Diabetes costs ‘out of control’, and why this is no surprise given standard dietary advice for diabetics

I saw this story on the BBC website this morning. It concerns the costs of treating those with diabetes. Apparently, the cost of drugs for managing diabetes is rising (a lot), and now accounts for 7 per cent of the total amount spent on prescribing in the UK. Between 2000 and 2008 prescriptions for diabetic drugs rose by 50 per cent, apparently, and costs (even taking into account inflation more than doubled.

What to do? Well, for a start, perhaps people could be given appropriate advice regarding how to eat to better control their diabetes. Sugary and starchy carbohydrate tends to cause considerable disruption in blood sugar levels. So, it makes sense that limiting such foods may well improve blood sugar (“glycaemic”) control. Not so long ago I reported on a study which employed a low-carb diet in a group of type 2 diabetes. The result: more than 95 per cent of them were able to reduce or stop their medication.

Admittedly, the diet used in this study was really quite low in carb. But it gives some indication of the sort of results that can be achieved by employing the logical and correct nutritional approach to diabetes.

I was interested to read the comments of Dr Niti Pall – a spokesperson for Diabetes UK (the UK’s pre-eminent diabetes charity) – in the BBC news story linked to above. She claims, according to the article, that the job of GPs is to get blood sugar levels as low as possible by whatever means possible. Really? Because, such an approach may promote attacks hypoglycaemia (low blood sugar) that can cause symptoms such as weakness and confusion. Sometimes, hypoglycaemia can cause injury and even death.

Maybe Dr Pall is aware of this but neglected to mention it in her enthusiasm regarding getting blood sugar levels as low as possible. But even if we ignore the obvious gaff regarding hypoglycaemia, is it really true that getting blood sugar levels as low as possible is the best way forward? I ask this because there is some evidence that intensive lowering of blood sugar levels using pharmacological agents (i.e. insulin and/or other diabetes drugs) actually increases risk of death [1].

Should we be too surprised that perhaps not the best advice for diabetics has come out of Diabetes UK? Maybe not, bearing in mind that it is this organisation which continues to advise diabetics to eat like this (taken from the Diabetes UK website):

At each meal include starchy carbohydrate foods
Examples of these include bread, pasta, chapatis, potatoes, yam, noodles, rice and cereals. The amount of carbohydrate you eat is important to control your blood glucose levels. Especially try to include those that are more slowly absorbed (have a lower glycaemic index) as these won’t affect your blood glucose levels as much.

However, even the lower GI foods recommended here can be very disruptive for blood sugar levels, especially when eaten in quantity (as they often are). This advice, if acted on, will generally destabilise blood sugar levels in a way that will do little or nothing to help individuals control their condition and reduce their medication or even eliminate the need for medication entirely. But, then again, as I commented here, perhaps that’s the point.

References:

1. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008;358(24):2545-59

8 Responses to Diabetes costs ‘out of control’, and why this is no surprise given standard dietary advice for diabetics

  1. Andre Chimene 2 August 2010 at 8:55 pm #

    Thanx for the vigilence doc. This needs to be trumpeted loud and clear for diabetics world wide. Please give me the ok to interview you in my new book on diabetes. I need your expertise. Andre

  2. S Williams 2 August 2010 at 11:08 pm #

    Diabetes UK is most certainly ‘anti-lowcarb’, however there are now a number of lowcarb advocates (diabetics) amongst its members and trustees so the tide may be gradually turning.

    Anyone interested in controlling their blood sugars would be well advised to read ‘Dr Berstein’s Diabetes Solution’and make up their own minds.

    Diabetes UK refused to take an advert for this book, not wanting to be seen to tacitly endorse a low carb propsition.

    Like many charities Diabetes UK’s primary objective is to continue to sustain its organizational structure.
    They are not bad people , just ordinary folks trying to make a living, do good and avoid controversy.

    Maybe if you had to be a diabetic to work there things would be different.

    I am a diabetic.

    Best Wishes

  3. Peter Phillips 2 August 2010 at 11:41 pm #

    Dr. Briffa,

    I’ve wondered if you’ve come across different approaches and rates of success in diet recommendations, internationally.
    In Toronto ,Canada , while there is an emphasis on eating carbs, this is interpreted by fellow type 2 diabetics as eating more veggies. Its expected that ‘white death’ carbs should be minimized if not totally removed from one’s diet.

    This was the situation 5 years ago,when I was involved in a couple of patient support groups. I’m assuming the situation hasn’t changed much.

  4. Katrina 3 August 2010 at 2:12 pm #

    Hi John,

    Great post, when I was dianosed as type 1, my diet advice included a packet of crips for a quick lunch when not at home, 1 oz of cornflakes for breakfast and a scone for snack in the afternoon. My energy lvels were almost non existannt and my inslin requirments high with high amounts of carb for lunch and evening meal.

    All that started to change as I read about nutrition and then sort the advice of an excellent nuntritional consultant, thank goodness now a whole change in the amount of insulin I take and and of course my energy. Main stream advice is just high carbohyrate which creates fats and the need for high amounts of inslin needing yet more mediation for side effects , it needs to change.

    Good new look website!

  5. Robin Davies 3 August 2010 at 8:50 pm #

    When I saw the dietician a few years ago after being diagnosed with Type 2, the diet sheet she waved at me was just the standard rubbish, stuffed full of high levels of carbohydrates. When I explained some of what I ate, she seemed confused and asked me if I was on the Atkins Diet. Mind you, she was young, inexperienced and probably NVQ Level 1. The GPs just churn out the same stuff and you know that there thinking is moulded by the drug companies.

  6. Kevin eakins 29 August 2010 at 7:11 pm #

    While it is true that many medical conditions have a complex etiology where more than one causative factor is at play, it is also true that in many conditions one factor predominates (ie: smoking and lung cancer). Not only this but in many cases one factor probably predominates in the etiology of multiple diseases.

    In this case hyperinsulimia & hyperglaecemia caused by an assault of excess sugar & starches in our diet is the root of many evils: excess weight, diabetes, cardiovascular disease, and cancer. I am not claiming its the predominant factor in cancer or cv disease but for sure its an important factor.

    The irony is that all one has to do is change one’s eating habits. The patient looks at you with a puzzled gaze: is it really all that simple? Yes, to large extent it is.

    This is the kind of clinical common sense which you’ll rarely find in research of evidence based medicine because these types of insights are very difficult to prove or disprove.

    God help medicine if everything we do has to be firmly based on EBM….

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