LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Wednesday, June 19, 2013

Resistance is futile… or maybe it’s fact

I had food for thought the other night while I was feeding my face at a drug rep dinner. The presentation was on the GLP-1 medicine Victoza, and even though I feel pretty up to speed on this med (we have fifty or more patients who take it, my wife takes it, and I even use it off-label myself), the dinner was at a place I like to eat, so of course I went.

Now, the quality of this kind of program varies a lot. The marketing logic behind a drug rep dinner is that if an important doctor speaks highly of a product, average doctors will be more likely to prescribe it. Oh, right. And to get the average doctors to listen to the important doctor in the first place, you need to offer them a free expensive meal. This marketing strategy has been scientifically proven to work, which is why Big Pharma throws a ton of money at important docs who are willing to take the dough. Of course, this means the speaker is literally bought and paid for, so I bring not only my appetite but a healthy dose of skepticism with me when I go to these things.

Sometimes the speakers are ballyhoo men, sometimes they are interesting and amazing. Sometimes they are entertaining speakers, sometimes they drone and put the audience to sleep with a heavy dose of PowerPoint sleeping pills.

Sometimes I learn something new, sometimes I don’t. So I never quite know what I’m going to get out of attending, but I can always count on the wine being free and flowing equally freely, and I often enjoy the company of the other participants—if not the program itself.

In this case, the speaker disappointed. Big time. His slides were out of date, and he didn’t know them well. He kept harping on the AACE guidelines and how they were so much better than the ADA guidelines, but his PowerPoint was showing the old guidelines. He was oblivious to the ongoing trials of the med he was peddling for both weight loss and type 1s. Hell, I could have done a better job. Of course, what average doc would listen to little ’ol un-certified me?

During the post-talk Q&A, over desert and yet more wine, a lady doc in attendance observed that when she starts patients on Victoza they do great for a month or two. Their blood sugars improve, their weight drops, their appetite curbs. Then they often lose traction. It’s almost like the drug stops working as well, she said. Then she asked the speaker: “Do you think there’s such a thing as GLP-1 resistance? Do you think our patients might be developing resistance to the Victoza?”

Wow! What a great question. What an astute observation, I thought to myself. I’ve seen the same thing that she was describing happen, although not often. Yet, never in a million years would it have occurred to me to think about the possibility of GLP-1 resistance. My ears perked up. Maybe I was about to get something other than free wine out of this dinner.

Doctor Important, without even taking two seconds to consider the question, waived his hand dismissively, “No. It’s all a patient compliance issue. The diabetics start eating too much again and overwhelm the effect of the medication.”


Same old endo song and dance. It’s always the patient’s fault, no matter what. I hate the word compliance and it’s more evil twin: non-compliance. In my wine-fogged mind I briefly had a vision of every type 1 in the country arriving at their endo appointments wearing T-shirts that say: Comply This!

The lady doc dropped it. But I didn’t. When I got home I spent some time investigating the clinical research net (more commonly known as Google with Whiskey). I couldn’t find anything about people developing resistance to the meds, but GLP-1 resistance itself is actually a well-documented biological fact, and one theory is that it might even be the driving force that triggers gestational diabetes! So if some people are resistant to GLP-1, it only stands to reason that you could become resistant to the effects of an artificial “supersized” GLP-1 in a pretty baby-blue pen.

Maybe our speaker should have had some of the free-flowing wine himself. It’s been shown to be a good prescription for opening closed minds.


Anonymous StephenS said...

Where do I get my T-shirt? Great post... thanks.

8:44 AM  
Blogger Lesley said...

I want a t-shirt too! Thank goodness for people like you (& that lady doc... maybe she went home & researched too seeing that the presenter wasn't going to be any help). I had a primary care doc (a long time ago, and for a short time) who used to dismiss anything that he personally had never seen in his practice (and he was about 32 years old so hadn't seen all that much in my estimation) -- compare that to my endo at the time who used to say "whether there is research or documentation or not, if you are experiencing it then it is real and we should see what we can do." Keep up the great work & thanks for the post!

11:54 AM  
Blogger Scott K. Johnson said...

I love your storytelling talent, Wil!

It's an interesting issue, and one I'm curious about, too.

4:54 PM  
Anonymous Anonymous said...

Great post! As a T1D using Victoza off-label I find that I need to be continually increasing my dose. My body seems to get used a one dose and I need to add in an extra click the next day to keep the effect. Not sure if there is a resistance mechanism at play here, but it could surely be worth some investigation.

6:15 PM  
Blogger Sara said...

I hope that lady doc does some investigating too and finds out the REAL answer to her question!!

I think it is interesting when doctors so quickly place blame on non-compliant patients when most of the issues can be traced back to the lack of education and/or support provided by their office in the first place.

11:01 PM  
Anonymous Lauren said...

Why can't docs just admit that the human body is completely outsmarted by disease?! Come on, if the whole world goes down like Pompeii, everyone knows that the only survivors will be cockroaches and disease spreading microbes. Resistance to drugs is how we evolved. Or am I completely nuts?!
I would like to tell Dr. Dumbass that non-compliance is how many T1's survive a crappy endo and find success in self management.
Wil, how in the hell did you stay quiet and what did you really want to say to this guy?!

10:12 AM  
Blogger Mike Hoskins said...

You could also get a medical alert bracelet that says: "Non-Compliant Type 1. DEAL WITH IT." I may know a guy in Indiana who has one of those... :)

8:39 PM  

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