How to Talk to Your Doctor About Reducing Medications

Did you know that many people who make lifestyle changes are able to reduce or eliminate the medications they have been taking for type 2 diabetes? Are you curious if you can leverage your lifestyle changes to help you reduce or eliminate medications?

You have likely seen how you can keep your glucose in check by observing your Continuous Glucose Monitor (CGM) and made lifestyle changes to help you on your way to remission from type 2 diabetes.
We want to ensure your medication plan aligns with your lifestyle changes and your health goals. Follow these steps to get started:

Understand Why You Were Put on Medication

Has your provider taken the time to explain why you have been prescribed certain medications? Has your provider explained to you how the medication works? If reducing medications is a goal for you, the first step is knowing why you were prescribed medications, what the medication is intended to do, and what other impacts the medication may have.

Understand What the Medication Does

Medications used in treatment of type 2 diabetes:

  • Insulin: takes the place of insulin normally produced by the body and moves glucose from the blood into other body tissues
  • Thiazolidinediones (TZD)(e.g.: Actos, Avandia): improves the way insulin works in the body by allowing more glucose to enter muscles, fat, and the liver
  • Sulfonylurea (SFU) (e.g.: Glucotrol, Amaryl, Micronase, DiaBeta, Glynase, PresTab): lower blood glucose by causing the pancreas to release more insulin
  • SGLT-2 (e.g.: Invokana, Farxiga, Jardiance): causes kidneys to excrete glucose into urine to decrease blood sugar overall
  • GLP-1 (e.g.: Byetta, Trulicity, Victoza, Tanzeum, Rybelsus): increase the release of insulin, reduce glucose release from the liver after meals and delay food from emptying from the stomach
  • DPP-4 (e.g.: Januvia, Onglyza, Tradjenta, Nesina): help your pancreas release more insulin after meals and lower the amount of glucose released by the liver

Understand the Potential Secondary Impacts of Medication

Did you know your medications might be causing harmful secondary impacts, like weight gain, that directly impact your ability to put type 2 diabetes into remission?

Harmful secondary impacts are side effects or the action of a medication that can negatively impact your long-term health.

For instance, take drug-related weight gain.

Blood sugar (glucose) can be turned into fat deposits when it is not properly processed as energy. In a perfect storm where blood sugar and insulin are at high levels, the fat deposits occur faster and can turn into visceral fat (fat around organs). Visceral fat accumulation can lead to more insulin resistance and lipotoxicity (metabolic syndrome which negatively impacts kidneys, pancreas, liver, and heart).

Many medications work by increasing insulin levels. High insulin levels (hyperinsulinemia) can lead to general malaise including:

  • Excessive or frequent feelings of hunger
  • Lack of concentration
  • Lack of energy
  • Exhaustion
  • Weight gain

How to Talk to Your Provider About Other Options

Are you curious if you can leverage your lifestyle changes to get off some of these medications causing the above effects? It’s the perfect time to talk to your provider. 

We will take you through the steps of a successful conversation with your health provider.

Prepare:

  • Define your goals. (For example, you’ve learned from Level2 that type 2 diabetes remission is possible, and remission is one of your goals.)
  • Write down your medications
  • Inform your provider of all the new lifestyle changes you are working on.
  • Review any documentation you have from your last appointment.
  • Write out any symptoms you’re feeling or secondary impacts you’re noticing that you want to review with your provider.

 

During the Appointment:

State your goalsYour provider is there to help and you can ask for their support to help identify how to personalize your current treatment plan to your biology, lifestyle, and goals.

Don’t be afraid to ask curious questions. Ask your provider if any of your current diabetes medication could be contributing to weight gain? Are there any medications that you could reduce or eliminate with the lifestyle changes you’ve been making? What lifestyle intervention could you continue to reduce the diabetes medications you are on?

Ask for support. Ask your provider to help monitor your medication plan as you implement lifestyle changes to treat your diabetes.

Take notes or ask to record the appointment. You’ll want to come back to what was discussed and the actions later.

Consider bringing a family member, friend, or advocate. Somebody else in the room can help keep track of what’s advised and serve as a liaison to ensure there’s an open dialogue.

 

What to Say:

Not sure how to begin the conversation? We’ll help you with that. Here is a sample script that you can use or adjust in your own words.

I’m hoping to start a dialogue about how I can work to put my type 2 diabetes in remission.

[If your provider is not aware about Level2 yet, explain what Level2 is, if not—skip below]

With Level2, I’ve learned that lifestyle changes can help reduce my need for certain diabetes medications.

I want to learn more about the best lifestyle changes for me and I would like to work with you to reduce or discontinue some of my diabetes medications. I have started <insert new lifestyle changes here>.

As I implement lifestyle changes, it might impact my current medication plan. Can we proactively come up with a plan to safely get my off medications together? Can we make it a standing item to revisit my medication plan to ensure that I am on the best medications to fit my improved lifestyle?

 

After the appointment:

Reflect. Did your provider take the time to explain why you are on your current diabetes medication? Did your provider have time to talk to you about specific lifestyle changes and your diabetes treatment goals? Are you satisfied with how the appointment went? Did you get your questions answered?

Take Action. If you weren’t satisfied with how the appointment went or still have lingering questions, follow up! Level2 can help support you too. Message your coach to request a Diabetes Nurse Consult.

 

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