Absolutely right. I have fought that battle personally and have the scars to prove it.
Well, weāve hit a nerve here havenāt we! That makes for a lively discussion though Iām puzzled by the degree of acrimony. I see a lot of n=1 anecdotes with a lot of unsupported opinions. So what would you advise diabetics to do? Ignore the available research waiting for your perfect study? Thatās not responsible. Look, if statins cause you side effects donāt take them. But for those who can take them, perhaps there is a benefit. As for āStatins for Women?ā, whenever someone takes an absolute totally extreme view, theyāre likely wrong: this psychiatrist says āI do not want a single one of my patients on statins, for any reason, ever.ā Well, apparently, she doesnāt treat sedentary, overweight diabetic woman over 50 with coronary artery disease and an LDL of 200. Itās easy to say, as she does, we should exercise, be mentally healthy, not eat grain or sugar and do healthy things. Thank you Caption Obvious.
As for aspirin, of course it is safer than warfarin (at low dose) but theyāre for different disease states. Likewise, itās not meaningful to compare aspirin to statins as the two are totally different drugs. Interestingly, they are often both used together to lower someoneās risk of a serious cardiovascular event.
As for the Grade A evidence, I suggest (1) donāt be a hypocrite: if that is your standard, then donāt mention anything here that you canāt support with such evidence and (2) that Brian_BSC contact the ADA and correct the classification of their studies if you feel they are wrong.
As for the premise that purely glucose control will prevent complications, well, that is not supported by Grade A evidence and in fact, the very premis is in question, for example, in Ann N Y Acad Sci. 2013 Apr; 1281(1): 36ā50.Published online 2013 Feb 6. doi: 10.1111/nyas.1204: The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, the Action in Diabetes and Vascular Disease (ADVANCE) study, and the Veterans Affairs Diabetes Trial (VADT) have shown NO beneficial effect of intensive glucose control on primary cardiovascular endpoints in type 2 diabetes.
Finally, as for doctors āharassingā us about preventing heart attack, then well, I would criticise them if they didnāt! Is a smoker āharassedā if told of the dangers? Are you āharassedā because they have you check your A1c? No. We are all on the same page trying to best manage our disease and prevent complications. Thereās no single answer for everyone but the evidence suggests strongly that statins can benefit some.
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Those sedentary, overweight diabetic women with CVD should probably be thoroughly checked for and treated for thyroid disease if there is any question about thyroid status, before starting on statins. Just my 2c. Because I understand that low thyroid is a very common comorbidity with diabetes, and probably even more common in overweight late middle aged women.
From my reading, statin drugs do have some anti-inflammatory effect, but they also damage muscle (both cardiac and skeletal). And if those overweight sedentary women complained of muscle symptoms (also very common in low thyroid), it would be blamed on them being female, late middle-aged, inactive, and obese - and not looked into any further. With those women then spirally downward into even less activity and worse health.
I dare to say thyroid management and inclusion in community support programme on nutrition, blood sugar control, becoming more active, may be more beneficial than a statin drug.
Yes, you did hit a nerve here! Before I got diagnosed with thyroid failure, I had many drs blaming my overweight and symptoms on me being a woman and eating too muchā¦ never mind that I wasnāt eating much, and wasnāt even very old at that time. Diabetes came much later for meā¦ my cholesterol is all very low (even the HDL), and my Dr recently asked me to consider statins - because that is the blanket recommendation for people with diabetesā¦ but then grudgingly acknowledged that my levels probably shouldnāt be reduced any furtherā¦ and that I didnāt have any risks for CVC (aside from well managed diabetes).
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I am truly stunned. One word. DCCT. A randomized controlled intervention trial with the express design to determine whether improved glycemic control reduced complications and in particular CVD. It was totally successful providing such compelling evidence (Grade A) that further studies of the question are considered unethical. That you would deny that study and pull out other studies that looked at totally different questions is weird. Are you actually a doctor? Why you would come to a diabetes forum and deny that glycemic control has a commanding role in the development of complications and CVD is just beyond me.
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I reduced my A1c from 7.1 to 5.5 and quit the statins cold turkey. My trigs dropped into the 40s, my total cholesterol dropped 80 points and the HDL/LDL ration settled at 2.5 to 1. But Iām sure thatās just a complete and utter coincidence.
I hope you donāt have too many scars 
Itās funny that the first cardiologist I saw after my diagnosis said I didnāt need them. The second said she would like the ldl lower only because of the effects of bg fluctuations/high bg/diabetes etc. It was my endo who was harassing me on and off about it. My ldl dropped about 50 points last time either from prunes or levo or both.
The second cardiologist started me on a low dose of one she thought would have less side effects and which was cheap/generic but I had immediate effects to the point I had to take a painkiller everyday and I still felt awful even with that as well as feeling so dopey and exhausted I didnāt feel safe to drive. So that was the end of statins for me, the pain was bad enough that I wasnāt willing to try another one.
Brian,
That is extremely frustrating. My expectations for honesty on the part of doctors is extremely low. When I was diagnosed with Type 1 48 years ago, the Joslin Clinic promised a cure āsoonā and also assured the newly diagnosed that once daily insulin doses would produce perfect control, meaning no sugar in urine.
Wish I could offer a solution on this issue.
Sue
Itās a real conundrum. IMHOP there is a fundamental human tendency, shared in one degree or another by most people, to exaggerate our own knowledge for reasons of self esteem, ego, or whatever. Happens all the time in casual conversation. But the problem becomes much more pathological (if youāll excuse stretching the term a bit) in the case of doctors. There are two reasons. First, their training encourages them to adopt an attitude of superior knowledge. Second, the majority of people want them to be that way and put them on a pedestal, mentally. Add up all those factors and itās no wonder that many (not all) doctors assume a patronizing father-knows-best, be-quiet-and-donāt-argue attitude.
Itās not hard to see why doctors generally take a dim view of online health forums, and generally donāt participate-- which is unfortunate. I for one, am happy to be thoroughly convinced that my medical doctor is significantly smarter than I am, as well as being tremendously better educated, and having decades of experience managing the health of people with diabetes. Therefore I value his expertise and judgement far more than I value the expertise of people on internet forums who generally just learn their facts from Google.
Internet forums have their place, theyāre tremendously valuable for tips and techniques, pointers on day to day management, etc., camaraderie and encouragement, but they are not a place for sound medical advice or analysis of research.
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āAlways seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition, including without limitation diabetes. Never disregard professional medical advice or delay in seeking it because of something you have read on the DHF Sites.ā
ā from tudiabetes terms of service ā
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Unfortunately we allow people to choose their ānameā when they join TuDiabetes. Someone who claims a name with the authority of āDrā can just come into our community and claim authority even if they are not a medical professional. If you see a doctor in an office and you see their medical degree on the wall and see the licensing from the state, that entitles them to being regarded as providing professional medical advice. And while I would always encourage our members to make sure their providers have actual credentials in diabetes care and are competent, that doesnāt mean they provide good adviceā¦ In particular, if someone who comes here, chooses a name which claims credentials, and then never proves them and then displays fundamental incompetence, deserves no respect. It is my job as an admin and a member of our community to keep these people from scamming our community and to keep these people from harming our members.
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Iām not referring to any member who may or not be a medical professionalā Iām saying that people should follow their own doctors guidanceā and if they have questions, concerns, unwanted side effects, etcā they should follow up with their doctorā not just find a group of people on the internet who might give them the impression, for example, that doctors donāt know anything and that nobody should take statinsā¦ That is also potentially quite harmfulā¦
I agree with you completely that nothing read on the Internet is valid medical advice even if it really is coming from an actual Doctorā unless theyāre your doctor.āNo more than writing captain in front of my name on the Internet would give me authority to direct ships half a world away in situations and circumstances i know nothing about
Iām apparently in the rare āless than 1%ā for hom Pravastatin caused hair loss. And I donāt mean a little extra hair in the sink. I would comb my hair and it was getting to the point Iād just cry due to how much was being left behind. Iād get horrible knots in the morning from it falling out and knotting up, and ended up cutting it short.
Iāve refused to take any medication for my cholesterol, much to my doctorās dismay. Iāve told her that one day SOMETHING is going to kill me, no matter what I do, and if itās a heart attack from high cholesterol, so be it. That said, while my cholesterol is āhighā itās not terribly high, and my HDL is high along with it. It probably wouldnāt be an issue at all if I werenāt diabetic. I honestly think the levels they set for a diabetic are pretty much not reachable without medications and are unrealistic expectations, if not just one more excuse to sell us one more drug to a captive audience.
Ok, I actually think that key value of the on-line community is that we not longer are ācattle.ā We actually learn about things and become āinformedā consumers of healthcare. That as patients we should not longer simply accept commandments from our doctors to take some statin, particularly when it appears that it harms us. It is appropriate for us to ask pointed questions of our doctors and if they cannot justify their recommendations we should not feel pressured to just ācomplyā because they have some degree. I have a right to the information related to my treatment and to make informed decisions about my care.
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Nobody would question anyoneās right to make informed decisions about their care. That is always a fundamental right. Where it gets a little bit unsettling is when people come onto Internet forums, read exchanges, and then feel they are well enough informed and equipped to disregard their doctors instructions based on exchanges between total strangers on internet forumsā¦ That could cost people their lives potentially.
And frankly not everyone on the internet is intelligent or educated enough to understand the difference between a conversation on a web forum, and actual legit medical guidance they are receivingā¦
People can claim they have a right to being called āDr XXXā when in fact they have no competency or licensing to provide diabetes medical advice. Should we trust Dr. XXX if they have never heard of the DCCT? That would truly put peoples lives in jeopardy. I feel a duty to protect our members.
Separate issueā I have no idea if that guy is a doctor, a con-man, an idiot, or an artist, and I really donāt careā because what Iām trying to say is that everyone should realize that absolutely nothing that is read on any web forum is legit medical guidance. Ever. No matter who writes it. As is expressly written into the terms of serviceā¦
But many people donāt fully understand their rights regarding their own care until they engage in discussions in online forums. Iāve seen numerous people on various forums state theyāre doing XYZ ābecause my doctor told me to,ā without understanding they have every right to question the advice. Another example is the unfortunate number of people misdiagnosed as Type 2 who had no idea there was even a possibility that they might be Type 1. They didnāt know they could question the diagnosis and get other tests until they learned the information online.
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Sam19 - I actually had a doctor āfireā me when I first moved to San Antonio in 2006 and I was looking for a new Primary Care doctor. She absolutely flipped over how much insulin I was taking, and berated me for dosing ārandom amountsā of insulin, because sheād never heard of matching your insulin to your carbs. She insisted on my going onto a sliding scale insulin protocol and eating a set amount of carbohydrates per meal. INSISTED. She swore up and down that I was going to kill myself doing what I was doing, even though Iād been doing it for 5 years already by that point. When I refused, she flat out refused to see me as a patient.
So yes. Doctors can, and will, question your right to make informed decisions about your care. They will sometimes even tell you that they know more than you, even when that isnāt true.
Certainly, there are doctors at the other end of the spectrum as well. I never saw an endocrinologist until 2008 or so. I was given insulin by a previous PCP at my own request. I brought in the action charts of various insulins, instructions from the manufacturer on how to titrate doses, and Ron Sebolās tutorials that showed how to find your insulin-to-carb ratio. From the very beginning she let me figure out my own insulin dosing regimen after reviewing what I brought her, and told me Iād probably done more reading on how insulin actually works than she had up until that point.
There are certainly some idiot doctors out there, that one would have fired me too, actually Iām pretty sure Iād have beat them to the firing. The point Iām trying to make though (apparently ineffectively) is that nothing you read online is valid medical guidance. That doesnāt mean that ā ā ā ā -poor guidance doesnāt exist other places too and from people who should know better-- it means that I think itās dangerous for forum members to essentially discourage others from taking meds that were prescribed by their own doctor and encourage each other to disregard our doctors advice in cases where we have no valid reason to believe other than our own personal experiences, and consulting Dr. Google, that we know better. (in this case statins, but any example applies just as well)
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