Diabetes sufferers are not necessarily to blame

Dr Ben Daniels

140986345 227x300 Diabetes sufferers are not necessarily to blame

According to recent research about to be published, Type 2 diabetes treatment will use £16.9bn of the NHS budget as the number of diabetics rises from 3.8 million to 6.25 million by 2035. This has fueled scaremongering media reports with talk of “diabetes bankrupting the NHS within a generation”. Unlike other diseases, discussion about type 2 diabetes often results in debate about who is to blame. The head of diabetes UK states that the NHS needs to improve its care of diabetics. Other commentators recommended the government should be blamed for not taxing sugar rich food and others suggest supermarkets are responsible because of the cheap unhealthy foods that they push. The other obvious villains in the piece are the diabetics themselves who are usually portrayed as unrepentant fatties who can’t stop shoveling down the doughnuts? I’m not convinced that looking to blame any one group, especially those who have the condition, serves any purpose other than demonizing the disease and alienating the sufferers.

Firstly it is important to state that Type 2 diabetes isn’t solely caused by obesity. Age and genetics play a significant role too, but I accept that significant improvements in diet and lifestyle habits would cause levels of the disease to plummet and would also significantly reduce complication rates for those already with the condition.

Part of my job is to improve the lifestyle of my patients but the more bullish I am about the advice I give, the more defensive and unresponsive my patients become. Early on in my career I remember having a patient with a BMI of 40 who insisted she only ate lettuce. When I suggest this couldn’t be true, the ensuing battle escalated to a full blown row. We got nowhere and the result was that she completely disengaged from any of the support services available and completely failed to gain control of either her weight or her diabetes. The longer I’m a doctor, the more I realise that sticks rarely work with regard to encouraging lifestyle changes. As with any addiction, the addict needs to admit the problem to themselves before he or she can accept any help and change behaviour. Deep down most of us have issues with food at some level and I am no exception.

I spend a lot of my time explaining the perils of excess sugar to my patients and so this week I decided to practice what I preach. I completely banned myself from eating any sugar during my working day. How hard could it be? It was going well on Monday until one of my morning patients bought me a Twix bar. It sat on my desk goading me for at least 3 patients but then temptation got the better of me. The shiny gold wrapper poked out of the bin mocking my poor will power for the rest of the morning. The afternoon was going well until our nurse brought in some home baked chocolate brownies to celebrate her birthday. It seemed rude not try one and they looked so much more appetising than the pot of sunflower seeds I had optimistically brought in to stave off that predictable mid-afternoon sugar craving…..Changing diet and lifestyle habits that we have held for all of our lives are hard. Our brains are trained to respond positively to the reward of a sugary treat, well mine is anyway.

Fortunately for my diabetic patients, we have a fantastic new community diabetes team. The nurses who run it are enthusiastic and welcoming and offer clear non-judgmental advice and support on everything related to diabetes. They don’t preach or lecture, but just allow patients to come and ask questions, meet each other, dispel myths and hopefully motivate themselves  to make the changes they need to take control over the disease.

Right now I’m slim, young and active, but I’m certainly not immune to getting diabetes one day. For those of you “holier than thou” who can live on a diet of porridge oats and celery, I salute you, but for the rest of us mere mortals lets perhaps look at some more practical ways of helping fight diabetes rather than solely looking to vilify the victims of the disease. Our community diabetes team is brilliant but I really wish we had a similar service to help overweight patients before they develop the disease. Practical, simple, non-judgement support would be a real investment and potentially pay for itself many times over if it successfully reduced diabetes rates. We do need to work hard together to effectively prevent and treat type 2 diabetes, but ultimately if the NHS collapses, it will do so because of underfunding and government privatisation. Let’s not blame type 2 diabetics who already have enough on their plate. (pun intended)

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  • JaneJH

    “I spend a lot of my time explaining the perils of excess sugar to my patients..”

    Yes. There is an interesting (free to download) interview with American cardiologist Dr William Davis on Red Ice Radio – here is the slightly emotive blurb for the hour’s interview; however, it is a good listen:

    “Dr. William Davis, cardiologist and seeker-of-truth in health exposes “healthy whole grains” for the incredibly destructive genetic monsters they’ve become. Over 80% of the people he meets today are pre-diabetic or diabetic. In an effort to reduce blood sugar, he asked patients to remove all wheat products from their diet based on the simple fact that foods made of wheat flour raise blood sugar higher than nearly all other foods, regardless if the wheat is organic, multi-grain, whole grain or sprouted. The results were positively drastic. Dr. Davis will discuss the benefits of going wheat free. We’ll cover genetic changes of wheat verses ancient grains. He explains how modern wheat is an opiate and appetite stimulant. William also breaks down the internal components of wheat and how they interact with the body in negative ways linked to a slew of health problems. He also explains the great lie of gluten free bread. Why aren’t doctors giving this important research any attention?”

  • RichardMahony

    Currently, according to the Diabetes UK website, the cost of treating Type 2 Diabetes Mellitus (T2D) costs the UK taxpayer one million pounds per hour.  The projected cost in 2035 of £16.9bn is almost double that at 1.93 million pounds per hour.

    After a lifetime of overeating, insufficient exercise, and eventually becoming morbidly obese in her early sixties, in her late seventies my elderly mother was diagnosed with pre-diabetes three years ago, and then T2D about eighteen months later. Her prospects are not good, with signs that she already has permanent nerve damage of her feet.

    It’s true that not all those who are morbidly obese will eventually be diagnosed with T2D, and that not all those with T2D are morbidly obese.  Indeed, some very fit athletes, like Stephen Redgrave, have been diagnosed with T2D.  Nevertheless, in the same way that there is evidently a strong link between a life time of smoking and the likelihood of developing lung cancer (LC), even though not all smokers get LC and not all LC is caused by smoking, there is a strong link between morbid obesity and the later development of T2D.

    There is little evidence that education of T2D sufferers or the morbidly obese works.  Further, very worryingly, once someone is morbidly obese it seems that the damage is done.  For reasons we still don’t understand, the metabolism seems to reset itself in the morbidly obese and resists all attempts at intervention.  Bariatric surgery, a high-risk procedure in itself, brings short-term benefits but some studies suggest that long-term results are not so good.

    If neither admonishment nor education work, then what will?  My guess is that the only thing that will see a reduction in the rates of morbid obesity and T2D over the next few decades is a dramatic price hike in the cost of food and drink.  Not just sugary, fatty food and sugary drinks but all food and beverages.  This is because we know that as the cost of goods increase, so consumption decreases.

    My tentative proposal then?  Start by imposing VAT at the special rate of 5% on all foods and beverages that are currently not subject to VAT.  Measure the effect on domestic consumption.  Keep increasing the rate gradually over the next two decades to see if by taxing food and beverages we can start to bring down the national rate of morbid obesity and T2D to where they were just after the end of WW2.  At the same time, all national revenues from food and beverage taxes should be earmarked for the treatment of morbid obesity and for the illnesses that result from the condition.

  • OnlyObserving

    370 million people in the world have diabetes and a billion have metabolic syndrome or prediabetes (80 million in USA alone).  Estimates are that diabetes costs the world about a trillion dollars a year in medical costs and lost productivity.

    It is easy to reduce your diabetes risk with nutrition, exercise and lifestyle changes.  See, for example: 

  • IngaMorgan

    I suppose the passion for finding people are “to blame” for their illnesses is rooted in Protestant judgmentalism, the stubborn refusal of the English to give a damn for people worse off than themselves and a bone deep meanness that resents every penny spent on someone other than oneself.

  • Meewah

    “For those of you “holier than thou” who can live on a diet of porridge oats and celery, I salute you…”

     I wouldn`t. As a 
     person offering “practical, simple, non-judgement support “, you should know that oats can actually INcrease the risk of diabetis

  • Stephen ‘Sam’ Evans

    Both my brother and I suffer from type 2 diabetes which in our case has a genetic component .  In both our cases, before we crossed the line when Type 2 is pronounced as the diagnosis, we were prone to diabetic episodes for a goodly few years.  Trouble was that by the time we got to see a GP the symptoms had subsided.  I cannot help feeling that if we had been diagnosed earlier as beginning the on the path to full blown diabetes we might have been able to take avoiding action and at least put off the evil day.

  • anneteak

    As a well controlled diabetic,average blood glucose 5.2, I found that just before a hospital operation my BG shot up to 13… unknown before. As I’m on round the clock medication and had eaten nothing this should not have happened.

    I firmly believe stress plays a big part and that people who eat when stressed may become diabetics, because you have to ask why some people who are overweight become diabetics but most don’t.

  • rabbitlug

    Nice blanket generalisation, do you usually read the Daily Mail?

    Remind me: Asian Tsunami – who lead the world in terms of private donations, embarrassing governments the world over? 

  • clasper

    Mrs clasper has Type 2 diabetes, but it is under control.  She checks her blood sugar once a fortnight and takes BP and cholesterol lowering medication (for other than BP and cholesterol reasons).  She is 5ft 4in tall, 6 and a half stone, and her BP is 110/65 …. Pure genetics

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