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)Tagged in: diabetes, health, nhs, sugar
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