Tuesday, February 24, 2009

Is Diabetes Just Down to Rising Obesity?

Earlier this morning I did an interview with the BBC News Channel about the government report which says that the incidence of diabetes is soaring, Between 1997 and 2003 there was a 74% increase in diabetes being diagnosed. The government puts this all down to a dramatic rise in obesity. Up to a point, Lord Copper. I know from my own case that had I not stuffed my face with Mars Bars over the years it is more likely that I would have avoided getting diabetes, or at least put it off.

However, it's not always that simple. As I understand it the propensity of doctors to diagnose it has changed over the years. Ten years ago, if you had a blood sugar count of 7, you wouldn't have been diagnosed. Nowadays you would. So it clearly follows that the numbers being diagnosed will rise. In addition, for every patient a GP diagnoses with diabetes, his or her practice gets an annual payment from the NHS - so there is almost an incentive to diagnose borderline cases. This is reflected in the fact that Type 1 cases have been relatively constant. It is the less serious Type 2 (which is what I have) where the incidence has shot up.

However, this should not detract from the central message of this report, which is absolutely right. Obesity leads to diabetes. Douglas Smallwood from Diabetes UK says...
Research shows that losing weight can reduce the risk of developing type 2 diabetes by 58%. It is imperative that we raise awareness of the importance of eating a healthy, balanced diet and doing at least 30 minutes of physical activity a day if we want to make any headway in defusing the diabetes time bomb.

He's right. When I was diagnosed, I did change my diet, I lost more than a stone quite quickly. I am a shame to say that some of it has gone back on, so I now have to redouble my efforts to lose it again. The pills have controlled the diabetes, but you can only ever really start beating it by losing weight and exercising.

Several people have emailed me to thank me for outlining the symptoms of diabetes on the News Channel, as it has prompted them to make an appointment with their GP to get tests. So, dear blog readers, if you have these three symptoms, you might want to do something about it...

  • Do you feel more lethargic than usual?
  • Do you constantly feel thirsty?
  • Are you going to the loo more often than usual, especially during the night?
  • Do you have a numbness on your legs or feet?

If you answer yes to three of those, go and see your GP.


Old Holborn said...

Darwinism, pure and simple.

Jim Millen said...
This comment has been removed by the author.
Damon From Birmingham said...

Hi Iain

I am a type 1 diabetic, and whilst all of what you have said is true, I am concerned that the message that Type 2 can be caused by being overweight (which it can) obscures the fact that many Type1 diabetics (myself included) LOSE a lot of weight just before they are diagnosed with the condition. Just before I was diagnosed with the condition I looked like a rake (not that I'd ever been obese).

DocRichard said...

I suppose it would be tendentious to suggest that Dave should bring in a sugar tax hypothecated to NHS dentistry and diabetic services when he assumes the reins of power?

Jim Millen said...
This comment has been removed by the author.
Gerry and Kate said...

Losing weight and keeping it off, is an uphill battle. I sympathise. My doctor has me on fat busters, not that I'm terribly overweight,but my body is unable to deal with fat. I don't like taking drugs of any kind, and I can honestly say that they have not helped me one iota....


Forlornehope said...

My father had and my two siblings have type 2 diabetes. Being fit and lean I thought myself pretty safe, then I read the report that Sir Steve Redgrave had the condition. It is not just the overweight and unfit who can develop this.

bobthedog said...

I concur with Damon from Birmingham as my condition was diagnosed with rapid and dramatic weight loss, going from 11.5 stones to 8.5 in 4 months. The thirst was there, but at the time I was in an extremely stressful job doing long hours often not finishing work until 9 in the evening. Meal then bed ready for next day starting at 7. At first the doctor said it was nothing to worry about, my sister who is an RGN diagnosed the condition over the phone and insisted I return to the doctor for a blood test. Hey presto 12mmol!

Elby the Beserk said...

Bottom line is that regardless of the qualification you note, Iain, we have a major problem in the UK with obesity, and also accepting that for many people, it is a matter of personal choice. I.E. - They choose to be obese, ergo, choose to have a far higher chance of getting diabetes, ergo have a far higher chance of dying young and before they do, costing the NHS a fortune.

Of course, as it is now forbidden to offend anyone, we are told that obesity is down to genes, etc. etc. How then would it be that as a young man in the 60s, I can hardly recall seeing people as fat as we see all the time now - at all? Do genes change so radically?

No, of course they don't. Indeed, I was witness to an extraordinary conversation in hospital a few years back, in which a grotesquely overweight woman was being treated for lung problems. Not once was diet mentioned, not once overeating - rather, a wander through the spectrum of drugs she was being treated with to see of they could prescribe better.

What they should have done is told her - sort your diet out, sort your weight out, then lets see how you are.

Essentially, it is suicide, but suicide that costs the country a fortune.

rob's uncle said...

You can be confident that this paper, by foreign epidemiologists with no vested interest, uses a consistent internationally accepted definition. So the increased incidence [up 65 % in 10 years] is real. The abstract of the paper is at: http://jech.bmj.com/cgi/content/abstract/jech.2008.080382v1

The main risk factors are said to be:
• A family history of diabetes.
• Abnormal cholesterol levels.
• Age over 45.
• Being overweight.
• History of gestational diabetes.
• Hypertension.
• Metabolic syndrome (also called insulin resistance syndrome)
• Race or ethnic background: The risk is greater in Hispanics, blacks, Native Americans, and Asians. [http://diabetes.webmd.com]

I have not found any estimate of their relative importance. Government focuses attention on ‘weight’ [not just obesity] because it is a factor that individuals can do something about by changing their lifestyle. The political importance of this stems from the huge and rapidly growing cost of managing the disease in millions of people for half or more of their lives. That is what this blog should be discussing.

subrosa said...

Couldn't put it better myself Elby the Beserk. In my mother's side of the family there was a lot of type 1 diabetes but fortunately it seems to have skipped a generation. Have to admit none of my family has problems with obesity although I could do with losing around 7-10 lbs.

Martyn said...

Wow, Elby the Berk is a Doctor now?

Think about it this way, If I drink too much, smoke too much and die early I'm actually costing the tax payer (lets not forget all that lovely duty on fags and booze) less.


rob's uncle said...

'About 80 percent of people with type 2 diabetes are overweight and don't take enough exercise. If you're at risk of getting type 2 diabetes, you can reduce your risk if you exercise. For example, if you're overweight and you lose about 5 % of your body weight, and you also take regular, moderate exercise (such as a brisk walk for 30 minutes, five days a week), your chance of getting diabetes is reduced by one-half.' [http://www.guardian.co.uk] The abstract of the study on which this advice is based is at: http://tinyurl.com/b7gsp5 Exercise was twice as effective taking metformin, the standard preventative drug.

Paul Burgin said...

A lot of it is genetic (I write as someone, half of whose family in my Dad's side has had it). That said just because it's genetic doesn't mean it can't be avoided. Heart disease can also be genetic, but if those who are candidates for it keep to a healthy lifestyle and have regular check-ups then that minimalises the risk.
So yes, obeisity can be part of the cause, but taking care can help reduce the risk, and I write as someone who is over a stone overweight and is aware of the long-term consequences because of my family history

Old Holborn said...

Elby, get over to the Vegan Gorilla's place.

She's asking whether Africans in Africa have nut allergies. You couldn't make it up.

Perdix said...

Excellent post. I consider myself a borderline type 2 case and have been concerned about "incentives" to medicalise the population.Having said that, the resulting awareness of possible causes is beneficial if acted upon.

Dilog said...

Iain it is great to see you talking about this condition - and yes diabetes is a condition it is not a disease as you cannot catch it!

But it is also so clear very few people understand what it is so here is the way I explain it ...

Type 1 - you do not produce any insulin
Type 2 - you are insulin resistant

Insulin is the hormone that helps you metabolise glucose so you have enough fuel in the body and incidentally this fuel turns to fat if not used.

If you do not have enough insulin then your body will excrete the excess glucose which results in, amongst other things, need for more water - thirst, excess trips to the loo, overworked kidneys, sweet sweat, sweet breath and weight loss. Plus increasing damage to other vital organs a bit like a car without adequate oil.

Insulin requirements are not simple to control - all sorts of things affect it from the simple what you eat and how much you exercise to stress. Stress is the worst as different types of stress effect in different ways but essentially it is the fight of flight syndrome and to cope your body releases glucose and adrenalin but of course today stress rarely results in a physical response.

So without any insulin you will metabolise no glucose and it will go straight through you, the net result will be weight loss and pretty quickly ketoacidosis - coma and death.

With a resistance to insulin you will just get less fuel - be tired - and the damaging side effects will occur more slowly.

Back to the plot - excess fat cells can make you insulin resistant and loosing them in some cases can improve the way your body metabolises glucose.

Bottom line the more damage that is done to a body the more it costs the NHS and it is none too pleasant for the recipient either. Numbers of Type 1 are not increasing it is Type 2 and that as said is more down to lifestyle which with a little warning can be changed so awareness of what is actually happening is no bad thing.

Damon From Birmingham said...

An excellent post Dilog!

One thing I would add to any Type 1 diabetics reading this, if you don't have an insulin pump, ask your diabetes specialist about them. I've had one for 6 years now and my HBa1c's have improved from the mid 8s to the mid 5s since I've been using it!

stanislav said...

Is massive problem, especially in Scotland, best part of England and every other fat bastard is diabetic; is diet, mind, and being bone idle; cross-dressing and wife-beating and noncing, too, is all activity associated with diabetes, get chill around arse and is fucking-up Islets of lederhosen and hey McPresto! is no insulin and life spent thereafter in tyranny of G P and useless diabetic nurse who all dress-up like they just come from nightclub and too posh to wear proper uniform, useless filthy bastards is.

And then is Consultant, Mr Lancelot Spratt in bow-tie and shiny shoe, honest, not invent,and S Class Merc.

And then is Diabetes UK, living with diabetes can be fun; some exciting new recipes for diabetics; some celebrity has got diabetes, what do they think ? Could your family help you more? Make blood monitoring an inclusive, fun activity for all the family. Join Diabetes Uk. Spend every moment of life worrying about Diabetes; help us find a cure. Buy this blood glucose mointoring machine, it's wicked.

Actually, Mr Old Holborn, the pandemic of diabetes is absolutely nothing to do with Darwinism; contra-Darwinism, in fact, partially explains the rise; quiet simply a condition which pre 1930s killed its victims, keeping them out of the gene pool, is now treatable, manageable and although some complication or other of Type 1 will kill all who have it, eventually, for most in the developed world it is not immediately, or in the short-term a life-threatening condition; diabetics, therefore, who would formerly have died, now breed and pass-on not only whatever inheritable (sic) aspect there is to the condition but, and this is more subtle, the treatability and survivability of not just diabetes but other conditionds like AIDS, leads to irresponsibly dangerous eating - or sexual - behaviours. Widespread diabetes is, in fact a consequence of NHS success in managing it, people no longer fear it.

Obesity, of course, plays a part in many if not most illnesses and conditions but fat people should not be seized upon as the new Moslems, the new Gays or any of the betes noire which bring such delight to Cyberspace thinking.

These are complex matters, irresolveable by cheap know-it- all soundbites. People eat too much for many reasons but mainly because they can, we have too much, others have too little. the very notion of sophisticated consumerism imperils the national health, yet it is the yardstick by which buffoon Chancellors measure themselves.

It has become a cliche that Cocains is God's way of telling you that you have too much money; something similar applies to diabetes; it is a disease of rich nations and as so-called emerging EconomiesStupid embrace McDonalds-led junkfood consumption, their rates of diabetes skyrocket, even though they lack the infrastructure to treat them.

Not then, Darwinism but capitalist consumerism; not intrinsically bad, suicidal behaviour on the part of the fatties, just learned, enculturated behaviours - eat all you can for a tenner, two sugars or three, A Mars a Day, PIck 'n' Mix for the sake of your immortal. well upholstered soul.

DAMON from Birmingham describes himself, dutifully, as a diabetic; he should try thinking and saying, instead, that he has diabetes. He is, obviously, much more than "a diabetic" but by defining himself thus he buys into the Industry, the maelstrom of careerists and their pet therapies, pruducts and the global domination of PharmaCorp.

Much of what these people said twenty five years ago is now discredited and - with the exponential growth in research and understanding - that renewal and relacement of knowledge and treatments will only accelerate.

Short of complete economic collapse and a period of Ruin, it is hard to see how dangerous eating behaviours can be modified. A more optimistic scenario would be the continuance of the current system and - within it - the development of a synthetic, easily implanted pancreas, an uberTreatment.

The matter of Harry Secombe, the warbling Welsh professional diabetic and goon must await another Health Questions occasion (sings) If I ruled the World, lah de dah de dah de dah de dah....

sgl said...

It's easy to rationalise peeing a lot of you're drinking a lot but in fact, if you have (undiagnosed) diabetes it's the opposite: your body is peeing a lot to get rid of sugars and you're drinking a lot to replace the water.

If you have these two symptoms - see a doctor, If you have these two symptoms and are losing weight then you may have a serious problem - see a doctor today.

Mirtha Tidville said...

One of the problems with Insulin is that it puts weight on and is very difficult to get off (if not impossible in my case). Many Insulin dependant diabetics are overweight, despite excercise and good diet. The better the control the faster the weight gain.

The Grim Reaper said...

Anyone else fancy a Mars bar? ;-)

simon said...

Pedantic point, I know, but "Up to a point, Lord Copper" is a euphemism for "No", not an embellished version of "Up to a point", which seems to be how you've used it.....

Rohan said...

The problem is that there is a lot of hidden sugar and indeed salt and trans fats in food. Even a loaf of bread will contain a lot of sugar. Now you might think that you are eating a balanced diet but the truth is somewhat different. Add that to the fact that we simply don't exercise properly and hey presto chunky butts.




Lady Finchley said...

I'd be grateful if any of you with diabetes have tried to get life insurance after you have been diagnosed and could let me know. My husband has tried and it is impossible.

Doctor Syn said...


Mr. Dale -

Any chance you might post the details of your diet here?

I, for one, would appreciate the advice.

arthur said...

It's deplorable that GPs are offered cash incentives to do anything. They should be acting in the patients' interest not their pockets'.

Dr John Crippen said...

arthur said...

February 24, 2009 11:53 PM


May we have a salary Arthur?

If so, shall we have a system in which the GPs who do a good job are better rewarded than the ones who don't?

Actually, I hate the target culture too...but you are being too simplistic. And silly.


Matt Wardman said...


Redgrave has Type 1. The report you read must have been wrong or perhaps you misinterpreted it.

For the record, Type II is roughly doubling every decade, Type I roughly every generation.

Matt Wardman said...


I don't think he'll have much luck with that, and even if he does the exclusion clauses will be fractal.

OTOH, we do better with pension annuity rates as we die off earlier - from memory I think NICE estimate 10-15 years earlier as an average for Type Is.

Look after it well and you do get that small benefit later on.