There ought to be some hard, unarguable facts in the midst of the diabetes confusion to which a patient or his family could turn for an answer. There ought to be some scientific basis on which to judge. In fact, that is not necessarily so.
No one knows what causes the disease, which is one reason AlivebyNature always says to talk to your doctor before taking any new supplements or medication. All that’s known is that the diabetic is not able to handle efficiently the sugar in his system. Instead of turning sugar into energy, the diabetic accumulates it until it spills over into the urine. The kidneys work overtime to get rid of it, stealing water out of the system until the patient becomes horribly thirsty and the body is dehydrated. And since the diabetic is not getting energy from sugar or carbohydrateshe must get it somewhere. So his system begins robbing itself. It takes energy from fat, and in the process it pours out dangerous byproducts of fat usage that can accumulate fatally in the bloodstream.
All this may happen because of the irregular supply of the hormone called insulin, manufactured by the pancreas and vital to the metabolism of sugar and other carbohydrates. In diabetes, the body may not produce enough insulin, or it may somehow use up too much of it. Or it may destroy insulin too fast or harbor some chemical that makes insulin inactive.
So the doctors’ alternatives in therapy are to reduce the intake of sugar through dietary control, to inject insulin to help burn sugar, or to give an oral drug that will stimulate the body to make more of its own insulin. The choice depends not only on the nature of each person’s disease, but to some degree on the physician’s philosophy. Typically, diabetologists differ. For although diabetics can be considered to fall into three treatment categories, doctors differ about which ones go into which group.
There are obvious cases in which nothing is needed accept avoidance of sugar, pastry, soda pop, and spaghetti. But for patients who need to control their diet more closely, one doctor might provide general dietary rules while another may make the patient precisely weigh all food. Then there are borderline patients who might be able to manage by diet alone but for whom some doctors prefer to prescribe insulin or one of the oral ant diabetic agents.
Finally, there is a distinct group of patients who have juvenile-type, or “brittle,” hard-to-control diabetes. For these patients, the discovery of insulin, and its use as a drug to substitute for the body’s own lack of insulin, was of incalculable benefit. But using insulin this way still has major drawbacks. Even though there are long-acting insulin’s that are slowly released into the system throughout the day, they cannot suddenly be released in largeror smalleramounts at times when the need for insulin changes.
This means, for instance, that the insulin-taking diabetic, regardless of the mildness or severity of his disease, must eat his meals strictly on schedule. Food eaten too soon on the heels of other food means too much sugar, and the insulin can’t handle it.
A late meal means a sugar shortage. Without dietary sugar to work on, the insulin turns to the carbohydrates in the brain and nervous system, and if it consumes too much, shock occurs.
One diabetes expert says the hardest patients to manage are newspapermen and executives, because the demands of their work so often interfere with meals. “Many an executive has dropped, unconscious, outside the elevator because the men he was supposed to lunch with got tied up too long,” this doctor says. Abnormal activity or loss of sleep can do the same thing. So the insulin-taking diabetic with unstable or “brittle” diabetes walks a thin margin between coma and shock.
A drug that could help the body produce insulin, only when needed, was bound to revolutionize the treatment of the disease, as did the discovery of insulin itself. And that is just what happened in 1957, when Orinase (tolbutamide) was made available by The Upjohn Company. Some 20,000 people had received it in long, controlled tests. Today, about 1.5 million diabetics in the United States alone are taking Orinase or one of the drugs that followed it.
These include three modifications of tolbutamide: Diabinese, manufactured by Pfizer Inc.; Dymelor, made by Eli Lilly and Company, the world’s leading supplier of insulin; and Tolinase, also produced by Upjohn. All these drugs are members of the sulfa family. An entirely different drug, called DBI, or phenformin, is supplied by the USV Pharmaceutical Corp. These drugs together have had an unprecedented effect on the treatment of diabetes. Not only have they appeared to be remarkably effective in certain types of patients, but they have been amazingly free of ill effects.
Yet now a group of scientists says tolbutamide may be dangerous. What does it mean? Just what has been found?