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September 30, 2002

Pills for Diabetes

Question from Los Angeles, California, USA:

I was diagnosed with type 2 diabetes two years ago, and after about six months on Amaryl [glimepiride] and Precose, careful diet and dropping 30 pounds, my doctor and I were able to keep my sugar under control (all hemoglobin A1cs 5.7% or less) just using Precose. Recently however, my HMO changed providers, and my new doctor considers the Precose a "crutch." He insists that if I can keep it under control with just the Precose, I should be able to adjust my diet further to need no medications. The problem is even just 20 grams of carbs per meal puts me at almost 300 mg/dl [16.7 mmol/L] after meals, and it takes three hours for level to return to normal. I don't know if I can handle a diet of less that 100 grams of carbs per day on an ongoing basis, but he refuses to renew my Precose prescription telling me instead to "have a little willpower".

Answer:

It sounds like what you were doing was working, and I operate on the theory that if it is not broken — don’t fix it! It disturbs me that your current physician calls Precose (acarbose) a “crutch” and not a valuable tool to control your diabetes. One option would be to find another doctor on your plan that is happy to work with you, not against you. Think about it!

JS

[Editor’s comment: It doesn’t sound like it’s appropriate to tell your current doctor, but Precose (and all the other diabetes medications on the market in the US) have to demonstrate their efficacy (ability to help control blood sugar levels) to the FDA before they’re approved for marketing in the US.

I think you seriously need to consider switching doctors, and probably also should contact the HMO’s ombudsman (the patient complaint department — it probably has a different name in every HMO) and let them know your story.

WWQ]