Blood Sugar Derangement

Two studies published yesterday point to new health risks faced by diabetics. A Japanese study in the Archives of Internal Medicine found that diabetics have an increased risk of all types of cancer, but especially liver, pancreatic, and kidney cancer. And a study in the journal Critical Care found that diabetics are at greater risk of organ failure and of death from any cause.

The context for the Japanese study is the growing rate of diabetes in Japan and around the world. The context for the Critical Care study is the steady rise in body weight characterized as an obesity epidemic, also worldwide. These two studies will no doubt add new vigor to the aggressive treatment of diabetes.

The studies have weaknesses. Two struck me the most.

The first concerns what counts as “diabetic.” Subjects in both studies were asked whether a doctor had told them they were diabetic or whether they had been prescribed drugs for blood sugar derangements. This tells us nothing about just how deranged each subject’s blood sugars were—what the pros call glycemic control. Are the naughty people whose blood sugars are out of control at greater risk than the nice people who are good patients? We don’t know, although the assumption is that the naughty people are punished with death and disease.

The second weakness is that we know nothing about the drugs these people were taking. Loading up diabetics with drugs is standard practice. There are the drugs for blood sugar control itself and then there are the drugs prescribed to prevent the health disasters that await diabetics, treatments like prescribing statin drugs to prevent heart attacks. What kind of toxic soup is being brewed with these mixtures? No one’s asking. What we know from toxicology doesn’t bode well: when combined, chemical pollutants do more damage than the individual chemical alone.

We don’t even need to go as far as combined effects—just knowing what drugs each person is taking should be examined. Let me give you an example.

Sulfonylureas are a class of drug that have been around since the 1950s. In 2001 almost over 32 million prescriptions were written for one or another of the sulfonylureas that have a risk of death associated with them. That risk was first observed in 1970. Earlier this year, a study in the Canadian Medical Association Journal looked at this issue and found that, for example, deaths among people taking these types of sulfonylureas exceeded deaths among people using other drugs by 28 deaths per thousand. If we assume that those prescriptions were issued monthly, that’s almost three million people taking sulfonylureas. At 28 excess deaths per thousand, 76,000 people die each year as a result of taking this drug.

It’s known why this happens. Sulfonylureas stimulate insulin secretion by blocking potassium channels in pancreatic beta cells allowing calcium to flow into the beta cells causing insulin to be released. But these drugs don’t distinguish between beta cells and other cells—like those of the heart and arteries. This is not a side effect. It’s how the drug works. Newer versions target only beta cells, yet the versions that do not discriminate are the most widely prescribed.

Knowing this, careful, well-funded studies on the risks faced by diabetics never wonder about the effect of those toxins we call pharmaceuticals. If you believe, as a recent client of mine does, that it’s the drugs that are making you sick, you’re probably right.

Related resources are available on the Diabetes page.