Posted by on Thursday 22 September 2011

BBC: Designer diabetes drugs 'cost NHS millions'

There are many hopelessly inaccurate news stories published about diabetes, too many to count, but this is the first one whose tone was so indefensibly vile that I have been moved to immediately write a letter of complaint. Accurate and impartial this wasn’t. Not even close.

If I try really hard, and because I know a good deal about the subject I can just about glean the real story here - that some people with diabetes are being given different treatment options in the wrong order. If I read through layman’s eyes, I'd see everyone with diabetes as a scandalous leech on the NHS’s purse. A costly and, if I build in information from most other media coverage (including that on the BBC), largely self-inflicted plague on society.

I read a lot about obesity causing diabetes. I read a lot about the ‘lifestyle’ disease. I don’t often read that only around 10% of those classed as overweight or obese in the UK are diagnosed with diabetes. I never read that a significant proportion of people diagnosed with type 2 diabetes are normal weight or underweight at diagnosis, and that those who are overweight have in all likelihood been gaining weight for some time as their body begins to struggle to metabolise carbohydrates. I rarely if ever read a media article that properly distinguishes the metabolic disorder and autoimmune disease. The recent Diabetes UK campaign to highlight the huge number of people with diabetes in the UK who are not receiving the basic checks to ensure their health went largely ignored. It is suggested that 90% of the cases of sight loss in diabetics could have been prevented with earlier identification and treatment.

But those things don’t fit the default media’s diabetes stereotype of “fat, lazy and all their own fault”.

I have been using insulin as a treatment for diabetes for over 20 years and I wish to point out to Helen Briggs that there is no such thing as a ‘designer’ insulin. Insulin is not something I choose to match my summer wardrobe. This is not some flimsy, inconsequential part of my life. All insulins are not the same. Diabetes is a complex condition to manage. Whether type 1 or type 2, every single mouthful one eats has to be considered. For those using insulin, particularly rapid-acting analogues, the timing, dose and activity curve of the insulin needs to be matched as closely as possible with the likely absorption of carbohydrates in food, while factoring in exercise, illness, stress, even ambient temperature.

The target blood glucose range that I am asked to hit is so tiny that the permitted BG meter inaccuracy of 10-20% almost entirely covers it. And if I stray very far outside that target? Blindness. Kidney failure. Nerve damage. Heart attack. Loss of limb. Coma. Death.

The benefits of using the very best treatment options available to me are not ‘modest’. My circumstances are not ‘exceptional’.

The potential consequences of using inappropriate treatment options to save the NHS ‘£625 million over 10 years’ in the short term, could cost the NHS a great deal more in the treatment of unnecessary diabetic complications. I have been diabetic long enough to pre-date analogue insulins. I’ve used the cheaper human formulations and they are not ‘just as effective’. Not for me, and not for many others.

I accept that diabetes is costly to treat. I accept that incidence is increasing and that this raises concerns over the future cost to the NHS of treatment. What we need though is better treatment. Better education. And above all better, more balanced, more informed coverage in the media.

Enough of the diabetes-bashing.

Shame on you BBC, I had thought better of you.


  1. So angry about this on so many levels.

    It's fag packet maths - 'designer' insulin costs x, normal insulin costs y. All insulin does the same job. Therfore x minus y = savings to the taxpayer.

    One word sums up the main argument against this logic - Complications. Short-term savings = long-term costs.

    I could rant about most sentences in the BBC article, so I think I should stop now before my BG shoots up because of the stress - which I'd then treat with my ultra-fashionable designer insulin and become a further burden on society.

  2. Well said.

    I'd like for the journo who wrote this to come & spend a day with me. Then tell me my insulin is "designer". It is still rubbish in comparison to a working pancreas. I'd far rather not be using any insulin at all - there is no need to make me feel guilty for struggling by with a new insulin, rather than struggling even more with an old one.

  3. The source article on the BMJ:

  4. Thanks Dave. Yes I'd subsequently read the source material (and realised that the quoted savings are based on 100% conversion to human insulins, with 'presentation' being taken into account... ie everyone on human delivered by vial and syringe - no pens!).

  5. Well said Mike! I commend this article. The mere idea of going onto Mixtard gives me the shudders. It's hard enough to get decent control on the analogues and as Emma so rightly says it's still rubbish in comparison to a working pancreas. Which leads me to insulin pumps - they are definitely out of the question then if vials and syringes are what we should all have.