Paying for overindulgence (Rachel Hall)

Type 2 diabetes is certainly on the rise. At the moment I seem to be diagnosing at least one patient a week. One chap I’ve been seeing recently told me he had been feeling thirsty and tired for the past year.

He had a random sugar level of 20.1mmol/L. This is not an unusual scenario, and there are many more like him out there waiting to be diagnosed with diabetes. Quite often people put these non-specific symptoms down to stress or working too hard.

We all know most men put off going to the GP until things get really bad or they’re fed up with their family nagging them. The forthcoming NHS Health Checks for people aged between 40 and 74 years will help identify additional cases of type 2 diabetes, as well as those deemed to be at high risk for developing the disease.

But how do we reach those people who neither attend GP surgeries nor visit community pharmacies and ignore the letters of invitation. What about establishing “clinics” at sporting events or in pubs, or is that going too far? At what point do we need to let individuals take responsibility for their own health?

It’s clear that patients under-report their dietary intake of sugary and fatty foods, alcohol consumption and smoking, working on the basis that “it will never happen to me”. Unfortunately it does — and we see time and time again the results of years of poor diet and overindulgence. Most people want a quick fix, but this is usually not possible, except perhaps for the type 2 diabetic patients who qualify for bariatric surgery.

Ironically, one of my patients with a BMI of 45 was told she did not meet the criteria for gastric banding, then a couple of months later she developed type 2 diabetes; so I immediately rang the bariatric specialist nurse who seemed quite pleased that this was now the case since the patient could now legitimately have the operation on the NHS! “Has the world gone crazy?” I ask myself. It must make more sense to try to prevent a complex, costly long-term condition such as diabetes.

I realise that the NHS needs to prioritise funding, but surely treating people before they get too ill would have better long-term outcomes for both patients and the health economy. Or perhaps we shouldn’t be offering medical solutions at all to those who choose to continue their unhealthy lifestyles despite numerous warnings on the long-term effects. If it were a smoker needing heart surgery we would look at this very differently.

The bottom line is, people have to want to change. We can only remind them of the consequences of not changing and provide them with the information and guidance they need to succeed. One of my patients went as far as switching his “obsession” with food to exercise, and has dropped from a BMI of 45 to 26 in the space of 16 months!

Sometimes it takes a diagnosis like type 2 diabetes to prompt someone to make changes.

 

Rachel Hall is clinical pharmacist at The Old School Surgery, Bristol