Overtreating Diabetes Can Have Serious Consequences, Experts Warn

Too-low blood sugar can cause hypoglycemia, fainting, comas and seizures

With type-2 diabetes, it’s important to keep blood sugar under control, but there’s also a danger in using too many drugs to bring levels to unhealthy lows, says Dr. Rozalina McCoy, from the Mayo Clinic.

McCoy and her colleagues report in JAMA Internal Medicine about a study of more than 31,000 adults with type 2 diabetes. They analyzed those who were treated aggressively to see how often they experienced dangerously low levels of blood sugar requiring hospitalization or other medical care. They considered aggressive treatment any case in which people were taking multiple medications to keep their blood sugar levels down.

About 20% of the people in the study fit this category, and such aggressive treatment, says McCoy, might have actually done them more harm than good. For people who are older and have other health problems, aggressive treatment of their diabetes led to a complications including dizziness, fainting and in sever cases, seizures and coma.

“Our goal in managing diabetes is to really get people’s blood sugar into a safe, normal range. Which means not too high—but it also means not be too low,” says McCoy. “And this applies to many people, not just the people in the study.”

While the risk was highest for people who are older and those with other health problems, McCoy says there is a lesson for everyone with diabetes, and for the doctors who treat them. “In an effort to reduce undertreatment, and to make sure patients are tested and receive the appropriate treatment medications, we don’t have a counterbalance to ensure that patients are not over treated.”

She points to several factors in the aggressive over treatment, the most important of which are guidelines and recommendations that focus on reducing blood sugar without a companion emphasis on warning against what levels can be too low. The long-term health dangers to high blood sugar include damage to the kidneys, eyes and risk of amputation. The harms of low blood sugar are more immediate, and should also be part of any doctor’s treatment of people with diabetes, McCoy says.

She hopes the results of the study serve as a lesson for all doctors, not just those who treat people with diabetes. “The same principle applies to many chronic diseases,” she says. “We may hurt patients in our desire to help them if we do too much.”

http://time.com/4357333/diabetes-treatment-side-effects-hypoglycemia/?

chris c wrote:I can see the point, this is probably what happened in trials like ACCORD where they used heroic amounts of medication on top of a high carb diet. However I used to get hypos on a regular basis just from my "low fat" diet. Now I eat far fewer carbs and never do. The lack of carb stops the BG spikes, which stops the subsequent insulin spikes, which stops the hypos. 

Those breakfasts would have my BG through the floor a few hours later even without any drugs. That's after it went up to damaging levels first of course. But that's OK, the spikes and lows cancel out and don't show in the A1c, which I have been told is "the only thing that matters".

Actually there's been a lot of research into the effects of widely varying BG levels, none of it good.

yoly wrote:The lesson of ACCORD is that well establish diabetes even with strong medications is impossible to control if you don't reduce your input of carbs in your diet. Many of does that did worst even on the high intensity treatments weren't able to control their diabetic numbers. And that all medications have side effects and in some they may do more harm than good. But you got to be careful with what some studies and doctors call hypoglycemia, they don't want diabetics with normal blood sugar. Anything in the normal range and they panic they want diabetics with diabetic numbers. They are doing a lot of harm frighting diabetics with the risk of hypoglycemia.