Dr. Roach

Dr. Keith Roach

DEAR DR. ROACH: What’s the best medication for Type 2 diabetes? — P.H.
ANSWER: If I asked one of the students or residents I teach to answer that question, I would warn them that it’s a trick. The best medicine is none.
In most cases, Type 2 diabetes can be prevented and treated with a lifestyle that includes regular moderate exercise as well as a diet that is mostly plant-based and avoids excess sugar. Unfortunately, many people don’t follow that advice (and our society makes it more difficult to do so).
It is true that there are some people who get Type 2 diabetes despite leading a very healthy lifestyle. Type 2 diabetes isn’t really one diagnosis, and there are several different metabolic issues that lead to this final end point. The best medicine depends on the underlying problem, and we do not always find that out.
Still, for the majority of North Americans who are overweight or obese and have a high enough blood sugar to get diagnosed with diabetes, the best treatment is a combination of improved diet and exercise, along with medication if necessary. For most people, the initial medication is metformin, which is inexpensive and effective. Metformin also promotes weight loss, which helps blood sugar control in overweight people with Type 2 diabetes.
Many people need a second medication, which must be tailored to a person uniquely. The GLP-1 agonists like semaglutide are increasingly used, as the data on prevention of heart disease are very strong with this group of medications. There are many other classes of medicines that are appropriate in different situations.
A team of clinicians, including a registered dietitian nutritionist, a diabetes educator and sometimes additional specialists like podiatrists and ophthalmologists, is ideal for the optimal management of this common multisystem condition.
DEAR DR. ROACH: My mother was prescribed gabapentin for her chronic pain and was gradually increased to three times daily. It didn’t seem to be working, so we stopped it. Now she is shaking all over. What should I do? — Y.G.
ANSWER: Like many medications that affect the brain, gabapentin can cause a withdrawal syndrome if it is stopped suddenly. Symptoms usually begin about 24 hours after stopping the medicine. Common symptoms include anxiety and insomnia. Shaking all over (tremors) is also common, but I would also be concerned about seizures.
For moderate to severe withdrawal symptoms, gabapentin should be restarted at the previous dose, then tapered slowly. Depending on how high the dose was, the taper might take as little as a week or as long as several months.
You should be very careful about stopping medications suddenly and discuss this with the prescribing provider or regular doctor prior to doing so. They can give you advice, like whether another medication might be indicated to treat the problem at hand while tapering down gabapentin.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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