood pressure, and 10-year heart desease risk under 1% according to Framingham calculator. Yet my doctor wanted to give me statins for mildly elevated LDL with normal ratio. Of course the evidence for statins for primary prevention in healthy women is ever so compelling…
AmyT
The obvious thing to do is explain to patients the medical risks of running high BG versus taking the BG-lowering drugs. I daresay most patients would choose the drugs.

Lowering blood sugar

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