Thirty years ago, when we were residents and fellows at the Philippine General Hospital, there was not much that could be done for patients with diabetes. In those days, there was almost never a day that there was no patient for amputation or peritoneal dialysis. Today, thanks to a more correct understanding of diabetes, newer and better therapies are being developed that target the cause of diabetes rather than just lower the blood sugar.
Only three drug therapies were available in those times—sulfonylureas, exemplified by glibenclamide, which directly stimulate insulin secretion by the pancreas; metformin, which facilitates muscle and liver uptake of sugar; and finally, insulin. The order they were given was according to the understanding of diabetes then, which was that diabetes was primarily a lack of insulin, so sulfonylureas were first to be given. This unfortunately further exhausts the insulin reserves.
In reality, diabetes is caused by an inefficient uptake of sugar by the muscles due to lack of exercise and a high saturated fat diet (the fat that gets thick when they cool down), principally beef and pork. This forces insulin to be oversecreted to get the sugar and the fat from the blood. Since blood sugar is normal, early diabetes is not diagnosed; the only clue is an overweight or an obese individual. Once insulin reserves are depleted and blood sugars go up, that is the only time diabetes is diagnosed.
New drug therapies available now act by conserving insulin, not exhaust it. Metformin, which does not stimulate insulin, is still the cornerstone of initial therapy but sulfonylureas are losing their utility and popularity. A new class of antidiabetics allow the natural intestinal insulin controllers, called incretins, to stay longer. And the most recently available drugs act by excreting the excess sugar in the urine. If insulin is needed, as a lifetime or temporary replacement, newer and better insulins are also available that more closely mimic the natural insulin secretion.
Take-home messages: First, prevent diabetes by daily exercise (20-30 minutes of brisk walking or equivalent is recommended) and consumption of healthy low saturated fat, high fiber, low sugary diets and drinks. Second, if you already have it, take heart, diabetes progression can be slowed down or prevented, and in a great majority, may still be reversed. Third, drug therapies are constantly being developed that seek to accomplish these goals.
Finally, when it comes to prescription drugs as were mentioned in this article, remember, you are not the doctor, you are the patient—never take prescription drugs by yourself just because they are cheap or were recommended by your friends; they may do you more harm than good.
Dr. Guillermo Manalo Jr. is fellow and former director of the Philippine Society of Endocrinology, Diabetes and Metabolism. The A to Z of Health information advocacy is a joint initiative of a group of medical specialists and supported by AstraZeneca Philippines aimed at raising public awareness on various diseases and providing health information and updates to the healthcare community.