Over 40s should be health checked for type 2 diabetes

[TPMB12]

Just read about this advice from NICE. The aim of the test is to find those at risk of type 2 diabetes due to obesity and family health history. Then those identified get help with diet, fitness sessions, lifestyle coaching, etc. An estimated 5 million will be affected by this.

Well what do you think about that? Do you agree with intensive lifestyle change programmes? Do you think there are other ways? For example I heard that in Sweden you can get things paid for you if they're for fitness and health. For example gym membership, fitness classes and I heard they'll even pay for a bike if that's how you choose to get and stay fit. Not sure it's exactly like that but the idea that there's universal help to stay fit and healthy through subsidized fitness provision is something I'd prefer. I can't afford my local gym but I know from when I could it greatly improved my health.

So what's your view? Targeted or universal fitness assistance?

[ScumOfTheRoad]

Hah. As someone who has type 2 diabetes, I have never been offered fitness sessions, free or otherwise.
In fact my doctors surgery refused to prescribe the glucose testing strips which are used for checking blood glucose levels with the little meters.
And now at a later dat ethey want to put me on metformin. So the surgery will pay for metformin but not helping me keep th esuger levels in check. WTF?

[mrcharly-YHT]

Enabling lifestyle changes has been shown to be cheaper and more effective than symptom-treating with drugs and dealing with long-term health effects.

It can be difficult to get people to enact the changes, but if the choice is between paying for drugs or attending a gym that costs the same amount, a proportion of people will opt for the gym. Diet advice offered with the gym attendance will help.

My son smokes. He has damaged lungs from a childhood illness so really really should never smoke.
When he started running (with the goal of completing a half marathon), he didn't try giving up smoking, but his smoking dropped from 10 (admitted) cigs a day to about 1. He said he just didn't want the cigs so much. Stopped running and smoked a lot again.

That's the sort of thing that can be achieved.

[TPMB12]

So should gym membership be paid for?

[davelodwig]

My Dad was diagnosed with high cholesterol levels and the doctor offered him, Statins or 6 weeks membership of Slimming World.

Dad took the slimming world deal and lost enough weight that he doesn't need the Statins.

My brother who was much bigger than both of us was offered the same deal as a preventative to needing medical intervention in later life, after some encouragement he managed to loose a lot of weight and keep it off.

I think the question really is, would we rather spend money treating or preventing, in some cases the investment in prevention is better value as it reduces the financial burden later on.

D.

[mrcharly-YHT]

So should gym membership be paid for?

Just paying for gym membership alone would not work.

It needs to be tied in with some sort of nudge. Subsidise a gym - have it run at a hospital, or nominated gyms and make patients log a diary with the doctor (just like you'd have to do with medication, really - because if you stop taking statins or or insulin the doctor will be wanting a chat).

[Chris S]

Something needs to be done - T2DM already costs the NHS £10bn annually; it's an incredibly expensive condition to treat because its progression is slow, and it encompasses expensive associated chronic illnesses.

We're reaping the whirlwind of 40 years of dietary clusterfuck.

I have no idea what the solution is on a population scale; we all want to eat bread, cake, pasta, chips, ice cream. Industrial Growers, Big Food and Big Pharma all want us to too.

One of the most successful ways of tackling individual metabolic syndrome is fasting (see other threads hereabouts) but nobody gets rich from people not eating.

ETA: By the way - here's a lunchbox handed out to delegates at a recent conference on the "Diabetes Crisis": 

[Sergeant Pluck]

So should gym membership be paid for?

Just paying for gym membership alone would not work.

It needs to be tied in with some sort of nudge. Subsidise a gym - have it run at a hospital, or nominated gyms and make patients log a diary with the doctor (just like you'd have to do with medication, really - because if you stop taking statins or or insulin the doctor will be wanting a chat).

No. Payments after proven attendance, perhaps, but not subsidised memberships. Most people that this would be applicable to will not want to or be unable to attend regularly and the overall effect would be to take money out of the NHS and to give it to the private sector. And there is enough of that already.

Longer term, in the field of public health I think the diabetes glut is seen as a prolonged blip, a temporary phenomenon rather than an ever-increasing trend, much in the same way as asbestosis or smoking-related illness. Partially self-limiting as a result of scientific advances and public awareness.

[LEE]

If you are interested in T2 Diabetes then I advise you to watch this (and other Jason Fung videos).

https://www.youtube.com/watch?v=eUiSCEBGxXk

For some people it's not as simple as Fasting because it's a genetic/hereditary problem.  For most people however it's a simple problem of high sugar levels, over long periods, leading to high insulin levels over long periods, leading to insulin resistance, leading to high insulin levels.

What is the most common prescribed treatment for a condition of (Insulin resistance) high insulin levels?  Insulin supplements !!!!  A classic case of treating the symptom not the condition.

I'm no doctor...watch the video and see if it makes sense.

As for that snack at the Diabetes convention.... OMG!!! Carbs, Carbs and sugars.  Fundamentally the cause of T2 Diabetes.

As for diabetes being a "Blip" it's getting worse.  "Pre-Diabetes" affects millions, if not billions, of people.  It's a ticking bomb of actual diabetes.  The NHS will never cope with what's heading its way. 

Globally more peoples are becoming constant "grazers" of carbohydrates.  That means raised insulin for most of their waking hours.  That leads to insulin resistance which is "Pre-Diabetes".  Long exposure to insulin promotes fat gain (that's insulin's job) and more insulin production.  Eventually your body just loses the ability to offload sugar/glycogen into the cells and it stuffs it into places it shouldn't be...Diabetes, amputations, blindness..etc.

Big problem.  Buy shares in Pharma companies that make Diabetes treatments.  You won't regret it.

[mrcharly-YHT]

So should gym membership be paid for?

Just paying for gym membership alone would not work.

It needs to be tied in with some sort of nudge. Subsidise a gym - have it run at a hospital, or nominated gyms and make patients log a diary with the doctor (just like you'd have to do with medication, really - because if you stop taking statins or or insulin the doctor will be wanting a chat).

No. Payments after proven attendance, perhaps, but not subsidised memberships. Most people that this would be applicable to will not want to or be unable to attend regularly and the overall effect would be to take money out of the NHS and to give it to the private sector. And there is enough of that already.

Longer term, in the field of public health I think the diabetes glut is seen as a prolonged blip, a temporary phenomenon rather than an ever-increasing trend, much in the same way as asbestosis or smoking-related illness. Partially self-limiting as a result of scientific advances and public awareness.

Most hostpitals have gyms already.

It does not need to end up 'in the hands of the private sector'.

What do you think happens with pharmacy? This is a source of vast profits for private companies and massive cost to the nhs.

[ScumOfTheRoad]

In my case I will admit that a gym membership would have done no good.
I am a classic middle aged male. I work full time, and at the time I was in a job which involved a 90 minute to two hour commute round the M25 each way.
So I was leaving home at 8 (I was able to get into work late) ad regularly worked till 7pm, getting home at 9 in time to eat in front of the TV.

That job was literally killing me. There are many middle aged people (men and women) in the same boat. I think our GP system fails us. Admittedly my GP surgery has early appointments from 8am, so I woudl try to book these when needed.

I now work in a different job, in a country where the EU working time regulations are enforced. I was even asked by my manager one time why I was working so late - if I couldnt get my work done then it was the job of the company to find someone else to help. Not just load more on you and make you sign away EU working time regulations, like in the UK.

[LEE]

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*

Exercise all you like but, if you're having carbs for breakfast, a mid morning granola bar, carbs for lunch, mid afternoon snack bar, Dinner of carbs and a late evening Beer or carb snack then you're basically full of sugar all day (Carbs = Sugar) and your body uses insulin to process sugar. 
That's natural. 
What's not natural is for Insulin to be processing sugar all your waking hours.  We weren't designed to work that way long-term, we were probably designed to have one or two Insulin "spikes" during the day then a long gap before next day's "spikes".
Give your body a break from sugar, drop the carb intake, only eat for a short window of the day, eat say at 12pm & 6pm, then give yourself 18 hours free of carb/sugar/insulin.

Apparently that is enough to regain your sensitivity to Insulin such that normal amounts do the job as required.

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

[mrcharly-YHT]

Lee, the medical profession are in general agreement that being very overweight is a huge risk factor in developing type II diabetes (along with high blood pressure).

Not getting regular exercise doesn't help with food choices and desire to snack.

S.otR, I leave home at 630, if I get home by 630 it is a short day and frequently work in the evenings and on the weekends. I guess I'm one of the people you are talking about. It is still possible to fit in exercise, but difficult.

[ian]

The primary risk factor for type 2 diabetes is being overweight and more and more people are overweight. A majority of adults do no exercise. They drive from home to office. And eat, eat, eat. And wash it down with a sugary drink.

Realistically we need people to take up active and healthy lifestyles. And we have to be serious about it, not that usual half-hearted crap. Everyone should have access to gyms and exercise facilities and they should be free. We have to stop people driving everywhere. A lot more effort should be invested in healthy eating rather than lining every high street with junk food emporia. When I wade through the litter left by the local schoolkids, it's all crisp packets, chocolate wrappers, and sundry junk. I've yet to see a banana skin or an apple core. It doesn't bode well for their future.

Basically we eat too much, and what we eat is crap, and do too little.

[Jaded]

Public Health rather than Public Illness.

[ian]

In 2017 we'd still rather build roads than sports centres and have junk food industry lobbyists on committees rather than dieticians.

[hellymedic]

We would rather build roads that are motor-friendly and pedestrian + cyclist unfriendly to 'smooth traffic flow' and end 'war on the motorist' than make cycling and walking comfortable and convenient.

We keep encouraging 'food on the go', a MASSIVE junk and snack food industry rather than proper, slow meals made of minimally processed PROPER FOOD.

There is little profit in encouraging people to avoid CRAP foods
C  Carbonated drinks
R Refined Sugar
A Artificial foods
P Processed foods

Though this would help many control their weight and blood sugar.

[sojournermike]

Ian an Helly sum it up -  along so many other areas, we have given up hope of effecting necessary change and so look to affix a sticking plaster.

To add a little to Ian's comment on obesity being the primary risk factor for T2D, fatty liver is heavily implicated. The work being done at Newcastle Uni on using restricted calorie diets to 'reverse' T2D is focused on this. By way of balance for the LCHF viewpoint, the mealdrinks they provide are basically sugar, but the candidates only get 800kcal/day and so lose weight.

Perhaps unsurprisingly, it you don't eat all the CRAP that is pushed in front of us all the time and you follow Helly's suggestion to cook you probably wind up eating:

1. Much less by amount and energy intake
2. A lower proportion of carbs, but nothing like so low as to be in Nutritional Ketosis
3. Have breaks between eating meals
4. Eat and enjoy more veg

I'm sure it's healthier, and nicer, but it does take time  away from the screens

[T42]

A few points in passing:

- I certainly favour T2 testing being recommended to everyone from 40 onwards.  I was diagnosed with severe diabetes at 43: doc reckoned I'd been diabetic for at least 10 years beforehand.

- A while back the WHO raised the upper norm for fasting blood-glucose from 110 mg/dl to 127 mg/dl (/18 to convert to mmol/L, ICBA).  I don't know, though, if this value reflects the level at which the effects of diabetes begin to appear, or if it's simply a bell-curve derived figure reflecting the fact that a significant portion of the world has become obese - I rather suspect the latter.

- They also raised the norm for HbA1c in well-controlled diabetics from 6% to 7%, and changed the guidelines for treatment away from keeping within the norms to giving priority to the patient's well-being - whatever that means.  In later years, too, it has emerged that whereas HbA1c was previously thought to reflect mean BG levels over the past three months, the value is mainly determined by the mean over the past three weeks.

- T2 patients can have hypoglycaemia at "normal" blood-glucose levels.  I certainly feel wonky if mine drops into the lower half of the normal range.

- During endurance exercise your metabolism acts like that of a normal human being, so CRAP is sort-of OK if you're in the middle of a ride and possibly just afterwards, in fact it's one of my main motivations for riding long distances.  You can skip the medication, too. Doesn't hold for doing a flat 10k to the CAEK shop, though.

- even if you've skipped it, if you're usually on metformin and then eat like a yuman bean on a ride you'll be farting like a wind tunnel for 24 hours afterwards. Rough old stuff but a life-saver.  And hell, the dogs fart so why shouldn't I?*  "Free as the air" applies to humans as well.

- my cardiologist's definition of endurance exercise is whatever makes you sweat for 45 minutes.

- Don't see why someone prescribed metformin should be denied a meter - in the US the pharmacies often give them away free with the first pack of testing strips (paging Mr. Gillette). Our health service gives me a new one every 5 years, or if the manufacturers discontinue supplies for my current model - a favourite sport.

- my current meter & testing-strips, from a reputable German manufacturer, have a margin of error of ±18% 

- generic metformin's dog cheap. Most of it comes from India or Israel.

- you can't win

* our parrot has been known to greet me with a beauty

[Chris S]

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.

[ian]

The current medical and dietetic advice is that everyone should eat a balanced diet, low in sugar and processed foods, but also low in saturated fats, and combine that with regular aerobic exercise. This is based on many decades of research and, more importantly, quite clearly and obviously works. This should be aim, not complicated and fiddly diets or other interventions. We do approximately nothing on this score. We faffed around the edges adding a couple of pence to can of soft drinks and that took years and is little more than a poorly applied sticking plaster for a wider problem that's only getting worse.

[Jurek]

<snip>We would rather build roads that are motor-friendly and pedestrian + cyclist unfriendly to 'smooth traffic flow' and end 'war on the motorist' than make cycling and walking comfortable and convenient.</snip>

While I would broadly agree with what Helly says here, Waltham Forest is one London borough which stands head and shoulders above most, if not all others, in implementing significant infrastructure to encourage walking and cycling, and discourage driving.
It has had a mixed reception with a notable number of residents vehemently opposed to it.
With that kind of mindset, I envisage that more and more of my taxes will be spent on the healthcare of ever increasing numbers of the population.

[IJL]

We have had a health trainer and being able to offer 3 month free gym membership for at least 5 years.  The take up is reasonable but the conversion from 3 month quick fix to long term change in lifestyle is very poor.  Different surgeries will have different practices but I do HBa1c tests as often as possible.  The challenge is the hard to reach groups of people who never set foot in the surgery, letters and phone call seem to fall on deaf ears and consequently  diagnosis only comes when symptoms develop.  I was told a few years ago that by the time T2D  is diagnosed blood glucose will have been raised for 10 years.

There are endless theories blaming particular foods and food groups, some are plausible, some reek of pseudoscience.  I don't believe there  is a single culprit rather the steady shift over 30 years to more sedentary lifestyles and jobs coupled with people eating diet to fuel a Stevedore.

I live and work in mining country, the ground under my corner of Derbyshire is like Swiss cheese, The miners used to the their lunch down the pit in a "snap tin"  its was tin so it was mouse and rat proof.  Google miners snap tin and  you'll see the size of lunch a man working a hard physical job in hot and wet conditions would eat.  These days it would be considered a starter.

So if you're 40+ and you've not had your blood pressure or blood taken in years book an appointment.  The finger prick at the pharmacy doesn't count you need a HBa1c

[ian]

<snip>We would rather build roads that are motor-friendly and pedestrian + cyclist unfriendly to 'smooth traffic flow' and end 'war on the motorist' than make cycling and walking comfortable and convenient.</snip>

While I would broadly agree with what Helly says here, Waltham Forest is one London borough which stands head and shoulders above most, if not all others, in implementing significant infrastructure to encourage walking and cycling, and discourage driving.
It has had a mixed reception with a notable number of residents vehemently opposed to it.
With that kind of mindset, I envisage that more and more of my taxes will be spent on the healthcare of ever increasing numbers of the population.

Except they won't, for those who've not noticed it, governments (whatever their colour) are floating away any part of the NHS they can get away with because they know that under current terms it's unsupportable and no one wants that liability. No matter what opinion polls say, when it comes to the election people generally don't vote to pay more taxes and politicians know it.

Surrey wants wider roads, Croydon wants more parking. You can see the focus. I get some half-hearted 'get active' stuff from the district council, that's about it. People consider a ten minute walk to the train station 'too far.'

The snap tin is a good example of how things have changed, I remember my grandfather's, and yep, a couple of sandwiches (usually beef dripping, eek) was lunch for an entire 12 hour shift of manual labour. These days we eat three times as much to sit at a desk for seven hours.

[hellymedic]

Older generations weren't eating ALL THE TIME.
They ate and then went several hours till the next meal, which gave their bodies a chance to clear the food and have a break.

My general impression is that people eat TOO OFTEN as well as too much.
They misinterpret 'peckish' or 'bored' as 'hungry', without really knowing how 'hungry' feels.