Doc: What works for Type 2 diabetes?
Dear Dr. Roach: What is your personal experience with the natural progression of Type 2 diabetes? Are medications like metformin used with the hope that the diabetes will get a little better or at least not get any worse? Does monotherapy usually progress to the use of multiple diabetic drugs and then eventually to insulin depletion, with required insulin shots?
Dear R.I.: Type 2 diabetes is mostly about resistance to insulin, and in general it can be treated by reducing insulin needs or by increasing insulin. Metformin works by reducing the amount of sugar made by the liver, thereby reducing the amount of insulin needed. This improves blood sugar in the short term, and in the long term, it helps the pancreas by giving it a bit of a rest.
In contrast, the oldest oral medicines, like glyburide, work by forcing the pancreas to make more insulin. Most people on these medicines fail after several years and need different treatment (which used to be insulin, before we had the myriad of choices we have now).
In my experience, many people recently diagnosed with Type 2 diabetes do very well on metformin alone, especially if they make some changes to their lifestyle. The critical changes are to reduce sugar intake (both simple sugars and processed carbohydrates, like most white breads, which the body rapidly converts to sugar) and to increase sugar utilization through exercise (which also reduces insulin resistance). The combination of improved diet and more exercise helps most people lose weight, which further improves diabetes control.
There are many other choices of medication for people with Type 2 diabetes now, both oral and injection. But metformin by itself, along with diet and exercise, is effective for many.
Dear Dr. Roach: My 89-year-old mother suffers from Cogan’s syndrome vasculitis. She was diagnosed three years ago, and is now totally deaf. She has since had serious vision problems in both eyes. She wants to have a cochlear implant, but was told by her general practitioner that her vision could be lost as a result of cochlear implants. Is there any research that indicates this could happen? I did some research, and nowhere was it mentioned that cochlear implants can cause blindness.
Dear S.D.: Cogan’s syndrome is a rare disease. It is thought to be autoimmune, causing inflammation in the inner ear, and also with variable eye problems, including inflammation in several parts of the eye. Hearing loss is often progressive, despite medical treatment, but blindness is by no means universal. Vasculitis, the inflammation of blood vessels, often accompanies Cogan’s syndrome.
Cogan’s syndrome is most commonly diagnosed in young adults (half of all cases diagnosed before age 22), but sometimes it occurs in older adults.
It’s estimated that 60 percent of people with Cogan’s syndrome will worsen to the point where a cochlear implant is necessary. This is an electronic device that sends signals to the brain in people with severe hearing loss due to nerve damage. They have been found to be very helpful in people with Cogan’s syndrome.
I am by no means an expert in this disorder, but I read quite a bit about it and was also unable to find reports that vision worsens as a result of getting a cochlear implant. I think you should find out from your mother’s doctor what the risk is. He or she may have knowledge that I don’t, or may have made a mistake.
Email questions to ToYourGoodHealth@med.cornell.edu.