Increasing obesity pushes diabetes drug bill to £600m

I'd like to ask why type 2's are being prescribed insulin in the first place. Whatever happened to diet control? And no, I'm not advocating the extreme ow carb diet, just eating healthily... as if it were difficult. Sigh.

I think a lot depends on how early the diagnosis is made, UPB.

Perhaps you were fortunate, as I was, to be diagnosed at the borderline stage, when diet and exercise alone can keep it under control.

I don't think it is entirely clear as to why some people's diabetes advances rapidly, and other more slowly - and it isn't as simple as cutting out starchy carbs - if only it were :?

Mind you - I think that those T2s who are conscientious about their diet and doing regular exercise may well be in a minority. Or am I being cynical?

I'd like to ask why type 2's are being prescribed insulin in the first place. Whatever happened to diet control? And no, I'm not advocating the extreme ow carb diet, just eating healthily... as if it were difficult. Sigh.

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This kind of smug **** shows no understanding of T2 diabetes.

My weight is a symptom of diabetes not the cause. I have genes which are better suited to a feast/famine lifestyle. This might have been a huge evolutionary advantage in times past, but unfortunately, late 20th early 21st century life is a permanent feast and my T2 body is very efficient at laying the excess down as fat.

The fat adds to insulin resistance, which means that my body does not use the insulin it does produce properly. T2s ironically start off by overproducing insulin. Those large quantities of insulin mean that all that circulating glucose (from a diet high in carbohydrate) gets laid down as fat.

Carbs are also very addictive and those extreme blood sugar swings feed carb crafings. I was permanently hungry when I was eating the Healthy Plate, always on the lookout for my next mouthful, in spite of having eaten a meal high on starchy carb which was supposed to fill me up. It is only since I stopped eating them that I have been able to identify the difference between carb cravings and real hunger.

Those toxically high sugar levels continue to damage virtually every system in the body, including the beta cells in the pancreas which produce the insulin in the first place, eventually killing them off. So diabetics who are prescribed insulin usually have very poor insulin production, I'd have thought you knew that UPB.

Mind you - I think that those T2s who are conscientious about their diet and doing regular exercise may well be in a minority. Or am I being cynical?

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They recommend a diet which most of us just can't tolerate. My blood sugar gets up to diabetic levels if I eat more than 50 carbs a day. When I eat the conventional Healthy Plate diet my blood sugar goes through the roof.

Instead of actually applying what is known about carbohydrate metabolism to evidence based practice they continue to recommend this high carb diet to peole who are intollerant of carbohydrate. Ironically T2s following this advice get labelled as non-compliant with no one to blame but themselves for their lack of self control as their weight continues to increase and they need more and more medication to manage their condition.

I'd love to be able to have a slice of toast and marmite on a regular basis, but I can't because I need to make every carb I eat count nutritionally, I'm trying to gain control of my diabetes by managing my diet because my aim is to have the same health risks as a non-diabetic.

Diabetes is a complex illness and medicine does not know enough about it, but all I can say about my contol now is that I have not felt this healthy for years.

Mind you - I think that those T2s who are conscientious about their diet and doing regular exercise may well be in a minority. Or am I being cynical?

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Possibly.
Anecdotally at least, I've met far more diabetics who try their best, follow the advice they are given, yet still find they cannot control their blood sugar or stop the slow creep of progressive illness. There may well be many who couldn't care less, but they seem harder to find (I guess they're not going to be showing up on the forum very often, are they?).
The ultimate irony of course is that those who are conscientious and base their diet on starchy carbs as recommended are almost inevitably going to be getting results that makes them wonder why they bother. If you are a dogmatic health professional, you will see that as a non-compliant patient. If you are the diabetic, you should seriously question whether the dietary advice makes any sense.

All the best,

fergus

Well said Spiral!

If only it were as simple as 'healthy eating'! Yes, I'm overweight but not hugely so.

I'm been a type 2 for 30 years, but I'm now insulin dependent - humalog and lantus, and here's an example of a very modest food intake and the subsequent BG.

On friday, following a nice low carb day, I went to a local Chinese restaurant where I had a long conversation with the restauranteur (another type 2 - who, incidentally, is slim). She suggested a menu that did not contain excess carbs and sugary sauces (one she follows herself). She also confirmed that they don't use MSG or GM - don't know if that makes a difference. The only carbs were ONE prawn cracker and ONE waver wrapped prawn. No sauce, no rice, no noodles. Two glasses of red wine. No dessert. Just stir fried prawns and stir fried lamb with beansprouts and water chestnuts . Pretty boring really. The only thing that I thought maybe a bit suss were 5/6 pieces of waterchestnut. This was taken over a period of 1-1/2 hours.

I injected 10 units 10 minutes prior. Two hours after my BG had risen from pre-meal 5.4 to 13.8 - all with a very miserly intake. I had to inject another 5 units to bring it down to 9 before I went to bed. To say I was shocked is putting it mildly. I shudder to think what my BG was if I'd tested at one hour.

Healthy food? Not to me it ain't! For me, any carbohydrate sends me right over the top. It doesn't seem to make any difference whether it's 'healthy' or not.

Oh well, I suppose Chinese is off the menu for a while!

Regards,
Barbara

UPB
Firstly, how are you to identify a healthy diet?
The Food Standards Agency's "Healthy Eating Plate" is pretty much what I was eating before developing T2. If I were to eat that way now, I'd cost the NHs MUCH MORE than the 4p or so per day that I use in Metformin.
I follow a low carb diet, exercise about 7 hours per week in formal settings and walk most places.
If you have a simple remedy for my weight problems and diabetes, please DO TELL!!! I come from a long line of overweight,T2 diabetics. My Czech ancestresses had no access to the foods that are blamed for the condition,ie chips, crisps,fizzy drinks. They were farmers and spent all their daylight hours working the land.
Yet they developed T2 and my grandmother's death from a stroke was probably triggered by it as was my aunt's.
They did use diet control only. That was all that was available to them.
I am of the firm opinion that weight issues are a SYMPTOM of T2, NOT a cause :evil:

I am of the firm opinion that weight issues are a SYMPTOM of T2, NOT a cause.

Some cases, yes.

Some people i know eat nothing but fast food and never exercise. Then wonder why they are overweight.
It's because they think nothing of eating an entire pizza, plus chips, and crisps, and normal coke.

In some people, it is just a case of them eating too much, and not exercising.

Some cases, maybe the diabetes is responsible. But certainly not all cases.
Eating over 5,000 calories a day and not exercising will make anyone overweight.
That is not a symptom of everything. That's just a lack of personal responsibility.

Not all overweight people are diabetic, even those who may be morbidly obese, even if they eat 5000 calories a day and don't exercise. This is why weight is a symptom not the cause. And it wasn't until I worked out the link with my carbohydrate consumption that I have lost weght.

So having to provide insulin for 300lbs of peson and 5,000 rather than 100lbs and 2,000 has nothing to do with it at all?

Not everyone who's morbidly obese has sleep apnea either, but that's certainly caused by being overweight in a lot of cases.
It can sometimes be a symptom, but i really don't think that it's ALWAYS the symptom and never the cause.

There isn't one single cause. But being hugely overweight makes it a lot more likely. Doesn't mean it's not a causal factor.

I'm one of the 20% of T2s diagnosed whilst having a BMI in the normal range, and yet we never get mentioned, probably because we don't fit into the "lifestyle disease" category. Yes we are in a minority but still a sizeable one so does this not indicate some sort of genetic disorder :?:

Graham

:sick:

I'm one of the 20% of T2s diagnosed whilst having a BMI in the normal range, and yet we never get mentioned, probably because we don't fit into the "lifestyle disease" category. Yes we are in a minority but still a sizeable one so does this not indicate some sort of genetic disorder :?:

Graham

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I also have a normal BMI diagnosed with Type 2 at 60 , when I asked my Gp why I have Type 2 late in life , he replied , If I had been overwight i would have been diagnosed 20 yaers earlier , the implication is that Type 2 is genetic and indeed does run in families so if you are Type 2 your family members should probably think about getting tested / and try not to put wight on

I've yet to hear a Doctor tell me about low carbing even though Diabetics in the 50's/60's etc were instructed to follow low carb diets. Why are we going backwards? I'd love porridge for breakfast , jacket potatoes or pasta for my daily meal but it ruins my levels.

Why won't the NHS revise it's food advice?

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Top question, Shygirl.

To my mind, the thing which unites type 2 diabetes and overweight is hyperinsulinemia. It's extremely rare to find an overweight person without hyperinsulinemia, just as it is with the great majority of type 2's. The same hormonal imbalance is also apparent in a number of other disorders, but those are the most relevant conditions here.
In the west, the conventional wisdom for the past 30-40 years has been to reduce the fat in our diets and replace it with carbohydrate. The very thing which induces an overproduction of insulin and sets in motion the journey towards obesity and diabetes. I think it's almost better to think of these outcomes as different points along the curve from a healthy non-diabetic state to being overweight and diabetic, not seperate triggers which necessarily lead from one to the other. Either of those destinations might appear first, but when it does, the other may not be very far behind.
So, by that reasoning, the government and the medical profession (a few notable exceptions aside) is implicit in the escalation of diabetes and overweight over that 30-40 year period. Their recommendations make each of these outcomes more, not less, likely.
In that case, these authorities are faced with two choices. Either admit their advice was wrong and face the consequences, or stick their fingers in their ears and shout 'starchy carbs with every meal!'

All the best,

fergus

I think fergus is spot on, hyperinsulinemia is the common link and causitive factor in T2D and obesity (and many, many other conditions - a quick google of "hyperinsulinemia + other condition" is often very interesting). Insulin is an incredibly important hormone in all sorts of processes in the body, and when it gets messed up it has all sorts of consequences.

The genetic predisposition to T2D is, in my opinion, overplayed - and I know that will make me unpopular with some people here. But the thing you need to remember about genetics is that it is genetics + environment that lead to the expression of a phenotype. Remove the environmental factors that cause hyperinsulinemia / T2D and you can avoid the expression. This is why people with type 2 can achieve non-diabetic bloods on low-carb diets - they remove the environmental factor. It makes sense that different people have different tolerances for the amount of carbohydrate they can eat before problems set in, but that's it - the answer is to keep carb intake below that individual level.

It's the same as sunburn - I'm caucasian, and I have a genetic predisposition to getting sunburn. But I know how to handle this - I stay out of the d*mn sun (not hard in northern England) or I use sunscreen! My Caribbean friends have a much higher tolerance to sun exposure so they don't need to be as careful, but even they can overdo it - it's a question of individual tolerances, much as it is for diabetes and carb intake.

I also completely agree with the points about dietary advice - advising everyone to eat a high carb diet is causing most of the problems, and advising diabetics to continue with a high carb diet prolongs and exacerbates them. The sooner we see guidelines that take into account carbohydrate's role in all sorts of metabolic conditions, the better.

100% right Nick.

The exasperating thing is that the seemingly inexorable rise in rates of diabetes and obesity could be reversed if only the health profession paid appropriate attention to measuring insulin levels instead of fannying around with relatively meaningless cholesterol counts.

Serum insulin has been testable since the 60's (Yallow & Berson) and an accurate result can be had for less than £20 today. Straight away, patients could see if their insulin levels were elevated and the long term implications are well understood - impairment and permanent damage to organs and metabolism. It's equally straightforward to treat - simply cut out the sugars and starches until the insulin level returns to normal. Improvements in weight, lipids and much else would quickly follow, diabetics may become unmedicated and in all liklihood there would be noticable improvements in the outcomes of many other conditions, cancer and Alzheimer's disease included.

If only there was a financial imperative, like the vast profits which come from selling statins..... :roll:

All the best,

fergus

The £600m figure is interesting, it breaks down to about £2000.00 per month per diabetic.

Now I am on Metformin and Insulin, I have one eye test a year and a couple of visits to a diabetic nurse. I can't see that lot adding up to £2000.00 a month, now lets factor in all the diabetics who are on diet only and these figures seem even more bizarre.

I assume this amount includes money spent on diabetic complications, I think you all know where Im going with this eh?

Yet another reason to prescribe every diabetic with test strips and the knowledge to use and act on the results wisely and so reduce the amount of complications.

Seems so obvious when you look at it like that, dont you think?

I would LOVE to see most of these comments ADDED to the article in the comments part!! Please post them there ........... give them a fight - why should those type of articles being printed be left unchallenged by "this camp" and you guys put it so well!!

Please go get him!! LOL


Alice

Spiral said:

I'd like to ask why type 2's are being prescribed insulin in the first place. Whatever happened to diet control? And no, I'm not advocating the extreme ow carb diet, just eating healthily... as if it were difficult. Sigh.

Click to expand...

This kind of smug **** shows no understanding of T2 diabetes.

My weight is a symptom of diabetes not the cause. I have genes which are better suited to a feast/famine lifestyle. This might have been a huge evolutionary advantage in times past, but unfortunately, late 20th early 21st century life is a permanent feast and my T2 body is very efficient at laying the excess down as fat.

The fat adds to insulin resistance, which means that my body does not use the insulin it does produce properly. T2s ironically start off by overproducing insulin. Those large quantities of insulin mean that all that circulating glucose (from a diet high in carbohydrate) gets laid down as fat.

Carbs are also very addictive and those extreme blood sugar swings feed carb crafings. I was permanently hungry when I was eating the Healthy Plate, always on the lookout for my next mouthful, in spite of having eaten a meal high on starchy carb which was supposed to fill me up. It is only since I stopped eating them that I have been able to identify the difference between carb cravings and real hunger.

Those toxically high sugar levels continue to damage virtually every system in the body, including the beta cells in the pancreas which produce the insulin in the first place, eventually killing them off. So diabetics who are prescribed insulin usually have very poor insulin production, I'd have thought you knew that UPB.

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Yeah, but there simply isn't any way for me to feel sorry for anyone who has eaten themselves into diabetes. I'm sure a lot of people with T2 would rather look at their weight as a symptom than a cause, because then it isn't their fault.

Simply not being able to stop eating isn't a medical condition, no more than feeling sad every now and then is. But instead of just living with the sadness every now and then, we're becoming a country of pill poppers. And instead of simply not gorging, we start prescribing expensive insulin instead. I'm a type 1. I'll die within a month if unable to inject insulin. Slowly and painfully. Type 2's won't. So I just can't bring myself to feel any sort of sympathy. I'd give anything to be type 2 instead of type 1, but instead I'm stuck with my needles (and I'd like to point out I've had to get past my needle phobia in order to inject) while type 2's blame their genetics for not being able to stop eating.

That just doesn't wash with me.

Nobody "eats themselves" into diabetes. What of all the massively overweight people that are not diabetic?

I understand your frustration at T2s - I don't envy you one bit being T1. But I didn't eat my way to Diabetes. I've dieted since I was 13 (years and stone!), and developed Diabetes at 19 (years and stone!).

I'm sure if I'd known about the dangers of carbs then i wouldn't be in this mess now...

Peace, Love and Bacon n' Cheese.