Weighing up the insulin risk

About 80 per cent of people with type 2 diabetes have weight problems, but carefully monitored diets can help to avoid the need for medication, writes SHEILA WAYMAN

WHEN JOHN Dalton was put on insulin for his type 2 diabetes three years ago, he thought it was “a life sentence”.

He had been diagnosed with the condition nine years earlier and the medication he was prescribed initially was not enough to keep his blood glucose levels in check.

When he had to start injecting himself with insulin three times a day, he could see no way back.

A retired FÁS supervisor and former farmer living in Co Laois, Dalton (66) says: “I did a lot of physical work and sport in my time. I suppose when all that stopped, I put on the weight.”

He tried various diets but nothing worked until this summer, when he heard about the Orsmond clinic in Portlaoise.

About 80 per cent of people with type 2 diabetes have problems with weight management so the number of cases is escalating in line with the rising obesity problem. An estimated 191,000 people in Ireland have diabetes, of whom approximately 30,000 are still undiagnosed.

What’s more, 146,000 people are “pre-diabetes” – they have a blood glucose abnormality. If they don’t lose weight and get more exercise, they are going to be diagnosed with diabetes in the next five years, says Dr Anna Clarke of Diabetes Ireland.

Earlier this year a small Newcastle University study suggested type 2 diabetes can be “reversed”.

Eleven people with the condition were put on a severe diet of 600 calories a day and, after two months, the insulin-producing cells in their pancreas were back working.

Three months later, after reverting to normal eating under guidance about portion control and choice of food, seven of the 11 remained free of diabetes.

This proved what was already known, says Clarke, namely that diabetes can be managed through weight loss. She uses the word “managed” rather than “reversed” because, she explains, it is a matter of keeping it at bay.

Diabetes Ireland advocates gradual weight loss, to increase the chances of it being kept off.

Currently, one-third of people can control their type 2 diabetes with diet and exercise alone, one-third will need medication and one-third will probably go on to need insulin. The numbers needing medication and progressing to insulin could be reduced, says Clarke, if people received better healthcare support.

“Ireland is very good at giving the technology and the medication to manage type 2 diabetes but there are many deficits in regard to the support for people to utilise those effectively.”

Avoiding the necessity for medication is, in the majority of cases, about losing weight; it is as simple – and as difficult – as that.

Dalton weighed 165kg (25st 13lb) when he started a 600-calories-a-day programme with Dr Eva Orsmond, who runs six private weight-loss clinics around the country.

For breakfast he had diet products to prepare, such as omelette or pancakes; he was given soup recipes to cook for lunch, accompanied by crackers and cottage cheese, and for the evening meal, it was more products.

This “fake food”, she explains, are nutritional supplements to ensure the diet is not lacking in anything except carbohydrates.

In the first week he lost 4.5kg and as his weight dropped, she reduced his insulin before bringing him off it altogether by mid-August.

He was recording his blood sugar levels four times a day, so he was going to see very quickly if there was any adverse reaction. “I thought the bloods would go out of reach again but they didn’t,” he says. He also came off his cholesterol-lowering medication.

Orsmond, a native of Finland, believes people with type 2 diabetes often do not realise that the need for medication is due to their lifestyle and that once they go on medication, it will be harder to lose weight.

She is not suggesting programmes such as hers are the only way for people to lose weight but she does believe patients need specific advice, support and monitoring. “You can’t just say ‘cut down’. The advice given to diabetics is too generalised.”

The challenge is how to motivate a patient to alter eating and exercise habits for good. “They need to see results to be motivated.”

Dalton and another patient, Aisling McMorrow (40) from Bray, Co Wicklow, say the rapid weight loss and immediate feeling of increased wellbeing encouraged them; not feeling hungry was a big plus.

On a very low-calorie diet, Orsmond explains, the appetite is suppressed when the body goes into ketosis – burning fat for energy because of the lack of carbohydrates.

After McMorrow was diagnosed with type 2 diabetes more than two years ago, she also tried lots of diets. Her BMI was 34 and she had high blood pressure when she started the 600-calorie programme in July.

She lost 9.5kg (21 lbs) in the first month and came off her diabetes medication in August. Her cholesterol levels have also dropped. “I am feeling happier, able to buy new clothes and am sleeping very well.”

McMorrow says she did not really understand diabetes when she was put on medication. Now she knows the effect different food choices have on her body. As she makes the transition to normal food, she is determined to stay off medication. “I know it is going to work for me.”

Dalton lost four stone in 12 weeks and while the weight loss slowed as he moved on to 1,000 calories a day, it has continued.

“I feel an awful lot better. The big life change is going off the insulin,” he says. He is back walking daily for exercise. He is well aware it is up to him now to stick to healthy eating.

“I know the consequences of putting on extra weight,” he points out. “It is a big motivation.”

Brendan McDonagh (54), a life coach living in Lucan, Co Dublin, “reversed” his type 2 diabetes by losing weight through changing the way he eats. A former chef, he does not believe restricted diets work because they are all about deprivation. The key is “mind-set change”.

His “blood ran cold” when he was diagnosed with type 2 diabetes in 2008, having seen his father suffer with it before his death four years previously.

He started a “scientific mission” to inform himself about type 2 diabetes.

He kept meticulous records of his blood readings and food he was eating. People have to get the balance of what they are eating right, he explains.

“I eat whatever I want now and I have learnt to be satisfied with what I eat.”

Gradually his weight dropped from 96kg (15 stone 3lbs) to 84kg and his blood glucose levels have been consistently down.

It is about “taking control”, he stresses, but people have to be told how. McDonagh is devising workshops to help people to turn their lifestyle – and thereby their health – around.

Diabetes Ireland is running a Health Awareness Exhibition in Rochestown Park Hotel, Douglas, Co Cork on Sunday, November 13th, noon to 5pm, where diabetes testing will be available. See also diabetes.ie or call its helpline 1850-909909

An estimated 191,000 people in Ireland have diabetes, of whom approximately 30,000 are still undiagnosed

Living with insulin Type 1 diabetes support group

When Niamh Monaghan started to suffer a terrible thirst and feel sick after returning from a long-haul trip in 2008, she thought it was some bug she had picked up. But a visit to the doctor resulted in her being diagnosed with type 1 diabetes at the age of 28. “I have to have insulin four times a day and that’s my life.”

Only 10 per cent of people with diabetes in Ireland have type 1 and most of these are diagnosed when they are children. People like her, who have a late onset of the condition, often “have no idea what to expect or where to go for help”, she says. So she has helped to form the Type 1 Diabetic Dublin Support Group.

It meets on the first Wednesday of every month in a room provided by Diabetes Ireland in its offices on Lower Gardiner Street. A different topic is chosen as the focus of each meeting, at which there is also a chance to chat and share experiences.

Three years after her diagnosis, Monaghan says the biggest challenge of type 1 diabetes is “keeping yourself motivated and upbeat about it”. There is no day off, she says, and she has to think constantly about what she is eating.

For more information, e-mail t1diabetic.dublin@gmail.com