Working on weight loss with type II diabetic patients
Dr David Unwin
A few years ago I was interested to find out how a patient had improved her diabetic control. She confessed she had ignored my advice and learnt a much better way to look after herself, from the internet. I suppressed my wounded pride and looked at the Low carb forum on Diabetes.co.uk There were thousands of type two diabetics on there ignoring their doctors - and getting great results (now that is just not allowed).
My interest piqued I noticed something in the BMJ mentioning that wholemeal bread has a higher glycaemic index than table sugar itself (71 vs 68) and came to understand that the starch in bread is really just concentrated sugar - so why tell type two diabetics to eat it ?
Well I reasoned because they have to eat something, surely without carbs there isn't much left to eat. I like a challenge so started on the low carb diet nearly two years ago and have more energy, need less sleep and moan less, for me - no going back.
Our practice nurse tried it out too and we started offering the approach, as a choice to patients, initially to 'pre diabetics' but they were so delighted it seemed mean not to include the type two diabetics as well.
The initial pilot was published in Practical Diabetes you can read it here. For those of you interested it includes references as the low carb diet has been around since 1797 (ref Rollo) as of course it was the only way to treat diabetics in the pre-insulin era.
Since the Pilot we have treated more patients and my most recent results are:
Note the improved cholesterol despite a diet higher in fat - also nearly a third of the patients were able to come off medications.
Our practice has run a regular low carb evening for those with diabetes and their families for over two years now. Also an evening nurse led clinic for working people.
Whether this diet is the best or not, I'm convinced that if we offered patients the choice of weight loss with more regular follow up or medication, most would rather try the diet before drugs nearly every time - I know I've tried it.
For three years we have been pioneering a new low carb approach at the Norwood Surgery and now have our latest figures:
- Diabetes drug spend at Norwood has been static for three years. The only practice in the CCG with this result – saving between £15,000 & £30,000 pounds a year.
- Diabetes drug spending as a percentage of total spend static too, nationally this is rising.
- Obesity: QOF prevalence at Norwood dropping and lower than CCG and national averages.
- Improving markers for diabetic control at Norwood: HbA1c is <=59mmol/mol in last 12mths is the national marker. We were average in 2012/13, now improved by 10% to 69.1%, much better than the National average of 61.5%