Type 2 diabetes and an older rider

[horizon]

Just want to point out type 2 diabetes is a result of poor lifestyle and nutrition choices, eating far too much sugar.

In public health terms eating too much, being too heavy, and not taking enough exercise are exactly the right targets for decreasing the number of people with type 2 DM and the harm that results.

Although there are many other causes and risk factors this is the big one to go for in the UK at the moment.

Jonathan

So it looks like we are all agreed on that then!

My question then is, Why? Why should someone not exercise when it is obvious that it will affect their health? And why should anyone choose sugar and carbs over vegetables?

Apart from all the usual answers to these questions, I just wanted to add my tuppence ha'penny worth. One answer is that technology has created a labour-saving world, the principal component of which is the motor car. The second answer is the development of supermarkets and the way that food choices are presented by them.

Although these of course have been identified already, my take on them was to reject the car for personal transport and never go into a supermarket (apart from recycling my plastic bags, I haven't been in one for decades and drive now just a couple of hundred miles per year).

The point I want to make though is that I found it incredibly hard to do both, not because I was personally disinclined but because it meant running against the grain of society. Obesity seems to be built in to our way of life, it is structurally embedded.

Obviously you can shop sensibly and still get exercise even if you use a car; but it has to be a much more conscious choice and one that takes a degree of effort. And when you do make that effort, you find often that society has set things up in a way that might discourage you from the start.

[531colin]

...........Most of the medical profession and drugs companies want type 2 diabetics to remain on medication such as Metaformin for the rest of their lives which will keep doctors, drugs and food manufacturers in cushy well paid jobs for life. .....

I think we need some numbers. Metformin is "patent expired" so there are many manufacturers. Its my impression that GP practices have a drugs budget; I have certainly had more than one conversation with a GP about the desirability of prescribing a generic medication. So, here we are, NICE guidelines...https://bnf.nice.org.uk/medicinal-forms/metformin-hydrochloride.html. A 28 day supply of Metformin needn't cost more than a pound or two....with prescription costs, the lions share of the cost is often doing the paperwork rather than buying the drug.

[Vorpal]

The point of editing some posts is that the posters themselves were criticised, as opposed to addressing the arguments at hand.

We are not going to repeat every little sniping comment or justify every moderator action.

[mikeymo]

The point of editing some posts is that the posters themselves were criticised, as opposed to addressing the arguments at hand.

We are not going to repeat every little sniping comment or justify every moderator action.

What is wrong with "criticising" people? There's a difference between criticism and abuse.

Quick, let's get Mr J Stalin on, see what he's got to say, eh? It's very very important that we don't criticise him, just his arguments.

[Jdsk]

Its my impression that GP practices have a drugs budget; I have certainly had more than one conversation with a GP about the desirability of prescribing a generic medication.

GPs and practices in England don't have a drugs budget. There is pressure to minimise expenditure, and in particular to prescribe cheaper alternatives and generics.

Jonathan

[horizon]

It is my fond belief that while doctors do dish out the metformin willy-nilly (and pharmaceutical companies do like to make money), it is based on their own fond belief that it is a very rare patient who is going to suggest otherwise:

Doctor: Well I've looked at your test results and your blood sugar is out of control and you are clinically obese!
Patient: In that case doc, keep the metformin - I'm going to go out and get a bike right now, cycle every day for at least ten miles, cut down on my sugar and carbs intake and eat lots of vegetables.
Doctor: That's what I like to hear! Come back in a month and let's see how you are getting on.

In his dreams.

[al_yrpal]

They tested water quality at one of the lower Thames bridges. There was a high level of metformin detected in the water.

Al

[Vorpal]

The point of editing some posts is that the posters themselves were criticised, as opposed to addressing the arguments at hand.

We are not going to repeat every little sniping comment or justify every moderator action.

What is wrong with "criticising" people? There's a difference between criticism and abuse.

Quick, let's get Mr J Stalin on, see what he's got to say, eh? It's very very important that we don't criticise him, just his arguments.

There is a difference between criticising a *person* and what they have written. Considering, Mr. J. Stalin is not posting on here, I don't think we need worry about him.

[Jdsk]

They tested water quality at one of the lower Thames bridges. There was a high level of metformin detected in the water.

It's been repeatedly detected in sewage, but I don't know what "high" means". There's something like 3M people in the UK who take it.

Jonathan

PS: I run a thread in another mailgroup called "Unusual specimen types". This started with the detection of illegal drugs in the River Po. It's a particularly useful technique for identifying who's taking what where because survey methods have particular problems when illegal behaviour is involved. It's also used to identify pollution from oestrogens and from other hormones and antibiotics used in animal husbandry.

[Oldjohnw]

The point of editing some posts is that the posters themselves were criticised, as opposed to addressing the arguments at hand.

We are not going to repeat every little sniping comment or justify every moderator action.

What is wrong with "criticising" people? There's a difference between criticism and abuse.

Quick, let's get Mr J Stalin on, see what he's got to say, eh? It's very very important that we don't criticise him, just his arguments.

There is a difference between criticising a *person* and what they have written. Considering, Mr. J. Stalin is not posting on here, I don't think we need worry about him.

I believe my post was deleted because I said another post was judgemental. I could be wrong and have either inadequate recollection, bad eyesight or both.

[thirdcrank]

horizon

It's not just the motor car. Mechanisation has led to much less hard physical work.

Food and drink manufacturers have been allowed a lot of freedom in the way they advertise. Guinness is good for you and A Mars a day helps you work, rest and play were typical until quite recently.

[horizon]

horizon

It's not just the motor car. Mechanisation has led to much less hard physical work.

Fair point, and I did say it was the principal (i.e. not the only) component. But yes, physical paid work has diminished too. I recently had a friendly chat with a council chap using a leaf blower in the street: his view was that it would be too hard to do it with a broom.

As an office worker though for much of my working life, I tend only to see the peripheral activity and I think for most people like me it meant running for a bus on the way to sitting at our desks all day.

Having said that, I think the gist of this thread is that diet is fundamentally the problem: you don't lose weight through exercise and hard work. In this podcast from the Guardian, the speaker (a doctor) notes that obesity (and presumably therefore diabetes) has come about largely through the change in our diets (as opposed to the amount we eat). He looks at the Bedouin diet in the Middle East and compares it to that of his patients' in Dubai. I think it equates well to the traditional diet of manual workers in the earlier part of the twentieth century, allowing perhaps for the cost of food and how much someone could afford.

What we eat therefore is the key, not how much or indeed how much exercise or hard work we do. Your diet and mine (If I may presume) is largely based on a 1950s diet of vegetables and reasonably "whole" food, for which we retain the taste and liking for developed in childhood.

Here's the podcast:
https://www.theguardian.com/news/audio/ ... ose-weight

[Jdsk]

What we eat therefore is the key, not how much...

It's nutrition so the levels of evidence for most assertions aren't great... the trials just haven't been done.

The amount eaten and the composition aren't independent... some foods are much easier to eat than others.

But I'd never recommend people who want to lose weight not to take into account the total amount.

Jonathan

[horizon]

Jonathan: let me know what you think about the podcast - it would be good to have a second opinion (if you will excuse the pun!).

[ymfb]

My input as someone who has T2

Mine I believed is probably self inflicted, it was first diagnosed when I had 11 nights in hospital recovering from a bad leg infection picked up in China. As a child (in the 60s) I was so thin my mother gave me malt extract. My younger brother was always a bit tubby. After school I worked outdoors and had a voracious appetite, smoked and enjoyed a pint. At no time have we eaten food from boxes, apart from the very occasional pizza, I gave up sugar and milk in coffee in the 80s. I started to put weight on and did so gradually for over thirty years.

When first diagnosed I lost a bit of weight, not much, my BG was controlled with a mixture of drugs including Metformin, Empaglifloxin and Gliclazide but my HbA1c started to rise, I was getting small infections and irritable and at about 120 I was told it’s time for insulin. That was almost 12 months ago. It did several things, one galvanised me into getting on my bike, reducing my carb intake and measuring my BG 4 x a day.

My HbA1c, measured every 3 months after starting insulin was 90, 60, 56, 52, my metformin intake has halved, I’m still losing weight and feeling much better. Although I’m still taking drugs, it’s an improving situation and I no longer use the diabetic clinic.

I am monitored by a Dr in the Chemical pathology dept who is relatively new to my case and having heard my entire story including the loss of my brother at 32 and mother at 59 has suggested that there is a link between my Cholesterol and Diabetes, for the sake of mothers grandchildren she wants to disprove or confirm there is a hereditary link and I have some kind of type 3 (not diabetes) situation.

My unscientific analysis is not everyone is fat at the clinic, but many are, but then again so are many people in all walks of life. For me the journey continues and on Monday I’m going for the blood tests needed for genetic profiling to see if my own children (both thin) are predisposed to the health conditions my parents, brother and I might have passed on.