Thursday, August 20, 2015

"Diabetes could bankrupt the NHS"



This week and next (as it’s such a large topic) I wanted to talk about the facts behind the alarming headline that was splashed all over the news and media on Monday – it was reported that Diabetes in the UK had increased by 60% in the last decade and treating this increase would basically destroy and bankrupt our entire NHS…..so I figured we should look a little more at diabetes – its types, its symptoms, those at risk, the correlations between health/weight and diabetes, worse-case scenario outcomes and then prevention vs end stage medication (and NHS spending) and of course take a look and what we can do to help ourselves avoid diabetes.


“60% rise in diabetes cases in the last decade”

As this is no nonsense let’s start with the initial report from diabetes.org.uk:

And here are how a couple of the papers reported the new statistics:
The Guardian (http://www.theguardian.com/society/2015/aug/17/diabetes-bring-down-nhs-charity) have quoted a lot of the initial report, whereas the Independent (http://www.independent.co.uk/life-style/health-and-families/health-news/diabetes-could-bankrupt-the-nhs-after-60-rise-in-number-of-cases-charity-warns-10458353.html) has lead with the cost factor and used words and phrases such as “bankrupt”, “amputations”, “stroke”…. Using shock language and looking at worse-case scenarios on all counts for the health system and for people with diabetes.  Both are great reports and both give the facts and figures.  Maybe it takes sensationalism to make it to our conscious and get us talking about it, maybe with all repots just giving the facts and figures this would have passed the general population without issue, so I’m grateful for a little doom and gloom and the splashing of disaster headlines sometimes to raise awareness.

In any case and via any reporting what we can see is that there has been a 60% increase in those diagnosed with diabetes in the last 10 years in the UK.   I imagine this could be due to a number of factors including for example
1) the rate of diagnoses has increased due to better methods of diagnoses
2) the rate of awareness has increased leading to more people being tested and therefore more diagnosed 
3) even with 1 and 2, we can see the disease is on the increase
Looking more closely at number 3 I wanted to look at why diabetes is on the rise, what’s causing this rise and the correlation therefore between risk factors such as health, weight, obesity and diabetes.

Next week we will look further into these risk factors (as well at those at a higher risk due to age, ethnicity, gender), then into symptoms, outcomes, treatments and prevention and what we can do.

This week to start with I wanted to just give an overview of diabetes.


Types of diabetes:
For a start let’s break it down – there are 3 types of diabetes – TYPE 1 and TYPE 2 and Gestational Diabetes. Here is a handy video from www.diabetes.org.uk that helps explain what happens when you have diabetes in no nonsense terms that we love:






The following info is from www.nhs.uk and simply identifies each type.

Firstly: “Diabetes is a lifelong condition that causes a person's blood sugar (glucose) level to become too high. The hormone insulin  produced by the pancreas  is responsible for controlling the amount of glucose in the blood”.

Type 1 Diabetes  where the pancreas doesn't produce any insulin

Type 2 Diabetes  where the pancreas doesn't produce enough insulin or the body’s cells don't react to insulin

Gestational Diabetes - occurs in some pregnant women and tends to disappear following birth

For the purpose of this blog (and next weeks) we will only be focusing mainly on type 2 diabetes as this is on the increase, this is the type the NHS is spending the most amount of money on and this is type we may well be able to help ourselves prevent.

Type 1:
In type 1 diabetes, the body's immune system attacks and destroys the cells that produce insulin. As no insulin is produced, your glucose levels increase, which can seriously damage the body's organs.  Type 1 diabetes is often known as insulin-dependent diabetes. It's also sometimes known as juvenile diabetes or early-onset diabetes because it usually develops before the age of 40, often during the teenage years. Type 1 diabetes is less common than type 2 diabetes. In the UK, it affects about 10% of all adults with diabetes. If you're diagnosed with type 1 diabetes, you'll need insulin injections for the rest of your life”.

It's important that type 1 diabetes is diagnosed as early as possible, so that treatment can be started as quickly as possible. Type 1 diabetes can't be cured, but treatment can blood glucose levels as normal as possible and control symptoms, to prevent more health problems developing later in life.  With type 1, your body can't produce insulin so you will need regular insulin injections to keep your glucose levels normal. With treatment, you will be shown how to do this and how to match the insulin you inject to the food you eat, taking into account your blood glucose level and how much exercise you do.

Type 2:
“Type 2 diabetes is where the body doesn't produce enough insulin, or the body's cells don't react to insulin. This is known as insulin resistance.  If you're diagnosed with type 2 diabetes, you may be able to control your symptoms simply by eating a healthy diet, exercising regularly, and monitoring your blood glucose levels.  However, as type 2 diabetes is a progressive condition, you may eventually need medication, usually in the form of tablets. Type 2 diabetes is often associated with obesity. Obesity-related diabetes is sometimes referred to as maturity-onset diabetes because it's more common in older people”.

As with type 1, there is no cure for type 2 diabetes, however if you're diagnosed, you may be referred to a diabetes care team for specialist treatment, or your GP surgery may provide first-line diabetes care as in some cases, it may be possible to control type 2 diabetes symptoms with lifestyle changes, such as eating a healthy diet and taking regular exercise (which we will focus more on next week). However, as type 2 diabetes is a progressive condition, you may eventually need to take medication to keep your blood glucose at normal levels. This may be in the form of tablets initially, but move on to injected insulin at a later stage.  This is where the cost factor to the NHS comes in as the disease is both incurable and degenerative, so preventing and managing symptoms for as long as possible with a healthy diet and lifestyle will keep us fitter, healthier and lower our risks at the same time as saving the NHS money.


NICE care processes:
You will see from the news articles and the initial report from diabetes.org.uk that there are 8 NICE (The National Institute for Health and Care Excellence) recommended care processes recommended to the NHS to use when monitoring  patients at risk or diagnosed with type 2 diabetes.  These tests are completed annually and these functions are what we can try to prevent increasing with the use of diet, exercise and lifestyle change:
 


1) Measuring the effectiveness of diabetes treatment with blood test
2) Measuring cardiovascular risk factors (such as blood pressure)
3) Monitoring cholesterol
4) Checking your BMI – Body Mass Index
5) Cutting down / out smoking
6) Monitoring early complications: eye screening and foot health
7) Checking urine serum albumin (a protein made by the liver, the main protein of blood plasma)
8) Creatinine – testing kidney function

So these are the no nonsense basics – if you are interested you can find the full audit for care process and treatment targets in the resources section here (downloadable as a PDF): http://www.hscic.gov.uk/catalogue/PUB14970


So, after establishing these basics behind the headlines, next week we will look at:

  • Type 2 diabetes risk factors and those at higher risk
  • Type 2 diabetes symptoms
  • Treatment and worse case outcomes of type 2 diabetes
  • The correlation/link to obesity
  • And finally prevention vs end stage medication ie things we can do in relation to our own health, weight loss, exercise and lifestyle factors - things we can change now to prevent type 2 diabetes

I hope that’s been interesting so far and given an overview of the diabetes basics – if you want more info you can take a look at www.diabetes.org.uk ; www.diabetes.co.uk and www.nhs.uk or of course contact us at info@nitakothari.com

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**Please remember this is nutritional advice ONLY (as is all other information and advice contained in this blog and the websites and social media related to it) – none of the info or advice is intended to override any recommendation from your GP or health professional**



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