Diabetics potentially have a LOT to lose by using hydroxychloroquine
This is a guest post by Gary Cornell. Gary holds a Ph.D. in mathematics from Brown University and was the co-founder of the the major technical publisher Apress. He has written or co-written numerous best selling programming books and has been a Mathematics professor, a visiting scientist at IBM’s Watson Labs and a program director at the National Science Foundation.
I’m not a doctor nor do I play one at daily press briefings. But like most mathematicians, I do know something about basic statistics. And, like most academics, I read everything that comes out about drugs I am taking. Obviously, I concentrate on the statistical sections and the list of side effects and drug interactions in these research papers. And so, this being 2020, I have a google alert for the drugs I am taking.
Anyway, one drug I am taking is the maximum dose of metformin. It is the fourth most prescribed drug in the United States and is used by more than 150,000,000 people world wide. It is the usual first drug prescribed for Type 2 diabetes. It is a good drug, the side effects are usually mild and it is even being explored (the TAME trial) as a possible “longevity” drug. A good drug…
So I was shocked to see this link popping up in my in box:
This note is from researchers at Johns Hopkins – which I hasten to point out is currently rated the #2 school in the United States for “medical research”. People there are not general considered practitioners of psycho ceramics, in other words.
Holy ^&%$#, I thought. And then I tuned in to the Sunday “briefing” where Trump doubled down on his pushing claiming that “what do you have to lose” – and prevented Fauci from tempering his response. Though mice results aren’t conclusive and perhaps fatalities are off by a factor of 10 or a 100. Who the &^%$ knows if taking this will kill me? Maybe it is much worse for people on the maximum dose of metformin like me. But, absent proof it is safe for people taking metformin, pushing it if you are taking metformin except in life or death situations would seem to me malpractice for a doctor and practically criminal for an economist or politician.
Oh, in case you are thinking that maybe except for people taking metformin, hydroxychloroquine is a “good” drug, Drugs.com says there are 332 drug interactions (59 of them being major). And here is the list of side effects
So, answer is, you have a lot to lose.
mathbabe 
I’m not a pharmacologist, but coadministration of these two common drugs appears to be a known thing. They both lower blood glucose so maybe the Hopkins researchers simply overdosed their mice into hypoglycemia?
Definitely not a good drug interaction to self-experiment with.
https://m.pdr.net/Mobile/Pages/drug-summary/Plaquenil-hydroxychloroquine-sulfate-1911
“Careful monitoring of blood glucose is recommended when hydroxychloroquine and antidiabetic agents, including metformin, are coadministered. A decreased dose of the antidiabetic agent may be necessary as severe hypoglycemia has been reported in patients treated concomitantly with hydroxychloroquine and an antidiabetic agent.”
Use in type 2 diabetes on top of metformin:
https://pubmed.ncbi.nlm.nih.gov/31713476/
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You can stop to take metformin when starting to take hydroxychloroquine – the drug with a lot of side effects without metformin, or you may hope that a doctor prescribing you hydroxychloroquine will do this. The blood sugar lowering effect of metformin is very moderate and can be compensated by dietary changes.
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The paper actually speculates that the problem may stem from “autophagy” i.e. protein recycling not hypoglycemia. HCQ and CQ both inhibit autophagy but Metformin increases it. The point is suggesting you give a drug prophylacticly requires an insanely high safety standard as oppose to giving it to someone who is just about to be admitted to an ICU. Pushing this drug for widespread prophylactic use is insane.
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This is great information; I am 70 years old and take the max dose of Metformin as well. So far I’m healthy.
All that being said, a lot of this is speculation; let’s wait for trial results before weighing in on whether or not CQ or HCQ are appropriate for treating or preventing Covid-19.
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