From Medscape Education Family Medicine
Intensifying From Oral Therapy to GLP-1 Agonist/Basal Insulin Combinations CME / ABIM MOC
CME / ABIM MOC Released: 9/20/2016; Valid for credit through 9/20/2017
This is education program. Next month there would be another episode, so I hope I will watch it and give my attention to the clinical education program.
Now the question is, what about all time medical statement how to delay diabetes type 2 diagnose? It is all time said by medical publishers that diabetes type 2 can be delayed. Really, what is the meaning of this statement? Millions of diabetics type 2 live with already full bloom diabetes, and still medical practitioners delay to diagnose the potentially fatal medical condition their patients do live today. Why the level of sugar is not vital? if it is vital then there would not be diabetics who live with diabetes and do not know about it.For patients, diabetes can be a difficult disease to control, and treatment, once it begins, is generally a lifelong process. A 1-size-fits-all treatment approach does not work. To achieve and maintain optimal glycemic control, clinicians must individualize and intensify treatment plans based on combining drugs with complementary mechanisms of action -- ideally, as early in the disease course as possible.
There is second statement that: " once it begins, is generally a lifelong process". What about Dr. Oz and professor R.Taylor who cure diabetes withing 8 weeks with Starvation diet and shakes? It was ADA who proudly presented that diabetes type 2 can be cured with starvation diet. Now ADA participate in another studies and the educational program suggest to trust in the statements they present? I better to trust in my own studies then in any Medical presentations.
To achieve and maintain optimal glycemic control, clinicians must individualize and intensify treatment plans based on combining drugs with complementary mechanisms of action -- ideally, as early in the disease course as possible.Really? No, thanks. I use another mechanisms. I do not base dose of insulin I take every day on any plans. I base it on the meter reading I take every day a few times. Regarding of that readings I inject basal insulin a few times daily depending on the glucose meter readings.
I do not take any intensification in my treatment with basal insulin therapy. Diabetes is very complicated medical condition. Our medical condition get worse even with weather changes deep in space. Personally I feel it when rain will come or rainy days would be stopped and sunshine would above in the sky. I cannot prove it, but I feel it. It is all the time in my bog book. I take more Excedrin in these days.
The dose of insulin also would be different. I already posted that level of sugar is seasonal. No one Medical publishers ever stated it. Why, really? It is so easy to see with good observation to many patients in medical settings. There are flu season, why? Because of many healthy individuals would get flu in this particular time. There are possible to get flu in any other time, but still, in Fall there are more people get sick then in any other seasons. Then why in no one medical publications it is mentioned that level of sugar very sensitive to seasonal changing? Did someone medical pro studied combination of wind and cold and Sunshine on the level of sugar in blood?
Recently it was published that Glycemic Index cannot be reliable. Is the possible that Health plans and diets are not reliable as blood sugar control plans? I do think so, so I do not relay on any plans medical care suggest. I relay on insulin injections day after day. No any combination.
Consensus statements from the American Association of Clinical Endocrinologists and the American College of Endocrinology and from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recommend adding 1 of 6 choices to metformin in a dual therapy approach.Well, how Metformin effective to the blood sugar control? It is easy to see by own blood sugar level. Just take Metformin and see how it effect the level of sugar in your own blood. If one is not diabetic then one would have low blood sugar then normal. If one is diabetic then high numbers would go down. It is if Metformin works. If it does not then there is no effect on the level of sugar in any blood, diabetic or not. To compare, take insulin and see if level of sugar would drop. It drops in every blood, diabetic or not. This means that insulin works, and it effect blood sugar level.
Now, if Metformin did not work in first place then why it is still be taken and another medicine must be added as add-on? Probably it is better do not take Metformin and take another type of medicine which control blood sugar level?
The oral drugs recommended are the sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, thiazolidinediones (TZD), and sodium-glucose cotransporter 2 (SGLT2) inhibitors. Or you could add an injectable agent -- basal insulin or a glucagon-like peptide-1 (GLP-1) receptor agonist.Sulfonylureas (SU) is type of medicine to force ill pancreas to work harder and secret more insulin. Reason? Pancreas is already in critical condition. SU added to treatment plan with combination with Metformin will lead to fatally high or fatally low level of sugar in blood, but never to blood sugar control.
Dipeptidyl peptidase-4 (DPP-4) Junuvia, Junumet, Ongliza.
Current oral treatment modalities for type-2 diabetes are aimed at suppressing hepatic glucose output, stimulating insulin release, mitigating glucose absorption, and increasing peripheral glucose utilization.So, the action of medicine is to suppress glucose release by liver which human body uses between meals. So, there is why diabetics type 2 do have wide middle area, and no one work out work for us to lose weight. In all those actions there is only one, stimulating insulin secretion to solve the problem. It is easy to see why diabetics type 2 die withing ten years after being diagnosed with diabetes and started treatment with all these Junk Medicine.
Clinical data have revealed that these therapies improve glycemic control while reducing body weight (GLP-1 receptor agonists, specifically) and systolic blood pressure (SBP) in patients with type 2 diabetes.It is article in ADA and it is first paragraph. So, why it is so important to lose weight and systolic blood pressure but not anything about blood sugar level reduction?
At present, many available treatments for type 2 diabetes fail to maintain glycemic control in the longer term because of gradual disease progression as β-cell function declines.If so, then why all these treatments are still on market and our doctors still Rx them one year after another? Probably it is ADA guidance how to treat diabetes type 2, first line, second line, dual therapy and so on.... . Probably it is time to put ADA on Starvation diet and let them try to survive on it.
Dr Wysham: Clinically speaking, when and why would it be more appropriate to initiate fixed-dose combination therapy?My Goodness! This doctor pretend to speak 'clinically'? How any fixed dose can be appropriate in constantly changing blood sugar readings? At least try do not ask questions which show how unprofessional you are. Still, another doctor happily to answer to this question. Does he understand the subject he pretend to discuss? Not at all. If he does then he must answer to the question in different way. Still, he discuss that fixed dose of injections can be initiated.
Dr Buse: .... Specifically, for a patient who is currently at an HbA1c of 8.4%, using insulin and a GLP-1 receptor agonist in combination reduces the nausea and other GI adverse events seen with GLP-1 receptor agonist use and the weight gain and hypoglycemia seen with insulin.I was going to take one step after another to show how all this discussion looks from diabetic type 2 open mined perspective. But when I read this part of discussion I realized, there is nothing better what I can say. Diabetics type 2 on medicine to treat diabetes type 2 do have A1c=8.4% and now they discuss combination therapy basal insulin + DPP-4? You must be kidding!
(Victoza, Saxenda), approved 2010
(Byetta/Bydureon), approved in 2005/2012
(Trulicity), approved in 2014—manufactured by Eli Lily K
Now it is 2016. Why medical providers did not use Victosa or Byetta to treat those diabetics type 2 and led them to develop A1c>8.4%? Did providers were looking when combination medicine would be developed? Or this medicine simple did not work, so now it in combined with basal long actin insulin Lantus Solo Star and presented that combination of two will provide better result then any one of them separately?
No, thanks. I really cannot trust in doctors. Insulin works without any add-ons. It is dose of insulin which can be increased to reduce level of sugar. But no one combination therapy when really good medicine combined with Junk Medicine can be better then any one of this medicine separately.
How it was possible that diabetic got to 8.4%? This is why diabetes type 2 progressive. With proper therapy there is no progression. I take Lantus Solo Star now. I started with insulin Detrermir in 2011. No progression in my diabetes and blood sugar readings. All progression boost right away when insulin supply terminated, and I cannot afford to pay for medical care.
My A1c dropped from 9.4% down to 7.1% with basal insulin only. No combination therapy, just Lantus Solo Star. I already lost 20 pounds in weight, no any diet at all, no any work outs. Just my regular healthy life style. My dose of insulin dropped form highest dose 400 units daily down to 160 units some days. So, do not say, diabetes is progressive. Do not say diabetes can be treated with life style modifications or any combination therapy. Do not say, there is diabetes type 2 which resulted by obesity. There is no 'insulin resistant body'. It is only 'Insulin Resistant Medical Care Providers' who aggressively push diabetics to the treatment which kills millions of us year after year. Diabetes type 2 is number 7 cause of Death in America, and it is number 4 cause of Death in NYC.
Dr Buse:..... Further, the tolerability and titratability provide patients with the ability to increase or decrease their dose as their blood glucose control waxes and wanes with changes in diet, activity, stress, or just aging. It puts the patient in control, which is really the key to enhancing adherence and long-term control.Sorry Dr. Buse. You better to stop to put finger to patients that it is our diet or low activity that leads to increase level of sugar in blood. Your duty to provide treatment that no stress or aging result early timeless Death or disability. Your patients develop high progressive disease, and it is only result of wrong treatment. Try to use this type of treatment on those who get pneumonia and patients would die. With right treatment they recovery and live long. The same as diabetics type 1. They take insulin in injections and live full lives, over 80 years after being diagnosed as children. In contrary we are, diabetics type 2, die withing ten years after being diagnosed with diabetes, why?
Just say me, why I am insulin resistant diabetic? Why I am 'insulin independent diabetic'? I cannot live without insulin. Even one dose skipped rise my level of sugar dramatically. And providers resist to Rx insulin to me because of my diagnose, diabetes type 2, insulin resistant (Hell do know what does it mean) and insulin-independent. Providers insist, I do not need insulin. Really,what do I need according to Medical Care? Grave? Crematorium? Recycling Center in my local Coney Island Hospital?
via Ravenvoron
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