Readers Respond En Masse to Avandia Article

The dLife community asks many questions after last column about Avandia.

Theresa Garnero By Theresa Garnero, APRN, BC-ADM, MSN, CDE

The Avandia article struck a chord with our virtual dLife family. Many readers got inspired to throw in their two cents or to ask more questions. Here is a sampling of emails with my responses. Thanks to everyone who wrote in. I regret I cannot answer all of your emails.

I read your article. It was a lot of words we have already heard with no more conclusion than ask your doctor. If my doctors knew what they were doing why did they write in my permanent medical record that I am difficult when I told them I don't want to take Avandia because I don't need heart complications? Signed, Cynical but alive.

The majority of people, including healthcare professionals, are not aware of the underpinnings to the Avandia debate. If you have already heard the nuances that brought us to this place and time with the thiazolidindiones (TZDs) class of drugs, consider yourself very well informed! My conclusion was to have a conversation with your diabetes advocates, not just to ‘ask your doctor'. Your advocates may include your doctor, your pharmacist, and your diabetes education team. A conversation requires someone who will listen, engage, and participate. It sounds like your relationship with your physician has room for improvement. Whenever a doctor or any healthcare provider isn't listening, doesn't have a clue to current events related to your health (and isn't willing to investigate further), or gives you reason to question their trust as a practitioner, shop around! A little cynicism goes a long way to protect oneself. Find your team that can help you thrive while staying alive for years to come.

I just read your response to the Nissen study that ramped up the Avandia panic. At the end of your article, you mention that patients should rely on their healthcare professionals in deciding about the use of Avandia, Actos etc. How can you rely on their feedback when they are just as confused and concerned as the patient? My doctor and I decided to err on the side of caution and discontinue use of Avandia and just double my intake of Metformin — so far, so good. The doctor really had no idea about the study, but was reacting to the "bad" news. It is unsettling to say the least.

Your point is well taken. The medical profession is confused about the Avandia issue. As a columnist, I cannot give you individual medical advice—that's where I will point you back to your healthcare team. The Avandia issue has been on the diabetes community radar (and in mainstream media) for many months now. If your doctor didn't know about this landmark, controversial study, that demonstrates he or she is missing mainstream diabetes educational opportunities. How can you talk about it with someone who hasn't kept up? Have you worked with someone (like an endocrinologist or diabetologist) who is aggressive in the treatment of diabetes? Someone who reads diabetes research over breakfast and enjoys it? Someone who can be proactive instead of reactive? Luckily, you and your physician have found a solution that is keeping your diabetes in check, unlike our next reader.

I was extremely well controlled on Avandia; actually it did the controlling. I never had to think about it. The exact morning the "news" hit TV I just happened to have a panic attack. I was in the hospital with a possible heart attack. I knew my telling them I was on Avandia set off thousands of signals in the doctors' brains. All the tests I suffered showed I was in great shape for my age and that the Avandia did not harm my body. I was offered Zoloft and have been semi-happy since. Now I am on Medicare and Avandia is not allowed. I have been put on Glyburide 5 twice a day and my diabetes is not well controlled. I don't understand why I have to suffer the great debate. I so loved Avandia. I wish it was accepted, but I cannot afford it.

Thank you for your testimonial. Many others have shared their annoyance of losing diabetes control while getting caught in the cross fire of Avandia politics. Have you checked with your pharmacist or called the makers of Avandia, GlaxoSmithKlein to see if you qualify for their prescription assistance program called the Orange Card? You can call them directly at 888-672-6436.

Are Avandia and Actos the same drug?

No. They are different drugs that belong to the same classification (TZDs) because they act in similar ways to reduce insulin resistance. Much like Fuji and Red Delicious apples are both red apples, they also have unique characteristics within their own category.

I am a type 2 diabetic for 3 years. I lost 30 lbs. in past month, with a target of around 30 more. AIC was 6 last the time I checked. Actos is extremely expensive — even at Costco it's about 5-6 dollars per day. There is generic available thru Canada at 1/4 the cost. Any ideas?

Although I'd love to congratulate you on your weight loss, you are losing way too fast! Please see a registered dietitian about your weight loss program. Was the A1C within the last 3 months? Some people will get an ideal A1C/EAG reading and wait the better part of a year to get it rechecked. I am not familiar with the generic Actos via Canada, nor am I aware of the legal issues of crossing the border to get cheaper medications. The makers of Actos – Takeda Pharmaceuticals – have a patient assistance program. Call 877-825-3327, and press 3 to learn more.

I don't have a question, I wanted you to know that I really appreciated reading your thoughtful article about Avandia. One doctor took me off this medication, another felt it was still safe, and I was very confused. My blood sugar control has worsened since I stopped taking Avandia. I just feel that you clarified, intelligently, what the research was all about, and have helped me make a more informed and confident decision. My thanks!

Thank you for the feedback!

I have taken Actos for 8 years for my diabetes and now I have anemia. Doctors cannot find out why I am anemic. Could it be from Actos?

The cause of anemia may be difficult to determine as many possibilities exist. According to the Actos website, "Actos may also be associated with … anemia." Have your doctors considered this?

I took Avandia years ago. I stopped as I was putting on weight. I switched to Glucophage which eliminated the problem. Unfortunately I can't take it now as I only have 1/3 of one kidney left. Your thoughts?

Why take pills that may challenge your kidney? My thoughts are on the hormone itself, insulin!

We don't know what all the fuss is about with Avandia. We have been taking it for two years with okay results. Our A1C is between 8-9 and our doc says that is real good. I take twice the amount that most people do and my husband takes the regular amount with Metformin 2000 a day. It hasn't done us any harm. We get our blood labs done once a year and that is coming up soon and the doctor always says it is okay. We don't do much exercise and our diet is typical of America. As you can see our diabetes is very well in order. I wouldn't change this drug at all. What would happen if we don't have it? Shots? Well that is for the sickish of the diabetes world and that ain't us. Thanks.

Whoa! Insulin does a body good. Many people who need to take insulin injections are less "sick" than those who don't use insulin. The bottom line comes down to the A1C, the target goal of which is less than 7% according to the American Diabetes Association. It is recommended to have the A1C done at least twice a year if you are in control, or every 3 months when not in control. If you and your husband are still in the 8-9% range, you are in the danger zone and at risk for complications. Do yourself a favor and see a certified diabetes educator who can help you figure out a way to get your A1C into the safe range of less than 7%. You can find one by calling 1-800-Teamup4. And if this is my brother writing in with a prank email to push all my diabetes buttons, you succeeded.

When I first heard about the Avandia mess, I called my doctor and he immediately changed my prescription to Actos. I tried this for 3 months and my ankles swelled up. Then came the news that Avandia might not be all bad after all. So I changed back to Avandia. I've been taking it for the past 2 months, with no swelling, and the results were the same as before. Now what choice do I have as a type 2 diabetic? I either quit taking Avandia/Actos and go on insulin, or I continue to take Avandia/Actos. What am I to do? I am not content with taking shots at all, as I do not like needles. So, some advice please.

If you liked needles, we'd worry about you! You do have a choice. You are armed with the pros and cons of TZDs, but what about insulin? You can speculate all you want about how it would feel, just like we can talk about riding a bike. Until you get on that bike and ride, you'd never really know the feeling of freedom. Until you take a shot of insulin (or as we teach people in a diabetes program, a shot of normal saline—it's like water), you will never know that the discomfort is minimal. Most people agree, thanks to the advances in shortening the needle size and length, insulin injections hurt less than poking your finger for glucose monitoring. And many people say how good they feel just taking the hormone itself rather than pills. The point is, you are making a judgment about insulin without ever having given it an educated test drive. Putting that aside, your diabetes is in control with Avandia. As long as your doctor keeps up with doing the lab tests to assure your kidneys and liver can handle it, you are not forced to decide between insulin and pills for the present time.

I just had my blood test and my A1c was 7.8. My doc took me off Actos because of fluid retention and ever since, my numbers have been in the high 200s on average. I'm on Lantus insulin 62 units and 2000mg of metformin. I asked about Byetta and he said it would not work. He wants me to start on the short-acting NovoLog insulin for meals. Is there another alternative for Actos other than insulin?

In terms of pills, you could talk to him about Januvia. The problem is, when your glucose level is above 250, it creates a toxic environment for the insulin-producing cells, which then makes it more difficult for pills to work. The mealtime insulin will lower your numbers into a safer range, make it less stressful on your pancreas and increase the chance of an ideal A1C.

 

Read Theresa's bio here.

Read more of Theresa Garnero's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Last Modified Date: June 19, 2013

All content on dLife.com is created and reviewed in compliance with our editorial policy.

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