The NHS T2 Treatment Regime

kokhongw · Apr 7, 2017

It appears that the glucose centric view of diabetes, seems to ignore, overlook, obscure the fact that Type 2 has elevated insulin responses that could be many times above normal.

Perhaps that is why FATs in the low carb high fats diet works...fats don't cause a huge insulin response and those gives our impair pancreas some much needed rest.

Rosalie_900 · Apr 9, 2017

AM1874 said:
Two recent articles (or new book plugs) by well-known doctors Muir Gray and Michael Mosley focus on pretty much the same thing, ie. Type 2 diabetes is largely self-inflicted. Gray wants to rename T2D as "walking deficiency syndrome" .. for Mosley, it's about being fat, "particularly around the belly".

I have not put this thread up to criticise these articles .. or to generate another round of discussion about their rights and wrongs. I am more concerned, here, with the fact that neither of these eminent authors appear to accept, or even recognise, that their own paymaster, the NHS, bears any responsibility for today's T2D epidemic.

Scattered right across this forum are countless posts from people who have received poor standards of either perceived or actual care from their GPs and HCPs. This ranges from lack of interest, to a "one size fits all" approach, to inappropriate or incorrect advice, to an almost slavish adherence to a treatment mindset that was generated decades ago and has not been updated. There are, of course, a lot of exceptions to this and many T2s do not experience any such problems. Many GPs (mine included - now that I have changed my Doc) offer advice and support outside the NHS guidelines. Mosley himself, for instance, even quotes his wife, a GP, who tells her diabetic patients, "Sorry, but we’ve been giving you the wrong advice for 20 years". Unfortunately, though, many (probably the majority) of GPs and HCPs continue to plough the same dated furrows that the NHS has been cultivating for years.

But we're a stoic lot and we put up with this. We comment on the forum, get a few " likes" and "winner" ratings .. and then fall back into a stance of resigned acceptance. We CARRY ON and even joke about it .. the "Listen, Nod, Smile, say Thankyou, Ignore" approach to the advice that we receive from Dieticians about the "Eatwell PLate" and starchy carbs just about sums this up.

I would point out, here, that I am talking about T2, rather than any other type of diabetes. Also, all of the issues that I have raised are generalised, rather than specific and I am fully aware that lots of folk on this forum, and their GPs, take a highly positive stance in terms of managing their T2 diabetes and their treatment. But I believe that my main point is valid and important, namely ..

Why does the NHS promote and deliver a T2 treatment regime that does not work for many (most?) patients .. and how do they continue to do so without any (apparent) change, advancement .. or criticism?

It's not a question of funding .. the NHS now spends more on medication for diabetes than any other condition .. but there has to be something that is preventing the NHS from updating and changing their advice and their treatment regime. I must admit that I'm baffled by this .. and I can't avoid asking myself what would happen if, say, cancer care was run in a similar way

Just my thoughts .. and apologies if this has all been previously discussed

I absolutely agree. What can we do about it? Create a pressure group? We could do with someone appropriate to front a campaign. I know more research is needed, but I think there is enough knowledge now to start a change in NHS advice. As you say it is in the nation's ( NHS/ government) interest to save money in this way, so they should give it a priority. Is there someone affiliated to diabetes.co.uk who would be prepared to take this on. I am a new member so not quite up to speed on everything.

Rosalie_900 · Apr 9, 2017

AM1874 said:
Two recent articles (or new book plugs) by well-known doctors Muir Gray and Michael Mosley focus on pretty much the same thing, ie. Type 2 diabetes is largely self-inflicted. Gray wants to rename T2D as "walking deficiency syndrome" .. for Mosley, it's about being fat, "particularly around the belly".

I have not put this thread up to criticise these articles .. or to generate another round of discussion about their rights and wrongs. I am more concerned, here, with the fact that neither of these eminent authors appear to accept, or even recognise, that their own paymaster, the NHS, bears any responsibility for today's T2D epidemic.

Scattered right across this forum are countless posts from people who have received poor standards of either perceived or actual care from their GPs and HCPs. This ranges from lack of interest, to a "one size fits all" approach, to inappropriate or incorrect advice, to an almost slavish adherence to a treatment mindset that was generated decades ago and has not been updated. There are, of course, a lot of exceptions to this and many T2s do not experience any such problems. Many GPs (mine included - now that I have changed my Doc) offer advice and support outside the NHS guidelines. Mosley himself, for instance, even quotes his wife, a GP, who tells her diabetic patients, "Sorry, but we’ve been giving you the wrong advice for 20 years". Unfortunately, though, many (probably the majority) of GPs and HCPs continue to plough the same dated furrows that the NHS has been cultivating for years.

But we're a stoic lot and we put up with this. We comment on the forum, get a few " likes" and "winner" ratings .. and then fall back into a stance of resigned acceptance. We CARRY ON and even joke about it .. the "Listen, Nod, Smile, say Thankyou, Ignore" approach to the advice that we receive from Dieticians about the "Eatwell PLate" and starchy carbs just about sums this up.

I would point out, here, that I am talking about T2, rather than any other type of diabetes. Also, all of the issues that I have raised are generalised, rather than specific and I am fully aware that lots of folk on this forum, and their GPs, take a highly positive stance in terms of managing their T2 diabetes and their treatment. But I believe that my main point is valid and important, namely ..

Why does the NHS promote and deliver a T2 treatment regime that does not work for many (most?) patients .. and how do they continue to do so without any (apparent) change, advancement .. or criticism?

It's not a question of funding .. the NHS now spends more on medication for diabetes than any other condition .. but there has to be something that is preventing the NHS from updating and changing their advice and their treatment regime. I must admit that I'm baffled by this .. and I can't avoid asking myself what would happen if, say, cancer care was run in a similar way

Just my thoughts .. and apologies if this has all been previously discussed

Why don't we create an online petition to Simon Stevens head of NHS England? Any supporters?

serenity648 · Apr 9, 2017

I dont go along with this idea that people are too lazy to change their diets. I know a fair few people who are gluten intolerant, or lactose intolerant. They have changed their diet, with the occasional lapse, but they took the advice serious. They had to change their diet or keep getting it.

I think of there were clear guidelines, like there are for other medical dietary conditions, and the research to back it up, then many people would follow the advice. Its the ambiguity, the "it may help" wishy-washy-ness of the HCP's which is doing the harm. Who is going to change their diet so much just on the perceived off chance, with no way of testing to see if it is working, except an annual hba1c test?

We need a proper study done, proper research to back low carbing up, or it isnt going to change.

Avocado Sevenfold · Apr 9, 2017

serenity648 said:
I dont go along with this idea that people are too lazy to change their diets. I know a fair few people who are gluten intolerant, or lactose intolerant. They have changed their diet, with the occasional lapse, but they took the advice serious. They had to change their diet or keep getting it.

I think of there were clear guidelines, like there are for other medical dietary conditions, and the research to back it up, then many people would follow the advice. Its the ambiguity, the "it may help" wishy-washy-ness of the HCP's which is doing the harm. Who is going to change their diet so much just on the perceived off chance, with no way of testing to see if it is working, except an annual hba1c test?

We need a proper study done, proper research to back low carbing up, or it isnt going to change.

I changed my way of eating when I was diagnosed and I have changed it again since. It's all good. What peed me off about being handed the Eat Well diet when I was diagnosed was that I was told there was no alternative when there obviously is. I was told by a dietician that I must eat porridge. I didn't so was a bad diabetic.

Any diet that is nutritious, sustainable for life and yields good results is the best diet. It is the NHS's stance on self testing that is wrong.

Daibell · Apr 9, 2017

bulkbiker said:
So how much research has there been that the Eatwell plate is so much better that it is recommended?
Pretty much none...

Hi. I agree. It's the traditional mantra that there has not been enough research into the low-carb diet despite the many 1000s of us who have actual experience. The research that went into the Eatwell Guide is very weak. It comes from university research departments funded by the food industry or pharms with an obvious agenda.

ickihun · Apr 9, 2017

CherryAA said:
My on doctor ( a private GP ) told me he saw little point trying to roll out what I was doing amongst has patients because they also use the NHS and take the medications.

My little rant in Waitrose yesterday was a result of feeling that one should at least try to get the message out. I now have two male friends each of whom has lost 28 kilos as a result of low carbing and one who has reduced by 10 kg and reduced insulin.
Funnily enough I have found my female friends much more resistant to the idea, maybe because they ( like me) spent so many years going low fat. whereas for each of the guys the whole idea that diet could matter so much was a complete revelation which once embraced they did not find too difficult to follow. (Its actually quite a "macho" way of eating )

Its looking like males are more affected by sugary diets. Mosely mentioned it on trust me im a doctor.
Males therefore benefit more from a low carb diet than females. Some females see this as competition but a competition they very rarely win, or are disadvantaged at. Also other health problems are more prevalent in woman. The female body is more complex.
Some males have their meals planned and cooked for them. Alot of females dont have that advantage either.
It is harder for females to lose weight. Lets be honest fat cells hold the insulin resitance solution. Women are renound for having more fat around the middle to cater for child bearing. Very disadvantaged. Hereditary shape also adds to disadvantages or advantage too.
Short rounder shaped people hold more fat around the organs. We all know that is the big solution to insulin resistance.
Ive had "you dont look that heavy Vicky" all my life. Thats because fat was held around organs too.
I used to breath in to look slimmer in my teens. Wear holdin underwear to look slimmer. Anything in fact to make my external fat not look so fatty. Unlike my 2 sisters who arent indulin resistant. (Maybe).

Freema · Apr 9, 2017

well I think part of insuline resistance is also that mucsle cells cant recieve the glucose either and store glucose untill needed for use...maybe I am wrong in that, but as I have understood that , that is the reason why insuline resistance can be bettered by excercise and muscle building, in which men also has both advantages as they from natur have a greater muscle mass ratio than women even before exercising but also usually do build muscle up much faster than do women...

I don´t really understand why diabetics are not told to "bodybuild" and exercise if they are cabable of it , when there is so much evidence of a up til a 30% bettering of insuline resistance by "getting fit and going"...

donnellysdogs · Apr 9, 2017

After seeing all the mature persons in hosp with severe leg / feet problems... how would these people react if the NHS suddenly said... "we got it wrong".. they cant....

They are too scared of being sued...

Such a shame, no answers.

Human nature though as a whole is mainly led by greed.. greed for food-incase of famine. Greed for money, incase of none! Etc, etc.

Doesnt matter what the NHS advice really is the damage of lifestyle is done a long, long time before needing the NHS advice..

serenity648 · Apr 9, 2017

donnellysdogs said:
Doesnt matter what the NHS advice really is the damage of lifestyle is done a long, long time before needing the NHS advice..

Dont think I quite agree with that. I first got diagnosed as pre-diabetic 5 years ago. My father has been type 2 for nearly 40 years since diagnosis, so lots of time to get further damage after diagnosis. If its caught early enough and addressed properly, some of the damage appear to be reversible, and further damage can be prevented. So only a small amount of irreversable damage may happen before diagnosis.

donnellysdogs · Apr 9, 2017

serenity648 said:
Dont think I quite agree with that. I first got diagnosed as pre-diabetic 5 years ago. My father has been type 2 for nearly 40 years since diagnosis, so lots of time to get further damage after diagnosis. If its caught early enough and addressed properly, some of the damage appear to be reversible, and further damage can be prevented. So only a small amount of irreversable damage may happen before diagnosis.

Nowadays though the foods are different and the nicey, nicey, approach are letting the populations down.. and the T2's...

Too many T2's just get poor advice nowadays... and havent got particularly good diets to start off with.

In this day and age, there really should not be people having amputations due to diabetes... it breaks my heart.. i was shown 2 amputees 30+ years ago (T1 tho) and it scared the heck out of me...

Perhaps the nicey, nicey approach could change?

donnellysdogs · Apr 10, 2017

How many T2's are really given good advice straight away on foot care?

Ok, I was shocked in to compliance but I was given fantastic advice on foot care and especially shoes, enclosed, lace ups.. no high heels-and the reasons why...always, always wear enclosed shows or slippers etc...

I feel very sad lustening to T2's saying they can eat packaged food as long as theres no red markers on the packaging for fat or sugars.. but tgey not understand what a carb is....

Pinkorchid · Apr 10, 2017

Chook said:
I think most doctors / medical professionals don't actively encourage LC because they know the vast majority of T2s are happy to rely on medication and GPs just don't have enough time to persuade someone in to doing something completely new.

About a year ago my pharmacist (lovely lady who is VERY interested in low carbing as a form of treatment for T2) asked me to give a little talk about LC to a small group of recently diagnosed T2s. It was hopeless, out of about 40 invited only a dozen showed up and all but one of that dozen said they couldn't live without their chips / cake / porridge / pasta - even though the pharmacist and I offered on-going FREE support. The one that did show some an interest kept in contact with me but gave up when she got carb flu.

The thing is that we, on this forum, are only a tiny fraction of the diabetics world wide - everyone with internet access could also find their way here if they were interested - but they don't. So, presumably, they are happy with their lives as they are.

I must admit after the 'talk' fiasco I have a lot more sympathy for HCPs who suggest lifestyle change as an option.

Yes a typical example of ...you can take a horse to water but can't make it drink.....if people are not interested in changing their diet then no one will make them. I know some people with T2 who think as long as you take the Metformin you can eat what you like and they do so they would not be prepared to change

Pinkorchid · Apr 10, 2017

donnellysdogs said:
How many T2's are really given good advice straight away on foot care?

Ok, I was shocked in to compliance but I was given fantastic advice on foot care and especially shoes, enclosed, lace ups.. no high heels-and the reasons why...always, always wear enclosed shows or slippers etc...

I feel very sad lustening to T2's saying they can eat packaged food as long as theres no red markers on the packaging for fat or sugars.. but tgey not understand what a carb is....

Well our nurse says do not got barefoot indoors but have never heard anyone say no high heels and wear enclosed lace ups what woman will do that especially in the summer when we like to wear sandals

JohnEGreen · Apr 10, 2017

"some people with T2 who think as long as you take the Metformin you can eat what you like"

I know someone who thought that, a trip in an ambulance and a few days in hospital soon changed their attitude.

Chook · Apr 10, 2017

Pinkorchid said:
Well our nurse says do not got barefoot indoors but have never heard anyone say no high heels and wear enclosed lace ups what woman will do that especially in the summer when we like to wear sandals

I got told to wear properly fitted, enclosed flats because if we get a blister it will take a long time to heal. I also get told to wear slippers around the house but with three large dogs I would do that anyway.

Did anyone get told about the woman with neuropathy who went to the podiatrist wearing a pair of high heels and couldn't feel the piece of Lego her child had put in one of her shoes? I've had that same story from

donnellysdogs · Apr 10, 2017

Pinkorchid said:
Well our nurse says do not got barefoot indoors but have never heard anyone say no high heels and wear enclosed lace ups what woman will do that especially in the summer when we like to wear sandals

I have always abided by the rules I was given...no open toe sandals ever. Now coming on 54 and 30+ years in to T1....

donnellysdogs · Apr 10, 2017

Pinkorchid said:
Well our nurse says do not got barefoot indoors but have never heard anyone say no high heels and wear enclosed lace ups what woman will do that especially in the summer when we like to wear sandals

I got told that the only thing that keeps feet in high heel shoes is the fact they are so tight that they are not properly fitting shoes...

My skechers, abd italian speedy ducks when first diagnosed have kept my feet beautiful..

Bluetit1802 · Apr 10, 2017

Surely these footwear "rules" are somewhat OTT for a diabetic with tight control? It's high blood sugars that cause the problems with slow healing, not the label "diabetic". Another case of one size fits all. Or should that be one shoe size fits all.

We all know that badly fitting shoes and very high heels are bad for everyone, so nothing new in that. But sandals?

serenity648 · Apr 10, 2017

Pinkorchid said:
Yes a typical example of ...you can take a horse to water but can't make it drink.....if people are not interested in changing their diet then no one will make them. I know some people with T2 who think as long as you take the Metformin you can eat what you like and they do so they would not be prepared to change

But that is what they are told. Thats what I was told. I wouldnt search for ways to change my diet if i had any other condition unless I was told to do so, I would just take the medicine. I only found this site by an typo accident.

We cant blame people for what they dont know and arent told by medical professionals. Anything we say is random woo from the internet, because their Doctor told them differently. Which is a reasonable attitude to take in most cases. Think how the discovery about stomach ulcers and bacterial infections was greeted for a long time.

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