A new review last week from Quebec Universities of insulin use in 69674 elderly diabetics is both limited in application, and instructive. We regularly see older patients who were started on insulin when they were first diagnosed diabetic because they were acutely ill, but who mostly should have been weaned off insulin fairly soon onto metformin etc, since even insulin is associated with higher mortality let alone complications. The topic is thoroughly discussed recently.
Since hypertensive and glycation damage is a common consequence of even the prediabetic metabolic syndrome, a crucial issue is what we see in practice, that for the treatment of hypertension, the triple combination of low-dose thiazide diuretic eg HCT 12.5mg combined with amiloride 1.25mg as eg amiloretic /coamilozide and with lowdose reserpine (rather than betablocker) has no risk of aggravating or causing diabetes. It is unsurpassed for the gentle normalization of most mild to moderate hypertension- especially when combined in the overweight with metformin to tolerance so as to virtually abolish the future risk of developing diabetes. This combination brings no serious problems, unlike the betablockers or the now-heavily punted but troublesome calcium channel and angiotensin blockers.
It is encouraging to see confirmed that in these elderly Quebecois (even with only 71% on metformin; 29% on sulphonylurea monotherapy – which like cortisone doubled the risk of needing insulin; 25% on thiazide and 30% on betablocker therapy, and 5740 on 16 or more drugs) – the incidence of becoming dependent on insulin is only 1% a year over the 7years of this study – possibly less since
1. we have no idea how many of these patients were coached enough on avoiding sugars and reducing both cooked fats, salt, alcohol and fructose, and
2. it is better to start early especially antidiabetic antioxidant antilipidemic antiatheroma balanced minerals, vitamins B C D E K, and biologicals (including the likes of fish oil, metformin/galega, coQ10, arginine, carnitine; appropriate parenteral balanced human HRT (estrogen, testosterone, progesterone) , and relevant other herbs). All these combined (in just two blends) can in a first-world population largely avoid both need for cortisone and insulin therapy, fattening, diabetes, vascular / renal disease, dementia, osteoporosis, blindness, and cancer ;
3 taking metformin to tolerance (which is bizarrely uncommon practice) is far better before if necessary adding sulphonylureas/ glitazones/ insulin which promote fattening and other problems, with little net benefit..
4. starting on metformin preventatively ie well before diabetes presents can reduce the incidence of new diabetes, pancreatic burnout and cancer by up to 80%.
Yet preventative metformin- with zero serious adverse effects and halving of mortality in appropriate use- is still irrationally vociferously objected to. Is this because of the Disease Industry’s driving force, to avoid prevention at all cost since only disease pays: effective prevention with natural supplements like metformin and appropriate parenteral HRT would deplete surgeries and hospitals of serious chronic degenerative illnesses.
The BARI study showed clearly that by the time vascular disease presents in diabetics, surgery has no better outcome than medical therapy. All four major diabetes prevention programs (in China then USA then India then Greece) confirmed the major benefit (even against cancer) of adding metformin early if the patient cannot implement permanent effective diet and exercise.
So why are “Authorities” still not mandating preventative metformin in the resistant overweight at all ages? Why are those who should know better still attacking preventative physicians for practicing evidence-based medicine ie using appropriate metformin in a life-threatening situation- progressive or persistent overweight ie BMI above 25kg/sqm?
One hopes that this Quebec analysis pushes authorities to enforce that metformin built up slowly from eg 250mg/d to tolerance -ideally with blood level control- is the only firstline chronic drug therapy of type 2 diabetes, even where the new patient has also to be temporarily stabilized with insulin.