Over 40s should be health checked for type 2 diabetes

[LEE]

Lack of exercise isn't the cause of Type 2 diabetes*

../..

*I'm no doctor I just watched Michael Moseley and Jason Fung videos.

In another of Michael Mosley's films, "The truth about exercise", he gets himself measured for insulin sensitivity before and after several weeks of 3x a week 3x20s HIIT; and just that small amount of high intensity (essentially three minutes a week) has a massive positive effect on his insulin sensitivity.

You selectively quoted me and distorted my point.
I am in no way saying exercise won't help or is a bad idea.

I said:

Lack of exercise isn't the cause of Type 2 diabetes*

Long-term exposure to high levels of Insulin is the cause of Type 2 diabetes*

Anything (healthy) to get Insulin sensitivity and levels to normal seems a sensible option, diet, exercise or both.  What seems to have happened is that drugs seem to be the first and only recourse for many people. 
Treating Insulin resistance* with more insulin is treating a symptom in the same way that "curing" hangovers with "hair of the dog" is. 

*Referring to Insulin resistance brought about by lifestyle.

[IJL]

Much T2D is caused by lifestyle, although I see the occasional patient who bucks the trend and is T2D despite good diet, low BMI etc,  In which cases genetic factors are likely the major factor so choose your parents very carefully.

What seems to have happened is that drugs seem to be the first and only recourse for many people

All the treatment guidelines start with "lifestyle interventions"  unfortunately these are not often very effective as many people are big boned/don't eat a thing/ come from a long line of bloaters/ cant lose weight/ its their glands/ they'll grow into it/

its easy to forget that any discussion on YACF is coloured by the fact that its a cycling forum, I would think virtually everyone on here rides or exercises at some level on a fairly regular basis.  Its easy to lose sight of just how sedentary the general population is.  Metformin is cheap as chips, persuading people to have a few less chips and get off the sofa is a tough task.

[Pickled Onion]

My life insurance is through Vitality. They give points for being healthy, doing exercise, not smoking, etc. And what do points mean? Prizes! Well, sort of. If you get points you get rewards - free cinema tickets, coffee, money off stuff. If you get points they give cashback once a year and reduce the monthly cost. They just bought me a Brompton.

They are not doing this altruistically - obviously they have done the sums and the chance of them paying out is vastly reduced if you exercise the regularly. Whenever I tell anyone about it the response is "why don't the NHS do something like this?" Surely it would be far more cost-effective to pay incentivise people to look after themselves and not be an expensive patient draining resources. And that's even before you add in the cost of lost working time, the often hidden cost of carers, and the psychological cost of people not being as active, and so on.

Is it motivational? Absolutely! I'm not a total couch potato, but it's quite easy to not bother going out for a ride, put it off to tomorrow. But there's points - yes go out for 30 minutes, perhaps up it to an hour to hit the maximum. Stairs or lift? Points - I'll take the stairs. Sit at desk for lunch, or go for a walk? Points again. I used to think it didn't matter I was 95 kg (at 172cm tall) because I cycled a lot – I'm fit, right? Oh, and I'm big boned with muscly thighs, BMI is a useless measure. Now I'm 71 kg and feel so much better for it. This is not something I would have done on my own.

tl;dr Absolutely the government should incentivise people to get healthy. As long as they can find a way that works, targets the right people, and is non-patronising. That's a big ask but it would benefit us all.

[ian]

Much T2D is caused by lifestyle, although I see the occasional patient who bucks the trend and is T2D despite good diet, low BMI etc,  In which cases genetic factors are likely the major factor so choose your parents very carefully.

What seems to have happened is that drugs seem to be the first and only recourse for many people

All the treatment guidelines start with "lifestyle interventions"  unfortunately these are not often very effective as many people are big boned/don't eat a thing/ come from a long line of bloaters/ cant lose weight/ its their glands/ they'll grow into it/

its easy to forget that any discussion on YACF is coloured by the fact that its a cycling forum, I would think virtually everyone on here rides or exercises at some level on a fairly regular basis.  Its easy to lose sight of just how sedentary the general population is.  Metformin is cheap as chips, persuading people to have a few less chips and get off the sofa is a tough task.

Metformin may be cheap, but it's not side-effect free, and we know that many people fail to adequate control diabetes (and even controlled, there's still a significant likelihood of long term problems). Of course, then it gets a lot more expensive. Not that type 2 diabetes is the only problem, there's cardiovascular and other lifestyle-related morbidities, and a general decline in overall quality of life as people get older.

It might be tough to persuade people to take their own health seriously, but as PO says, but I don't think that's reason to not take the challenge. The costs otherwise are likely to be unaffordable.

Sadly, nothing I've seen from current governments has suggested that they're up to any kind of challenge.

[T42]

I had a circular from the health service offering me a free check-up for diabetes. The same health service as has had me categorized as a 100% covered T2D sufferer for the last quarter-century.

[IJL]

It might be tough to persuade people to take their own health seriously, but as PO says, but I don't think that's reason to not take the challenge. The costs otherwise are likely to be unaffordable.

Sadly, nothing I've seen from current governments has suggested that they're up to any kind of challenge.

Its very tough to get people to take their health seriously and I think even tougher for government led programmes to get people to take control of the own health.  I have seen a few programmes over the years that have attempted to achieve these goals, in general they have been very expensive, time consuming and very ineffective.  At present in general practice we do the CVD health checks, these take a good chunk of time and cover a good number of different factors.  Unfortunately the people who would gain the most out of the health check ignore letters, phone calls and texts and so don't attend.  The people who do attend are generally those with the least need who are already taking good care of themselves.  In the mean time this accounts for 5 hours per week of nurse time. 

[ian]

Sadly it's mostly too late telling someone in the their mid-forties, sedentary, and overweight to change their ways. That boat has sailed (at least as far as the nearest sofa).

Interventions and nudges have to be societal and happen earlier. That's the challenge. You've seen our current government. The current plan seems to be to slowly disassociate themselves from the the health system and those future liabilities. When it all becomes unaffordable it won't be their problem.

It doesn't have to be that way, but the alternative requires vision and effort.

[T42]

Sadly it's mostly too late telling someone in the their mid-forties, sedentary, and overweight to change their ways...

Worked for me.  My fasting blood sugar was 19.07 mmol/l, my total cholesterol 8.77 and I weighed 92 kg for 1m74 in height. Nowadays it's 71 kg, HbA1c 6.2% and total cholesterol 4.44 mmol/l. Height may be the same, I haven't checked.

[TPMB12]

So I have a question that's slightly linked to this thread on account of age and health assessment.

You've turned 40 (OK a few years back honest). Should you be considering any regular health checks? Things like cholesterol and blood pressure. I've last had my blood pressure taken 2 years ago when I had a knee op. I think I had a cholesterol check (basic high-low test) maybe ten plus years ago.

I know most nhs testing regimes kick in at 50 (eg bowel cancer which being high risk I'll probably do) but what about 40? I get the feeling that artificial age barrier is possibly where things stop getting better, hence the query. What to n do to minimize it being worse more quickly. I've got the healthy eating and exercise sorted. Stress only kicks in at certain, regular times of the year with work and home life. So a lot is possibly covered.

Jeez! Do I sound like a hypochondriac?! It's not like that at all.

[hellymedic]

The NHS tests don't seem to be very frequent and arranging other tests outside its wings can be cheap and easy. I think many pharmacies can check sugar and cholesterol and home blood pressure machines are cheap enough.
I am not much of a hypochondriac myself. I'm 59, with no family history of heart disease and diabetes only in one great-grandfather who died in 1939!

I bought a blood pressure machine online for around £20 when my pressure was up at the surgery on routine testing. (I got stressed getting partner to take me there!) It sits unused in a drawer after I confirmed my unstressed BP is fine.

My weight and waist are OK.

As untreated high BP can lead to strokes that could spoil your day, I think this is worth checking occasionally.

If your lifestyle and weight are reasonable and you don't have any symptoms, then I think checking sugar and cholesterol about twice in 5 years is fair. Any abnormal tests should be repeated a few times before definitive action is taken.