Managing diabetes without weapons

Automatic TRANSCRIPT

Donovan and today on the retail we talking diabetes a courter of a million new zealanders diabetic. That's touch over. Five percent of the population and that number is increasing exponentially with mody pacific and south asian people. Most at risk it's one of the leading contributors to cardiovascular disease kidney failure and amputations and management of diabetes costs nearly two billion dollars a year. So why is new zealand's treatment plan so far behind the rest of the world and why a to effective medications facing barriers to being introduced here the co authors of an editorial in the new zealand medical journal published today a calling for the drug buying agency farm act to fund to drugs that could dramatically improve the lives of people with diabetes. It's affecting modern pacific populations much more. It is in the form of any epidemic and the truth is things that we can do. That will change it. Filemaker's is considering funding. These two new drugs and we saying that got to do it right. Gotta do it now. Here's dr brian beating medical director. The royal zealand college of general practitioners. Who's put his name to a news. Release calling out phonic for its lack of progress on medication for diabetes. The fundamental thing was diabetes. A male is the body loses its ability to control blood sugar levels. Lodge sugar or glucose is very very important for the way the body functions. It's essentially the patron of the body and like any any pitcher orange and we need to control. How much is in the body. Soft too much glucose guys into the body or too much sugar. We tend to flood the engine and caused damage. And so he fled the body and caused damage. Diabetes as fundamentally with the body loses the ability to control sugar levels and we get too much of it in the body now. This basically fundamentally two types type one diabetes Often with younger people and children. And that's what we call an autoimmune disorder and that is where the body tunes on itself and actually shuts down the pancreas. Now the pancreas is the thing that produces insulin. And insulin is the thing that controls blood sugar levels. So this autoimmune thing the pancreas seems to be shot stan. These no insulin. That's released into the body. The body can control sugar levels because it has now been and we cool that type. One diabetes the second type of diabetes type two. And that's essentially other time. The pancreas gets worn out. It's slowly starts to be not as effective at producing insulin. The body can't control the sugar levels as well as would and generally just gradually comes on. I've read number of years to appoint Really the body can't With suga anymore because the pancreas isn't working as well as was In that situation we normally use medication to try and boost the body's ability to control sugar and at cambridge. To a point where. We actioning use insulin as well to replace insulin in the body to control the sugar so really. It's the inability of the body to control sugar when we talk about diabetes innocent of issue scenes as we are here. Are we talking about both type. One and type two diabetes fear to sort of group those two together and talk about diabetes as as a whole or is it quite important to separate those out. I personally believe it's important to separate them out that someone living with type. One diabetes has a very very different ginny to someone living with type two diabetes. So we do have to make that distinction has separate in what they do and how they come about by coming out in different ways. They often have very different trajectory in terms unfold. One actually is a very blunt. Differences with type one diabetes dodig sizes important. That's very important with all diabetes with type one from the moment you had diagnosed you require ensure there is no option because the body is not producing insulin. The in for if you're a child who develops taiwan diabetes from the diet you develop. It becomes part of the rest of your life so that is very different with type. Two there is a softness very slow unfolding of the loss of sugar control and a number of strategies that can be put in place to try and mitigate detto change that inside the coast of the two conditions are very different. And i think we do have to separate them out in their minds. We can't live the two. We can't sort of a one condition. Now today. we're talking largely about type two diabetes. This is not because it's necessarily worse than type one at as an but at has more flexible treatment options with type. one diabetes. Yarn body is attacking the pancreas. The insulin manufacturing plant therefore you need and chilean full. Stop type to on the other hand. Involves your body not producing enough and chillan in. This can be mitigated even managed with more exercise to three glucose. Faster through paying attention to what you're eating which helps manage your glucose and so one thing is for sure. New zealand has a lot of people with diabetes. More than two hundred sixty thousand as of last year. Two hundred twenty thousand of whom have talked to and that is bad. News diabetes overtime. Kinkel is hot attacks or scheming hat. Disease can cause strikes Something co per for vascular disease that is with the circulation to in particular. The league's fate is blocked. And as a result that leads to amputation. causes a lodge cluster of the tie and related to the hat to the brain and the seeking big group of problems. That actually could is what we call micro-vascular that is a pig's. I'm eyesight can cause blindness. It affects the kidneys. Sought can shut down the kidneys over time and that is particularly important in new zealand because mallory and pacific patients literally twelve to fifteen times more likely to progress twinstar drain Heavy can these shutdown by diabetes more about vet and a few minutes in the food area to fix as the news the body. it can start to kill off. News to the fate into different parts of the body and that can lead to all sorts of problems. surreally diabetes encompasses and cancun's damage to to every part of the body. If you start to look at it and Is a major major contributor to heart disease rights new zealand to insight kidney failure zealand dialysis to amputate shouldn't of fate and legs and to blindness. Soy it is it is a really really major problem in the new zealand seating. It usually takes a while for people to accept that they have a A diagnosis a condition and chum often go on for months without fully really acknowledging the fact that they have diabetes. That is to call it. Took an associate dean at auckland. University's medical school and he has an interesting perspective on this. Because i have had diabetes type two diabetes for fifteen sixteen years now and i managed my so Injecting myself. So i'll have kind of bought from the fact that i use that i use to treat a lot of people diabetes. I'm living with what were the circumstances around you finding that out. We not feeling great and so you went to the doctor. Did you speak something. Well i guess being a medically trained. I was the aware of the fact that my mother and my father. And my mother's siblings all diabetes so in a sense i was programmed to have diabetes. It was just a question of time if you like. And as i got older put on more weight in the risk go higher and higher. But i didn't feel on well i wasn't sick just happened. One time i went to see a gp. Faw something else would just the usual story. And i got a blood test Came back and and confirmed that. I had thai blood. Sugar essentially diabetes and we tried with diets and didn't say a little and i moved onto tablets. And and then onwards. That's kind of how things happen. In fact it's very rare for people experiencing these symptoms so diabetes particularly type. Two diabetes usually found as a result of a blood test for something else. Having diabetes. means you're more likely to develop heart. Disease leads to hundreds of amputations each year. It costs the country nearly two billion dollars a year and treatment costs and the problem is getting worse over the past decade. The number of diabetes and new zealand has risen by forty percent from one hundred eighty eight thousand and twenty two two hundred sixty four thousand and twenty nine nine. Nearly forty percent of people with diabetes and new zealand are of molly pacifica or indian descent which biggs the question. Why well there are some people who still go on about the fact of their dynamically predisposed meaning. They have a genetic makeup that makes them at higher risk. Most people most doctors most business will now tell you that in fact the problem with diabetes relates to the environment in in which people live so in the food eat and reduce levels so excess is and that pretty much explains the bulk of it and As this is some people would still talk about a genetic link if there is one that's pretty weak and most of it has to do with the environment in which people live mainly because of the type of food. They eat high in sugar salts. Fats and and not enough exercise. People who are overweight or obese will have elevated risk of developing diabetes. So it's pretty much. And then a a as opposed a human body reaction to a toxic environment with the types of food that people are eating their these days. One thing that i found interesting about this is this is a phenomenon that we see around. The world among indigenous populations i. I'm curious your thoughts with that. Perhaps this is also a reflection of almost the residual effects of colonized health system. The idea of a lack of trust and the health system behaves and not seeking out medical treatment until problems become really big problems. That's an issue and we'll come to that in a minute but there was for a time and probably still is a theory. Somebody's theory it's called the thrifty genotype of this gentleman called. Neil what is is that polynesians in particular pacific. People from the islands are genetically programmed to live in environments where they go through prolonged periods of drought. Whether they're sailing or maroon on an island know something and then there's periods of plenty of food so in the since genetically bodies program to those kinds of environments the problem. now of course is Anytime you hungry you go to the fridge. Will you go to the local Takeaway place in this ongoing availability of food often not good quality food. And so you'll make up is not being able to adjust to your new environment. So that's been a theory obviously has a lot of Merit but difficult to prove and then to come to the point you just made and we talked a little bit about this earlier on often. People with diabetes Under treated like high blood people were high blood pressure. They'll they either not treated at all under treated and medical care or medical interactions between a patient and So doctor is a subject to so many things and one of those things is the level of trust in the doctor little trust in the nurse liberal trust in the system confidence in the treatment concerns about safety and generally pacific people. Don't get care that they need pretty much full for a whole lot of medical conditions including diabetes. So really these three to the treatment. Number one is locked style diet and exercise. I really really important in trying to control blood. Sugars and this is by Exercise teams to burn up sugar in the body so if we exercise on a daily basis we tuned to ben up sugar and bring out sugar levels down and if we control the amount of carbohydrate that we eight and suga the tyke and the body that teams to reduce the amount of sugar that has been put onto the body so those two things balancing those two things out really independent or the foundation of starting to treat. Diabetes dot is really really critical. The second treatment modality is medication now in new zealand. We've had basically two medications available to us that something mitt foreman which has made a cashless that patients go on strike off with. They stopped to get diabetes and something called salt from urea. Which which which. Actually stimulates the pancreas to to produce insulin about two years ago. We had another medication. Who voted clinton which came on board and at the moment there is a there is a third seat of medications. Something quotas Lt twos and gpl ones which the rest of the western world of head for the last five ten years new zealand has been very very slow in adopting them but family is very very close to releasing these medications in the new zealand system. Now these are really important medications because not only did they reduce shogo. They actually predict the kidneys from damage. And i predict the hot from damage with blood. Sugar salt Suga like focus on the heart and kidneys jalen context where narayan pacific instance at twelve forty times more likely to progress to rain. Failure a medication that protects the kidneys very very important zealand fell behind the olen. Tim's having access to the medication. We hope that that will be accessible on the next two to three months and night will change the landscape and confirms what we doing. So medication is very important. The food pat which which is incredibly important as well as the use of insulin and that is replacing the bodies insulin. Levelstrump insulin injections to bring down and control should illegals so dot makes us. Is the usa medication. And the use of insulin. I really the backbone of treating a type two diabetes type one diabetes. The there is A bit of consternation at the moment around pharmacy and in two types of treatment. I think impact low flow zain and do leg lutai. I've which have ridiculous names all we. These names come from brian. It's is outrageous comes over time. It is confusing. I don. I can tell me a bit about these these treatments and why there is a bit of consternation around then a case. Let's focus on the equity issue with diabetes new zealand. I believe that type. Two diabetes is one of the biggest medical equity issues. We have zealand. And that's because of the statistics like at marian pacific three to five times more likely to get type. Two diabetes a twelve to fifteen times more likely to progress twins dino files diaz seven times more likely to die from diabetes than europeans. So we'd have this of equity gap entombs of type two diabetes. Now as i mentioned they new medications are really really important because they protect the kidneys predict the hot now. What just see it as the we have this. Massive equity gap in terms of outcomes with talked to diabetes so these medications are very very important for new zealand. And i believe there are actually very important for addressing some of the equity issues. We have now the problem that has being with these medications emerged on the international scene about ten years ago now well established across wisdom world in terms of use and x dot patients living with diabetes however in museum because of the cost of these medications and one of the issues that actually rose was. We had two hundred. Twenty thousand patients will pay eighty living with diabetes and new zealand. it's potentially a huge cost to new zealand. System to fund. These medications. And i believe that that that was very slowed and understanding the problem with diabetes. Very slow to understand the equity or the iniquity intimidated outcomes new zealand and very slow to respond in terms of bringing these indications into the new zealand marketplace. A consequence of that as a treatment of diabetes really did full well below the standards. What was acceptable across the western world. We will lift with essentially mid foreman softener. And then sean which was was at is now considered a very old treatment paradigm intimidates national practice about phonics struggling to to reconcile the cost of the medication with how accessible it would be. Two hundred and twenty thousand yuan does living talk to diabetes has really lead to very prolonged the lion access to them. Which in many ways i think the diabetic provisional dominant community deals with general practitioners into chronologies cardiologist. Freedom physicians Do think is unacceptable. If you were given a day to enact some sort of achievable policies in this kind of area that would really make a difference to to diabetes. What would you do with individuals families and communities and really get him in the ten so to speak and get them to do more to prevent Weight gain to participate in activities to really change their diet. She work with where they get their food. So you you gotta do that. Then you gotta think about some legislative is like And physical mrs like texans offerings to discourage consumption of drinks high sugar. I would work with the doctors. And the nurses to support them to identify and to basically treat people with diabetes because many of them are missing out. at the moment i would Improve the availability of the drugs and some that we talked about and particularly working with You'd have to do A range of things. I i you know. It's not easy but you have to do these things and promoted and put some attention on what leads to diabetes. That's it for today. I'm emile donovan. The detail is brought to you by newsroom. Dot co dot in seed in my possible by our seed and you can get downloaded free to mobile device every weekday from podcast platform and of using april. Please leave us. A ratings are others can find us to jeremy ansell engineer. Today's episode which was produced by alexia russell. And thanks to dr brian. Busy and dr colin. The quintana mateo.

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