How many drugs is too many drugs?

I’m type 1, so won’t comment on the meds, but I’m confused why he isn’t focused on nutrition and exercise. It is good his numbers are down. That’s a positive .

I am type 2, and my A1C was also past 10. For the last year, it has been dropping.
I am on metformin, atorvastatin (preventative), mounjaro and tamoxifen (for cancer)
Once my A1C dropped to less than 8, Jardiance was removed. I had been on Ozempic but moved to Mounjaro, as its more effective and covers the role of lowering A1C and protecting your heart like Jardiance.

Your friend should ask about Mounjaro, then we could also stop Jardiance.

All of those medications do different things to lower A1c / glucose. He still has high sugar if it is above 6, just not at diabetic levels so why change something that is working. Pioglitazone should be discontinued if it is causing water retention, this generally shows up as swollen ankles. That side effect happens to about 20% if also taking insulin or sulfonylureas and they are not listed. It is a cheap generic. It reduces insulin resistance making the insulin he has more effective. If his dose is above 15mg (lowest) might reduce dose since side effects are more common at higher doses.

I take all of those except Jardiance and they control my A1c down to normal levels (5.6 or below). Jardiance keeps the kidneys from recovering glucose allowing it to pass in urine, so it has a side effect of increasing UTIs since glucose is in the bladder. If his A1c was below 5.6 and he wanted to discontinue a medication I would choose that since it is expensive and not as effective as the also expensive Ozempic. Metformin is a dirt-cheap generic.

Thanks. My own history is that I started out horribly, on insulin, Jardiance, and metformin, but fortunately - or whatever - within 60 days I was down to just metformin! But I was immediately all over the carb counting and exercise.

My impression has been that just one of the big drugs, plus metformin, should be enough. The problem is all the diabetes drugs (perhaps even including metformin) have bad side effects profiles. Though as I said, my friend seems to be fine on his combination.

With blood pressure drugs it's otherwise, one is seldom enough, many people are on as many as four - but most of these have fairly limited side-effects (one had bad side-effects for me). So, heck, maybe that's the trend for diabetes.

@malebreastcancer47 thanks.
You were on one major diabetes drug, plus metformin, I thought that was generally the practice.

My friend had been on the Ozempic-equivalent pill - which didn't work at all for him and made him feel sick. As soon as he went on the injection - along with the other drugs - his BG and A1C went down dramatically.

I guess we see how he does without the pioglitazone and if that's good, and my guess is it will be, they could try the Jardiance, I'd say that's probably the next most risky. If there's a problem I'll certainly forward your experience that Mounjaro might work better than Ozempic.

Meanwhile I continue to beat on him about the diet! He says he wants to do it, but he doesn't do it. I guess this is pretty common.

@carbcounter Diet was very hard, as I live alone and still work. When cancer happened at 47, it forced me to slow down, listen to my body and take it seriously.
I have a cousin at Mayo who is a cardiologist. She suggested Jardiance as it lower or stabilizes A1C and protects your heart. Any drug I take, I confirm with her. I have an endocrinologist at Northwestern Medical.

Stabilizing A1C any way you do it protects your heart. Jardiance was the first to get the OK from the FDA to connect the two things, now several other diabetes drugs do so as well.

What's so hard about diet? Once you get a few charts of carbs per serving two things happen. First you realize it's actually really simple, that it's basically 10 carbs per serving of stuff that has carbs, meat and green vegetables have basically no carbs (veggies may have a few), and whole fruit is OK but juice isn't. Keep your meals down to 60-80 carbs for starters and get used to it. Avoid pasta meals, but you can usually get away with a small side of pasta. Cut down to 40-60 if necessary, etc.

(plus there's a magic trick! put the pasta in the fridge overnight and eat it cold over the next day or three. it is now "resistant starch" which affects blood sugar much less, and in fact can also block some carbs from other foods in the same meal!)

Anyway at that point you can glance at a plate on the table and count the carbs in two seconds.

Or simplify it even more to this single rule: don't pig out! Serving size matters very nearly as much as contents. Avoiding 200 or 500 carb meals is the most important thing!

Then the only complicated part is learning how much you can cheat, without sending your BG soaring! It turns out some packaged cookies and such are also resistant starch and you can cheat with them quite nicely, lol.

It sounds like all you all are working hard on your journeys to deal with diabetes. (I am too.) It is great to share our experiences to provide hope and encouragement (as long as we don’t try to diagnose or prescribe; that is what our providers are for.)
The question & title of this discussion “How many drugs is too many drugs?” reminds me of an important point; Side Effects. We all know that most drugs have them. I’ve seen situations when a medication is prescribed; side effects occur; another drug is prescribed to treat the side effects ….. and so on. Before long a vicious cycle has been created and the patient is left with an entire pharmacy of drugs.
Early on in my education and career I had the opportunity to receive training and certification on “trained medication administration”. A principle I learned then was something called “minimally effective dose”. What this meant was to use the smallest dose of a medication to effectively treat the condition. That practice helped to avoid side effects and prevent the accumulation of a boat load of drugs. It also guards against unnecessary unpleasant interactions between multiple medications.
Please don’t misunderstand what I’m saying. I’m not one of those people who believes in NO drugs ever for any reason. I’m saying get a provider to help you create a treatment plan consisting of the most necessary meds for your situation while preventing side effects & med interactions as much as possible. This plan is ideally customized to the individual patient and the medical history because everyone is unique. People don’t all respond to drugs in the same way. There is no such thing as “one size fits all”.

@celia16
It's just what everyone says about American medicine. PCPs and even endocrinologists mention diet but they don't emphasize it. Frankly it's hard to say if they even take it seriously.

Part of this is experience, it is hard to get people to change their habits and they just don't do it. I could tell you some of my friend's excuses but I've talked to others, too. It's easier to just pump people full of drugs - though even that is challenging, "compliance" they call it.

Type1 you have little choice, you comply or suffer the immediate consequences!

I was actually admitted for a weekend for treatment and observation when first diagnosed, I'm sure they thought I had LADA - but I didn't! So I got to talk to a diabetes coach who gave me a few handouts on diet. They make it sound complicated, but as I just babbled in another post, it really isn't! But simple or complex you still have to *do* it!

Again with type1 you have to do it with every meal and no kidding. How difficult would you say that is, to count the carbs and avoid 200 carb meals?!

@carbcounter , yeah, well while my insulin pump does a great job at keeping my blood sugar down, I usually don’t challenge it with a 200 carb meal. Lol. I don’t consider myself a low carber, but in reality I suppose I am. Most of my carbs are in the form of veggies and some fruits. Definitely under 100 carbs per day. But in many ways insulin is easier to manage BG as you can cover those carbs,

It’s good you responded so well to limited meds and targeted diet. I think a lot of people struggle with that. For me, it’s not so bad. I enjoy delicious food everyday.