A lot of the topics I write about are inspired by something that has come up in one of my classes. This blog is no different.
Avoiding taking diabetes and blood pressure medicine
Several weeks ago a patient was referred to our 10-hour comprehensive diabetes class. When reviewing the patient's health questionnaire with her she spoke up and said that she had listed all of the medications she was supposed to be taking but that she was not taking any of them. I repeated back to her what she had just told me to make sure that I had heard her correctly. When she confirmed what I thought she had said was true I asked her why she was not taking the prescribed medications. She told me that she wanted to try and control her blood pressure and blood sugar levels without having to take medications, and that is why she was attending the class.
I can certainly understand her desire to do this and respect her attitude for being willing to do what it may take to accomplish her goal, if it is possible. At this point no one knows if it is possible or not. As I reviewed her list of medications I saw she had been prescribed at least one diabetes medication as well as one for high blood pressure. She then offered to show me the sheet where she had been recording her blood sugar values and blood pressure readings. The blood sugar readings were not horrible but were definitely too high. A hemoglobin A1C was not available. Of real concern were her recent blood pressure readings with frequent diastolic pressures in the 90s and on occasion in excess of 100 mm/hg. Her systolic readings were in the 140-upper 160 range (1).
I reiterated to the patient that trying to manage her diabetes and blood pressure without medications definitely had some advantages and was a goal to shoot for down the road -- however, that until she was able to achieve good blood sugar control and blood pressure control she was increasing her risk of diabetes related complications and stroke. I am not sure about this but I suspect that either the look on my face, or the tone of my voice, in combination with what I said was enough to cause the patient to rethink her decision. She responded, "So you think I should be taking my medications? OK, I'll start taking them then." (I wish things were this easy with my kids.) I told her I thought that would be a good idea.
When is it OK not to take your prescription medications?
If your doctor has prescribed medications to treat a condition or illness it is never a good idea to not take the medications as directed without first discussing it with the prescribing doctor. When rosiglitazone was under suspicion for causing heart attacks and being investigated a few years ago one of my patients spoke up in class one day and said that as soon as she heard the news on the television she never took another pill.
I can certainly understand the patient's concern -- however, I would have advised her to talk to the doctor as soon as possible to discuss the situation first. Suddenly discontinuing certain medications can be very dangerous so if a patient wants to do that it should be done with the advice of the doctor so as to do it safely.
Want to control your diabetes without medication?
If I had Type 2 diabetes I would want to be able to control it without having to take diabetes medication for sure. But this is how I would do it.
If my HbA1c was elevated above what I wanted it to be, let's say under 7 percent, and it was more than 0.3 or 0.4 above 7 percent I would ask the doctor to prescribe medication for me even if the doctor was not planning to. What! Why would anyone in their right mind do that? This is why. We know from studies as far back as the Diabetes Control and Complications Trial that people that are able to maintain a HbA1c score under 7 percent have far less likelihood of developing diabetes related complications (2). We also know that eating better, losing some excess body fat and getting plenty of exercise can many times have a normalizing effect on blood sugar levels. I would tell the doctor that I definitely plan on making all of the desirable lifestyle changes and that I would expect my HbA1c to drop below 7 percent as a result of making these changes, however, just to be sure that I get it under 7 percent as quickly as possible I would appreciate a prescription for some diabetes medication, probably metformin to help ensure that I accomplish my sub 7 percent HbA1c. Once under 7 percent then I would talk to the doctor about weaning me off of the medication.
Don't take your time getting your HbA1c down
Something I always tell my patients is not only is it important to get their HbA1c less than 7 percent but also important is to do it as quickly as possible because the longer it is elevated the more likely complications will occur (2).
So to summarize my patient's situation, for the time being she needs to take both her diabetes medication and her blood pressure medications until such time as her blood sugar levels and blood pressure are far better controlled at which time she should discuss her situation with her doctor again. Hopefully making some positive lifestyle changes will make it possible to reduce or eliminate her medications but that remains to be seen.
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