Diabetes – NHS under pressure

Lugosi, Going Postal — *An NHS West Midlands Ambulance Service emergency ambulance, outside the Accident & Emergency department of Warwick Hospital.*
Lydia – Licence CC BY 2.0

What is it they don’t understand?

We all know that the NHS is either creaking or broken. Your opinion of the NHS is based on your experience and reports in the media. I have both praised the NHS for the most brilliant attention and condemned it for its inability to rapidly attend to pain and suffering.

Two recent items in the Daily Mail illustrate the crisis in Diabetes:-

Hospitals deluged by 5,000 diabetics a DAY: One in 10 admissions is for diabetes as cost of treating patients DOUBLES in a decade.

More than 1.7million type 2 diabetics were admitted to hospital last year
GP leaders warned some type 2 diabetics need up to 200 appointments a year
The illness even appears to be having a worrying impact on younger women

Hospitals deluged by 5,000 diabetics a DAY: One in 10 admissions is for diabetes as cost of treating patients DOUBLES in a decade

The diabetics who use NHS 200 times a year: Doctors’ fears as patients put huge strain on GP surgeries

Doctor reveals hardest part of her job is telling parents their children are too fat
Professor Helen Stokes-Lampard says diabetes puts huge strain on GP surgeries
She warns the ‘steady increase’ in new cases was creating ‘significant problems’

The diabetics who use NHS 200 times a year: Doctors’ fears as patients put huge huge strain on GP surgeries

I have been a diabetic type II for just over 40 years. One day I decided to go to see my doctor “Doctor, I’m drinking too much”. As he reached for a leaflet from Alcoholic Anonymous I said “No, I mean I’m drinking lots of fruit juice and feeling thirsty”.

He reaches for a blood glucose testing strip and tells me “This is dangerously high. I want you to go to hospital immediately”. I did and they showed me a syringe the size of your worst nightmare and said “You will be on insulin for life”. Because of my own argumentative and analytical mind I worked out that my pancreas wasn’t dead but inefficient.

I was ignorant about how to control my diabetes so I took the Metformin, suffered loose tummies and wondered why it didn’t work at controlling my diabetes properly. So, I volunteered for insulin.

Here is the point. Mr & Mrs Public don’t understand diabetes (and neither do some GP’s). First of all many don’t understand the signs. If you drink ten pints and visit the loo six times in a night your assumption is that “six pints in – six pints out”. What you don’t understand is that the sugar in the first three pints bumps your blood sugar high and the body compensates by making you thirsty in the hope you will drink water and flush the excess sugar out of your kidneys. Instead you drink more beer. Your answer is more sugar which means more drink.

Diabetes treatment schemes don’t ban alcohol, you may be relieved to hear. A small amount of alcohol can make a drink almost sugar neutral because alcohol can lower the blood sugar. For example, vodka with orange can work out neutral. Sugar in the juice is counteracted by the alcohol after 30-40 minutes. (That’s my story and I’m sticking to it!)

Excess sugar affects your blood vessels and arteries. It makes them fragile. They can more easily collapse giving you heart failure or a stroke. They can make blood vessels in your eye bleed and give you degrees of visual impairment including blindness. They affect the circulation in your legs and feet causing ulcers leading to amputation. Diabetes can wreck your kidneys.

My image of a diabetic in trouble, causing a load on the NHS is someone middle to old-age who has never understood diabetes and is now suffering from complications because they never knew they had diabetes. If they have been diagnosed then they fall into the common health syndrome “I have something wrong, you give me some tablets so I’m OK and can ignore it”

The second factor is the NHS believing that a few tablets and a diet sheet would mean a population of highly educated, self-managing and self-medicating diabetics. A diabetic consultant told me “Diabetes is the greatest health problems that worldwide is self-managed”.

Being a diabetic for 45+ years I have lived through the NHS naivety and mismanagement. I am still amazed when I speak with my family or acquaintances how little they understand about diabetes.

Standard procedure from the NHS was to medicate, send you to see a dietician and test your blood sugar once a year. The HbA1c test can tell you the average blood sugar for the last six months. Trying to get a diabetic to land on the perfect average blood sugar level of 6.0 was like trying to land on the moon from the earth using the image from a web-cam and “left hand down a bit”. There are some who did it very well. They were generally fit and could aid their management by being active and burning the sugar.

But the ageing diabetic, having gained weight because of their diabetes can’t exercise. Because of their weight they also become insulin resistant so any insulin produced by their body doesn’t work. Be aware that a Type II diabetic has a working pancreas. It just doesn’t work well.

For years the diet advice has been wrong. It starts with “What do you eat for breakfast, lunch, tea and dinner” in order to tell you what you’re doing wrong. I once ditched an NHS diabetic consultant for giving me an out-dated card to record my meals against those artificial labels. I can’t answer the questions. To me they are meaningless. My guess is that people answer the question based on what they ate last week, the dietician builds a profile on that and that profile is a waste of time for what you do next week or go off Wagon Wheels.

The diets themselves are what I call “A permission to eat” since they tell me what to eat at each of those artificial meal times. Traditional diabetic diet sheets tell you to eat sugar! It’s also known as “carbohydrate”. Rice, pasta and potato (in moderation) is “good” but they all turn into sugars by the body. So, they are actually “bad”.

I assert that all diabetics should be on insulin. The needles are so fine you won’t feel a thing. All diabetics should be given a blood glucose meter and be encouraged to take their blood sugar at least three times a day. By doing this they learn what effect certain food has on the blood sugar level. Knowing this will allow you to adjust the amount of insulin you take to keep your blood sugar near acceptable levels. I do that, plus before every trip in the car, as I am obliged to do by law. Look on the positive side. I have a fridge full of Snickers bars for that hypo emergency. Glucose tablets are best but they aren’t so tasty.

Don’t leave it six months until you have the Hb1Ac test (they now do it twice a year). That’s six months of high blood sugar too late. The NHS did a massive screw up on blood glucose levels.

Here is what the NHS website states:-

if you monitor yourself at home with a self-testing kit – a normal target is 4 to 7mmol/l before eating and under 8.5 to 9mmol/l 2 hours after a meal
if your HbA1c level is tested every few months – a normal HbA1c target is below 48mmol/mol (or 6.5% on the older measurement scale)

(“Every few months” frequency depends on your GP)

Hyperglycaemia (high blood sugar)

Crazy! You are monitoring your blood sugar on your meter. It’s looking good and you reckon you are averaging 7-9, not bad. You get your HbA1c test and you ask for the result:- “8.4%” says your GP. “Well WTF is that in mmol”? You are looking for an answer that reflects what you see every day on your monitor. WHY???!!!

You have to think like a pancreas. You have to accept that you are your pancreas’s buddy. There’s a great book that helped me understand what to do called “Think Like a Pancreas”

From Amazon website. Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin

The public don’t understand what diabetes is. It is a silent disease because you don’t associate your symptoms with your behaviour being the cause. If you are a woman and always feeling tired then that’s because women are always tired. Always thirsty? That’s because you are always busy and perspiring. Anyway, you are supposed to drink 8 pints of water a day.

The crisis with diabetes can’t be fixed quickly. It’s a generational education because once you have diabetes it’s difficult to get cured.

“This diet reverses diabetes!” No, it doesn’t. A diet that concentrates on protein and fats and excludes carbohydrates means the load on your pancreas is diminished to the point where your pancreas can cope, along with sugar burning exercise. You cannot increase the Islets of Langerhans in your pancreas once they have died. I had Type 2 Influenza a few months before I discovered my diabetes. Bed-ridden, high temperature, lost a lot of weight. It is thought that a virus can affect the Islets.

“Islets of Langerhans, also called islands of Langerhans, irregularly shaped patches of endocrine tissue located within the pancreas of most vertebrates. They are named for the German physician Paul Langerhans, who first described them in 1869. The normal human pancreas contains about 1,000,000 islets.”

In conclusion my programme for fixing this is:-