Statins and rising BG

Type 2
1

I had bloodwork done a few days ago for an upcoming appointment with a new doctor. I’m ramping up my exercise program with a trainer at the gym, and finally got off the antidepressant that contributed to a 20 lb weight gain over the last year, and just wanted to check in with some labs and a chat with the doctor about an old knee problem before I drastically change my routine.

So today I get an email from his assistant saying that my LDL was “too high” (it’s 102) and they want me on statins ASAP. My other levels are pretty OK, I think – cholesterol 167, triglycerides 83, HDL 50. My A1C is not that great – 6.7, up from 5.5 a year ago. I think it’s all because of my lifestyle changes over the last year – started a new totally sedentary job, basically stopped exercising, ate way too many office cookies and pizzas, and went back on an antidepressant that I’ve gained weight on before.

I’ve been back on track for almost a month though, and want a chance to see if diet, exercise and weight loss will get my numbers back where I want them without adding another drug. Especially one with such serious side effects, including big increases in BG and insulin resistance (at least for the diabetics I know who have tried statin therapy). I just don’t think my numbers are bad enough to take the risk. That’s not such a crazy plan, is it?

I guess what’s bothering me is that I haven’t even MET this doctor yet, and he’s already prescribing a dangerous (in my opinion) drug without knowing anything about me except the numbers he saw on my chart.

I switched to this doctor because the last one I saw didn’t listen either, but just told me basically not to worry about my weight or my blood sugar, because both would be impossible to control as I get older (I just turned 46) – but not to worry, because there are so many great medications to help with anything that might go wrong. Blah!

This is Kaiser California, by the way. I had to switch insurance when I started my new job, and I’m wondering if this is just how they do things now … just match up the symptom with the corresponding medication and be done with it? So far I am not impressed.

Anyway – STATINS. Any thoughts?

2

Well, I hear ya. I have a bottle of Pravastatin sitting on the shefl, been afraid to try it.

My LDL is 115, but everything else is normal.

My Endo insists, despite my having a liver condition and fibromyalgia, that I simply have no choice but to take the drug.

My arthritis doctor said she gets why he says that, but she thinks I ought to cut the pills in half (to 10 mg) if even take them at all. She is of course, really not allowed to say the latter, but she hinted.

If I had not met the doctor, I most certainly would not start until discussing. Especially if only at 102.

My problem is,in my case he is my long time doctor and we get along really well all the time except on this issue.

I truly would arrange for a meeting first.

3

LDL > 100 is considered high for diabetes, but exercise and diet will bring that down. I would refuse the statins (at least for now), add fish oil (or flaxseed), keep up with the diet and exercise, and check again in three months.

4

If you have serious complications with diabetes 1 or 2 look into pulsatile insulin therapy.

It helps kidney complications, retinopathy, hypoglycemic unawareness, Neuropathy, it even reduce my fibromyalgia to almost nothing- have not had a flare since last February, In 4000 patients, not one have any adverse reaction. I have been able to drop one pain med and two BP meds. (do not tell the pharma companies) This treatment also helps wound heal and gastroparesis.

My A1c had come down and I have lost 20, without trying. They say weight loss is a happy side effect of this treatment.

I am type one for more than 30 years. I take lipitor, but then, my famiy history indicates cholesterol concerns. LDL-81

HDL-51, Tri-55. If you are facing dialysis, this Pulsatile INsulin Therapy, has halted my kidney decline and even reversed it, to a point. Blessed Be

5

Why all the hate on statins?

The sad fact is most diabetics die of heart attacks and strokes. Why not be a little proactive to avoid possible future problems with a statin?

More than likely once your weight drops your cholesterol will come down as well so you shouldn’t have to be on one but a couple of months.

6

I wouldn’t say I hate them, I just hesitate to take a drug that is so likely to raise my BG and A1C, when exercise, diet and losing weight will likely solve the same problems without the risk of an additional drug. Especially when it’s prescribed by someone who’s never even met me, and has no idea of my willingness or ability to do any of the other things that can improve those numbers.

My understanding is that it isn’t necessarily diabetes per se that causes heart disease and other complications – it’s chronic high blood sugar. Sure, diabetics struggle with BG control (and I do too, as much as anyone), but my previous doctor agreed with my personal research indicating that if I can keep my blood sugars and other numbers in a healthy (meaning non-diabetic) range, I’m no more likely to develop those complications than anyone else.

7

That may work for some but in my case I’m underweight and LDL wont budge. And it could be thyroid disease related but my doctor wont discuss that with me.
And I dont believe a doctor should prescribe something like that without talking to the patient first.
At least that much is necessary!

8

That’s key too. My dr. never suggested any kind of alternatives (change your diet, or exercise program etc.)
Wasnt given the choice, was just told to use the preventative (pharmacy) measure.

9

This sounds very interesting – thanks! I will definitely be looking into it.

10

I don't hate statins per se; but I do detest the current over-prescription of unnecessary medications. To prescribe in these circumstances borders on malpractice:

So today I get an email from his assistant saying that my LDL was "too high" (it's 102) and they want me on statins ASAP. My other levels are pretty OK, I think -- cholesterol 167, triglycerides 83, HDL 50.
[snip]
I guess what's bothering me is that I haven't even MET this doctor yet.

I'll expand more in my response to the OP. In the meantime you may find this report of a paper presented at the EASD a couple of weeks ago interesting:

Lisbon, Portugal - Mounting evidence supporting a link between statins and new-onset diabetes should give clinicians pause for thought when initiating drug therapy in people with prediabetes or even a new diabetes diagnosis. That's one of the messages to emerge from sessions here at the European Association for the Study of Diabetes (EASD) 2011 Meeting.

Dr Naveed Sattar The risk/benefit balance is particularly important given the ongoing debate over whether diabetes itself is a cardiovascular disease (CVD) "risk equivalent," experts say.

"At the point of diagnosis, many physicians are considering diabetes as a CVD risk equivalent, which is part of the case for commencing statins, with the presumption that once a patient has moved to the threshold of diagnosis, that is the same as if they had already had a heart attack," Dr Naveed Sattar (University of Glasgow, Scotland) told heartwire. "But clearly a number of individuals who are at the threshold of a diabetes diagnosis are at very low vascular risk. And if we start a statin, we will gain little benefit and in fact, we may push that individual over and above the threshold for diabetes."

Read more here: Should you start a statin in a newly diagnosed diabetic?

Cheers, Alan, T2, Australia

Everything in Moderation - Except laughter

11

So today I get an email from his assistant saying that my LDL was "too high" (it's 102) and they want me on statins ASAP. My other levels are pretty OK, I think -- cholesterol 167, triglycerides 83, HDL 50.

Before you accept the statin, consider asking the doctor whether the prescription is based on your personal situation or a statistical research paper based on subjects who may not represent you.

Your trigs/HDL ratio is 1.66. When converted to mmol/L that 0.72. This paper suggests that low ratio indicates that your LDL of 102 is mainly fluffy, useful particles and not dangerous dense particles: Ratio of Triglycerides to HDL CholesterolIs an Indicator of LDL Par...

I include several links to other papers in this article I wrote a while ago: Cholesterol, Fats, Carbs, Statins and Exercise

It is worth reading the papers I cite on Parkinsons Disease and cancer which imply that low LDL is not necessarily always a good thing. Heart disease is not our only concern for those if us on the wrong aside of 50.

The decision is yours, not your doctor's.

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter.

12

My total cholesterol was 202 and doctor insisted I go on statins. He assured me that they were safe. My HDL was very high though 89. Now I understand that will raise your total. So I did the statins for 14 months until they almost killed me. They gave me severe fibromyalgia and every joint in my body hurt. I also got terrible swelling and my BP dropped to below 100. On top of that I was dizzy all the time and my brain was in a terrible fog. I finally took myself off of them and within a few months most of my symptoms disappeared. Also while I was on statins my bg went up because of the constant inflammation. Before going on them, please do some research. There are other ways to lower cholesterol. It always gets me that doctors go ballistic with LDL above 100 but allow diabetics to have higher bgs and HbA1cs above 7, and that is no big problem for them. To me higher bgs is a much bigger threat than higher LDL.

13

Higher BG’s are much harder to control than high LDL would be my guess why Doc’s are more proactive about LDL than A1c’s. High A1c’s take time to recognize pattern’s, discuss diet, exercise etc etc…High LDL- well take this pill…

Although all your symptoms are of considerable detriment to you and should be acted on, these side effects certainly aren’t seen in the majority of cases (I am by no means pro statin but also don’t want to scare people away from them either). Any Doc assuring that any medication is safe for everyone is blowing a WHOLE lot of smoke.

14

Interesting for sure. I think it puts Doc’s on notice that their supposed “gold standard” of care can’t be superimposed on people with pre-diabetes (I HATE that term!).

However, the OP’s stated date of Dx is 2007 so does not apply to her situation as she is already considered to have a “risk equivalent” .

15

Were it my decision I would NOT with your lipid panel. There is a qualifier to that- if you have high rates of heart disease in your family I MIGHT consider it. There are simply too many unknowns about long term intake of any medication to take that risk with numbers that look pretty darn good.

16

Very interesting – I will be forwarding this to the pharm tech. It turns out that she was the one who felt I should be on statins, not the doctor. He’s turned out to be very much the same page with me, agreeing that diet and exercise are the best first response, and that the risk of raising my blood sugars is not worth any potential benefit to the statin therapy at this time. He also agreed that it’s not necessarily accurate to say that just because a person is diabetic they have the same heart attack risk as someone who’s already had a heart attack, regardless of their actual numbers. After talking with him for a half hour or so, and reviewing the rest of my blood work, I think he’s going to be a good ally.



It still bothers me, though, to have been pressed so hard by a pharmacy person who’d never even met me. I think a lot of people would have just accepted her recommendations, started statins, and started the roller coaster of increasing BG, more medications, more side effects, etc. etc. etc.



I’m writing a letter to Kaiser to let them know how I feel about the whole thing.



As an aside, it has always bothered me the way so many people in the medical profession use the term “diabetic” to mean “a person with uncontrolled high blood sugars and all the complications that go along with them.” It’s not necessarily the same thing! Protocols that assume every diabetic has dangerously high blood sugars can cause more harm than good for those of us who ARE well controlled. They also cause confusion for the general public, especially those newly diagnosed. I think I will mention that in my letter as well!

17

Thanks for this, too, Alan. Great article. I will be sharing this one as well.

18

I think that the whole idea of statins affecting blood glucose needs to be looked into further before it is something we can assume is going to happen. Take a look at this blurb that I copied from here.

Sattar et al. (5) showed that risk for the development of diabetes with statins is highest in older participants, while trials with pravastatin have reduced the development of diabetes in participants below a mean age of 65 years. We previously observed that pravastatin improves insulin sensitivity, whereas simvastatin worsens insulin resistance despite comparable improvements in lipid profiles and endothelium-dependent vasodilation in patients with hypercholesterolemia (6).

Seems as if there is a difference between hydrophilic (simvastatin, atorvastatin) and lipophilic (pravastatin, rosuvastatin) effect's on insulin resistance.

19

As soon as I was diagnosed, I was handed the statin Rx. My lipid profile was fine, but I was told statins were prevention… No thanks. I can pass on the muscle weakness & wasting. I’ve resisted at every subsequent doctor’s appt.

20

Interesting - and worth looking into further, if I ever decide to go that route. I’m not unequivocally against statins, and if there were one that would lower my BG that would be the obvious choice if I ever decide to use them. My main desire right now though is to avoid adding ANY drug that is not totally necessary, and right now I don’t think statins fall into that category for me.

In any case, thanks for the link! I hope someone does follow up on the research into metabolic effects. Most of what I’ve read has been so focused on scaring people about heart attack risk, that it doesn’t seem to take the risk of drug effects very seriously at all.