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

Posted Jul 27 2010 3:08pm

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

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