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Question:

From Lisle, Illinois, USA:

I was diagnosed with type 1.5 diabetes this past March. I'm taking 10 mg of glipizide in the morning and 1000 mg of metformin morning and night. I had fairly good glucose readings until recently. My morning (fasting) readings are now around 150 mg/dl [8.3 mmol/L] and two hours after eating are near 300 mg/dl [16.7 mmol/L]. My last A1c was 6.1 in August and I am due for another test this week.

My doctor doesn't seem to want to put me on insulin. She wants to add Byetta if my A1c goes up. What is the downside of being on insulin? What are the side effects, if any, of insulin? Would I have better blood glucose control with insulin? I feel that I am being treated for type 2. Am I missing something?

Do doctors get a kickback from prescribing new medications?

Answer:

You have to go back to the diagnosis. How sure are you that you have something else besides type 2 diabetes? Byetta is not meant for patients with type 1 diabetes. For patients with type 2 diabetes, it is very good and would be appropriate. Perhaps your doctor could look at your C-peptide and insulin response to a mixed meal challenge or glucose challenge and see if you mount much of an insulin response. If you do, the Byetta may be okay to try. If not, insulin is more appropriate to use. The downside of insulin is the multiple injections (although Byetta is two injections per day as well), the possibility of weight gain (where people lose weight with Byetta when it is successful), and you use more than one kind of insulin. Usually, a basal insulin that treats blood sugars between meals and a rapid-acting insulin with meals are used together. You are being treated for type 2 diabetes with that regimen. At some point, if you really have an autoimmune form of diabetes, there is beta cell failure and you need to be on insulin.

JTL

Additional comments from Dr. David Schwartz:

Doctors do not get "kickbacks" from using medications.

Doctors do want to get experience with new medications and the main way they get that experience is to begin to prescribe new medications to their patients.

Some doctors are involved in "Clinical Trials" which essentially means relatively controlled protocols for new medications which, typically, have NOT yet been completely FDA-approved for the use in the Clinical Trial. These Clinical Trials are often sponsored by the pharmaceutical industry. Your doctor is required to have you sign materials indicating your willingness to participate in a sanctioned Clinical Trial. Clinical Trials of this sort are RESEARCH and non-standard and it should be clear if you are participating in such. The sponsor does typically pay some remuneration to the institution (not typically the doctor, personally) for the doctors' and staff's extra time, paper work, testing, etc involved in enrolling patients into research protocols and Clinical Trials.

DS

DTQ-20051214170559
Original posting 19 Dec 2005
Posted to Other and Insulin

  
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Last Updated: Tuesday April 06, 2010 15:10:04
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