HEALTH: Physician modified diabetes meds to keep away from too-low blood sugar | Information

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DEAR DOCTOR. ROACH: I have a question about medication. I will soon be 77 years old. I have had type 2 diabetes for about 53 years. I’m still on medication – Metformin, Glipizid, and Actos. I was on glyburide before and did well with an A1C of 7.1% or 7.2%. Then suddenly my doctor said that glyburide was a dangerous drug and that I need to stop taking it. She replaced glipizide. This drug doesn’t seem to work as my A1C is now in the 7.8% range. Both drugs are of the same class and have the same heart failure warnings, etc. I can’t get my doctor to stop and give me the glyburide back. She wants me to have a solution for injection instead, Victoza, and I’m not interested. What do you think? – SCH

ANSWER: I think your doctor is concerned that glyburide causes low blood sugar. Not only does glyburide last a long time, but your body converts it into other compounds that can also lower blood sugar. In the elderly in particular, these agents can put them at high risk of dangerously low blood sugar, and many experts tend to avoid glyburide and use glipizide or glimepiride instead. If you had low blood sugar I would agree with the change.

Liraglutide (Victoza) is called a GLP-1 antagonist. It is very helpful in people who need to lose weight, including many people with type 2 diabetes, and in people with known cardiovascular diseases. In my opinion, this class of drugs has been shown to be safer than drugs like glyburide and effective in people with these risk factors or at a higher risk of low blood sugar.

After all, A1C is a measurement of total blood sugar, and I’m not sure if additional medication is needed for someone in their mid-70s with an A1C of 7.8%. A reasonable goal is 7.5%, and it may be safer to get changes in diet or exercise than additional medication.

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DEAR DOCTOR. ROACH: I am curious to see if there is a link between the Asian flu in 1968-1969 and possible immunity to COVID-19. I got the flu while pregnant in 1968. I had very close contact with someone in September who got COVID the next day. A serious case but not hospitalized. I did quarantine and then tested negative after two weeks. – JM

ANSWER: No, I don’t think that’s likely at all. The influenza virus and COVID-19 are very different viruses, as different as a pineapple and a pine cone.

I don’t know why you didn’t get infected after being in close contact with a known case. It’s not clear why some people seem more contagious and some may be more susceptible. You may have had an asymptomatic case in the past. However, it is a mistake to consider oneself possibly immune to COVID-19 and a grave mistake to believe that this proves that COVID-19 does not exist as some people have written to me. Even after receiving the disease or the vaccine, people must continue to take precautions. No vaccine is perfect and it is clear that even people who have had COVID-19 can get it again.

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Dr. Roach regrets that he cannot answer individual letters but will include them in the column if possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu or email 628 Virginia Dr., Orlando, FL 32803.