How do doctors decide if a diabetes patient needs to be on medication?

How do doctors decide if a diabetes patient needs to be on medication?

There are many who responded to the question. I am not member of that forum. I am outsider. No one diabetic forum accept me as member. Usually after a few posts I am banned. Why? I am not aggressive or negative person. Just do not start to bark on me. What is important, I never follow leader or shepherd. I do have my own personal experience, and all my responds are hones.

Do doctors immediately prescribe medication if your blood sugar is at a certain level, or do they wait and see how your glucose level is affected by diet and exercise?

         No. Regardless of the level of sugar in blood first line or medicine is all the time Life Style Modifications. All MD do know very well, there is no such diet which will reduce level of sugar in effective way. But with diagnose according to the level of sugar it is easy to be manipulated. Simple, even when sugar is high after a time of fasting sugar will drop without any medicine. Level of sugar is higher after meal, and lowest after night sleep. So, to diagnose diabetes no one use highest level, but only lowest level of sugar in blood. If this level still high then MD will say, patient is not fasting.       
         Every visit to clinic paid by Health plan. So, it is important to hold patient as long as MD possible can. Do not even hope that your health is important to your doctor. Healthy patient no more paying patient. If sugar in blood is elevated it is time to spread The Net.
        MD will sent patient to all his friends to evaluate health, as it is presented to the patient. One round after another prospective diabetic walk from one clinic to another, hold Rx to huge amount of medication every one MD Rx to patient, and no one diagnose what is going on. Be ready, no one will diagnose any medical condition.

It depends on the Dr. technically if you get 2 fasting blood sugars at 125 in a row that is a type 2 diabetic diagnosis usually. Some will consider to try with a weight loss plan and diet and exercise and start on a low dose of oral meds.Depends on the patient. How overweight, what had they been eating before, how many bad carbs were they eating, calories a day?? etc...

As I said, spread The Net. Fish is coming.

My doctor knew I was the dedicated type who would stick to a new way of eating and exercise, so didn't put me on medicine right away. 3 years later, I'm still off medicine.

       Best way to pretend that diagnose and treatment work.  I am off cancer medicine. Why not I am hero? Why it is so widely spread that diabetes is all about overeating? Because how to explain to public why 80,000 patient died due to diabetes every year? The medicine is already on the market almost 100 years. There are so many good and effective types of insulin. Why 96% of diabetic population treated with life style modification when they do have fatally danger medical condition such as Diabetes type 2?
     Why when we do have flu we take some medicine? Why if we do have infection we take antibiotics right away? Why if we are diabetics with elevated level of sugar in blood and with reduced insulin secretion or limited insulin storage capacity, why we have to be off medicine?
     This is why I banned from every diabetic forum. The diabetics who are off medicine, and I still do not get, why they are diabetics?  will bark on me that if they do it then every one can do it. In some post one person posted that she dropped her weight aver 100 pounds. She was 320 pounds at age of 24, and now with diet she was 230 pounds. My Goodness! At age of 24 how she was able to get 320 pounds? Sure she must watch what she eat. At that time I was 200 pounds, and every MD told me, if I lose weight I will be diabetes free. My blood sugar was 370 mg/dl, fasting.

A year ago at diagnosis, I was put on metformin the day I was informed by the nurse on the phone. I argued back and forth for 2 weeks through the nurse that I wanted to try with diet and exercise. Finally, Dr. relented. One month later he stated that if I continued on the diet and exercise that I would never have to take any meds. Knowing the progressive nature of the disease, I am working to stay med free for as long as I can. Maybe forever, maybe only a few years. Optimistically, I have my sights on forever!

        Very lovely story. Only one point still not clear, why author argued that he will try on diet and work out? No one limit for that.  Just start to do what you want to do, and no one problem. It is medicine we have to argue we need, and MD refuse to Rx it. If one wish to take Metformin then it is not so complicated. Try to get Rx to Insulin. There would be Big Problem, Usually it is presented that Health Plan does not pay for effective medicine. In practice, it is MD who never Rx medicine which is effective. Fish is already in net. Just try to keep it alive and treat as you wish. Money will be follow.
      Also pay attention when posting. You said that " Knowing the progressive nature of the disease". So, if your plan works and diet and work out solved the problem, what is next? are you cured? If not then all attempt to stay off insulin only increase the gap between insulin available in secretion and insulin in demand for body function. Work out need more insulin, it is energy in demand. So, more insulin would be used to keep body to function healthy. At the same time diet means some restrictions such as carbs, calories, and so on. Anyway, it is restriction in nutrition.
      All what I can say, author is not diabetic, according to the post he posted.

Expert: Great question about how doctors decide about medication. Standard guidelines recommend a general approach of starting with lifestyle modification (eating and exercise) and then adding medications if blood sugar levels are not adequately controlled. If diabetes is newly diagnosed because a patient presents with symptoms of high blood sugar (such as excess thirst, excess urination, blurry vision, etc.) then we typically use medication immediately to bring the blood sugar closer to normal and alleviate the symptoms. Furthermore, metformin is approved to use in prediabetes to delay or prevent the onset of type 2 diabetes, and one can justify using metformin in anyone with type 2 diabetes or prediabetes.

      Let us start from the end. If Metformin used to prevent diabetes type 2 development, and still, patient developed diabetes type 2, then what is the reason to take Metformin? It does not work for this patient.
      Why metformin used in prediabetes? Because of it is not high blood sugar and treatment can be delayed.  At the same time Fish is in Net. Naive diabetic go to doctor, and all rounds around and about all his network.
      Now, in clinic in doctor's office patient with potentially fatal medical condition. If left untreated patient will develop severe medical condition, leading to amputations, CVD, and all many other. What doctor is doing? What doctor is talking? Recommendations. Doctor deny treatment for patient, but talk recommendations. As I said, just read what they said and keep your eyes open and do not let your brain be washed.
    Finally in this psrt, metformin never bring blood sugar numbers to normal level. Usually it is Norms adapted to the level of sugar in patient. What blood sugar level patient developed, this is The Normal. Works perfectly for every one MD.

Expert: The threshold for starting medication can therefore be any point between A1c of about 5.9 to 7.0. Once the A1c is higher than 7.0 it is harder to justify delaying medication. In any case, doctors and patients need to have discussions about the benefits, risks, and drawbacks of using medications, and these benefits, risks, and drawbacks change depending on the degree of glucose control and the type of drug(s) being considered.

       At this point metformin would be added. It does not bring blood sugar down. So, SU would be Rx. SU is perfect way to keep Fish in the tank. Slow, SU kill insulin secreting  beta cells  so, diabetic type 2 secured on the hook for the rest of 10 years. Then diabetic usually transferred to Marque.
      It is well known that every oral medicine reduce A1c down to 1%. Regardless how high dose of it, the A1c would not be normal with any oral medicine. So, right from the first visits doctor deny patient right treatment. Every MD know very well that Insulin will reduce any level of diabetes down to normal level. Why insulin is not first line in diabetes treatment? Why? Simple, healthy patient no more paying patient. In every clinic most patients are diabetics type 2. Stop diabetes and what? No more needs in medical clinics, at least in the spending our public system pay for medical bills.

Expert: Personally, I start to think about starting metformin if a patient cant keep the A1c below 6.5. If someone wants to use lifestyle change and weight loss to reduce medication I usually discontinue the sulfonylurea type drugs (glyburide, glipizide) if the blood sugar levels start to dip below around 70-80 mg/dL, or the A1c goes below 6.5. I like to stop the metformin once the A1c stays below 6.0 for about 3 months, provided that the patient can maintain or extend the weight loss and lifestyle changes.

       As I said, SU,  the sulfonylurea type drugs (glyburide, glipizide, would be strated. What Expert did not say, when and why it is SU he start in stead of insulin? Su is the same idea, to add insulin in blood stream. Insulin in injections keep diabetic's ill pancreas out of herd work, and let all the system slow recovery. In contrast, SU push pancreas to secret more and more insulin.Diabetic pancreas, which is ill, chronically ill, must work hard to do job which body system does not need it does. Insulin secreted regardless of demand, just under stress and force of medicine. Is this healthy way to treat chronically ill patient? It is the same as critically ill patient sent to do contraction work.
      Does Expert understand it? Yes, he does. What he does not understand that we also can see the way by our own eyes, despite of any brain washing Expert's recommendations.
      Personally, I prefer to inject 700 units of insulin rather then take SU and metformin. What is important in this Expert options, they never say that oral medicine they Rx to the diabetic diabetic must take for the rest of short life. At the same time, insulin will prolong life and well being. With proper and timely use of insulin next generation of diabetic's patients will be born diabetes-free. Of cause, if insulin would be available. To keep diabetic livestock  best way is to stop manufacture insulin .
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