It's becoming increasingly difficult for diabetics to know which is worse -- having the disease, or realizing the treatment for it just might be fatal, too. Late last month, a federal drug advisory board voted overwhelmingly in favor of keeping Avandia, a medication for Type 2 diabetes, on the market, despite findings that it raised the risk of heart attacks and angina.

Many in the medical community, let alone in the general populace, are shocked. The Food and Drug Administration (FDA) knew for more than a year about studies suggesting the drug's link with elevated cardiovascular risks. The combined analysis of more than three dozen short-term studies revealed the possible complications, but the FDA dismissed concerns after a long-term trial did not yield the same results.

This, shortly after scandals over Vioxx, a Merck painkiller known to create cardiovascular problems, including heart attack and stroke, and immediately preceding the latest controversies over Nexium and Prilosec, heartburn medications now also linked with fatal heart attacks. It would seem that the FDA and the pharmaceutical industry knew about risks surrounding these drugs, too, well before public statements were released. AstraZeneca recently handed over the results of a fourteen-year study on the link between Prilosec and fatal heart attacks in which, within the first year of its inception, the association was found. Understandably, the public may be growing weary of pharmaceutical giants' promises of drug safety.

Dr. David Graham, a drug safety officer for the FDA, protested the federal drug advisory board's recent decision on Avandia, firmly stating that the medication should be pulled. Graham estimates the toxic side effects from Avandia caused more than 200,000 heart attacks and strokes between 1996 and 2006, some of which were fatal. For every month the medication is sold, he said, 1,600 to 2,200 patients will encounter more of these problems.

"If Avandia were up for approval today, based on what we know now, it would be rejected," said Dr. Sidney Wolfe of Public Citizen, a drug safety advocate. Wolfe believes that there are even more associated risks, in fact, than what the FDA is revealing, including the increased likelihoods of fractures and liver failure.

Ironically, diabetics are already disproportionately affected by heart disease and stroke. Those with diabetes are seventeen percent more likely to develop cardiovascular disease, have an eight percent higher chance of suffering a stroke, and show a forty-three percent elevated risk of hypertension -- even before medications further increase these risks. Further complications include amputations, kidney disease, eye disease, neuropathy, and depression.

Texas may be one of the states hardest hit by additional complications to the epidemic. Diabetes is the sixth leading cause of death in the state, more than 1.3 million Texan adults have it, and another estimated half a million are undiagnosed.

What's worse, perhaps, is that there has been a steady increase in the disease's incidence, with predictions it will rise further. Between 2000 and 2005, the number of diagnosed diabetics went from 927,834 to 1,325,244, a rise of more than six percent, and within the next thirty years, that number is expected to increase another seventy-seven percent. The fact that the majority of Texans are now obese -- a risk factor itself for diabetes -- only further complicates the issue.

Lack of health insurance is a significant part of the problem. Twenty-five percent of the population in Texas is living without any health coverage whatsoever. Despite the fact that some of the best medical facilities in the country are located in Dallas, Austin, and Houston, twenty-four percent of those with diabetes in Texas could not see a physician due to cost in 2005. In fact, statistically, those with the disease are less likely to be able to afford medical care than those who do not suffer from the condition. Life-threatening complications from medications believed to treat it could prove disastrous for those diabetics already dealing with problems from being uninsured or underinsured.

Decisions affecting major health issues are difficult enough. What is one to do if a doctor is not affordable, the possible effects of a disease are life-threatening, and getting the treatments for it just may ruin credit scores? Now, throw in the fact that the drugs claiming to alleviate some of these physical problems just may be fatal, too, and it's -- if not a no-win -- a very hard-to-win situation.

Running drug companies into the ground seems to be neither a desirable, nor realistic option, nor does dissolving the FDA, which, for years, has been building a reputation that's just as unfavorable. Encouraging all of us to act like adults seems to be the only real solution -- that is, being conscientious about actions that concern both personal and public health, and taking responsibility for just how dramatically our behavior may affect the next person. Simplicity is usually the answer: patients need to make conscientious decisions about their treatments, and drug companies need to be absolutely transparent about their products.

Being aware of safety issues affecting your health is an important part of taking care of yourself. Minding your health will certainly affect you as you age, and eventually your wallet.