Diabetes Dialogue

Is there a cure for diabetes? I had gout and was told to take allopurinol tablets for the rest of my life. I stopped taking them some years ago and I have had few attacks.
I want give up tablets for diabetes. Will losing weight help to get rid of diabetes? I have recently joined Diabetes UK. Paul Leppard

If we are to truly empower people to manage their diabetes we need to ensure that we as Health care Professionals give consistant, up to date, evidence based advice, in a format that means something to the individual. In order for that to happen we need to invest in training and support for Health Care Staff to be able to deliver excellent services. People with diabetes in my experience neeed time invested at specific points of their diabetic career, they need to be listened to, and for the professionals to understand what it is like for them as individuals to live with diabetes, there is no one size fits all remedy. To truly empower a person there needs to be a focus on the partnership between the person with diabetes and those who are involved in their care, where the person with diabetes determines what is important for them, and the Health care Professional supports where the individual is at.

Firstly, can this website save comments please? I have just been DISempowered by losing everything I've typed it the last 15 minutes!!!

Secondly, Empowerment. I believe this is essential for people with chronic disease, and it is all about building relationships between good people who have time to act, and ensuring that an incompetent admin such as my first paragraph does not cock it up. There should not be a sausage machine approach to patient admin, but one can see why, in a world of targets and expense-driven treatment, there is. Above all, can I recommend the words of Dr W Pickles, first president of the Royal College of General Practitioners: "Never use the word 'case'. You are talking about PEOPLE!"
But as an example of excellent empowerment practice, can I also recommend the Expert Patients' course. I have just completed this and I can't praise it, and my two tutors, too highly. It has enabled me to build friendships with other people with different chronic diseases, I have benefitted from their thoughts and I think they have benefitted from mine. It will more than repay its costs, both for me personally and in encouraging a more efficient use of medical professionals' time by patients.

Lawrence Hanney
Diabetes Type 2 - Metformin and Rosiglitazone

I am a firm believer that with a chronic condition like diabetes, self management by the patient is more likely to affect the outcome than any other intervention although of course advice and support from HCP's is essential. To this end and most successfully, there has been an initiative by a Diabetologist where I live to train patients as advisors to other patients and to educate them so that they are equiped with the skills necessary to help themselves and others to self manage. These patients have been trained on a program similar to the Govts, Expert Patient Program but with longer training periods, a disease specific syllabus and an assessment by examination at the completion to ensure that they are capable. This concept has been exported to other PCT's and presented at National Conferences attended by senior NHS staff. Would it not be to the universal benefit of people with diabetes if the programme was supported by the NHS and widely disseminated?

As an independent researcher, consultant, and lecturer in diabetes, I have to say that I believe the medical and health professions are woefully inept in their service for diabetics.

Helping diabetics to manage their condition -- or not succumb to it in the first place -- involves giving them truthful and accurate advice. This is not happening.

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.

Doctors seem to have a fetish about pills. They don't discuss exercise and interesting ways to get fit without joining a gym. They are not much good at diets or how to cut down drinking. This is preventative medicine not pill oriented medicine.
Doctors also have a thing about blood pressure. Blood pressure goes up and down principally because of stress. Pills do not make a lot of difference and there are side effects. I have stopped taking mine and I am monitoring blood pressure at home regularly.

Partnership and or empowerment is just a myth which is promoted by the NHS and from my experience the NHS uses such terminology to obfuscate, given the reality being is they talk a good game when in reality they do not empower or partner.

Sadly I have to agree that empowerment is often a myth and depends largely on the skills and abilities of the professional rather than being the norm.

Information is given reluctantly and discussion about treatment consist mainly of being told the results of tests are rather high (or low) and that 'this medication' should be better.

I was 'given' Metformin which gave me horrendous uncontrollable diarrhoea. I struggled with it for three months and decided that as it meant I could not be more than 2 minutes from a loo at any time I needed to stop taking it so I could have a holiday. On return from holiday when thankfully my body functions returned to normal - I visited the GP to be shouted at for taking this decision on my own and told I must take it. At the same time I was told I must get my blood pressure down (it was 140 over 65!). I refused to go back on the metformin and having seen a different GP am now taking an alternative which is moderately successful.

I help to run a local diabetes support group (not Diabetes UK) and we all have different experiences but generally feel we are 'given' medication without being told of the possible side effects, what its effect will be, how it works or why, and we feel we are not treated as equal partners or even junior partners in our care, being told what to do rather than having time to talk about alternatives.

Indeed alternatives seem to be sadly lacking - even though most of us feel it would be useful to have a prescription for exercise rather than medication.

We advise all members to go back to their GP if they have side effects or unusual symptoms and say that they are not prepared to take medication that makes them feel ill or worse, especially if there are alternatives available - but we do feel that the cheapest option is often considered 'the best' and if it does not suit it is the 'patient' who is seen as awkward rather than the medication being seen as unsuitable for that person.

We are first of all people, people who happen to have a medical condition, but no less human or intelligent or deserving respect.

The main problem seems to be the different view of what is meant by partnership and what equal means. It still feels that you have to be awkward, difficult and/or outspoken to be treated as an individual and have your views taken into account.