Confessions of a Diabetic Pill Pusher

Being diagnosed with diabetes is a life-altering event for several reasons.  Besides the initial thoughts of confusion and, at times, disappointment and fear, diabetics are in for a myriad of changes to their daily healthcare regimen. 

While the basic treatment of diabetes consists of oral medications for those with easy-to-control cases and insulin injections for those with difficult-to-manage disease, there are several other medicines and guidelines that must be adhered to in all diabetics, as these things have been proven to reduce cardiovascular and kidney complications and, in some cases, reduce mortality. 

Below is a list of medications and recommendations for all patients with diabetes.  As always, please consult with your physician for any applicability to your personal situation or to that of a loved one.

Let me just say this before you get to the information below though (queue the opening theme from “Doogie Howser”): Part of my job as a young physician building a new medical practice is to not piss people off.  However, as it pertains to medical care, it is in the best interest of all involved for me to tell patients what they need to hear and not what they want to hear. 

I bring this up, because I saw a diabetic patient this morning who was frustrated that I recommended that she adhere to the guidelines presented below.  Long story short, she was an obese, middle-aged type 2 diabetic that was solely on insulin for therapy.  As you will read below, such management of diabetes is incomplete. 

Usually whenever I reveal to someone that they have been inadequately treated for something in the past, he/she is grateful and eager to resolve the deficiency.  Occasionally though, patients are satisfied with the substandard care they have received in the past out of some desire to repress the reality of their current medical condition. 

If you find yourself following this line of thought, stop and try to adjust your approach.  Otherwise, you will unfortunately find that the risks of such most definitely outweigh the benefits.

Now, on to the list:

• Stop smoking.

• Start a blood pressure pill in the ACE inhibitor/ARB class.  Even in patients without high blood pressure, these medicines protect the kidneys in diabetics.  For those patients with high blood pressure, pressures should be kept below a level of 130/80.

• Start a cholesterol medicine in the statin class.  Even in patients without high cholesterol, these medicines reduce the risk of stroke and heart attack in diabetics.  The goal “bad cholesterol,” or LDL, should be under 70.

• Start a daily baby aspirin.  This provides heart protection.

• Initiate yearly eye exams done by an ophthalmologist.  Diabetics have a higher risk of eye problems when the disease is not well controlled.

• Initiate yearly foot exams.  Diabetics with advanced disease have issues with sensation in the feet (called neuropathy) that can lead to difficult-to-heal wounds.

• Have the urine checked yearly for protein, which suggests kidney disease.

• Obtain a yearly flu shot.

• Obtain a pneumonia vaccine.