one of my greatest pleasures in life is to help patients achieve remission of their type 2 diabetes. this means their blood sugar levels have become normal in the absence of any diabetes medication. many clinicians and patients are interested in learning my views about how to go about decreasing and discontinuing diabetes medications. the main role for medications is to help reduce or delay the risk of nasty complications of diabetes particularly the damage to the retina kidney nerves and circulation. the higher the average blood sugar level as indicated by the hemoglobin a1c level the greater the complication risk (which increases exponentially with increasing a1c). we know from clinical trials that using medication to keep the a1c at or below 7% can help reduce the risk of these complications. there is broad agreement that clinicians should recommend starting or increasing diabetes medications to patients who cannot get their a1c level to 7% or less via lifestyle change. many patients come to me because the a1c is already over 7% and their primary care provider proposes increasing their diabetes medication unless the patient can get to 7% or less with improved eating and/or exercise habits. some of these patients are already on many pills and insulin shots are the frequently the next appropriate treatment. many patients would rather make the lifestyle changes than take more medication so when the doctor frames the issue in this way then a patient might become inspired to renew or increase the lifestyle efforts. the clinician might say “let's recheck the a1c in three months and start the new medication if it is still above 7. 0%. ” there can be little doubt that using lifestyle changes to normalize the glucose levels and a1c is a good thing. in contrast the strategy of driving the a1c well below 7. 0% with multiple medications has little to offer most patients in terms of quality of life or reduced risk of complications. most patients i see are already taking metformin which is the preferred second-line treatment after lifestyle change. i typically recommend initiating it in patients with a1c’s of 6. 5% who cannot push it any lower via lifestyle change. for patients who are already on metformin i do not decrease the dose unless the a1c is 6. 0% or less. i might reduce the dose by half every three months as long as the a1c stays at 6. 0% or less. i stop the final 500 mg of metformin when the a1c is 6. 0% or less for at least three months. some drugs can lower the blood sugar levels below the normal range causing symptoms of hypoglycemia. these drugs which include insulin and those in the sulfonylurea family (which are common in patients on more than one kind of diabetes pill) need to be reduced or discontinued by the clinician as required to avoid hypoglycemia so these are typically the first drugs to be discontinued. it is important that patients who take these medications check their blood sugar levels regularly particularly while making lifestyle changes. doing so lets us know the risk of future hypoglycemia and guides the decision about when to decrease or discontinue such medications. in the absence of insulin or sulfonylureas then other drugs (such as pioglitizone) come off next. i typically wait until the a1c is 6. 5% or less to propose stopping such drugs and would not initiate or re-initiate any diabetes drugs (other than metformin as noted above) unless the a1c is above 7. 0%. so in summary ambitious eating and exercise goals are important in all stages of diabetes and drugs are crucially important in patients who cannot otherwise keep the a1c below 7. 0%. it is clear that medications can be avoided delayed or discontinued when lifestyle efforts are intensified and sustained. for many (if not most) patients lifestyle coaching by a clinician dietitian personal trainer peer group etc. can dramatically increase the odds of success. . the first step toward weaning oneself off type 2 diabetic (and almost all medication) is to change the lifestyle that got you to your state of poor health. diet is #1 in my book followed closely by exercise. one can diet all they want and achieve good results but unless you are willing to commit to a change in your lifestyle of eating and or exercise you are wasting your time! you stop eating right you stop exercising right and soon you will be back to where you started sick! 18 yrs ago i was diagnosed with type 2 diabetes. for 16 of those years i took pills dieted i exercised but never could get this monkey off my back. in fact at one point i gave up and said ok like the doc said you have genetically caused diabetes so learn to live with it! i ballooned to 240 lbs suffered with high blood pressure hi triglycerides and taking the max dosage of lantus and the max dose of metformin. i used the gym on a regular basis but never could get my a1c even to 7. 0! then i discovered a lifestyle of eating that turned all that around. i am at 155lbs now and off all meds and will never go back to eating what people increasingly realizing is the cause of all our health problems the sad american diet! full of additives fructose syrups sugars processed grains processed meats. . once we started to cook with and use unprocessed foods cut out all the “fast foods” junk foods like ice cream all processed grains all fat cuts of meat and ate mostly fresh or fresh cooked veggies and fresh or fresh cooked fruits lots of nuts and seeds (like sunflower). my a1c was 6. 1 my totasl cholesterol was 144 and my b/p 105/65 with a perfect full blood profile in december! step 1 is to make up your mind to take control of your eating and get the unhealthy state of your body turned around. step 2 is make sure you get plenty of exercise get off your duff and walk run join the gym (and go there). if you are handicapped see your doctor about getting help! step 3. (and most important) permanently change your lifestyle of eating. most diabetics can decrease their meds simply by eating the right foods. eventually if you stay on your new lifestyle your insulin resistance will start decreasing and with this you can wean yourself off all med! blood pressure cholesterol diabetic etc. step4. vow never to go back to the lifestyle that got you to type 2 diabetes clogged arteries whatever your health situation was! my recommendation for a lifestyle change is the route i took to heart that really made a difference in my health! they call it the ph diet (you will learn if you read most any of the many books on this they will call it a lifestyle because diets do not work! remember you did something wrong to get you where you are change it and don’t do it again ever! ps: i am now off all meds for any health problem!
what are the steps for weaning off diabetes medication?