EPA Newsletter May 2016
Diabetes – a well-managed disease – or is it?
Every six seconds a person dies from diabetes (Diabetes Australia) (1)
Diabetes is an incredibly well-managed disease but what are the true implications of living with diabetes? Many people live with this condition without knowing they have it, until the symptoms become severe.
In a study published in 2015 by the University of East Anglia, it was estimated that there are 382 million people worldwide diagnosed with diabetes – that is more than the population of the United States by about 60 million people – and this staggering number is anticipated to grow to 592 million people by 2035 (2).
Often the perception is that diabetes is a disease that mostly affects Western countries, however the above study found that two-thirds of new diabetes diagnoses are in low and middle-income countries in Asia and Latin America where an introduced high-sugar diet is now more prevalent. In these areas, the cost of diabetes often falls more heavily upon the individual, as there is less government healthcare support.
However, for national health services like those in the UK, the cost of caring for those with diabetes is crippling them, with the announcement that as of January 2016, there are now 4 million people living with diabetes in the UK, that’s around 7% of the population. This is a 65% rise in just ten years 3.
It is estimated that in 2012 the National Health Service (NHS) spent £13.75 billion treating both Types 1 and 2 diabetes, with only £1.8 billion spent on Type 1 and the rest being spent on the lifestyle associated Type 2.
£1.5 million every hour, every day treating people with diabetes. (4)
Since this 2012 study, that amount will have increased, and there are recent stories appearing in the UK media that the cost of care for those with diabetes could bankrupt the NHS.
What do these numbers mean to those who live with diabetes in their lives and those who work with this disease on a daily basis?
A nurse’s perspective and insight into the diabetes epidemic
By Jennifer Smith, Registered Nurse
Working in hospitals for over 20 years, diagnosed cases of diabetes along with other chronic conditions has definitely risen. As an estimate, 1 in every 2 people we see has diabetes – usually type 2 diabetes, now known as a lifestyle related disease.
People often do not understand the ramifications of this disease, and will say that they only have a problem with their sugar levels, whilst not understanding the huge impact on their body.
When blood glucose levels are high in someone with diabetes, the small blood vessels are affected; this damages the blood vessels resulting in poor venous return, making wound healing very problematic. It is not unheard of for a person to have leg ulcers that do not heal for over two years. This is very restrictive for the person and requires many services to manage dressings, attend clinic appointments, and the possibility of surgical intervention including debriding of poorly healing ulcers or even amputation for gangrene. These blood vessels are also in the kidneys, so diabetics are at higher risk of developing kidney disease eventually leading to the necessity for dialysis.
Nerve endings are also affected and essentially damaged by the high levels of sugar in the system. Because of this, people with diabetes have reduced sensation in their feet, so their chances of injury without them knowing about it is high, again increasing the likelihood of ulcers. Heart disease is another risk factor, as is obesity.
In the more chronic cases, lethargy and exhaustion are common. I have seen young men who are non-compliant with medications (i.e. not taking their medications), consuming large amounts of alcohol, and coming into hospital with dangerously high glucose levels. They often seem happy to hand over responsibility for their care to someone else - many wives basically manage their husband’s condition, especially where they have chronic wounds.
There is a given-upness in those with diabetes, an "I can't be bothered" attitude, not realising that they can actually make different choices to their lifestyle. There is also a "that'll do" in how they approach and care for themselves showing a lack of self-worth and self-value. It makes sense that they would be exhausted and often depressed as a result.
I watch our diabetic educator struggle sometimes with some patients, because of their unwillingness to take responsibility for their own health and condition.
Interestingly, looking at Diabetes websites, there is no mention anywhere of the possibility of reversing diabetes through our choices, it's just about management, and there is definitely money to be made with the management of this disease.
I have realised that it no longer surprises anyone I work with when we have a patient with diabetes - we see it so often. We have become so 'numb' to the fact of how devastating this condition is. It has become so everyday and normal, but the truth is, it is far from normal.
The real cost of Diabetes
Interview with Louise Fry
Aimee Edmonds interviews Louise Fry a colleague who shares her experience of the serious implications that Diabetes has had on her family.
We read headlines like – ‘Every 6 seconds one person dies from diabetes’ or ‘4.9 million deaths in 2014’ by the International Diabetes Federation. But do we really stop to consider how lives are affected by this disease? Or the quality of life people living with diabetes have?
These headlines and the many statistics about diabetes are startling and shocking in themselves, but Louise’s story really brings home the severity of this disease and the ripple effect it can have. What Louise shares in this interview is a common insight into how lifestyle choices contribute to our health and wellbeing.
Louise’s father was the eldest of 7 children, and very committed to caring for his family whilst working full time. This included caring for his mother, brother and sister who were all diagnosed with diabetes. Every Sunday, Louise’s father would drive to his mother’s care home, 45 minutes away, to see her and do whatever was needed.
Louise’s grandmother was bed ridden in hospital for years having had one leg amputated due to diabetes. The hospital built a crane to lift her in and out of bed, as she was obese.
Louise’s aunt was a heavy smoker and diabetic, and also had one leg amputated. She continued to smoke heavily and had her second leg amputated. After having her second leg amputated, she suffered with phantom limb syndrome and would try and get out of bed to walk, resulting in falling on the floor.
Louise’s uncle was obese and diabetic. At 300 lbs. he was hospitalised and bed ridden. Despite having nothing wrong with his legs, he refused to walk and remained in a bed for the rest of his life (approx. 16 years). Louise remembers being surprised when hospital staff shared that her uncle could actually walk, but that it was his choice that he never got out of bed. He had given up on life after his wife died. On one occasion, he fell on the floor and could not get up. He rang Louise’s father for help, and when he tried to pick him up, it caused his eye to tear triggering visible bleeding along with a detached retina from the pressure of lifting someone so heavy.
Louise’s father was always very slim. In his 70’s he was diagnosed as pre-diabetic or ‘borderline’ as it was called, and that if he didn’t make some lifestyle changes, he would need insulin in the same way as his other family members.
He was grateful he had options, and chose to not go down the same path as his family. On that day, he committed to his own health and wellbeing and started to make lifestyle changes, one of which was a commitment to walking one mile every day - he didn’t ever develop diabetes.
For Louise, growing up like this and watching her father care for his siblings and mother was the family’s ‘normal’ - it was how her family was. Louise is now looking at this very differently - the ramifications of the three members of her family so extremely affected by diabetes and how that significantly impacted the whole family. Because this was accepted as ‘normal’, no one in the family ever questioned the demands that such a strong prevalence of diabetes had on the family as a whole.
The implications of diabetes are global in scale in terms of its physical and economic impact, but it is lived through by one person at a time.
What does the prevalence of diabetes mean to you?