These Drugs Can Raise Diabetes Risk

When your doctor pulls out his/her prescription pad, you probably assume that your health problem will soon be improving. Sure, there may be a side effect or two—perhaps an occasional upset stomach or a mild headache. But overall, you will be better off, right? Not necessarily. While it’s true that many medecine can help relieve symptoms and sometimes even cure certain medical conditions, a number of popular medications actually cause disease—not simply side effects—while treating the original problem.

Here’s what happens: Your kidney and liver are the main organs that break down medecine  and eliminate them from your body. But these organs weaken as you age. Starting as early as your twenties and thirties, you lose 1 percent of liver and kidney function every year. As a result, medecine  can build up in your body (particularly if you take more than one), become toxic, damage crucial organs, such as the heart and brain—and trigger disease, such as diabetes. Older adults are at greatest risk for this problem because the body becomes increasingly less efficient at metabolizing medecine  with age. But no one is exempt from the risk. Many commonly prescribed medecine  increase risk for type 2 diabetes. These medications include statins, beta blockers, antidepressants, antipsychotics, steroids, and alpha blockers prescribed for prostate problems and high blood pressure. There are a number of safer alternatives to discuss with your doctor, consultant pharmacist, or other health-care professional.

If you’re prescribed a beta blocker: Ask about using a calcium-channel blocker instead. Diltiazem has the fewest side effects. The twenty-four-hour sustained-release dose provides the best control.

If you’re prescribed an antidepressant: Ask about venlafaxine, a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) antidepressant that treats depression and anxiety and has been shown to cause fewer problems for diabetic patients than any of the older selective serotonin reuptake inhibitor (SSRI) medecine  .

If you’re prescribed an alpha blocker: For prostate problems, rather than taking the alpha blocker tamsulosin, ask about using dutasteride or finasteride. For high blood pressure, ask about a calcium-channel blocker medecine.

THE VERY BEST MEDECINE SELF DEFENSE

If you’re over age sixty—especially if you take more than one medication or suffer medecine side effects—it’s a good idea to ask your physician to work with a consulting pharmacist who is skilled in medication management. A consulting pharmacist has been trained in medecine therapy management and will work with your physician to develop a medecine management plan that will avoid harmful medecine. These services are relatively new and may not be covered by insurance, so be sure to check with your provider. To find a consulting pharmacist in your area, go to the website of the American Society of Consultant Pharmacists, www.ascp.com, and click on “Find a Senior Care Pharmacist.”

 

Also helpful: Make sure that a medecine you’ve been prescribed does not appear on the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Originally developed by the late Mark Beers, editor of the Merck Manual of Medical Information, the list has been recently updated by the American Geriatrics Society. To download the list for free, go to www.geriatricscareonline.org and click on Clinical Guidelines & Recommendations.

The Secret Invasion That Causes Diabetes

It’s easy to get the impression that diabetes is all about blood sugar. Most people with diabetes check their glucose levels at least once a day. Even people without diabetes are advised to have glucose tests every few years—just to make sure that the disease isn’t creeping up on them. But glucose is only part of the picture. Scientists now know that chronic inflammation increases the risk that you’ll develop diabetes. If you already have insulin resistance (a precursor to diabetes) or full-blown diabetes, inflammation will make your glucose levels harder to manage.

A common mistake: Unfortunately, many doctors still don’t test for inflammation even though it accompanies all of the main diabetes risk factors, including smoking, obesity, and high-fat/sugar diets.

SILENT DAMAGE

You hear a lot about inflammation, but what exactly is it—and when is it a problem? Normal inflammation is protective. It comes on suddenly and lasts for just a few days or weeks—usually in response to an injury or infection. Inflammation kills or encapsulates microbes, assists in the formation of protective scar tissue, and helps regenerate damaged tissues. But chronic inflammation—caused, for example, by infection or injuries that lead to continuously elevated levels of toxins—does not turn itself off. It persists for years or even decades, particularly in those who are obese, eat poor diets, don’t get enough sleep, or have chronic diseases, including seemingly minor conditions such as gum disease.

The diabetes link: Persistently high levels of inflammatory molecules interfere with the ability of insulin to regulate glucose—one cause of high blood sugar. Inflammation also appears to damage beta cells, the insulin-producing cells in the pancreas. Studies have shown that when inflammation is aggressively lowered—with salsalate (an anti-inflammatory medecine ), for example—glucose levels can drop significantly. Inflammation is typically identified with a blood test that measures a marker known as CRP, or C-reactive protein.

HOW TO FIGHT INFLAMMATION

Even though salsalate reduces inflammation, when taken in high doses, it causes too many side effects, such as stomach bleeding and ringing in the ears, to be used long term. Here are some safer ways to reduce inflammation and keep it down:

  • Breathe clean air. Smoke and smog threaten more than just your lungs. Recent research has shown that areas with the highest levels of airborne particulates that are small enough to penetrate deeply into the lungs have more than 20 percent higher rates of type 2 diabetes than areas with the lowest levels of these particulates. Air pollution (including cigarette smoke) increases inflammation in fatty tissues and in the vascular system. In animal studies, exposure to air pollution increases both insulin resistance and the risk for full-fledged diabetes.

My advice: Most people—and especially those who live in polluted areas —could benefit from using an indoor HEPA filter or an electrostatic air filter. They will trap nearly 100 percent of harmful airborne particulates from indoor air. If you live in a large metropolitan area, avoid outdoor exercise during high-traffic times of day.

  • Take care of your gums. Even people who take good care of their teeth often neglect their gums. It’s estimated that almost half of American adults have some degree of periodontal (gum) disease.

Why it matters: The immune system can’t always eliminate infections that occur in gum pockets, the areas between the teeth and gums. A persistent gum infection causes equally persistent inflammation that contributes to other illnesses. For example, research shows that people with gum disease were twice as likely to develop diabetes as those without it.

My advice: After every meal (or at least twice a day), floss and brush, in that order. And clean your gums—gently use a soft brush. Twice a day, also use an antiseptic mouthwash (such as Listerine). It’s particularly important to follow these steps before you go to bed to remove bacteria that otherwise will remain undisturbed until morning.

  • Get more exercise. It’s among the best ways to control chronic inflammation because it burns fat. When you have less fat, you’ll also produce fewer inflammation-promoting cytokines. Data from the Nurses’ Health Study and the Health Professionals FollowUp Study found that walking briskly for a half hour daily reduced the risk of developing diabetes by nearly one-third. My advice: Take ten thousand steps per day. To do this, walk whenever possible for daily activities, such as shopping, and even walk inside your home if you don’t want to go out. Wear a pedometer to make sure you reach your daily goal. • Enjoy cocoa. Cocoa contains a type of antioxidant known as flavanols, which have anti-inflammatory properties. Known primarily for their cardiovascular benefits, flavanols are now being found to help regulate insulin levels.

My advice: For inflammation-fighting effects, have one square of dark chocolate (with at least 70 percent cocoa) daily.

  • Try rose hip tea. Rose hips are among the richest sources of vitamin C, with five times as much per cup as what is found in one orange. A type of rose hip known as Rosa canina is particularly potent, because it may contain an additional anti-inflammatory compound known as glycoside of mono and diglycerol (GOPO). It inhibits the production of a number of inflammatory molecules, including chemokines and interleukins.

My advice: Drink several cups of tangy rose hip tea a day. It’s available both in bags and as a loose-leaf tea. If you’re not a tea drinker, you can take rose hip supplements. Follow the directions on the label.

  • Season with turmeric. This spice contains curcumin, one of the most potent anti-inflammatory agents. It inhibits the action of eicosanoids, signaling molecules that are involved in the inflammatory response.

My advice: Eat more turmeric—it’s a standard spice in curries and yellow (not Dijon) mustard. You will want something more potent if you already have diabetes and/or elevated CRP. I often recommend Curamin, a potent form of curcumin that’s combined with boswellia, another anti-inflammatory herb.

Important: Be sure to talk to your doctor before trying rose hip or turmeric supplements if you take medication or have a chronic health condition.

CHECK YOUR CRP LEVEL

An inexpensive and accurate blood test that is often used to estimate heart attack risk is also recommended for people who have diabetes or are at increased risk for it. The blood test measures C-reactive protein (CRP), a marker for inflammation, which can lead to heart disease and impair the body’s ability to regulate glucose. A high-sensitivity CRP (hs-CRP) test typically costs about twenty dollars and is usually covered by insurance. A reading of less than 1 mg/L is ideal. Levels above 3 mg/L indicate a high risk for insulin resistance and diabetes as well as for heart attack. If the first test shows that your CRP level is elevated, you’ll want to do everything you can to lower it—for example, through exercise, a healthful diet, and weight loss. Repeat the test every four to six months to see how well your lifestyle improvements are working.

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