Diabetes Dialogue

Regrettably it is not my experience that “all adults with diabetes will receive high quality care with support to optimize control of their blood glucose, blood pressure and other risk factors.” Self evidently NHS care when it comes to Diabetes is obviously still at best a Post Code Lottery at worse none existent.

Tim Midgley

I understood that all standards related to all people including children and adolescents, with naturally difference emphasis. certinaly in our region the GMS contract is influanecing pateint care within the peadiatric population with children being called to practises for blood tests rtc. we have noticed that it the young persons HbA1C is elevated - `it is left to the hospital` so not included in GP data.
Yyoung people and children require quality outcomes not target driven services which are primarily a political tool. outcomes such as - back at school, all activities previously undertaken, appropriate age related control goals, educational support to all direct and indirect carers, easy access to health professionals within locality, support for other children witihn the family and many more. all these come at a price - appropriate service provision and availability for the child and family. childrens diabetes services tend to be a last thought by those with the purse string (certainly smaller numbers but for every one patient there are a minimum of parents, grandparents, sibs, aunts uncles school staff etc to support and educate) but they are the population of the future

I agree with this post, that children and young people need quality outcomes. I believe that well trained paediatric Diabetes Specialist Nurses (DSN) are crucial for the support and education of children, families and the wider community, particularly schools, and that without this kind of support it is very hard for families to deal with the complexitites of diabetes management in children and so achieve optimal health outcomes. I would like to see paediatric DSNs made compulsory for all paediatric Diabetes clinics.

Targets to reduce complications of diabetes will only improve if individual patients can keep their blood sugars between 4.0 and 7.8 consistently.

The most effective way of achieving this is by eating a diet very low in the sugars and starches that raise blood sugars over 7.8 which is the level at which permanent cell damage to pancreatic beta cells and nerve cells occurs.

The mismatch in insulin administration which contributes to hypoglyaemia can then be minimised by the much lower doses required in these patients.

HBAICs of 6.5 or less become achievable for diabetics who adhere to lower carbohydrate/glycaemic diets but the current hospital diets are based on starchy foods.

The status quo had been advocated for about 25 years by the United States Department of Agriculture in their famous Food Pyramid. Diabetes UK currently advise diabetics to base their diet on lots of "healthy" carboydrates and little fat. Professor Willett of Harvard University Dept of Public Health and many others have discredited this high carbohydrate low fat approach in thoroughly conducted patient trials. This information however has been slow to reach both doctors and patients.

I am concerned that patients with glucose metabolism disorders are not being given balanced and reasoned advice on what the optimal diet for their condition may be. If the government really want results with diabetes they need to give patients correct information and choice of what they eat particularly in the hospital environment.

I am a General Medical Practitioner and mother of a 12 year old boy who was diagnosed with Type One Diabetes ten months ago. He is on a low carbohydrate diet as advocated by Dr Richard Bernstein (Website is "diabetes-normalsugars.com") He has blood sugars in the 4-6 range most of the time with a capillary hbaic of 4.8 which is in the normal range for non diabetics. He has had three minor hypoglycaemic attacks during this time. We are NOT following the dietary advice based on the USDA food pyramid. Are you?

As an independent researcher, consultant, and lecturer in diabetes, I agree wholeheartedly with Dr Morrison. The medical and health professions are woefully inept in their service for diabetics.

Diabetics are more likely to suffer from coronary heart disease than people without diabetes. So convention recommends a 'healthy' a low-fat, carbohydrate-based diet with 'five portions of fruit and vegetables a day'.

This advice demonstrates that the people who give it are blinkered to the real cause of diabetes. One frequently hears in the medical world, expressions such as 'the causes of diabetes have not been clearly identified', or 'we do not know what causes diabetes'. But this merely demonstrates their ignorance: we have known the cause since a Dr H D C Given pointed out the correlation between carbohydrate intake and diabetes in 1935. This has since been confirmed many times and it is now known beyond doubt that diabetes is caused by an excessive intake of carbohydrates -- just as obesity is. So current dietary advice doesn’t look like good advice.

It is hyperglycaemia and hyperinsulinaemia caused by a carbohydrate-based diet that increase the morbidity and mortality associated with diabetes -- not saturated fats. That myth has also been comprehensively disproven many times.

CONVENTIONAL DIABETES TREATMENT
Convention demands that diabetics eat lots of carbohydrate-rich food, and then prescribe drugs and/or insulin to reduce the consequent high levels of glucose in the blood. How does that make sense?

SENSIBLE TREATMENT, TYPE-1
The medical profession generally regards type-1 diabetes is incurable. It is managed conventionally with a low-fat, carbohydrate-based diet. As the carbohydrates in such a diet inevitably put large amounts of glucose in the bloodstream, daily insulin injections have to be administered to bring these high levels of glucose in the blood down to normal. This means walking a tightrope for life, as exactly the right amount of insulin must be given or it will either reduce glucose levels too much or not enough.

But the pancreas rarely produces no insulin at all. At diagnosis of type-1 diabetes, some five to fifteen percent of the pancreas's beta cells will still be producing insulin. If these are relieved of the burden of continually having to reduce excessive levels of blood glucose, they can usually produce sufficient insulin for the other metabolic processes that need it, and supplementation with injected insulin is not needed. But this requires that the correct diet be prescribed as soon as diagnosis is confirmed as damaged beta cells never recover.

That diet is one very low in carbohydrates, whatever their glycaemic index, high in animal fats (polyunsaturated vegetable margarines and oils are much too dangerous).

But if that is too late, merely reducing carbohydrate intake, particularly from fruit and cereals, is all that is required to reduce the symptoms of type-1 diabetes from a serious health hazard to a mere annoyance. And, even if it is still necessary to inject insulin, the amount needed can be reduced substantially.

SENSIBLE TREATMENT, TYPE-2
A type-2 diabetic, if properly managed, should never need drugs. Given a low-carbohydrate, high-fat diet, type-2 diabetes can be cured literally overnight. And as the beta cells of a type-2 diabetic are usually working overtime already, progression to injecting insulin is a sure sign of the failure of the protocol used.

PREVENTION OF DIABETES
Studies throughout the first two-thirds of the last century showed clearly that low-carb, high-fat diets were not only useful for the treatment of diabetes, they also prevented it. They also prevented the obesity linked to type-2 diabetes and all the complications of diabetes.

The 'healthy eating' experiment, introduced by the COMA report of 1984 has proved to be an unmitigated disaster. Diseases such as obesity and diabetes have risen dramatically since its inception. It's not a coincidence; it is cause and effect. This experiment must now be abandoned. That's the only way we will get some sanity back into diabetes treatment. Not to consider the totality of evidence is quite irresponsible in my opinion.

Hi Barry,

I was about to reply myself in support of Katherine Morrison's letter, but thought I'd just recheck to see if any other replies had been posted. Well, I should have guessed I'd see you 'here', I suppose! ;-)

Anyway, to add what little I can to what's already been said, I will go to the topic of organisational change. And what an organisation it is, that we need to change. Quite apart from its sheer size, the NHS also has its unenviable reputation for being totally conservative (emphasis on the small 'c'!) and thus very slow to adopt new ideas. The trouble is, this time we just don't have the time to wait for the whole NHS to wake up to the truth!

If those with decision-making abilities, in charge of the NHS, will need to commission their own detailed, authoritative and conclusive clinical studies before they'll accept the truth where diets for diabetics are concerned, then it's highly essential that they be pressured to start the process immediately. Of course, the alternative is that they could just wake up and smell the roses. As Barry Groves has said (above), the proofs are already out there to be found, if only someone would take the time to go and look them up, and stop listening to the biased opinions of the pharmaceutical companies, who only have a single objective.

We have, today, a whole raft of organisations who religiously follow the lead set by the Department of Health and the NHS, where the standard low-fat dietary advice is concerned.

This includes the whole of our food industry, who've been convinced of the need to produce our meat with the lowest possible fat content, and heaven knows how many thousands of acres of yellow weed, so they can produce vegetable oil as a 'healthy' substitute for the animal fats we all used to use (back in the days when there weren't quite so many people overweight). This, in turn, means that even those of us who accept the truth and wish to eat a low-carb, high-fat diet, have difficulty in doing so, because you just can't so easily get the fats - and as we know, an excess of proteins, rather than fats, has other consequences.

It also includes many ancillary organisations who dish out the same advice, including Diabetes UK themselves. On questioning the latter, you'll find a total lack of willingness to even contemplate going against the 'official' NHS dietary advice, so as a result, they spend all their time publishing books and leaflets by the million, further encouraging diabetics to ingest ever larger amounts of carbohydrates, and ever lower amounts of fat, whilst forever increasing their medication and/or insulin doses to compensate for the resultant raised BG levels.

So, to put it bluntly, until someone with enough authority has the guts to make a decision and show the way forward, the NHS cannot set a lead on this issue. Until they do, no-one else is going to shift in their position on dietary recommendations for diabetics - or anyone else, for that matter, so we're just going to keep creating more Type 2 diabetics, to further worsen the load on the NHS.

If those who are the decision makers decide they want to maintain the status quo, as far as dietary recommendations are concerned, then I want to call them to account in a public debate on the issues and have them submit the evidence for their position. If they can find any real evidence to submit, that is.

It's way past time that those responsible for creating the current obesity and diabetes epidemic were made to answer for their error. It would be bad enough if the error were due to no better information being available, but the fact that the truth has been known since at least the mid-thirties (if not much longer) just compounds the error to the extent that it constitutes one of the gravest and most damaging cases of professional negligence that's ever been perpetrated.

Nigel

Honest advertising by Diabetes UK backed by Government funding could help deviate the juggernaut.

Imagine a television commercial with a lot of smiley and healthy looking people jumping around singing the refrain from the well known biscuit advert. "If you want a lot of chocolate on your biscuit,join our club..."

Switch to the Diabetes UK Logo. Pink on white background.

Then lets see some realistic images of what being a diabetic means.

1. Double amputees in wheelchairs.
2. People hooked up to dialysis machines.
3. Cuddly Guide Dogs.
4. People crying at a funeral.

Perhaps Sue Townsend, the author of the Adrain Mole books, who has been so cruelly disabled by diabetes, would speak about what the loss of her vision and neurological function has meant to her. She is only 58.

I would understand if United Biscuits was unhappy to be singled out as the cause of this misery. And they would be right. Because it goes much deeper than biscuits or even sweet things. It's the unnatural weighting of high glycaemic carbohydrates in our diets that is the problem. But they have the most recognisable, appropriate and catchy tune.

I've come up against the same thing myself, the only difference being I am Type 1! Particularly in more rural areas, the level of support is pretty Victorian, and I have had prescriptions denied without ever being asked why I might need the sticks. Reasons just within my own life have been to improve my control and adopting a semi-professional career as a sportsman.. On the whole, the old thinking prevails that diabetes is very simple, and it's the fault of the diabetic if control goes awry. As a diabetic of nearly 20 years I can confirm that this is not the case. Looking forward, I have yet to see a situation where a diabetic comes in with the intelligence and works out with a doctor and/or clinician a realistic plan of action, let alone support such as provision of blood sticks. I have for years put my results (insulin, weather, subdivided food values- the lot) into excel spreadsheets and, despite my offers to share the info with doctors and diabetic clinics, they have never been viewed by the professionals before advising me on a course of action. In fact, the only time I have ever passed out with a hypo is in hospital when a diabetic specialist applied these old theories which, in the case of my physiology, simply don't work. The thing about that is that over the last 20 years the prevailing orthadoxies have altered as new things are discovered- or rather proved since there has not been any leaps forward in understanding I haven't heard from diabetics first- 20 years ago there was no relationship between sunshine and hypos, now there is- but for years I was considered a bit loopy for suggesting it despite the fact I had seen it myself and chatted in waiting rooms with other diabetics about it. For the last 5 years I've used a particular system of my own devising which has proved both safe and flexible (although requires many more blood tests)- initially I was told to stop it at once and that I was doing too many blood tests, but now I am encouranged since it as it turns out to be identical to the DAFNE system- new and revolutionarily effecive in the UK, but part of continental diabetic care for the last 22 years. The way forward is to recognise diversity and listen to the person who lives with that physiology before agreeing targets. Average systems only work on average, but it seems hard for a medical professional to see a diabetic as ever being as insightful, smart or smarter than them. They might be right, but the diabetic should be given the chance to have their side considered in depth just in case they are not average. Just in case they have the basis of a solution. What should not happen is doctors focussing on an average blood sugar of 7 as being the only measure of success- for a waiter working 50-60 hours a week, with breaks at indeterminate times this will be impossible, but they will be labelled as failures- and denied driving licences, life insurance for mortgages and more- when what they really need is professional help, which should take the longview of diabetes in the context of a person's life, listening to the person with the disease, agreeing a soluton that actually works then supporting it.