Type 2 Diabetes is a prevalent problem, and ideas and perceptions about diabetes have penetrated our routine conversations, stories have woven into the fabric of our culture almost reaching the status of folklores and myths.

A newly diagnosed person with diabetes who feels overwhelmed by the disease usually comes with only one request-I do not want to start the medicines. “Log Kehte Hain…(people say)” once you start a medicine, you have to take it lifelong. My question is “kaun Log..” Some relative, some neighbour, some friend…the sources are multiple and a person with diabetes would hang on to any story who helps her/him to make sense of this overwhelming reality of a lifelong disorder. Before I move forward: My answer in one line—No, None of the diabetes medicines including insulin are addicting.

Then there are those success stories of reversing diabetes with just diet and exercise, and all these success stories luring people with the idea of removing the label of diabetes. There motto being-if I can do it, you can too. Many of these success stories are branding their lifestyles commercially. My answer would be: Yes, Type 2 diabetes can be reversed. Studies on reversal of diabetes show that average 10-15kg weight loss, results in removal of fat from liver and pancreas. In most cases this would reverse diabetes and if weight regain is avoided, this reversal is durable. The reversal is more likely in the first 4 years of diabetes. So focusing on lifestyle is of paramount importance in preventing the development of diabetes and in reversing as well in early stages. 

Without this much amount of calorie restriction and exercise however, one cannot just wish away the disease. It’s not always practical for everyone to achieve this much amount of weight loss, and there are sometimes other pancreatic factors which prevent diabetes reversal. So it should not happen that while trying to reverse diabetes, one lands up with some irreversible complication of diabetes. 

My advise to someone new to this disease: Be clear about your goals, which is to achieve a long, healthy, productive, meaningful and happy life! The means to achieve that will be different for each of us. Some people follow rigorous diets, like intermittent fasting; others feel that might affect their work efficiency and want a rather moderate diet approach. Some run marathons, others enjoy strolls. Some need tablets, some don’t and some may need injectable therapies. But each of them have unique life values, perspectives. So do not compare yourself with others, do not judge yourself by the number of medicines you are taking. You are unique and so is your diabetes.

A strongly held belief: “Log kehte hain…western medicines have side effects. Herbal medicines are safe”. Its good to be aware and enquire about the benefits and side effects of medicines. 

The terms herbal and western are misleading! The term HERBAL has been exploited to give you a false sense of safety which is far from the truth. The same safety and quality insurance is not required for homeopathic or Ayurvedic or alternative medicine, and that’s a problem.

Any medicine should only be taken if the benefit outweighs the risks.

The medicines which help in reducing glucose are:

Metformin: Its a safe medicine, available for many years, good for heart, no risk of low sugars.Can cause a little weight loss. The only side effect is stomach upset in few individuals. There are no long term side effects. Sometimes patients come and say..”Log kehte hain…Metformin causes kidney damage.”My answer: Not true. It is safe for kidneys. Examples: Carbophage, glycomet, gluconorm, cetapin, glyciphage……

Gliptins: Safe medicines, do not cause hypoglycaemia, weight neutral. Safe for heart and kidneys. Examples: Sitagliptin (Istavel, Januvia); Vildagliptin (Jalra, Galvus); Linagliptin (Ondero, Trajenta)

SGLT2 inhibitors: A new class of drugs, which remove sugar in urine. No hypoglycemia, Cause weight loss, protective for kidneys and heart. Side effect: genital infection. Examples: Canagliflozin (Invokana, Sulicent), Dapagliflozin (Oxra, Forxiga), Empagliflozin (Jardiance, Gibtulio)

Sulphonylureas:  These medicines have been there for many years, effective in lowering blood glucose. Their use has reduced with the availability of gliptins and SGLT2 inhibitors because they can cause hypoglycaemia. However still useful in addition to these medicines, or if more economical options are needed. Examples: Glimepiride (Amaryl, zoryl, glimisave, azulix, apriglim, GP etc), Gliclazide (Reclide, Diamicron, Cyblex). Older sulphonylureas may not be cardiosafe, hence not preferred.

GLP1 analogues: These are injectable therapies either daily or weekly. They control glucose and help in weight reduction, reduce the risk for heart disease. Expensive and frequently cause stomach issues. Examples: Liraglutide (Victoza) daily, Dulaglutide (Trulicity, aplevant) weekly.

Insulin: Insulin is the main character of all folklores, highly controversial. 

“Log kehte hain…insulin once started always needs to be taken.” Not true at all. We start insulin during hospitalisation frequently and later it is stopped mostly.

“My aunt was taking insulin and she developed kidney failure because of it.”Not true.The reason why these complications develop is because of delaying insulin. If started timely it could have saved kidney problems in many, blindness in many, foot amputations in many. 

Some patients have a perception that “Insulin has lots of side effects”. It is a safe anti diabetic medication, even during pregnancy. One important side effect is hypoglycemia, which can be avoided by careful titration.

On the other hand sometimes people take insulin thinking it is better than oral medicines, Even that is false. Tablets have their place in management, and insulin has its own place. One cannot replace other.

Having type 2 diabetes and high glucose increases the risk of having kidney failure, blindness and heart attack. These complications can be prevented by good control of glucose, blood pressure, cholesterol, a healthy diet and regular exercise. Know more about diabetes and stay safe.