Articles

Diabetes Epidemic: Part 1

December 24, 2019


I think that Type Two Diabetes is
an absolute catastrophe worldwide. This is probably the “greatest
health catastrophe” of the century. Our food environment
is setting us up to fail. As a problem that, we,
as society are grappling with and particularly for children
coming through. We are just not doing it with any
sense of urgency whatsoever. 40 years ago, Type Two Diabetes
was almost unheard of. Today, almost a quarter of a million
New Zealander’s live with it and that is not including the
one hundred thousand more that have it and do not know it. Yet, Type Two Diabetes is
entirely preventable. We are all supposed to have control
over what we put in our mouths. So, what has happened
to us so quickly? Brian Kairua loved his job
as a Youth Social Worker, but last year, Type Two Diabetes
forced him into early retirement. Now that I am at end
stage renal failure, you cannot help but
want to kick yourself for not listening to the professionals
and being too stubborn. Pretty much devastated my body
because of all the poor choices I made. Five years ago, Brian was
given ten years to live. You do not think about Diabetes
when you first get it. I seldom went to doctors appointments
that I was supposed to go to. I never took any medication. I am less than half of the
guy that I use to be now that I’m in a wheelchair. And now I have lots of regrets. Five weeks ago, I was
admitted into hospital because I had a hypoglycemic episode. I just about “went” for good. You get lots of bugs when
you are on dialysis. So I had a bug in my blood and that bug had settled into
this infection in my hip. And as a consequence
I could not walk anymore. They got that under control
and it came right. Then unfortunately, and they
looked at one of my toes and they said, “That toe
needs to go.” I heard that when you have poor
diabetes you can have amputations but I did not think that
my toe was that bad. I said, “Nah its all good
mate it will come right.” It is an “out of it” disease
because it seems like people do not take too seriously. I did not even know what diabetes
was when he was diagnosed. Type Two Diabetes will cut
ten years off your life, number one cause of amputation
beyond car accidents, number one cause of
preventable blindness, number one cause of
impotence in men, number one cause of kidney failure,
dementia, doubles your risk, doubles your risk of heart disease. This is not a benign disease. So, how do people get
Type Two Diabetes? Years of high blood sugar or glucose
stops insulin from doing its job. And insulin is the magical hormone that allows the body to turn
glucose into energy. We get most of our glucose
from carbohydrates, especially sugar. And we are consuming well above
the recommended limits. The reality is we only need
about a teaspoon of sugar to maintain our blood
sugar at the right level, the rest gets stored in
our muscles and liver. But the problem is because
we eat too much of it, it goes to the liver and it
gets converted into fat. There is a complex way
in which being fat, particularly the fat you cannot see,
the fat in your liver, the fat inside your tummy, and
the fat in your muscles, means that insulin does
not work properly. And it is that that ultimately
leads to Type Two Diabetes. The epidemic of Type Two Diabetes threatens to overwhelm the
New Zealand health system. So Diabetes New Zealand
is out in the community to help diagnose it
before it is too late. (Man) Better to heed the
warning now than later eh? (Lady) That’s right, very good. People think because its in the family they do not have to do
anything about it. They think, oh ok, my family has
got it, I will leave it at that. And, if I get diabetes I will get it. They do not understand
that there are stages, and there are steps
that they can take to lower their risk of
developing diabetes. I know it is a pretty
severe condition that most Maori and
Pacific people suffer with. It is something that we can prevent,
I know that much about it. Ropata Adams-Walker is worried
that his unhealthy diet has put him on the
road to diabetes. How is your day going? Pretty good. I was walking past and thought I had better come and
see what this is all about, and see what my chances are. This simple blood test will reveal
if further testing is needed. While Ropata’s blood sugar levels
don’t make him diabetic yet, he is overweight and
has high blood pressure. He has been told to see a GP. I feel sorry for my family members
that are suffering with diabetes. It’s something I would like to prevent, to
be able to be around for my children. I have hit 30, so I have to do
something now or never. This is my antibiotic setup table
and all of this here is purely to combat the
infection in my hip. First I started losing my vision, then the sensation in my
lower legs, and then in my feet. Now I have kidney failure and
that is where I am at the moment. This is something I have
to do four times a day. And this it is going directly
into my artery, and rushing down
into my hip, I hope. High levels of sugar in the blood, or sugary blood going round
and round the system damages the blood vessels, both very small blood vessels like in
the eyes, the kidneys, and the feet. As well as medium size arteries
in the heart and in the brain, because these arteries,
it’s like rust is to pipes sugary blood tends to cause
little blockages in the small blood vessels
and also hemorrhages. Then in medium blood vessels
in the heart and the brain can also have blockages leading
to heart attacks and strokes. Ropata has come to his GP for a more accurate picture
of his diabetes risk. (Ropata) I fit the criteria
of a diabetic. It’s not uncommon to be diabetic
without knowing that you are. If anything there is a fear
of not knowing whether I am or not. I know it’s a silent killer
amongst our people. Your reading is 8.6 What does that mean? Readings should be between 5 and 7. A finger prick test shows
his blood sugar is high. Now he will be sent to a lab for a more accurate reading
of his glucose tolerance. About five years ago I had a
scare of becoming diabetic. So I took the precautions of joining
a membership at the gym to help try and fight back. (Doctor) Are you working
at the moment? Nah, I think that contributes a lot
towards the stress as well. You make a few lifestyle changes
then there are barriers that stop you, to allow you to get back
out in the workforce. Hence that overwhelming
feeling of stress. One door opens and before
you even get a foot in the door it gets slammed straight
in your face. On a daily basis we see lots
of patients with similar problems. Stress has become a very
common problem, and it’s one of the risk
factors for diabetes as well. You have got a family history, your weight is in the obese range,
and you have a stressful life. All of this puts you at a higher
risk of getting diabetes. What stress tends to do it causes
secretion of stress hormones, and those stress hormones
cortisol and adrenaline can actually help create
glucose in the body. Stress and guilt are the common
things that drive obesity. Guilt about being fat because no one
really wants to be fat or obese. Feeling it is their fault. And stress because you sleep badly
because your cortisol levels shoot up and that drives your blood sugars
up and then you get insanely hungry. And what you want is comforting carbs. You want chocolate and
all those lovely foods, which the food manufactures have
carefully created to satisfy those urges. Brian’s parents had diabetes,
but raising four children on his own meant that he had little time
to think about his own health. Now his kids are adults, it’s his
mokopuna he wants to be healthy for. At the very beginning dad
just did not care. He use to run around the bush,
hunting, all sorts of things, and now he is stuck in a wheelchair. So… I stopped caring when he did, I guess. And now he cares a lot but it’s too late. There were those days when doctors
told him to eat salads… but what is the point now?
Is it too far gone. I don’t care he can eat
whatever he wants. I know he is scared. Yeah. He has lost so much weight. He has always been tough. He has always tried to be “the man.” But these last couple of years,
he is actually breaking down. It’s sad that he’s not taken
the necessary precautions, earlier to prevent something
like this from happening. We always had bread and butter, you had to stretch it out because
you had four hungry kids. We were only allowed three
hot chips per sandwich. $10 worth of hot chips
that’s a lot of sandwiches. I cannot remember a single time we had
vegetables when we were young. A lot of fish and chips. It was simple diet
back in those days, potatoes, mince and bread. And always a bottle of
coke or sprite in the fridge. That was about it, meat, bread, salt… meant, bread, salt, butter… …meat, bread, salt. I’ll grab the grandchildren, feed
them all that terrible stuff that you can get diabetes from… Duh…. But they are kids, they are young,
and you think why not? But it is really cool that
they love their Pappa, and they know their
Pappa loves them. I let her have a little glass
of fizzy drink sometimes, not all of the time because
if I get caught… I get a hiding from my “Mrs”. The progression of diabetes
complications is by no means inevitable. And it is very closely linked to the
level of control that people that people have with their
blood sugar levels. I don’t think people are to blame. It’s a complex interaction between
the biology, society, the food and nutrition system we have, and the environment we live in. Our world has changed and
our biology has not changed. We are mismatched to
the modern world. While there is a tendency to
think that even in adults it’s all about voluntary
choice in behaviour. It is not as simple as that. There’s a lot of biological drivers
that are set up early in life, which are hard for people to change. Ropata has six children
and one on the way. Looking after his own health
is not a high priority. Because I have got young ones,
they are the motivation. It’s confusing, not knowing
how to diet properly, and especially when you live
on a set budget. I have got four children with
my partner now, and two to two previous
relationships. With the stressors of life you tend
to forget about dieting, and you want to go back
to your comfort foods. $1 pie, and you can get two pies
at the cost of a fancy lettuce. When you weigh up those options
to someone who’s on a budget who doesn’t have much money,
and has a lot of people to feed, which would be the cheaper of the two? It’s hard to break free of the cycle
when it becomes a normality. They explain to you to drink water
to help you feel full, but an hour later Maori boys are hungry. So you get a bite to eat, a quick burger,
that will last a good hour or so. (Narrator) Diabetes does tend
to run in families but that might not be entirely genetics. The biggest factor is families
all have similar diets and lifestyles. (Brian) My dad died of renal failure, his younger brother also had diabetes. My mum has diabetes, and my youngest
sister is also a Type Two Diabetic. I like my steak blood-red just about
running around a paddock. They’ve put a massive BBQ on,
and lots of salads. Normally I can’t see the salad because
I have really bad eyesight, so I will probably just
eat meat and bread. I think a lot about my own kids
and I hope they are bright enough… because I have made a big stuff
up of it, that they don’t do. He has always cared about
everyone else before himself. My kids don’t drink fizzies, I limit
their lollies, and sugar intakes. I say, “Do you want to
end up like Granddad?” “Do you want to end
up with no teeth?” I’ve put my kids through
so much this year. I was in ICU for ten days. It was the biggest shock of my life. I never thought I would end up
in somewhere like there. I nearly “went” a couple of
times when I was in there. I had to have three operations
while I was in there. I was sedated heavily. And on an artificial ventilator. When I came too, all my children,
and my family, my brothers, my sisters, my mum, were all
around my bed. My daughter in laws, they
were all there. You don’t realize how much love
can fit in one room, until you see it in their faces. I had tubes down my throat
and I couldn’t talk. But I could see their love
and I could feel it. I tried to tell them that I was sorry
for making them all worry. (Narrator) The diabetes epidemic
should be avoidable. But we are surrounded by food
that makes us fat. We need action on a population level, but individuals can make changes
to their own diet. Nutritionist Caryn Zinn,
is on a mission to show that healthy eating
can be affordable. I believe you have been
to the doctor today? Yes. I am boarder line and haven’t
yet been diagnosed. What sort of foods do
you normally eat? We eat a lot of packaged
and processed foods. Noodles. We try not to but when you’re
working with a budget, we are limited on the options. Ok, carbohydrates, eating lots
of breads, lots of cereals, lots of cereals, and lots of muesli bars
actually make you hungry. If we eat a diet that is very
high in carbohydrate, your blood sugar will need
to control that, and your hormone insulin
will be secreted to help control your blood sugar. So instead of getting highs and lows, like we do throughout the day
with lots of carbohydrate, the way forward is reducing the amount
of carbohydrate that you eat and improving the quality
of carbohydrate. Eating carbs from whole
unprocessed foods, vegetables, fruit, milk, and yoghurt,
and legumes, like lentils and chickpeas, which
are a cheaper source of protein. Those carbohydrates are good
quality carbohydrates. Eating whole unprocessed foods
is how we should all eat. But it will be particularly
beneficial for you because it will keep you
insulin levels down, which is what you want
for your diabetes. We are going to attempt
to make homemade burgers, with garlic in it and mix it
together with the mince. One of the more difficult things
about diagnosing diabetes is that you can go to the doctor and have your blood sugar measured, and the blood sugar could be normal. But your hormone insulin could be
raised throughout the day. So while your blood sugar is really
important to look at for diagnosis, it’s your insulin which is
just as important, but the doesn’t happen at the
moment with diagnosis. So that’s another reason that you
keep your insulin levels down. One of the simplest message is to
have a full fridge and an empty pantry, because it means you have lots of
fresh ingredients in your fridge. You can lots of frozen
vegetables in your freezer. And apart from having spices
and that in your pantry, if it’s empty it means there’s not
a lot of packaged stuff in there. (Ropata) So, that’s a good thing? Yeah, that’s a good thing definitely. This way of eating is not about
eating a lot of meat or protein. Do you know what happens to protein
if you eat too much of it? (Ropata) Does it go in with
your stored fat? Interestingly, it gets turned into sugar. (Ropata) To be honest, I would normally have two patties on one burger. And how many burgers? (Ropata) Two and a half. That’s a lot of protein. (Ropata) When you’re
brought up starving… you want to eat as much as you can. See these all look like little cups
and what you can do is put in… some red onion, tomato, a bit
of beetroot and then mayonnaise. So, you can then cover
it with the other side. And here’s your burger! (Ropata) (Laughs) thank you so much. Mmm, it’s actually better
than a McDonald’s one. (Caryn) Oh that’s good to hear. (Ropata) I’ve learnt that healthy
food can taste nice and that it’s very easy to cook. People eat poor quality food
because it’s there. If it wasn’t there they
would not be eating it. In my older days of being a dietician, I would look at people who were
overweight and think it was their fault, and think they were lazy, undisciplined,
and had poor food choices. Now I believe quite differently about it. I think the environment is
setting us up to fail. And also the physiology
is driving as to eat. Sugar is addictive. So when you eat a lot of sugar,
and a lot of fast-food, that drives to you eat more. So, it’s not the fault of the individual, it’s the fault of what’s happening
to the physiology, as a result of eating this
poor quality food, which is cheap and everywhere. (Bassy music) (Narrator) For 16 hours a week, Brian is connected to a dialysis machine. He’s been doing this for five years. When I am on the machine,
you get really cold as the blood leaves your body,
your core temperature drops. I am in a lot of pain at the moment
because of my feet. If my feet weren’t such a problem,
I would be a lot more relaxed. This has become a part of my life now. It’s weird thinking your life depends
on this machine and how well it keeps you
clean of all the toxins. This is me, this is my real
system right there. We have three shifts, morning,
afternoon, and evening shift. Life length on dialysis
is four to five years. But the evidence of our patients
is five to ten years. I believe this indicates
of our better service. It’s causing a massive impact
on our economy in terms of the healthcare costs
and loss of productivity. And it’s been very hard to
find a figure on that but it’s in the order of
three hundred million in direct costs to the public
healthcare system. It’s going to be a long term trend and I think we’re going to see the
number of people with diabetes, coming through the hospital
doors only increasing. (Narrator) The results are back from Ropata’s blood glucose test. I’ve come in for my test results, and if the worst comes to
worst with diabetes, I know that I am on the right track, that I have started my journey
to healthy living. (Doctor) I’ve looked at your results
and the good news is that you don’t have any diabetes
at this stage. But I did see some changes
in the liver test. (Narrator) Ropata has fatty liver, which can be caused by
insulin resistance. And is often associated with
Type Two Diabetes. Fat in the liver and pancreas
can be far more dangerous than more visible fat. About 20% of people with Type Two
Diabetes are not overweight. (Ropata) Choice. People may well be what we call thin
on the outside and fat on the inside. That means they appear relatively slim for their actual body fat in
their key organs. What happens is you put on weight,
particularly abdominal weight, weight around your gut, visceral fat, then this tips over and starts to fill up
the liver and the pancreas. And when these two organs
stop “talking to each other” that’s when you have serious
problems with insulin levels and therefore you tip over
into Type Two Diabetes. But there is a long build up to it,
many years during which maybe you haven’t been as active
as you once were, eating badly, You get the development of something
called insulin resistance. And all of these things contribute. But in the end it is about central obesity. (Ropata) I’ve come to realise now I’m
in the driver’s seat of my own life, and that I have control on the outcome, which as given me an incentive to
start regular exercise and start dieting. Although I look a bit flabby in the mirror, I can see the full potential
that my body could have. Exercise actually is important, because it’s not just the effect
of exercise on weight, but it’s the effect of exercise on the whole glucoses metabolism and being able to get rid of
glucose out of the bloodstream. I go agree that the dominant driver
of this increase of weight and obesity that we are seeing in almost all countries
is due to increase in energy intake rather than reductions in
physical activity. (Narrator) Brian has already
had his toe removed, but that hasn’t stopped
the infection in his leg. Now doctors want to cut
his right foot off. (Brian) The leg didn’t look nice,
the foot was all mangy looking. The doctor took one look at it
and wanted to chop it, take the whole leg. And I was ready
to run if they did that. So, Doctor Bevan said, “It’s going
to be along run Brian, but we will try our best.” So,
I was happy for the long run. It’s just a necessary thing of diabetes that your circulation is going to be poor. Because the circulation is poor
the healing factor is poor. And then you may lose a toe,
two toes, four toes, half a foot, and then eventually a foot. They say that once the surgeons
begin to chop it’s pretty hard for them
to stop after that. We are not even beginning
to see the beginnings, and also we’re not going to see the
end of this particular disaster. Predictions in New Zealand are doubling
of diabetes within the next twenty years. Already doubled in the last ten years. In the UK, rates of pre-diabetes
have tripled in the last eight years. Up from 11% to 36%. This is only the crest of the wave, and when I say crest of the wave,
it’s the crest of a tsunami. At the bottom of the crest of the tsunami. I think Governments are finally
going to be forced to act because it’s going to bankrupt the
health services all around the world. In our next program, Christina
has dealt with Type Two Diabetes for more than a decade. People get quite judgemental
and when you’re eating at a function or somewhere,
then someone says, “Should you be eating that?” I get really annoyed. I don’t want to be too skinny,
because I will look too sick. And Brian faces further amputations. Desperately trying to keep
it under control and trying to hang on to these
little tiny limbs I have left. I’m not on the winning side
of that battle I’m afraid.

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