Dear Dr Lee
I was saddened to read your newspaper quote suggesting that all diabetics should pay for their medications, because they owed their diabetes to "lifestyle choice".
You will be as aware as I am that this cannot possibly relate to Type 1 diabetics, whose condition is related to pancreatic failure, and can be genetic or auto-immune, among other causes. A shame that some of the Type 1s I know are having their test strips rationed by their GPs in an effort to save money!
I am a Type 2 of 2.5 years standing, and yes, I am obese. I have followed the NHS recommended low fat, high carb diet for many years, and watched my weight creep up. I could gain weight on 1300 calories a day. I have been dieting since I was 13, and have doubled my weight since then. This is not fun, nor a lifestyle choice.
I had an HbA1c of 6.5 on diagnosis in April 2010. I weighed 21.5 stone - morbidly obese. I immediately began to control my carbohydrate intake to below 70g per day, substituting extra fat and a little extra protein for the carbs, and eating plenty of low-carb fresh veg and a little carefully-chosen fruit. I now consume between 1300 and 2000 calories a day.
After all, my body has an inability to metabolise carbohydrates correctly. It seemed logical, therefore, to restrict my consumption of carbohydrates and give my poor, overworked pancreas a rest!
I now weigh 16.5 stone (and still losing), have an HbA1c of 5.4, total cholesterol of 4.6, an excellent lipid profile including a cholesterol:HDL ratio of 3.5, and BP of 122/78. I still have some insulin resistance, but my reaction to carbs is now much improved. I have lumbar spinal stenosis and cannot exercise much, but my condition is still improving.
I do not have any diabetes complications, and my diabetes costs the NHS 3 x 500mg Metformin daily (mainly to help with weight loss), a pot of 50 test strips monthly, and my routine tests. I am very lucky in that my practice realises just how useful a tool blood glucose testing kit is to someone who really understands and wants to control their diabetes.
Blaming all Type 2s for their diabetes is just plain wrong. 20% of newly-diagnosed Type 2s are of normal weight. 80% of obese people are not diabetic.
I assume you know that insulin resistance causes obesity, as all the unused blood glucose gets stored in the fat cells instead of being used for energy. Too much carbohydrate = too much blood glucose, and also = high cholesterol levels, particularly triglycerides.
In my opinion, and that of many of my fellow controlled-carbers of all Types of diabetes, the NHS dietary advice given to diabetics is just plain wrong for many of us. In fact, in some cases the low fat/high carb advice has actually caused Type 2s to become diabetic.
Diabetes is a very complex condition, and each diabetic is different from all the others. It is totally unfair to class us all as the same. The sweeping one size fits all message as given in the newspaper article that quoted you can also lead to unkind and hurtful comments and attitudes among the public at large - in some cases, as bad as race-hate and other types of discrimination.
The public is ill-educated about diabetes - which, I am sad to say, in far too many cases applies to HCPs as well.
I hope your staff actually draw your attention to this email.