Quality Outcome Frameworks, that vehicle to keep the proletariat 'healthy' comes under fire once more. This time in an area dear to my heart; Diabetes.
It's always interesting to look at what NICE recommends and examine from time to time that which is ignored and that which is adopted from the voluminous output of this august body. When there's a few quid for the cash strapped GP's we find it to be adopted without question. When it's something that is valueless, in monetary terms it seems to take a back seat. What a surprise !
NICE does a lot, some of it is even useful (rarely), some of it benign and some of it positively dangerous, such as the guidance for QOF targets for Diabetes outcomes. The Lancet, last week published the outcome of a study into the application of these targets in the management of 50,000 patients in the UK showing clearly that the pursuit of HbA1c levels below 7.0 was putting patients at risk for CVD events. Dr George Kassianos, a GP and research fellow in Cardiology went further suggesting that tight glycaemic controls for Type 2 patients was in fact dangerous and should be amended to 7.5% instead of the current 6.5%.
Diabetics generally have a tough time of it in the NHS with being 'over managed'. Constantly being told to lose weight, that they should lower cholesterol, BP and keep within very strict limits for glucose control. Practices are paid by results to achieve these targets so patients become a cog in the machinery of practice income instead of a human being with individual needs and problems that need addressing with patient centred protocols. The money gets in the way and the so called research that backs up the QOF is often an ill thought out hypothesis with little or no evidence to back it save for that from the drug company that thought it up. And we know how impartial their research is !
This study highlights the dangers to the extent that mortality was 52% higher in those with HbA1c levels in the lowest tenth of the study at 6.4%. That's 5000 patients ! Yes that's correct 5000 people died because they were put on 'tight' control protocols by a QOF ! Yet I've looked for a response to this study from Diabetes UK, the 'leading' charity and I can find stuff all !
I have long known about the piss poor protocols and treatments available to Diabetics in the NHS which eats up a huge portion of the budget, with drugs, insulin, dieticians, and so on and so on but it never seems that anyone really looks at the Science to see if the money is well spent or the patient is getting better. Because the former is a lucrative 'gravy train' of ever increasing length and the concesus on the latter is, it will never happen. It seems it is in the interests of all, except the patient of course, to maintain the 'status quo' and now we find that a major element in the treatment plan is so flawed as to be deadly ! It should have provoked an immediate rethink of policy but no doubt NICE will have to conduct a long and expensive review of the policy (QOF DM23) prior to reducing the target. In the meantime a few (hundreds ?) may actually die ! It should be urgently amended for the current year, not next !
Still, what does it matter, the cash is coming in and there's plenty more diabetics. It's not like we are a looking at a famine of people to treat. More are diagnosed every day due to the crap advice doled out by the Agencies of Government and the kindness of the soft drinks industry in feeding us High Fructose Corn Syrup. I always say if you are looking for the culprit for most events that cause harm, especially in Medicine; 'follow the money !'.
Friday, 5 February 2010
Tuesday, 2 February 2010
Frustration
It is without doubt, a travesty that defies logic, that Jane Barton has escaped the ultimate sanction that she rightly deserved. It is once again the destruction of an expectation of Justice, that most felt to be inevitable and desired. Ann Reeves, who fought long and hard for the opportunity to bring this profligate over subscriber of opiates to vulnerable and now dead patients, is both bitter and outraged.
At the same time 'teflon' Tony Blair was expounding his singularly individual account of how he got us into our own version of Vietnam; the Iraq War. With a confidence bordering on Evangelism he absolved himself of all blame, piling it on the head (now detached) of Saddam Hussien.
Both events are a travesty of the natural Justice that we all feel should be meted out to those that are guilty of sending people to their deaths, be it on the field of battle, or the Wards of Gosport Memorial Hospital. Not because people die in either place that is given, but because they died without need, without a purpose that their loved one's feel, they can espouse or understand.
Tony Blair continues to earn the inflated and undeserved reward that he would never have been heir to without the bodies he has clambered over. His £15 million a year income (as reported in the Sunday Mirror, so it must be true) would never have been possible without his unholy compact with Bush to invade both Iraq and Afghanistan. He would have been consigned to a different history, of Memoir and Scholarly endeavour, with a comfortable, but hardly lavish lifestyle.
Jane Barton too, continues albeit with some restriction, to continue the practise of Medicine. Probably with a lifestyle, that the victims of her particular penchant for profligacy with syringe driven morphine, would never have achieved, presupposing of course that were not already dead; which is a fairly certain curtailment of one's ability to earn a crust.
Blair seems to have stolen Barton's dubious victory from the limelight, which only the most paranoid would believe to have been a plan rather than kismet. But, in a country where basic, intuitive belief in fundamental justice, is now so eroded, we expect almost anything of the machinery of the State. One thing that does stand out as significant, is the lack of condemnation of Jane Barton by her peers. The medical bloggers, especially the Doctors have continually highlighted the case and roundly condemned the verdict, with splenetic utterings that are both deserved and even ingenious. You can read them at the side of this blog.
One however, stands out in his silence, which as I generally admire him is almost hurtfull, but with a nom de plume, linked with another poisoner of historical fame, maybe he thought comment to be inappropriate. That's as maybe, where are the other 30,000's view of this consumate figure of evil, in the eye's of her victims loved one's. If it comes to that, where are these men and women of letters views, on the litany of disasters, nigligence, accidents and sheer stupidity perpetrated in OUR NHS almost daily. Do they think that we do not notice their silence ? Is it too much for the servants of the Taxpayer to side publicly with their constituency, or am I being too dense ?
Doctors have been known to kill as Shipman proved but their ability to evade the Law is both tragic and counter to all the tenets that we as citizens have to abide by. Have we created a cohort in Society that has the power over life and death with none of the responsibility attached ? You would almost believe they were Politicians or Policemen.
At the same time 'teflon' Tony Blair was expounding his singularly individual account of how he got us into our own version of Vietnam; the Iraq War. With a confidence bordering on Evangelism he absolved himself of all blame, piling it on the head (now detached) of Saddam Hussien.
Both events are a travesty of the natural Justice that we all feel should be meted out to those that are guilty of sending people to their deaths, be it on the field of battle, or the Wards of Gosport Memorial Hospital. Not because people die in either place that is given, but because they died without need, without a purpose that their loved one's feel, they can espouse or understand.
Tony Blair continues to earn the inflated and undeserved reward that he would never have been heir to without the bodies he has clambered over. His £15 million a year income (as reported in the Sunday Mirror, so it must be true) would never have been possible without his unholy compact with Bush to invade both Iraq and Afghanistan. He would have been consigned to a different history, of Memoir and Scholarly endeavour, with a comfortable, but hardly lavish lifestyle.
Jane Barton too, continues albeit with some restriction, to continue the practise of Medicine. Probably with a lifestyle, that the victims of her particular penchant for profligacy with syringe driven morphine, would never have achieved, presupposing of course that were not already dead; which is a fairly certain curtailment of one's ability to earn a crust.
Blair seems to have stolen Barton's dubious victory from the limelight, which only the most paranoid would believe to have been a plan rather than kismet. But, in a country where basic, intuitive belief in fundamental justice, is now so eroded, we expect almost anything of the machinery of the State. One thing that does stand out as significant, is the lack of condemnation of Jane Barton by her peers. The medical bloggers, especially the Doctors have continually highlighted the case and roundly condemned the verdict, with splenetic utterings that are both deserved and even ingenious. You can read them at the side of this blog.
One however, stands out in his silence, which as I generally admire him is almost hurtfull, but with a nom de plume, linked with another poisoner of historical fame, maybe he thought comment to be inappropriate. That's as maybe, where are the other 30,000's view of this consumate figure of evil, in the eye's of her victims loved one's. If it comes to that, where are these men and women of letters views, on the litany of disasters, nigligence, accidents and sheer stupidity perpetrated in OUR NHS almost daily. Do they think that we do not notice their silence ? Is it too much for the servants of the Taxpayer to side publicly with their constituency, or am I being too dense ?
Doctors have been known to kill as Shipman proved but their ability to evade the Law is both tragic and counter to all the tenets that we as citizens have to abide by. Have we created a cohort in Society that has the power over life and death with none of the responsibility attached ? You would almost believe they were Politicians or Policemen.
Monday, 18 January 2010
5 A Day and Other Urban Myths
In the UK, politicians feel it incumbent upon themselves, to dictate lifestyles and healthcare for their citizens. They develop quangos to promote these objectives and protocols to achieve them, are foisted onto often overworked Doctors in the form of QOF's ( quality outcome frameworks ). The Doctors involved are rarely, if ever consulted to see if these are of value to his/her patient cohort and most will follow the dictat, either because they can't be arsed to check the science, or the money's too good to turn it down.
We also have that illustrious body, the Food Standards Agency, who exhort us to get our '5-a-day', take exercise and eat a 'healthy' balanced diet which shuns virtually all forms of fat. Well, is there any use in doing this or not and where does the information upon which it's based come from ? It was, to all purposes plucked from the ether. The 'balanced diet' advised, is largely based upon limited protein and large amounts of starches and very limited fats and certainly no saturated fats. This is lunacy of the dangerous kind and all it's likely to achieve, especially for the overweight, middle aged, is a descent into obesity and/or diabetes. It seems that this Agency, with its vast budget for TV and Newspaper advertising, is isolated from the real world and knowledge of the rising tide of obesity that Western Society is seeing, along with little in the way of a reduction in CHD and CVD (heart disease) together with strokes.
Since this dictat to the proletariat, was formulated in the 1980's to lower these disease factors, things have steadily become worse, yet no one seems to see a causal link. Surely, it's intuitive that if a policy is pursued, that after 30 years is yielding no fruit (sic); in fact is worsening a situation, then is it not time to halt and at least review the position ? Is it not sensible when one is in a hole to cease the excavation process (and review the depth) ?
The arch devil, most hated of all is fat, particularly saturated fat and we are all ordered to cease it's consumption because our arteries are clogging up with it, just like those water pipes in hard water zones. They even use this as an illustration in the advertisement. It's viewed as the ghost at the feast; the elephant in the room and we will suffer long and painfull deaths if we even look at dripping. The elevated lipids (fats) consumed are held responsible for just about everything that goes wrong in the human body, especially CHD, CVD, Stroke and Cancer. This has spawned an industry devoted to low fat products, cholesterol reducing supplements (even magarine!). low or zero fat milk and worst, soya milk!
This is frankly complete and utter tosh and neatly brings us to the belief that fat and cholesterol are the same, which they aren't. Cholesterol is the essential steroid metabolite found in all cells in animals and is transported throughout the body in blood plasma. Without it we are all dead. We could not absorb fat soluble vitamins, manufacture any steroid hormones or have a beating heart. It is more important than almost any other element of our cellular make-up and is largely, but not completely made in the body. Except in incredibly rare cases we all have the correct amount to sustain our lives. Whilst it is associated with LDL and HDL it is not either of these and elevated levels of these lipoproteins does not confer any real indication of health or otherwise.
Before every one starts to nod off lets get back to fat. Fat does not instantly turn into cholesterol, in fact we could not eat enough of any fat or any food come to that, that would supply our daily needs for cholesterol. It is, in the main, synthesised in the liver, or in fact every cell in our bodies except the brain. If you eat less cholesterol yielding foods your body simply compensates by producing more of it internally. If, however you eat more and more starches (=carbohydrates = glucose) you will in fact become fatter as a result and likely increase your risk of the killer diseases including of course diabetes. This simply is because our bodies cannot tolerate large amounts of glucose yielded by starches without sending them for storage and all storage of energy is in the form of lipids or glycogen. We are in fact quite primitive beings and have not yet evolved to a wholly starch based diet because we are only a spear throw from our ancestors who largely lived on fats and protein. Grains, potatoes,pasta and rice are an anethema, to our metabolism and together, with the vast amounts of sugar and fructose we consume have been largely responsible for the inexorable rise in obesity.
We get fructose from juices, fruit, especially apples, pears etc together with grapes and other exoctics like pineapple and bananas. In small quantities they do little harm to normal diets although fruit juice is a problem because of its concentration of the natural sugar fructose. Now that most soft drinks makers use cheaply produced high fructose corn syrup (HFCS) as a sweetener, the situation is worse. Even sugar (sucrose), being a disaccharide needs to be metabolised by division into glucose and sucrose. Fructose of course already is. So high intakes of fructose, found in juices, soft drinks and of course fruit in varieing quantities is not really a good route to health. This is especially true of juice, as it is not something that was available much in the past, but is now, by the intervention of modern production methods. It is of course, highly concentrated fructose and is often fortified with additional sugars. So whilst exhorting us to cut down on sugars, we are also told to drink juice and eat fruit which in effect cancels out the effort we make to kurb (our often ) 'sweet tooth'. It is highly contradictory, but the logic seems to escape those that advocate it !
Whilst I would not suggest the abandonment of fruit, I would advocate caution in the extreme. Berries and small fruits like grapes in limited amounts, confer other vitamins and essentials, that are good for you, provided they are used sparingly. Vegetables, generally green leafy types, do the same with little carbohydrate content. Root vegetables as they are pretty much like potatoes, and are very high in starch. The odd apple or pear or bananas too, are useful, especially the latter, if not too ripe, as this increases the fructose considerably. But, 'five-a day' is stretching healthy intake too far.
Primitive Northern humans, did not eat a diet, especially in Winter, high in any carbohydrates especially sugars and prior to the 2nd World War when we still had a very low carbohydrate intake, there was almost no discernable heart disease. Many Doctors went through their whole careers without seeing a single case, unless it was (rarely) triggered by Rheumatic Fever or some other disease. Today, you would be hard pressed to find one that hadn't handled hundreds. Does this 'paradox' together with others in Science, such as the French paradox, not impinge on the pointy heads at the DofH or the Food Standards Agency. Are they so sure of their ground, that they do not need to read the science, the trials, the refuting evidence that continually highlights the facts of the diet-fat-heart hypothesis as being completely wrong ? Or does this dept. and other servants of the people live entirely in a vacuum of denial ?
I suggest that they read some science, especially this;-
http://www.ajcn.org/cgi/content/abstract/ajcn.2009.27725v1
It lists the meta-analysis of twenty one studies involving 347,747 subjects over 5-23 years and concludes that dietary saturated fats are not linked to an increased risk of CHD or CVD. No doubt no equivocation. It is the most recent in a long line of scientific evidence that tells of the myth that it all is.
So tuck into the bacon and eggs with a light heart and in the knowledge that you 'do no harm' which is more than the buggers that are telling you otherwise do.
We also have that illustrious body, the Food Standards Agency, who exhort us to get our '5-a-day', take exercise and eat a 'healthy' balanced diet which shuns virtually all forms of fat. Well, is there any use in doing this or not and where does the information upon which it's based come from ? It was, to all purposes plucked from the ether. The 'balanced diet' advised, is largely based upon limited protein and large amounts of starches and very limited fats and certainly no saturated fats. This is lunacy of the dangerous kind and all it's likely to achieve, especially for the overweight, middle aged, is a descent into obesity and/or diabetes. It seems that this Agency, with its vast budget for TV and Newspaper advertising, is isolated from the real world and knowledge of the rising tide of obesity that Western Society is seeing, along with little in the way of a reduction in CHD and CVD (heart disease) together with strokes.
Since this dictat to the proletariat, was formulated in the 1980's to lower these disease factors, things have steadily become worse, yet no one seems to see a causal link. Surely, it's intuitive that if a policy is pursued, that after 30 years is yielding no fruit (sic); in fact is worsening a situation, then is it not time to halt and at least review the position ? Is it not sensible when one is in a hole to cease the excavation process (and review the depth) ?
The arch devil, most hated of all is fat, particularly saturated fat and we are all ordered to cease it's consumption because our arteries are clogging up with it, just like those water pipes in hard water zones. They even use this as an illustration in the advertisement. It's viewed as the ghost at the feast; the elephant in the room and we will suffer long and painfull deaths if we even look at dripping. The elevated lipids (fats) consumed are held responsible for just about everything that goes wrong in the human body, especially CHD, CVD, Stroke and Cancer. This has spawned an industry devoted to low fat products, cholesterol reducing supplements (even magarine!). low or zero fat milk and worst, soya milk!
This is frankly complete and utter tosh and neatly brings us to the belief that fat and cholesterol are the same, which they aren't. Cholesterol is the essential steroid metabolite found in all cells in animals and is transported throughout the body in blood plasma. Without it we are all dead. We could not absorb fat soluble vitamins, manufacture any steroid hormones or have a beating heart. It is more important than almost any other element of our cellular make-up and is largely, but not completely made in the body. Except in incredibly rare cases we all have the correct amount to sustain our lives. Whilst it is associated with LDL and HDL it is not either of these and elevated levels of these lipoproteins does not confer any real indication of health or otherwise.
Before every one starts to nod off lets get back to fat. Fat does not instantly turn into cholesterol, in fact we could not eat enough of any fat or any food come to that, that would supply our daily needs for cholesterol. It is, in the main, synthesised in the liver, or in fact every cell in our bodies except the brain. If you eat less cholesterol yielding foods your body simply compensates by producing more of it internally. If, however you eat more and more starches (=carbohydrates = glucose) you will in fact become fatter as a result and likely increase your risk of the killer diseases including of course diabetes. This simply is because our bodies cannot tolerate large amounts of glucose yielded by starches without sending them for storage and all storage of energy is in the form of lipids or glycogen. We are in fact quite primitive beings and have not yet evolved to a wholly starch based diet because we are only a spear throw from our ancestors who largely lived on fats and protein. Grains, potatoes,pasta and rice are an anethema, to our metabolism and together, with the vast amounts of sugar and fructose we consume have been largely responsible for the inexorable rise in obesity.
We get fructose from juices, fruit, especially apples, pears etc together with grapes and other exoctics like pineapple and bananas. In small quantities they do little harm to normal diets although fruit juice is a problem because of its concentration of the natural sugar fructose. Now that most soft drinks makers use cheaply produced high fructose corn syrup (HFCS) as a sweetener, the situation is worse. Even sugar (sucrose), being a disaccharide needs to be metabolised by division into glucose and sucrose. Fructose of course already is. So high intakes of fructose, found in juices, soft drinks and of course fruit in varieing quantities is not really a good route to health. This is especially true of juice, as it is not something that was available much in the past, but is now, by the intervention of modern production methods. It is of course, highly concentrated fructose and is often fortified with additional sugars. So whilst exhorting us to cut down on sugars, we are also told to drink juice and eat fruit which in effect cancels out the effort we make to kurb (our often ) 'sweet tooth'. It is highly contradictory, but the logic seems to escape those that advocate it !
Whilst I would not suggest the abandonment of fruit, I would advocate caution in the extreme. Berries and small fruits like grapes in limited amounts, confer other vitamins and essentials, that are good for you, provided they are used sparingly. Vegetables, generally green leafy types, do the same with little carbohydrate content. Root vegetables as they are pretty much like potatoes, and are very high in starch. The odd apple or pear or bananas too, are useful, especially the latter, if not too ripe, as this increases the fructose considerably. But, 'five-a day' is stretching healthy intake too far.
Primitive Northern humans, did not eat a diet, especially in Winter, high in any carbohydrates especially sugars and prior to the 2nd World War when we still had a very low carbohydrate intake, there was almost no discernable heart disease. Many Doctors went through their whole careers without seeing a single case, unless it was (rarely) triggered by Rheumatic Fever or some other disease. Today, you would be hard pressed to find one that hadn't handled hundreds. Does this 'paradox' together with others in Science, such as the French paradox, not impinge on the pointy heads at the DofH or the Food Standards Agency. Are they so sure of their ground, that they do not need to read the science, the trials, the refuting evidence that continually highlights the facts of the diet-fat-heart hypothesis as being completely wrong ? Or does this dept. and other servants of the people live entirely in a vacuum of denial ?
I suggest that they read some science, especially this;-
http://www.ajcn.org/cgi/content/abstract/ajcn.2009.27725v1
It lists the meta-analysis of twenty one studies involving 347,747 subjects over 5-23 years and concludes that dietary saturated fats are not linked to an increased risk of CHD or CVD. No doubt no equivocation. It is the most recent in a long line of scientific evidence that tells of the myth that it all is.
So tuck into the bacon and eggs with a light heart and in the knowledge that you 'do no harm' which is more than the buggers that are telling you otherwise do.
Tuesday, 22 December 2009
A Difficult Year
So 2009 draws to close, punctuated by snowfalls and freezing weather that, for me, illustrate the malaise, in most of the machinery of the state. In these annals I tend to highlight the shortcomings of the NHS and Healthcare. But, the sickness in Society (which according to Maggie doesn't exist) is more widespread. It penetrates Central and Local Government and Governance. Certainly, MP's have filled thier pockets with taxpayers gold, as have many Civil Servants including Doctors. But more; the widespread hubris of all dominates. They feel they are both being effective and successful when in truth they are believing their own rhetoric.
The NHS is the focus of my anger, but it is deeper; I am angry with Doctors who abdicate their role as the healer, to become the druggist. They fail to shun the rubbish claims of the most powerfull industrial conglomerate in the World, rivalling that of the Oil Cartels; the Pharmaceutical giants. Whilst the small and universally shunned groups scream foul, they largely sit in their ivory towers, dispensing what some truly believe to be the best for their patients, undertake procedures that both threaten and take lives in the name of best practise, when it patently isn't. At Consultant level they cherrypick patients with the cash to pay for the nanny and the Volvo for their fragrant spouses. They take the gold of the Taxpayer for part time work, to give them an inflated pension and care for them if they ever fall ill themselves. It has been this way for sixty years and despite some effort by Government to change the culture, it remains that way today. Well shame on them I say. Running with the hare and the hounds is unaccepable and needs to be kurbed. They should fulfill their roles for the NHS or get out and ply their trade in Private practise, I do not believe they can be in both camps.
It is sadly deeper even than that. Medicine has been corrupted as to be unrecognisable with that of thirty years ago. Invented illnesses predominate just so Big Pharma can peddle a pointless, expensive drug to the gullible or worse, greedy physician who sees a new cohort to treat for which he/she can extract more cash from an already hugely expensive system. Test regimes are devised to check for obviously frightening illnesses, such as cancer or heart disease but, there has been no discernable impact on mortality for those actually diagnosed (as opposed to those tested) and an alarming number of false positives have been found and treated to no good purpose. In fact, a significant number of scientists are now of the view that most screening of the population, has been counter productive and expensive.
In other areas, we also find the apparatus of the State failing in the provision of that which they exist to provide. The Police seem to universally fail to help in situations where they are the only agency capable of so doing. Leaving people who are vulnerable, to fend for themselves against the feral minority of Society that hounds them to death or to an action that is then unlawfull in it's desperation. Utility organisations that provide infrastructure at what seems to be a high price to the user, singularly failing to give us what we pay for and who are then found guilty of significant fraud against their own customers. The list is in fact endless including the great 'sell off' at bargain basement prices, of the state machinery we all worked so hard to pay for, including now all the Nuclear Power Stations to EDF, part owned by the French Government.
Where is Government in all of this ? Waiting in the wings with it's hand outstretched for the quite large crumbs that fall therein in the form of jobs, expenses, sponsorship of the ludicrous talking shops they are always arranging, in fact anything at all that gets the enormous cost of Privatisation out of the Chancellors ledgers, even if it does cost twice as much in the long term. This cynical manipulation or 'spin' of everything has rendered the citizenry impotent. There is nothing to choose between any party except a name or a younger face.
It is Government that has allowed the fat cat salaries, especially in Healthcare, to spiral out of control. There are I believe 144 separate agencies involved in NHS governance alone, and to what purpose ? They are singularly ineffectual in achieving higher standards of care or safety and seem to be a money pit to perform another tick box function that gets us nowhere. The MOD is just as disfunctional, incapable of supporting the cannon fodder they continually send to their untimely deaths in a far away country, that has never been subdued, by any who have tried in 300 years. It is time for them to go and yes I voted for Blair, because I thought he was a breath of fresh air in stale and smokey club. How wrong could I be !
Looking back I see myself as I was and as I am, burdened with debt, depression and post traumatic stress and some physical ailments that those are heir to. My life has been turned upside down and my wealth for retirement all but destroyed. I live in a constant state of anxiety as to the health and well being of my love and myself, all due to the machinery of that State failing me on the very few occasions I have asked it for help. The last of which nearly left me alone for the rest of my days. I have always paid my taxes of which there is an abundance, followed the Law and helped those I could when the chance arose.
Lack of care has killed my best friend, nearly killed my love, destroyed a friends career, almost lost an employee a leg, my sight in one eye. Yet that same State I now berate saved two of my children from certain death at birth way back in the early days of the NHS. It wasn't good the NHS then, but it was effective and CLEAN. I know not what to do to change things, some are now history and nothing can change them but surely people will see what a terrible legacy we are leaving for our successors. The gravy train has to be stopped. I with others have to commence to build the buffers. Since beginning to write these blogs I now know at least I have good company. Salutations to all; you have probably saved what's left of my life and for that I thank you.
The NHS is the focus of my anger, but it is deeper; I am angry with Doctors who abdicate their role as the healer, to become the druggist. They fail to shun the rubbish claims of the most powerfull industrial conglomerate in the World, rivalling that of the Oil Cartels; the Pharmaceutical giants. Whilst the small and universally shunned groups scream foul, they largely sit in their ivory towers, dispensing what some truly believe to be the best for their patients, undertake procedures that both threaten and take lives in the name of best practise, when it patently isn't. At Consultant level they cherrypick patients with the cash to pay for the nanny and the Volvo for their fragrant spouses. They take the gold of the Taxpayer for part time work, to give them an inflated pension and care for them if they ever fall ill themselves. It has been this way for sixty years and despite some effort by Government to change the culture, it remains that way today. Well shame on them I say. Running with the hare and the hounds is unaccepable and needs to be kurbed. They should fulfill their roles for the NHS or get out and ply their trade in Private practise, I do not believe they can be in both camps.
It is sadly deeper even than that. Medicine has been corrupted as to be unrecognisable with that of thirty years ago. Invented illnesses predominate just so Big Pharma can peddle a pointless, expensive drug to the gullible or worse, greedy physician who sees a new cohort to treat for which he/she can extract more cash from an already hugely expensive system. Test regimes are devised to check for obviously frightening illnesses, such as cancer or heart disease but, there has been no discernable impact on mortality for those actually diagnosed (as opposed to those tested) and an alarming number of false positives have been found and treated to no good purpose. In fact, a significant number of scientists are now of the view that most screening of the population, has been counter productive and expensive.
In other areas, we also find the apparatus of the State failing in the provision of that which they exist to provide. The Police seem to universally fail to help in situations where they are the only agency capable of so doing. Leaving people who are vulnerable, to fend for themselves against the feral minority of Society that hounds them to death or to an action that is then unlawfull in it's desperation. Utility organisations that provide infrastructure at what seems to be a high price to the user, singularly failing to give us what we pay for and who are then found guilty of significant fraud against their own customers. The list is in fact endless including the great 'sell off' at bargain basement prices, of the state machinery we all worked so hard to pay for, including now all the Nuclear Power Stations to EDF, part owned by the French Government.
Where is Government in all of this ? Waiting in the wings with it's hand outstretched for the quite large crumbs that fall therein in the form of jobs, expenses, sponsorship of the ludicrous talking shops they are always arranging, in fact anything at all that gets the enormous cost of Privatisation out of the Chancellors ledgers, even if it does cost twice as much in the long term. This cynical manipulation or 'spin' of everything has rendered the citizenry impotent. There is nothing to choose between any party except a name or a younger face.
It is Government that has allowed the fat cat salaries, especially in Healthcare, to spiral out of control. There are I believe 144 separate agencies involved in NHS governance alone, and to what purpose ? They are singularly ineffectual in achieving higher standards of care or safety and seem to be a money pit to perform another tick box function that gets us nowhere. The MOD is just as disfunctional, incapable of supporting the cannon fodder they continually send to their untimely deaths in a far away country, that has never been subdued, by any who have tried in 300 years. It is time for them to go and yes I voted for Blair, because I thought he was a breath of fresh air in stale and smokey club. How wrong could I be !
Looking back I see myself as I was and as I am, burdened with debt, depression and post traumatic stress and some physical ailments that those are heir to. My life has been turned upside down and my wealth for retirement all but destroyed. I live in a constant state of anxiety as to the health and well being of my love and myself, all due to the machinery of that State failing me on the very few occasions I have asked it for help. The last of which nearly left me alone for the rest of my days. I have always paid my taxes of which there is an abundance, followed the Law and helped those I could when the chance arose.
Lack of care has killed my best friend, nearly killed my love, destroyed a friends career, almost lost an employee a leg, my sight in one eye. Yet that same State I now berate saved two of my children from certain death at birth way back in the early days of the NHS. It wasn't good the NHS then, but it was effective and CLEAN. I know not what to do to change things, some are now history and nothing can change them but surely people will see what a terrible legacy we are leaving for our successors. The gravy train has to be stopped. I with others have to commence to build the buffers. Since beginning to write these blogs I now know at least I have good company. Salutations to all; you have probably saved what's left of my life and for that I thank you.
Monday, 21 December 2009
C6 H12 O6 and Diabetes
For those of you curious as to what this title means, it's the chemical number for the enemy of all Diabetics, glucose. Type 2 diabetes or NIDDM is generally due to a surfeit of this simple sugar and as I have previously said, we are in the midst of an epidemic of this condition. High levels of blood glucose are responsible for hyperglycemia, which can and does cause peripheral problems, to the human body in the form of blindness, circulation loss, heart and kidney problems and even limb loss. The drugs prescribed can cause obesity, kidney failure, heart disease, gastric upsets, headaches, and many other side effects, that at certain levels, can be as dangerous as the problem for which they are prescribed. The diet generally recommended for NIDDM sufferers can also contribute to the spiralling of the problem on a downwards path towards even greater co-morbidities.
My view is that, going backwards in time with our diets, is the sensible way for diabetics to exercise control, than is ever likely to be the case with drugs and the 'balanced diet'. Changing all of our diets would also likely decrease the incidence of diabetes or 'syndrome X' as it was, and is still called in some places, more than any other lifestyle change. Why one might ask ? Well, it isn't that complicated. Carbohydrates, figure quite highly in the diet you are told to adapt to, cutting out saturated fats and oils, eating fruits and vegetables, grains and low GI carbohydrates. Well carbohydrates, low GI or not are starches (C6 H10 O5). Starches are glucose waiting to be hydrolised (water to be added). See the numbers at the top ? Add H2 O and what do you get ? Yeah, that's correct, GLUCOSE, but worse, you now have 111g of glucose for every 100g of starch consumed. You have therefore now increased your calorie intake by 11%, simply by allowing your body to digest it in the only way it can, by hydrolysis. Frankly, you would be better off eating table sugar (sucrose) than starches, because water only adds 4% its calorific value.
A simple biochemical reaction. But, one that increases the glucose burden of a diabetic, so why do it ? It certainly has no sound scientific basis and prior to about 1980 the diet of a diabetic was largely bereft of carbohydrates. But, as over time, greater reliance was placed upon control with hypoglycemic agents (drugs), a diet form, populised by the stupid and completely incorrect view, that fat makes you fat, was adopted. Well, we once believed the earth was flat, because it was intuitive; look around and the ground around is, so that was the held belief. We know of course, that it isn't, but we know a lot of other facts that our eyes cannot prove. Obesity is often labelled as the disease of the lazy over eater, but I know this to be untrue because, I have read the scientific evidence, that shows it to be contrary. And of course it is biochemically impossible.
There is of course the other ghost at the feast, 'Big Pharma'. They fund most of the Diabetic organisations in the Western world and heavily promote their various products as the best method of Diabetic control. The inherent laziness of Doctors and the effect of their views on the patient cohort does the rest. It's simple to write the prescription for Biguanide (metformin) and tell the patient to book an appointment with the nurse, rather than putting some effort and time into discussing options and treatments, together with lifestyle changes. But, it places the patient into a group, that then abdicates responsibilty for understanding and being responsible for their condition. Far better to take another path to a better understanding and consequent long term prognosis.
How ? Well base your diet on the primitive one. Restrict your carbohydrate intake to as little as as possible, but more; increase your intake of fats and protiens to compensate. Restricting starches to 20 grams per meal or 50 - 60 per day as your goal. Together, with basing most intakes of food on a high fat content, together with protiens at reasonable levels, will rest your tired pancreas, satiate your appetite and improve your weight and general health. Shun all soft drinks, low cal or not because they contain fructose or polyols (sugar alcohols). Despite the view that these sugar substitutes do not raise blood glucose they are still carbohydrates and will, to some degree act as such. They also give you the 'trots' and can damage the liver and kidneys at high sustained levels.
To contain your Diabetes take some exercise. The Insulin reaction you have to all food intake, except for fats, which provoke no insulin response at all, is now limited. To burn off your glucose your muscles need to work and the best way is to walk, briskly or even do 'interval training'. But, if your exercise is compromised, you can still take some form, however light. Even a short walk will cause your muscles to take up some of your circulating glucose and can bring you down by 3 to 4 points.
I would also urge investigation of some simple herbal agents such as gymnema silvestre or other ayervedic agents. They work quite well for some and are relatively benign, so far as side effects are concerned. Doctors will say 'not proven' or you don't have any idea of the the content of the product you are buying. I say herbs are the foundation of all medicines and have been used to good effect for centuries and so long as you are carefull, do your research and pick a quality product, little harm can result. After all the first line drug, metformin, a biguanide, is a synthetic form of French Lilac (galega officinalis) and is galegine and guanidine. It's just that you cannot patent that and make lots of money off its sale. So no point in recommending that !
A combination of diet, exercise and a few herbs and vitamins has enabled Mrs B to achieve an Hba1c of 6.6 from 8.8 within a few months of diagnosis. She works hard to contain her condition and never did have a sweet tooth. But it does require a degree of effort, some are not prepared to give. But, any reduction of carbohydrate intake will reward, even if you are already on drugs or even insulin. It may allow a reduction of the drug regime or even allow some respite completely.
Discuss it with your Doctor (not the nurse). Make your own informed decision. Take control of your life; medicine is supposed to be a healing process not a vehicle for prescribing drugs alone.
Note:
This information is general. It is not meant to address individual needs or problems. Do not change what you are doing without checking with your Doctor or other Physician or being certain of your own research. Trust me, I'm not a Doctor.
My view is that, going backwards in time with our diets, is the sensible way for diabetics to exercise control, than is ever likely to be the case with drugs and the 'balanced diet'. Changing all of our diets would also likely decrease the incidence of diabetes or 'syndrome X' as it was, and is still called in some places, more than any other lifestyle change. Why one might ask ? Well, it isn't that complicated. Carbohydrates, figure quite highly in the diet you are told to adapt to, cutting out saturated fats and oils, eating fruits and vegetables, grains and low GI carbohydrates. Well carbohydrates, low GI or not are starches (C6 H10 O5). Starches are glucose waiting to be hydrolised (water to be added). See the numbers at the top ? Add H2 O and what do you get ? Yeah, that's correct, GLUCOSE, but worse, you now have 111g of glucose for every 100g of starch consumed. You have therefore now increased your calorie intake by 11%, simply by allowing your body to digest it in the only way it can, by hydrolysis. Frankly, you would be better off eating table sugar (sucrose) than starches, because water only adds 4% its calorific value.
A simple biochemical reaction. But, one that increases the glucose burden of a diabetic, so why do it ? It certainly has no sound scientific basis and prior to about 1980 the diet of a diabetic was largely bereft of carbohydrates. But, as over time, greater reliance was placed upon control with hypoglycemic agents (drugs), a diet form, populised by the stupid and completely incorrect view, that fat makes you fat, was adopted. Well, we once believed the earth was flat, because it was intuitive; look around and the ground around is, so that was the held belief. We know of course, that it isn't, but we know a lot of other facts that our eyes cannot prove. Obesity is often labelled as the disease of the lazy over eater, but I know this to be untrue because, I have read the scientific evidence, that shows it to be contrary. And of course it is biochemically impossible.
There is of course the other ghost at the feast, 'Big Pharma'. They fund most of the Diabetic organisations in the Western world and heavily promote their various products as the best method of Diabetic control. The inherent laziness of Doctors and the effect of their views on the patient cohort does the rest. It's simple to write the prescription for Biguanide (metformin) and tell the patient to book an appointment with the nurse, rather than putting some effort and time into discussing options and treatments, together with lifestyle changes. But, it places the patient into a group, that then abdicates responsibilty for understanding and being responsible for their condition. Far better to take another path to a better understanding and consequent long term prognosis.
How ? Well base your diet on the primitive one. Restrict your carbohydrate intake to as little as as possible, but more; increase your intake of fats and protiens to compensate. Restricting starches to 20 grams per meal or 50 - 60 per day as your goal. Together, with basing most intakes of food on a high fat content, together with protiens at reasonable levels, will rest your tired pancreas, satiate your appetite and improve your weight and general health. Shun all soft drinks, low cal or not because they contain fructose or polyols (sugar alcohols). Despite the view that these sugar substitutes do not raise blood glucose they are still carbohydrates and will, to some degree act as such. They also give you the 'trots' and can damage the liver and kidneys at high sustained levels.
To contain your Diabetes take some exercise. The Insulin reaction you have to all food intake, except for fats, which provoke no insulin response at all, is now limited. To burn off your glucose your muscles need to work and the best way is to walk, briskly or even do 'interval training'. But, if your exercise is compromised, you can still take some form, however light. Even a short walk will cause your muscles to take up some of your circulating glucose and can bring you down by 3 to 4 points.
I would also urge investigation of some simple herbal agents such as gymnema silvestre or other ayervedic agents. They work quite well for some and are relatively benign, so far as side effects are concerned. Doctors will say 'not proven' or you don't have any idea of the the content of the product you are buying. I say herbs are the foundation of all medicines and have been used to good effect for centuries and so long as you are carefull, do your research and pick a quality product, little harm can result. After all the first line drug, metformin, a biguanide, is a synthetic form of French Lilac (galega officinalis) and is galegine and guanidine. It's just that you cannot patent that and make lots of money off its sale. So no point in recommending that !
A combination of diet, exercise and a few herbs and vitamins has enabled Mrs B to achieve an Hba1c of 6.6 from 8.8 within a few months of diagnosis. She works hard to contain her condition and never did have a sweet tooth. But it does require a degree of effort, some are not prepared to give. But, any reduction of carbohydrate intake will reward, even if you are already on drugs or even insulin. It may allow a reduction of the drug regime or even allow some respite completely.
Discuss it with your Doctor (not the nurse). Make your own informed decision. Take control of your life; medicine is supposed to be a healing process not a vehicle for prescribing drugs alone.
Note:
This information is general. It is not meant to address individual needs or problems. Do not change what you are doing without checking with your Doctor or other Physician or being certain of your own research. Trust me, I'm not a Doctor.
Thursday, 10 December 2009
Now We Are One
Thanks to the efforts of the Architects of the blogs, NHS Exposed and NHS, all those damaged souls who have spent years of their lives battling the NHS and the Medico-Legal Conglomerate within, now have a place to call their own. Thanks, we all needed it.
The Whisleblowers, the Vexatious Complainants, the Doctors forced from their livelihood for no good reason have a common point of contact. Most have laboured alone, in want of the justice they deserve. Many, if not all, have been marked or damaged, some likely beyond repair. A lot of their loved one's have suffered the ultimate penalty of negligence, stupidity and sheer incompetence. That deaths take place in Medicine, that patients suffer and are maimed or injured is not surprising. That this is denied, obfuscated and is on a scale beyond any boundary of acceptability, is. That the UK is a more dangerous place to be treated, especially for trauma, stroke or a coronary than some East European or even Third World countries is a scandal. As we now spend in excess of £100billion a year to fund the NHS and yet fail to deliver on essential needs is a disaster.
The band of brothers and sisters we have now become, concentrates the minds and energy of a seasoned and battle scarred cohort with a common purpose. Justice and Candour is our battle cry. Robbie's Law and Elsie's Law our manifesto. We have few allies and no doubt we will attract some we could well do without, but more important, we are no longer single voices crying in a wilderness of indifference. Some like Will Powell have been fighting for justice for twenty long and difficult years. Those years have taken their toll; broken things in his life he will never fix. Others have told stories, bitter and sweet, of lost loves, brothers, sisters, parents and friends. More, we are privileged to stand with Doctors, like Rita Pal who were prepared to raise their heads over the parapet; fearlessly taking a position of integrity and horror at that which was being done on their watch.
Our main criticism is the lack of any truth or justice being delivered by the hugely expensive NHS Complaints Procedure. ICAS, PALS, and now the Ombudsman. All are spectacularly failing us in the search we all embarked upon, along with the GMC, and any of the other bodies the State has seen fit to construct. The Regulatory bodies are all singularly or jointly 'not fit for purpose' in any of the roles they purport to fulfill. The politicians are too embattled or embroiled in matters of the micro management of our lives to be interested in our plight. Most of the Doctors and Surgeons are too interested in their power, influence and salaries to display the courage of Rita Pal or Liz Miller or indeed the 'few' who live with their integrity intact but their careers blighted. The practise of Healing, is now reknowned for its penchant to shoot the messengers of its consumate failing.
We are disparate, we have different views no doubt about many things and we are learning the hard road to cohesion. We are only yet a platoon; a cadre for the army we are attempting to build. Some will fall by the wayside, but others will fill the gap in the ranks. We will succeed in this eandevour despite the machinery of the State being ranged against us. We have some of the finest minds at our disposal, battle seasoned, scarred but unbowed. We will each help the other; a shoulder proffered for crying, a hand to prevent the stumble and strong arms to lift us up when we do. We were one but now we are all.
See us at: http://groups.google.com/group/the-nhs-debate?hl=en.
The Whisleblowers, the Vexatious Complainants, the Doctors forced from their livelihood for no good reason have a common point of contact. Most have laboured alone, in want of the justice they deserve. Many, if not all, have been marked or damaged, some likely beyond repair. A lot of their loved one's have suffered the ultimate penalty of negligence, stupidity and sheer incompetence. That deaths take place in Medicine, that patients suffer and are maimed or injured is not surprising. That this is denied, obfuscated and is on a scale beyond any boundary of acceptability, is. That the UK is a more dangerous place to be treated, especially for trauma, stroke or a coronary than some East European or even Third World countries is a scandal. As we now spend in excess of £100billion a year to fund the NHS and yet fail to deliver on essential needs is a disaster.
The band of brothers and sisters we have now become, concentrates the minds and energy of a seasoned and battle scarred cohort with a common purpose. Justice and Candour is our battle cry. Robbie's Law and Elsie's Law our manifesto. We have few allies and no doubt we will attract some we could well do without, but more important, we are no longer single voices crying in a wilderness of indifference. Some like Will Powell have been fighting for justice for twenty long and difficult years. Those years have taken their toll; broken things in his life he will never fix. Others have told stories, bitter and sweet, of lost loves, brothers, sisters, parents and friends. More, we are privileged to stand with Doctors, like Rita Pal who were prepared to raise their heads over the parapet; fearlessly taking a position of integrity and horror at that which was being done on their watch.
Our main criticism is the lack of any truth or justice being delivered by the hugely expensive NHS Complaints Procedure. ICAS, PALS, and now the Ombudsman. All are spectacularly failing us in the search we all embarked upon, along with the GMC, and any of the other bodies the State has seen fit to construct. The Regulatory bodies are all singularly or jointly 'not fit for purpose' in any of the roles they purport to fulfill. The politicians are too embattled or embroiled in matters of the micro management of our lives to be interested in our plight. Most of the Doctors and Surgeons are too interested in their power, influence and salaries to display the courage of Rita Pal or Liz Miller or indeed the 'few' who live with their integrity intact but their careers blighted. The practise of Healing, is now reknowned for its penchant to shoot the messengers of its consumate failing.
We are disparate, we have different views no doubt about many things and we are learning the hard road to cohesion. We are only yet a platoon; a cadre for the army we are attempting to build. Some will fall by the wayside, but others will fill the gap in the ranks. We will succeed in this eandevour despite the machinery of the State being ranged against us. We have some of the finest minds at our disposal, battle seasoned, scarred but unbowed. We will each help the other; a shoulder proffered for crying, a hand to prevent the stumble and strong arms to lift us up when we do. We were one but now we are all.
See us at: http://groups.google.com/group/the-nhs-debate?hl=en.
Tuesday, 8 December 2009
The Magic of 7
The goal of all Type 11 Diabetics; 7.00 mmol/L as the fasting blood glucose figure in a morning and 7.0 or below for the regular Hba1c test. These represent the goals that most strive for because below them you are close to being 'normal'. Of course if you are one of the 2.6 million Diabetics the NHS alleges to treat you are unlikely to ever be normal per se, but if you can get below both of the figures on a regular basis then you are controlling your condition.
I say condition because it isn't an illness, it isn't infectious or contagious. It is a combination of problems with the basic biochemistry of the human body; the inability to readily store glucose from carbohydrates and protiens; 'insulin resistance' and a deficiency of the pancreas to manufacture insulin. Well, this last is not quite true; in the early stages of NIDDM you make more and more insulin as you become increasingly resistent to its properties. This in turn exhausts the romantically titled 'islets of langerhans', which then lose their capacity to produce sufficient for everyday needs. It can be a downward spiral and it is associated with obesity that is certain. How this comes about, I believe is the important element that is often overlooked.
OK, Diabetics are often overweight or obese, but some are not. However if you have a history of weight gain as you get past forty it is likely you could become Diabetic. Why ? Because I believe it is the early stages of Diabetes, termed 'metabolic resistence' that causes this weight gain. As your weight spirals upwards it becomes increasingly difficult to control even if you eat less and less. This is generally because most of your calorie intake is being stored as fat; you become rapidly hungry post prandial ( medics term for after eating) and the instinct of our brain tells you to eat again. This is due to the high levels (at this stage) of circulating insulin, metabolising the glucose in your blood. As your muscles are resistent by now, the only place to go is the adipose tissue (fat).
As this progresses these cells become laden and other cells, which are marked as preadipose, are 'recruited' for the additional storage required. Once such a cell becomes adipose it is forever; it cannot go back, so it becomes harder and ever harder to lose weight even at calorie intakes of 1500 or less. Yet, because of your overall tiredness, weight gain and reluctance to exercise, you will be universally branded as a 'couch potatoe' or worse. Finally you will be diagnosed as Diabetic, probably after some years on this slope of weight gain and you will be entreated to lose wieght, eat a 'balanced diet' and take exercise. But the diet you will be put on will to all intents and purposes, both exacerbate your problem and make you feel just as tired as before and likely permanently hungry.
As your pancreas is 'knackered' you would think that some effort might be made to 'give it a rest' but no, the drugs usually proffered will generally at first stimulate the poor bloody thing to even greater efforts. These will of course, likely make you gain more weight (metformin may not but that's the only one), as you are still on the slippery slope to Insulin injections, which will make you fat for sure.
Firstly it isn't really your fault you are fat. It is all of our fault in general, the NHS in particular and the food and drinks makers for sure. Your 'balanced diet' will include a high level of carbohydrates; complex or not, these will be rapidly converted to glucose, causing high levels of circulating blood glucose. This is the one thing you are trying to eliminate, as that is what causes the cellular damage symptomatic of your condition. Society needs to get a grip and Diabetics need to take control of their own destiny and that means eliminating the foodstuffs that cause the problem. Base your diet on fats and protiens, including saturated fats and you can achieve control without weight gain, without drugs and certainly without Insulin injections.
Leave out ALL carbonated drinks, especially one's with 'natural sugars', they are the worse. Fructose and High Fructose Corn Syrup are the sweetening agents in use today that are rapidly metabolised without insulin. Instant fat ! And no, fats don't make you fat, it is biochemically impossible. Fats were the mainstay of the food store of Primitive Man and still are, for the races left on this planet who are still hunter gatherers and they universally do not become Diabetic. That is, unless you start feeding them cornflakes and coke, then they succumb in less than a decade !
Is it not prophetic that as we all become 'five a day' eaters, consumers of grains (cattle food) and eat 1500% more sugar (sucrose) than we did in Victorian times, exercise more (yes we do) and live longer, that we have become significantly less healthy. Those of you, that aren't yet Diabetic, who are over 40 and gaining weight, get a test ! You can take steps now that could prevent it becoming a reality. All of us, need to review our lifestyles, some more than others and don't fret about a little weight. Statistics show that slightly overwieght people are more healthy, resistent to heart disease and stroke and colds and 'flu, than us skinny buggers. But slightly is good, obese is not. Each of us is different, with different metabolisms and our bodies response to inputs is varied. I will not ever condemn anyone who is overweight, nor should society, especially DOCTORS. Some can remain so all of their lives and be perfectly healthy, but if you see in yourself this gradual weight gain, as you age, then check it out !
I will go further into how to live as Diabetic, without drugs, another day. It is possible and the results are rewarding.
I say condition because it isn't an illness, it isn't infectious or contagious. It is a combination of problems with the basic biochemistry of the human body; the inability to readily store glucose from carbohydrates and protiens; 'insulin resistance' and a deficiency of the pancreas to manufacture insulin. Well, this last is not quite true; in the early stages of NIDDM you make more and more insulin as you become increasingly resistent to its properties. This in turn exhausts the romantically titled 'islets of langerhans', which then lose their capacity to produce sufficient for everyday needs. It can be a downward spiral and it is associated with obesity that is certain. How this comes about, I believe is the important element that is often overlooked.
OK, Diabetics are often overweight or obese, but some are not. However if you have a history of weight gain as you get past forty it is likely you could become Diabetic. Why ? Because I believe it is the early stages of Diabetes, termed 'metabolic resistence' that causes this weight gain. As your weight spirals upwards it becomes increasingly difficult to control even if you eat less and less. This is generally because most of your calorie intake is being stored as fat; you become rapidly hungry post prandial ( medics term for after eating) and the instinct of our brain tells you to eat again. This is due to the high levels (at this stage) of circulating insulin, metabolising the glucose in your blood. As your muscles are resistent by now, the only place to go is the adipose tissue (fat).
As this progresses these cells become laden and other cells, which are marked as preadipose, are 'recruited' for the additional storage required. Once such a cell becomes adipose it is forever; it cannot go back, so it becomes harder and ever harder to lose weight even at calorie intakes of 1500 or less. Yet, because of your overall tiredness, weight gain and reluctance to exercise, you will be universally branded as a 'couch potatoe' or worse. Finally you will be diagnosed as Diabetic, probably after some years on this slope of weight gain and you will be entreated to lose wieght, eat a 'balanced diet' and take exercise. But the diet you will be put on will to all intents and purposes, both exacerbate your problem and make you feel just as tired as before and likely permanently hungry.
As your pancreas is 'knackered' you would think that some effort might be made to 'give it a rest' but no, the drugs usually proffered will generally at first stimulate the poor bloody thing to even greater efforts. These will of course, likely make you gain more weight (metformin may not but that's the only one), as you are still on the slippery slope to Insulin injections, which will make you fat for sure.
Firstly it isn't really your fault you are fat. It is all of our fault in general, the NHS in particular and the food and drinks makers for sure. Your 'balanced diet' will include a high level of carbohydrates; complex or not, these will be rapidly converted to glucose, causing high levels of circulating blood glucose. This is the one thing you are trying to eliminate, as that is what causes the cellular damage symptomatic of your condition. Society needs to get a grip and Diabetics need to take control of their own destiny and that means eliminating the foodstuffs that cause the problem. Base your diet on fats and protiens, including saturated fats and you can achieve control without weight gain, without drugs and certainly without Insulin injections.
Leave out ALL carbonated drinks, especially one's with 'natural sugars', they are the worse. Fructose and High Fructose Corn Syrup are the sweetening agents in use today that are rapidly metabolised without insulin. Instant fat ! And no, fats don't make you fat, it is biochemically impossible. Fats were the mainstay of the food store of Primitive Man and still are, for the races left on this planet who are still hunter gatherers and they universally do not become Diabetic. That is, unless you start feeding them cornflakes and coke, then they succumb in less than a decade !
Is it not prophetic that as we all become 'five a day' eaters, consumers of grains (cattle food) and eat 1500% more sugar (sucrose) than we did in Victorian times, exercise more (yes we do) and live longer, that we have become significantly less healthy. Those of you, that aren't yet Diabetic, who are over 40 and gaining weight, get a test ! You can take steps now that could prevent it becoming a reality. All of us, need to review our lifestyles, some more than others and don't fret about a little weight. Statistics show that slightly overwieght people are more healthy, resistent to heart disease and stroke and colds and 'flu, than us skinny buggers. But slightly is good, obese is not. Each of us is different, with different metabolisms and our bodies response to inputs is varied. I will not ever condemn anyone who is overweight, nor should society, especially DOCTORS. Some can remain so all of their lives and be perfectly healthy, but if you see in yourself this gradual weight gain, as you age, then check it out !
I will go further into how to live as Diabetic, without drugs, another day. It is possible and the results are rewarding.
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