Dr. Keith Roach

DEAR DR. ROACH: My blood sugar level is around 150 mg/dL on average without medication. With metformin, I have diarrhea 24 hours a day. I am 82 and very active. I walk about six miles a day on average. I tried to tell my doctor about the severity of my problem, and with a smile, he said, “Metformin can do that.”
I insisted on a replacement medicine, and he prescribed Trulicity. The cost was terribly high. The first three months was realistic, then I went into the donut hole. Should people like me just suffer the consequences of high blood sugar? — R.C.
ANSWER: Your doctor did not treat you well, and I’m sorry about that. Metformin is the most commonly used first-line treatment for Type 2 diabetes. It is inexpensive and effective, and it reduces the risk of diabetes complications better than other agents. However, it often causes diarrhea, which can be reduced by lowering the dose or using a long-acting formulation. Taking metformin with food also reduces the nausea and diarrhea that often accompanies it. If you haven’t tried those strategies, please do.
Unfortunately, some people still can’t tolerate it despite trying these common strategies. There are many other options, and although dulaglutide (Trulicity) is a very reasonable treatment, it’s not a good choice if you can’t afford it. Your insurance company very likely has a preferred oral treatment for Type 2 diabetes that should be both effective and affordable. Your doctor or pharmacist should be able to help you find out the cost.
If you don’t have good coverage for medication, consider an old-fashioned medication like glimepiride. It’s inexpensive (about $5 per month without insurance using a cost-saving program like GoodRx) and effective for most people. Insulin is another highly effective medicine that many people don’t like giving themselves, but it can be inexpensive when older insulins are used.
DEAR DR. ROACH: I am having problems with extreme dryness in my mouth. It seemed to come on all of a sudden about a month ago, and initially, I thought it might be caused by some of my many medications. For several days, I quit all the medications that I could and saw no relief from this. Could you suggest where this could be coming from and where I could go to find relief? — D.P.S.
ANSWER: One consistent finding with aging is that we tend to dry out over time. We lose height because the intervertebral disks dry up a bit. Most of us get dry mouth and dry eyes by our 50s or 60s. However, sudden onset of dry mouth or eyes, especially in a younger person, is suggestive of Sjogren’s disease — an autoimmune disease where the glands that make saliva and tears are damaged by inflammation. Rheumatologists are the experts in making the diagnosis and treating this condition.
Still, most people with dry mouth do not have the uncommon condition of Sjogren’s disease. You are absolutely right to think of medicines, but rather than just stopping them, your regular doctor (or the specialists who prescribed them) can tell you if they are likely to be causing dry mouth. They should be able to suggest alternatives.
In absence of identifiable causes, keeping yourself well-hydrated (even at night), maintaining regular dental care, and eating sugar-free candies that promote saliva can be helpful. There are saliva substitutes you can buy for more severe symptoms.
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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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