Describing herself as ‘the original Doc Martin’ and ‘a GYPSY’ [GP with Special Interest], Dr Liz Martin came to the club in July to enlighten us on the important topic of diabetes. She has considerable experience, having set up a community team to help GP practices look after patients with type 2 diabetes, and worked at St James’s Hospital on diabetes with a particular interest in feet.
With the assistance of some informative but occasionally gruesome slides, Liz gave us a lucid explanation of the causes and effects of diabetes, and what can be done to control it.
She explained that diabetes is a potentially damaging high level of sugar in the blood, arising where the body has become resistant to insulin. Insulin is a hormone produced by the pancreas. As food is ingested, blood sugar levels rise and the pancreas responds by making insulin, which then unlocks the body’s cells to accept the sugar from the blood to be used as energy. Where the body does not have sufficient insulin, or has insulin that fails to work properly, the sugar remains in the blood instead of transferring to the body’s cells, and then causes damage. Obesity is the principal cause, where fat blocks the insulin from unlocking the cells to accept the sugar. Obesity also leads to cholesterol blocking arteries, increasing the risk of heart attacks and strokes.
Type two diabetes accounts for 90% of cases, and usually afflicts older people, although with the rise in obesity, children as young as ten are now presenting with it.
Type one diabetes is different, and typically afflicts young children. In these cases, a defect in the auto immune system destroys the cells in the pancreas responsible for creating insulin. The only treatment is to inject insulin, typically after meals, using a fine needle that looks like a pen.
Liz told us that more than 5 million people in England have diagnosed diabetes, but there are probably a similar number of sufferers without a diagnosis. Also a further 6 million are likely to develop diabetes in the future. In Leeds, it is estimated that there are 50,000 people who have diabetes, with a further 48,000 at high risk of developing it.
90% of cases produce no symptoms but over time the risk rises of cardio-vascular disease, kidney failure, blindness, and circulation problems such as neuropathy in the feet leading to gangrene and requiring amputation. Liz told us that vascular surgeons last year at St James’ hospital performed 167 amputations of toes, feet or limbs, costing £2million. Those with diabetes are estimated to have a 50% increase in the risk of premature death.
The principal cause of type two diabetes is obesity. The rise in obesity over the last few decades is alarming. It is estimated that only 40% of women and 33% of men are a sensible weight. Over 25% of children are now overweight or obese. Liz told us that the NHS now needs ambulances capable of taking a patient who weighs 50 stone.
There is good news, however. Blindness as a result of diabetes has become much rarer. Retinal screening every twelve months and painless laser surgery has seen to that.
The best way to combat diabetes is through good diet, and keeping active. Liz told us that a cola bottle typically contains the equivalent of 22 lumps of sugar: fresh fruit juice feels healthy but also contains a lot of sugar. ‘Eat less’ is the message. Also consider taking statins to reduce cholesterol. And stop smoking. Refreshingly, Liz did not mention alcohol, but we all know moderation is best.
Finally, Liz mentioned The LEEDS (Locally Enhanced Diabetes Support) programme in Leeds, which offers support to help people reduce their risk of developing type 2 diabetes. The programme provides various options, including face-to-face group sessions, recorded sessions with follow-up, and a remote, smartphone-based programme. Referrals are typically made by a GP or other health professional.
Click on the link to learn more. https://www.cityviewmedicalpractice.co.uk/images/The%20Leeds%20Programme%20Leaflet.pdf