Posted by on Friday, 18 May 2012

DBlog Week Day 5 : Setting the record straight

Today's DBlog Week topic asks "What is one thing you would tell someone that doesn’t have diabetes about living with diabetes?". Fortunately Karen seems to know how much we love the sound of our own typing: "Have more than one thing you wish people knew? Go ahead and tell us everything.". Well, since you asked...

There is more than one type of diabetes. Actually there are *lots* of different sorts, and some of the 'types' are really just umbrella terms for a multitude of different, but fairly closely related conditions. This next bit probably bears saying slowly, because it seems that you have difficulty grasping it: Diabetes. Is. Not. Caused. By. Eating. Sweets. There, that wasn't so hard was it? In general terms you probably only really need to think about type 1 (around 10% of the diabetic population) which is an auto-immune condition where the body destroys it's own insulin-producing beta cells. Nobody knows what causes type 1 diabetes to develop. No-one. On the other hand there is type 2 diabetes, where the proper metabolism of carbohydrate begins to fail. Type 2 Diabetes makes up nearly 90% of the diabetic population and last time I looked *nobody really knows* what triggers its development either. Nobody. There does seem to be a genetic link (so you are more likely to develop it if a close family member already has it). It is also more common in certain ethnic groups. Additionally people who carry more weight seem to be more at risk of developing type 2. Let me say that again - AT RISK. This is not the same as cause. Perhaps 15% of people diagnosed with type 2 are normal weight or under weight at diagnosis. And bear in mind that perhaps 90% of the obese and overweight population do NOT have diabetes. Let's go over what we learned earlier - eating sweets does *not* cause diabetes. If a person is overweight it would be wise for them to consult their doctor to assess their risk of diabetes. The extra weight may be an indication that their metabolism is struggling to efficiently metabolise carbs - but please, please, please stop repeating that diabetes is a 'lifestyle' disease 'caused' by eating sweets.

This is getting silly. Please. For the love glittery cupcake-eating unicorns, will you PLEASE just have a two minute conversation with a person with diabetes the next time you have a Brilliant Idea about using insulin-dependent diabetes as a way to spice up your flagging movie/action adventure/medical drama. It really is Not. That. Hard! Time after time you get it wrong at the most basic level. The problem is you get things so messed up so often that 'normal' people will be beginning to think you have it right. You know there's this time-critical thing (a hypo) where the person can be minutes from oblivion. And you know that diabetes has to do with insulin, which is hard to come by on a jet plane struggling to make a landing, while Denzel Washington and Bruce Willis swap oily vests and wisecracks as they wrestle the deranged and inexplicably English-accented baddie into submission. It all looks ideal... How will our rosy-cheeked cherubic child make it through as she plunges into a hypo when the only insulin on board was smashed under the nasty Brit's suspiciously shiny shoe. STOP! Insulin will KILL her. If she is mid-hypo what she need is a little something from the kitchen. Hypo is *low* blood glucose. All she needs is a swig or two of Coke. We are very sorry that this is rather inconvenient in dramatic terms, but there you are. If she misses an insulin shot? Well unless she's on a pump (let's not go there right now) the chances are she has got *hours* - especially if she doesn't stuff her face. She might get a bit grumpy. Not very Hollywood, but I'm afraid it's all you've got.

GPs and NHS beancounters
There are all sorts of people. Tall ones, short ones, loud ones, quiet ones. Some are really clever, others not so much. A mixture of all of these people will be unfortunate enough to develop type 2 diabetes. Now given this bewildering variety, don't you think it is perhaps likely that one identical approach will not work perfectly for everyone. Diabetes, perhaps more than any other chronic condition will be affected by the behaviours of the patient. Some people will be happy to take your advice on what foods they should be eating to keep their blood glucose levels under control. You will give them advice based on your knowledge and understanding. What you believe happens 'on average'. The problem is, we are not talking about 'average'. We are talking about individuals. When a patient comes to you with a desire to test their blood glucose levels using an effective framework, and to use those test results to establish a varied and nutritious diet which does not spike their BGs please consider their future health. 80% of the NHS budget for diabetes care goes on treating preventable complications. Once a patient has spent a few months building up a picture of BG friendly foods, testing can drop back to a much lower maintenance level. There is no 'one size fits all'. Don't mistakenly jump to a conclusion of 'non-compliance'. If you are advocating a diet with lots of 'healthy' carbs for t2 patients, their problem might be *too much* compliance. The only way for a person to discover what foods, and quantities they can eat (and at what time of day) is with a meter. Not everyone will want to put the work in, but don't just automatically deny the means for people to control their diabetes.

80% of costs on preventable complications are absolutely appalling stats. Perhaps the time has come, at last, to rethink the high-carb/no-test approach if these are the results you are getting. I'll put it more simply for the hard of thinking: Give. Type. Two. Diabetics. Test. Strips. And. A. Copy. Of. Jennifers. Advice. Then. Support. Them. In. Keeping. Their. Diet. Balanced. And. BG. Friendly.


  1. Great post! I'm totally on the same page with you on these points, particularly the media and movie notes about accuracy!

  2. Thanks Mike :)

    It's crazy that films and TV get diabetes so wrong all the time!

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