Diabetes: The Hidden Killer Panorama

This programme contains some scenes which some viewers may find upsetting

We think the best thing for you to do is to have an amputation.

Around four million people in the UK have Type 2 diabetes.

We need to talk about this and decide what to do.

It's mostly preventable, but it can be deadly.

It slowly came on, you see.

The trigger, bad diet and lack of exercise.

Half past four, going for more chocolate.

The result, all too often...

There's a blockage in the artery.

..heart failure, kidney disease,

feet and legs that must be amputated.

Say yes to me when I'm touching your feet.

Nothing? No, OK.

So I will just cut it, leave it open.

I will have performed two amputations alone today.

It's an invisible illness.

It basically rots your organs from the inside.

It used to be a disease of the middle aged and elderly.

How old are you now, then, Ameer?

15.

He's got a whole lifetime ahead of him with diabetes.

Just as the disease slowly grips a patient,

the costs are slowly strangling the NHS.

We are in a crisis now.

Panorama has spent six months at the sharp end of the battle

against this rising epidemic.

We are very much putting out the fires,

and whilst that is my job to do that,

I very much wish that these fires didn't exist in the first place.

Hi, Martin Claridge, I'll see you there in a minute.

Cheers. Thank you. Goodbye.

The vascular ward at Heartlands Hospital in Birmingham deals with

very severe, acute complications of diabetes every day.

We'll give you some glucose as well in the bag of fluid.

John Westwood is a Type 2 diabetic -

he has gangrene in his foot and his life is in danger from infection.

I was watching the television.

And there was a radiator at the end of the seat.

And I must've just pushed my feet against it.

But it was cold.

And then in the night they turn themselves on, you know.

You should've seen my feet in the morning.

Absolute blisters all over them.

Oh, it was horrible.

John's diabetes means he has lost sensation in his feet,

and his wounds won't heal.

Mr Westwood, nice to meet you. I'm Martin Claridge, vascular surgeon.

I understand you've got a problem with your foot?

I burnt it on a radiator.

It was all blisters. Up to Friday, it was healing, no problem.

Friday, I said, "There's something wrong."

That's when we called the ambulance.

All right. Is it OK if we have a look?

OK. What, and this happened about three weeks ago, did it?

-Yeah.

-OK, thank you.

With you, my friend, the infection is so much in the sole of your foot

and so spread up your foot, that I can't save your foot, I'm afraid.

So what you need to do is have an emergency operation to have

your foot removed.

It's what we call a guillotine amputation.

So we take all the infected tissue away,

and it allows the non-dead tissue that's only a little bit infected

to settle down and then we can actually finish off the operation

with what's called a below-knee amputation.

If we don't do that,

then what's going to happen is the infection is going to spread up your leg,

and you'll end up losing much more of your leg.

And ultimately, you would succumb from this, if we don't do this.

So we have to get on and get this sorted out for you.

Is that all right?

Yes, it is all right.

I've done my best, but I can't do any more.

No, well, it's very difficult to do any more than you can with this situation,

-so it needs some surgery now.

-Yes.

He needs an emergency amputation of his foot.

If we don't get on and get this done in the next few hours,

he's going to lose his leg or potentially his life.

He doesn't moan. He doesn't moan, you see.

When they tell you, you're in shock. You blank it out.

When the injury happened, John and his wife Pat were away on a special trip.

My son had paid for us to have a holiday in Cornwall

for our 50th wedding anniversary.

Things happen to him, knockbacks,

but I'll tell you something, it's never got him down.

And if he wasn't like that, I'd know there was something wrong.

That's the reason I knew there was something wrong with him,

when he wouldn't eat, and I thought, "That's not him."

Type 2 diabetes means the body's natural insulin system

stops working.

The resulting high blood sugar levels clog up veins and arteries

and that can lead to acute complications.

Type 2 diabetes causes furring up of the really small blood vessels.

This can rapidly escalate and cause gangrene,

cause toes to be lost,

cause foot loss and may result in amputations.

Type 1 diabetes - the sort you're born with -

accounts for just a tenth of cases.

It's Type 2, mostly brought on by lifestyle, that's now flooding

Heartlands Hospital with new patients.

Birmingham has one of the highest levels of diabetes in the UK -

an estimated one in ten people here has it.

The hospital has spent £6 million building a dedicated centre

to cope with the diabetes epidemic.

This is our main reception area, where patients come in.

We see about 8,000-9,000 patients every year.

We deal with a huge range of problems resulting from diabetes,

patients with damage to the nerves in their feet,

patients requiring regular dialysis, patients having severe eye disease.

Keep looking there.

The prevalence of diabetes is rising so rapidly that it is three times

the numbers of all the cancers combined together.

Nine out of ten Type 2 diabetes patients are overweight or obese.

Hi, Jonathan, how are you today?

OK, how are you?

-I'm all right, thank you.

-Good.

So, would you like to pop onto the scales?

Jon O'Hagan was diagnosed with Type 2 diabetes when he was 32.

He's now 40.

OK, so it's 123.4.

So your BMI is 41.7.

With a body mass index of over 40, Jon is classed as severely obese.

He's been told he needs to change his diet, but he's finding it hard.

I probably do eat a bit too much in general.

I could quite easily have four or five milkshakes a week,

depending on opportunity as well.

If I came to the weight management clinic on Monday,

I could have one after that.

But my big poison, if you like, is chocolate.

Now Jon has to rely on medication to control his blood sugar levels.

This is my daily diabetic medication.

I have metformin, 500mg tablets.

I have insulin in the form of an injection pen,

I have 120 units every night.

And I also have Victoza, which is this one.

Where do you inject those?

Into the legs, tops of the thighs or lower abdomen.

I try and rotate the injection sites so it doesn't get sore or lumpy.

The higher your blood sugar,

the more invisible damage it is likely to be doing.

Blood sugar is measured in millimoles per litre -

ideally it should be below eight.

We're now about half an hour, three quarters of an hour post-lunch.

And it's 14.3.

And you feel normal?

I feel normal at the moment. That, for me, is not high.

It's far too high for anybody, but it's not high that I'm unused to, unfamiliar with,

it's just too high.

Jon is a psychiatric nurse,

caring for patients with serious mental health problems.

Unfortunately, I work in a very stressful job

and eating chocolate is my big sort of stress-relieving thing.

I don't smoke, I rarely drink, I do go for chocolate.

This is Saturday, it is quarter past five in the morning,

I'm working a long day today, just about to have breakfast,

four Weetabix topped up with Frosties with a pint of tea.

We asked Jon to record a video diary of his regular eating habits.

Thursday 30th June at 12.36.

For lunch, I have just had a large bowl of tuna pasta salad.

And two Ferrero Rocher, yummy.

15.07 - feeling rather tired and jaded so I have just gone and bought

a bottle of Diet Coke,

500ml, and a Snickers bar.

Half past four - feel tired, weary and going for more chocolate.

I will just cut it, leave it open - open - with some gauzes on it

for a few days until the circulation here relaxes.

John Westwood is about to have his gangrenous foot amputated.

There is a small risk you may die during the procedure,

and the risk of that

starts from around 5%.

OK, do you have any more questions?

No, I think you've explained everything beautifully.

We need to mark this side just to show that it's the right leg.

Please put your signature where the X is.

OK, please don't eat anything now or drink...

'When they go in, you think, "Well, are they going to come out?"

'It's just that half of you is gone, you know, half of you ain't there.

You're diabetic. And your last BM was 10.5.

'I'd rather that happen to me, than to John.'

We need to do an amputation but it's going to be a guillotine amputation,

it's the best way to stop the infection and save the patient's life.

Guillotine surgery is an emergency operation for the most urgent cases.

The reality of amputation is brutal

and watching it is not for the fainthearted.

My name is Andreas. I'm the vascular surgeon.

We're just going to do an open amputation.

So it's just a guillotine. OK?

Can we start?

Do you have the saw?

OK.

OK.

Good.

It went quite well,

I think we did well, now the patient is going to recover.

This operation has saved this man's life?

I think that it did, and let's hope that he goes well, as we think.

But diabetics don't just face the risk of amputations.

Sharon Barnett is 44.

She was diagnosed with Type 2 nine years ago.

She is worried about the damage the disease might be causing her eyes,

kidneys, or heart.

Hello.

You can stop the disease progressing if you lose enough weight

and change your lifestyle.

But Sharon has tried many times and still weighs 18 stone.

In three weeks, she will have weight-loss, or bariatric, surgery.

She's here for a pre-op check.

-Your full name. Sharon?

-Sharon, yeah.

'I just know I need to do it.'

I know that I can't carry on, my health problems are probably

just going to get worse if I don't do something about it.

What do you do for your life?

My work? I work in a call centre.

-A call centre.

-Yeah.

'I weigh 119 kilos at the moment.

'I'm now a health risk.'

You know, I might not live as long as I could live

because I've let myself be overweight.

Thank you. Thank you very much.

Obesity has crept up on Sharon.

The result of too little exercise,

and too many calories from carbohydrates or sugary foods.

That's hideous.

Oh, my God, where did that come from?! I look really old, I was 19!

You've only got to go, probably, 300-400 calories a day over.

And I just think it's gradually over the years, just gone on.

That's me there.

You were in all the teams and everything.

Yeah, I played at school, I played rounders, netball, hockey, all them.

When I left school, I stopped exercising. I just stopped completely.

But I carried on eating the amounts I was eating.

Right, hello, how are you getting on?

After the amputation, John Westwood is doing well.

You look a different man, you look an awful lot better.

And you've got a smile and everything. That's really good.

So it's a bit of a long haul over the next few days.

I'll see you in a little bit, then, OK.

Right. I'm going to join the Long John Silver impersonators!

But I do feel 100%. No pain at all.

It's absolutely amazing.

All I'd say to you is what I told you before - if you're diabetic,

keep on top of it. If you don't, you'll end up like this.

It's a bad disease, it's a really bad disease.

Could we have...?

Vascular surgeons, who treat diseases of the veins

and arteries, do all they can to avoid amputations.

In the past, a large share of vascular problems

were caused by smoking.

Hello, how are you? How's your leg feeling?

It used to be that it would perhaps be unusual to find

a patient with diabetes, but now almost every patient I come across

on the vascular ward has diabetes.

The growing burden of Type 2 diabetes is having

a big impact right across Heartlands Hospital.

Diabetes just ravages most of the systems.

It has effects on the heart, has effects on the blood vessels,

has effects on the kidneys, and is just non-remitting, non-relenting.

You know, it just carries on.

At the back of your mind, you always think that they have a limited

lifespan because there's only so much you'll be able to do for them.

If you've got Type 2 diabetes,

you're almost twice as likely to have a heart attack

and over three times as likely to have kidney disease.

-How are you getting on with the dialysis, you all right?

-Yeah.

Any problems with the fistula or anything?

We probably get about 10 to 12 referrals a week.

Probably five of them, five or six will be Type 2 diabetic.

About 40% of our patients on dialysis are Type 2 diabetic.

Annette visits patients at home to explain what lies ahead

when they need kidney dialysis to keep them alive.

It's quite difficult, walking in to somebody's house and they

don't know what you're going to tell them. They're terrified.

But at the end of the day,

unfortunately the story is the same, really -

that, you know, you're going to need to have dialysis

and this is what it entails.

Their whole life now is going to be monopolised by the renal failure.

Annette's next visit is to John Jameson.

Will we go that way?

John has lost weight and controlled his blood sugar well

since he was diagnosed with Type 2 12 years ago.

But still, his kidney function has deteriorated.

It is a bit tight now.

Doesn't quite fit.

That was meeting the Queen at Lord's. That was...

-Which Test match was it?

-That was...

I was twelfth man at Lord's before I made my debut.

John used to play cricket for Warwickshire and England.

I was probably a little bit on the large side.

But I was still reasonably quick between the wickets.

But after I stopped playing, wasn't doing as much exercise

as perhaps I should have done.

And that's when diabetes set in.

It was much of a surprise to me that I'd got Type 2 diabetes.

At the end of the day, we're breaking bad news.

You can almost see the cogs inside their head.

They're not listening to what you've said,

the one word is going around -

"I'm going to die, I'm going to die, I'm going to die.

"Oh, my God, oh, my God, I need dialysis, I need dialysis."

We were chatting about Dr Thomas and the fact that he's referred you

to the renal team because the kidneys are failing and

there's a possibility you might need the dialysis.

The diabetes, unfortunately, very common, diabetic.

The first dialysis I'm going to talk to you

a bit about is called peritoneal dialysis.

You'd need a little procedure to put a catheter in.

This is the catheter, OK?

They're the dialysis bags,

and basically all you're doing is connecting...

..like that.

Takes approximately 20 minutes, sat there watching your cricket,

four times a day.

So, have you got any other worries or concerns at this time?

Not really, I just hope that it gets delayed as long as possible.

Absolutely, and that's what we're there for.

Just want to say thank you for your time, I appreciate it.

-No, you're welcome.

-Thank you.

-Thank you for coming.

I've cut down on meals. Basically, I'm only having one meal a day.

Might have a little bit of snack in the evening or that sort of thing,

but that's basically to keep the weight off.

Obviously I want to try and avoid that.

And, erm...

Whether one can do more exercise or not...

But it's a bit difficult when you've got a...to help the kidney function,

they've got a catheter fitted - you can't exactly go running.

Do what you can when you can and enjoy life when you can.

But the Type 2 epidemic is now affecting people

much earlier in life.

Just 16 years ago, there had never been a single case of a child

being diagnosed with Type 2 diabetes in the UK.

I didn't quite believe it. It wasn't in any of our medical text books,

we didn't get it taught it in medical school,

so we didn't expect to see it as an issue.

We just didn't think it was...

We thought it was an American problem.

But in the year 2000, we saw the first cases in the UK

here in Birmingham.

Ameer is 15.

He was diagnosed with Type 2 when he was just 13.

-Hello, Ameer, are you OK?

-Yeah.

People of South Asian origin are twice as likely

to have Type 2 diabetes, and the disease runs in his family.

Ameer must check his blood sugar at least four times a day.

-That's OK. Thank you, Ameer.

-That's all right, Miss.

Ever since I've been diagnosed,

every day before lunch, I'd come down, check my sugars.

At first it was annoying and I can admit that I never used to come

because, you know, it was kind of hard for me to come down,

check my sugars, people asking questions.

But then once I told them that, you know, it could happen to anyone

and everyone, they were actually quite calm at first.

-See you on Monday.

-See you, bye-bye.

No-one asks questions and they understand,

so I kind of feel happy about that now.

Being diagnosed young means life-threatening complications

are likely to occur earlier in life.

But as long as his blood sugar is well controlled,

Ameer can keep the disease at bay.

I am quite rebellious when it comes to, like,

"You can't have this, you can't have that."

Like, I'd go to the shops, like, my mum gives me money.

She says, "You've got to spend it on your lunch,

"you're not going to the shops to get chocolates or crisps

"or sugary drinks," and sometimes I'd get small chocolate bars.

But then when it comes to checking my sugars, I'm like,

"Oh, my God, I need to drink a lot of water."

Ameer and his mum, who also has Type 2, have to come regularly

to the hospital where his condition is being closely monitored.

Hello.

Hello, how are you doing? Nice to see you, nice to see you.

Nice to see you too.

'It's been three weeks since I saw him last.'

The glucose level for somebody who doesn't have diabetes would be

between about 3.5 and about 7.8, something like that.

We're trying to get him to manage his glucose between 4 and 7,

and once it's over about 14, actually,

it's much higher than we'd like to see.

So we're going to need to do a glucose check today, all right?

Yeah, OK.

OK?

-18!

-18?

So that's way too high, isn't it?

18 is a very high level.

Any reason why you think your sugar was so high this morning?

-I don't know.

-What did you have to eat last night?

Normal chapati and curry.

OK.

The problem is, Ameer, is that if we carry on like this at 15,

by the time you get to 25 you'll get eye damage.

And you've already had gout and stuff in your feet as well

and you will get these other bits of damage.

So I'm sure you're eating healthier, which would be great,

but you need to eat less.

OK.

'I'm worried in the long term

'because we're not winning at the moment,'

either in terms of his weight, which is static,

or his glucose control, which if anything it's got worse

than it has been before.

Thank you. Thank you, doctor.

All right, thank you, then. Thank you, Ameer.

'I think he's at a bit of a crossroads.

'He's got a whole lifetime ahead of him with diabetes.'

I'm quite gutted, actually.

I mean, this is what I've been banging on about to Ameer

when he's missed his dosage.

He'll go into his own bubble.

He's a nice lad. I think he finds it difficult to motivate himself.

He's still eating more calories than he's burning off in exercise.

I've just got to try even harder than I did before.

Ameer has to cut out even occasional lapses.

-INTERVIEWER:

-Is there sugar in your Ribena, Ameer?

I think there is.

Erm...

Yeah, look, it says here.

It's got 26g.

29% sugar.

Oh, God.

-You're going to be in trouble now.

-Oh, no.

You're going to be in trouble.

You did say to me, "Pick up any drink,"

and I just thought, "Ribena, it's rich in Vitamin C."

He's sneaky.

Like, he'll get snacks and not make it aware to everyone that

he's got them.

And then we'll just find wrappers and we'll be like,

"I didn't have that."

My brother will be like, "Well, I didn't,"

and my mum will be flipping. "Who's had it? Who's had it?"

And then we'll find out it was him. Hiding upstairs, he had it.

There are now over 500 children in the UK diagnosed with

Type 2 diabetes and the number of new cases is rising alarmingly fast.

Every new diagnosis of Type 2 diabetes in children

has been analysed by Ameer's doctor and academic colleagues.

It was August last year, so he would have been 15.

Definitely got diabetes - see the random glucose.

We're seeing twice as many children developing Type 2 diabetes

than we were in 2004, 2005.

A striking number of the children have evidence of

fatty infiltration of their liver and abnormal liver function tests.

An 11-year-old, a 12-year-old.

I saw a child last week who is actually developing

cirrhosis of the liver.

Type 2 diabetes in children may be a different disease to

Type 2 diabetes in adults.

So adults who get this at the age of 50

may not necessarily get these other complications.

But the children we're seeing with Type 2 seem to have got

a more aggressive progress, and they're getting these complications

earlier than you would expect.

As greater numbers of children are being diagnosed with Type 2,

the financial implications for the NHS in the future are grave.

Jon O'Hagan lives with his wife Severine and their two children.

He is still struggling to control his sugar intake.

Behave yourself, shorty!

Elle a mange toutes les carottes!

It's 6.45 on Friday 1st July.

I've just had breakfast.

Four Weetabix topped up with Frosties

and a pint of tea.

And I've also had a huge amount of the chocolate slab

that I was bought yesterday.

Over many years Jon has been unable to beat his compulsion

to eat chocolate, even though it threatens to devastate his health.

This I've had to buy because this was the chocolate that was in

the fridge this morning which my wife bought for our children.

And basically, I've stolen the children's chocolate

and I've now had to replace what I've stolen.

I can't have anything in cupboards on show because I know that

if I go out, it wouldn't be there.

-INTERVIEWER:

-Do you make a habit of hiding treats and snacks?

Yes, yes, all the time,

and he's very good at finding my secret places.

I'm like a bloodhound for chocolate.

I know!

Have you tried to change him?

I've stopped, really.

You know, I've got two children to sort of try to give

a good diet to and he's an adult.

You know, he's got to do it himself.

And I know it's hard.

And he's got no will, because he sniffs some chocolate and that's it.

-Let me go!

-Shh.

-Louis, shush.

-What?

-It's purple.

-No, it's pink.

-All right, it's pink.

That's pink.

You're right, it is pink.

I couldn't see it when you had it thrust halfway up my nose.

I've suffered depression an awful long time.

My first episode that I know of I was 15.

So...

-That's young.

-Yeah.

My mother and grandmother both showed

a lot of their love and affection through food.

So there was always lots to eat.

Mum was a fantastic cook.

So my brothers and I used to compete for the mixing bowl...

..erm, which was never light on sugar.

A lot of people self-medicate depression with booze.

I don't do that.

A lot of people with depression will smoke heavily.

I don't do that any more.

Erm, I eat.

Even though you know that that bingeing and being overweight

are damaging you?

In the same way that George Best knew that when he was on his

second liver, the drink was still going to kill him eventually.

It didn't stop him drinking.

You sit in Maman's chair.

Right, I've made you both far too much.

Eat what you can, don't worry if you have to leave some.

Jon has decided he can't beat his addiction on his own.

123.6.

So it's gone up from when I was I was last seen in clinic.

He too has opted for irreversible weight loss surgery.

I feel quite awful that I need to seek surgery

to affect the changes I need to affect,

but I've tried every other means and failed.

Thank you, baby.

Things have got to change now because I have two children...

..and I want to make sure I'm around to see them grow up,

I want to be part of their lives for as long as I can.

If I don't look after my diabetes,

I face the prospect of vascular problems, dementia, strokes,

heart disease and my life expectancy reduces dramatically.

I don't want that to happen.

It's as simple as that, I don't want to miss out on their lives.

Good girl.

Sharon's weight loss operation is imminent.

But the surgery will only go ahead if she completes a strict,

four-week crash diet in the run-up.

Until my surgery, it's 16 days.

I've got to stick to less than 1,000 calories...

..a day. So, it's...

And I'm trying to just still eat normally,

but obviously just eat a lot less than what I would normally do.

If my liver isn't looking good -

which is what the diet's all about, it shrinks your liver -

they might not do it, they might just say, "No, sorry.

"You've not followed the diet, we're not going to do the surgery."

And I would just be devastated if that happened.

I do actually feel, in some ways, ashamed that I've let myself...

Let this happen to me.

SHE WHISTLES

I'm never going to be a stick insect, am I?

As long as it gets rid of the diabetes and makes me

more healthy... I just want to be able to be more active and do stuff,

even going and having a dance and things...

-Nothing stops you from having a dance, though, Sharon!

-I know!

THEY LAUGH

Diabetes can have a catastrophic, long-term effect on patients...

There's a blockage in the artery.

..but it's also creating a potential catastrophe for the NHS.

All aspects of health care that are affected by Type 2 diabetes

are straining at the seams, bursting at the seams, trying to manage

this increasing number of patients with these complications.

Each time one of these episodes occur,

each time the patients come into hospital, there is a huge price tag

in terms of economic cost and mobilisation of staff and resources.

The NHS spends nearly a billion pounds a year on foot ulcers

and amputations caused by Type 2 diabetes.

That's almost 1% of the entire NHS budget.

We now probably need around double the number of beds that we used

to have in vascular surgery to help with this influx of the disease.

Nice glass of port.

-I pretend it's port.

-You pretend it's port?

John Westwood has had more surgery.

Doctors have constructed a stump that they hope will be robust

enough to support a prosthetic limb.

It's just traumatic, you know.

He knew what was going to happen

and I didn't.

I thought he'd be all right, you know.

I knew he'd lose his toe, but not the lot, not like that.

You get a pain here, and you're sitting thinking, "God, that hurts,"

and then you think, "But there's nothing there, so what's hurting?"

It's ever so weird, I tell you.

It's because the brain's trying to find the other foot, you see.

John's two operations cost the NHS about £18,000.

Rehabilitation will cost a further £20,000.

But some Type 2 patients require even greater levels of care,

to give them a chance against the disease.

Norma Edmonds has already lost both her feet to Type 2 diabetes.

Now she's back in hospital with an infection which is tracking

up her leg and threatening her life.

First, it was my toe, and I had to have that amputated,

and then it went into the bone so I had to have another operation.

And then it went onto the other foot.

So, you know, within two years, I had both feet amputated.

-You're in your 50s still, aren't you?

-Yeah.

-How old are you now?

-56.

-You're 56 years old.

-Yeah.

PHONE RINGS

-Can I answer that?

-Course you can.

Can I ring you back because I've got somebody with me?

All right. I'll see you in a bit. Bye. Love you.

That's my better half.

Norma got married at 19.

We've been married, erm...

..37 years now.

We was in the pub and he went down on his knee

and said, "Will you marry me?"

and I thought he was joking at first.

I was so happy that day.

I look so nice there as well.

Norma gradually put on weight in her 20s

and began to hit acute problems in her 40s.

So far, doctors have managed to preserve some mobility for her.

This time, it'll be harder.

Unfortunately, the infection is not really settling,

so we would have to go back and take out more muscle,

more skin, more bone from her leg below the knee.

Even if we did that, it's quite likely that wound would never

heal, so she would never get back a leg that was useful to her

that she'd be able to walk on.

The alternative is to do an amputation above the knee.

The old curtains were much easier.

Most patients who have an above-the-knee amputation

will never walk again

and will need costly ongoing care.

-Hi, Norma, how are you?

-I'm fine, thank you.

-Do you understand what we're going to be doing?

-Yeah.

Amputation, yes.

So, as you know, you came into hospital with a lot of infection

-in the leg, in the left leg.

-Yes.

We agree that probably the best way of getting you out of hospital

as quickly as possible would be to amputate the leg above the knee...

Yeah.

..which is obviously a big step and a big decision

but I think that's what you... You were quite clear in your own mind,

that's what you wanted.

-That's still your view now?

-Yes.

-That's what you'd like us to do?

That's what I'd like you do to, yes.

-OK, see you later. Bye.

-Yeah, see you later. Bye.

Seven and a half, please, Tom.

OK, watch your fingers.

That's the leg free.

We like it to look symmetrical and neat and tidy,

as much as an amputation stump can ever look nice.

I think having a good shape is important.

I'm happy, happy with the way it's gone. Thanks.

Norma won't be strong enough to leave Heartlands for nearly a month.

And the average cost of a single night in hospital is £400.

When all the costs to the NHS of Type 2 diabetes are added together,

the total is an estimated £10.3 billion.

That's nearly 10% of the entire NHS budget

and is set to continue rising sharply.

One way to save Type 2 patients from the worst consequences

of the disease is bariatric surgery.

It could also save the NHS money in the long run.

-Hi, Jon.

-How are you?

-I'm good, thank you.

Jon will have gastric bypass surgery in four weeks,

as long as he can stick to the pre-op diet.

Right, Jon, the principles are to create a small stomach,

and that should reduce how much portions...

how much food you can eat in one go.

And part of that is physical, mechanical

and part of that is hormonal because certain hormones will be released

which will encourage you to feel full.

So you can actually walk away from a small plate of food

-feeling quite satisfied and not hungry.

-That'll be nice.

-You've got to go on a very low-calorie diet.

-Yes, I'm aware.

800 to 1,000 calories a day, maximum.

This is not a punishment for you, Jon!

THEY LAUGH

-The reason why we're doing this is to shrink your liver down...

-Yes.

..and this will definitely help.

How do you feel you're going to get on with this?

It's going to be horrendous. I'm going to struggle,

but I have to do it, so I'm going to do the best I can.

-Thank you.

-See you soon.

-Bye now.

Jon hopefully will get a good result.

Diabetes resolution after gastric bypass surgery

is quite an amazing thing to see.

Within six weeks or so, we can get them off insulin.

But if you feel like you suddenly want to go out

and have a large meal, that's not going to be possible

without you either being sick or feeling pain

and there is a finality to that that people have to mentally be prepared for.

Sharon has completed her crash diet

and her bariatric surgery will go ahead today.

The main part of her stomach will be cut out,

leaving only a narrow tube with much less space for food.

Sometimes, we have noticed the tube is too narrow

for some of the patients.

If this happens, we may need to re-operate on you long-term.

If you're happy, I would like please to ask for your signature here.

-Print your name underneath and the date first.

-Yeah.

-Thank you.

The risk of serious complications is low,

but the impact on Sharon's life will be huge.

-Thank you.

-Thank you very much.

See you in theatre. OK, thank you. Thank you very much.

Today is the start of a new life, really.

Hopefully.

And hopefully a better one, not a worse one.

It's not something that you say, "Well, I can always have it reversed

"if it doesn't suit."

It's a complete life change, so she's going to have

to eat differently now for the rest of her life,

which I know is the whole idea.

I can't even imagine what that will be like.

Someone said to me the other day, "But it suits you, being big,

"that's you, that's who you are, and that's your personality."

And everyone knows me as me, you know.

You know, as Sharon, she's the big girl, she's, you know...

Yes, I'm quite bubbly and stuff like that.

I'm thinking, if I'm just a normal, average, slim person,

will I just be insignificant?

Do you know what I mean? Will I lose me?

And then I need to find myself a nice gorgeous hunk of a man, then.

We're going on the ground floor.

'Doors closing. Lift going down.'

-I feel a bit sick now.

-Do you? Getting a bit nervous?

-You'll be fine. We'll take good care of you.

-I know, I know, I know.

SHE EXHALES

'It's just that putting yourself through surgery,

'which I know is a risk,

'when really, if I just had willpower and self-control,

'it wouldn't be necessary.'

There you go.

'You know, they're cutting half of your stomach away.'

We'll do four very small cuts across the top part

of the abdomen of the patient.

We're going to remove the main part of the body of the stomach.

Nearly nine in ten Type 2 patients

see dramatic improvements after surgery.

Recent evidence suggests bariatric surgery

not only makes people eat less,

but it can also kick-start the body's ailing insulin system.

Yeah, yeah. Wait there, wait there, wait there for us.

Wait there for us.

We know that we can treat diabetes with bariatric surgery.

It is a cure. We have hard evidence now to use this phrase.

It is a cure. At the moment,

bariatric surgery is the only way to control the current problem.

One more clip, please.

Sharon's bariatric surgery cost around £5,000,

but it should prevent her from developing

complications in the future.

This could save the NHS money in the long run,

and many doctors think more patients should be offered the treatment.

It's an investment the NHS has to make,

so the resources have to be moved from somewhere else

towards bariatric surgery, and that's not always easy.

-We have the clip on here.

-Yeah.

Just the dog-ear at the end. Be careful of the dog-ear.

Specimen.

This is a life-changing operation.

We removed part of the stomach.

It looks like a narrow tube, but actually when we are eating

and drinking, this part of the stomach can really expand

and accommodate several litres of volume.

Very happy with the result.

In the whole of England, there are just 6,000

weight-loss operations a year, down on previous years.

But if the NHS met the European average,

it would do nearer 50,000,

enough to make a small dent in the epidemic.

I think it needs to be far more well understood

within the health care system. At the moment, I'm not sure whether

everybody understands those benefits correctly.

-INTERVIEWER:

-Within the NHS, there's been a reluctance

to embrace bariatric surgery.

I wouldn't call it reluctance.

I don't know whether that is the right word,

but I think the transition

has been very slow and a lot more people working in the NHS

need to be made aware of the benefits of bariatric surgery.

Once that is done, perhaps we would start seeing

more people preferring bariatric surgery as a treatment

and more people being offered surgery as a treatment.

For Sharon, the effects of surgery are immediate.

I came home last night, and I feel as though

I've pottered around today

and I feel quite bright and chirpy, really,

considering it was only three days ago.

I think I'm going to try some oxtail soup.

I'm not thrilled by the look of it.

Hmm.

Six.

Six. Six teaspoons of soup.

The NHS does have a plan to tackle the epidemic.

The idea is to intervene earlier to prevent

Type 2 patients ever needing expensive hospital treatment.

The hope is that hospitals, community services and GPs

will work more closely together.

But right now, many GPs

in the front line of the new prevention strategy

say they are already stretched to capacity.

Sorry about the wait this morning. Have a seat.

Six years ago, we maybe had just over 200 people

who had Type 2 diabetes. Now we've got over 400.

Absolutely huge amount of our time as a practice

is spent caring for people with Type 2 diabetes.

Are there any vegetables that you do like?

I don't mind, er...sprouts.

Within primary care, we are limited

in the resource that we are allocated.

I think that having to try and provide a good quality of care

for all the people on our books who have diabetes

that we see in our practice, of all age groups, is very difficult.

Say yes to me when I'm touching your feet.

Nothing.

No. OK, well, we knew that anyway, didn't we?

-Are you able to do any exercise at the moment?

-No, not really.

-OK.

-It's inevitable that we struggle.

-We're not coping now,

and my main concern is unless there is a real injection of resource

that is targeted into the problem,

that we will not really meet the challenge of Type 2 diabetes at all.

In a cash-strapped NHS, it will be hard to put enough money

into prevention and GP care,

while limited resources have to be spent on life-threatening cases.

I think I'm in a dip here.

Norma has been at an NHS rehabilitation centre

for seven weeks.

With help, she has learned to move from bed to chair.

-How does that feel?

-Lovely, thank you.

Thank you, Caroline.

It's getting better every day, sort of thing.

Sometimes I've got annoyed with myself

cos I can't do stuff that I want to do.

You know, getting in the car, going out for a drive,

going the shops... that's going to take some time.

John Westwood is out of hospital too.

After weeks of physiotherapy,

the NHS is gradually helping him to walk again.

One, two, three and...stand.

OK. And then start to take a step forward.

Take a step with it, small step,

then take half your weight through it.

And then step forward with the left. Lovely.

I'll move out of the way in a minute

so you can see yourself in the mirror.

OK. Right through there. Brilliant. How does it feel?

Magic.

To me, it means everything. I'm going to walk! Fantastic.

You wouldn't believe what I could...

You know, it's over the moon, innit, you know?

Well, the surgeon that did it, he said,

"Don't worry, it's not the end."

And, you know, it stuck with me, that did.

That's a big one.

I could have lost him, and that's...

I'm grateful for the fact that I ain't going to lose him.

For 50 years, apart from being at work, when we were at work,

never been shopping without one another,

we've never been on holiday without one another,

we never went out anywhere without one another.

Never ever.

And we've been married 50 years.

Well, I've got him and that's it.

And whatever he wants to do, we'll do,

and whatever I want to do, we'll do.

It won't stop us.

Stopping the Type 2 diabetes epidemic is a daunting task.

It could still be achieved

if bad diets and unhealthy lifestyles changed.

Have you some stickers somewhere?

Charities like Diabetes UK are doing their best.

This is five pounds of fat.

Now, if you're on a diet,

that is realistically what you could probably lose in a month.

Would you like to do a free Type 2 risk assessment?

Would you be interested in finding out your risk of Type 2 diabetes?

Would you be interested in finding out your risk of Type 2 diabetes?

It can be very frustrating walking down the high street

and seeing all the high-fat, high-sugar,

high-calorie, cheap food on offer.

There does seem to still be a huge resistance to looking at changes.

I do feel that a lot of what we do is such a waste of time and resource

and does leave patients very damaged and disabled.

You can still find out your risk.

Would you like to come on board and find out your risk?

The Government has proposed a sugar tax on soft drinks

and published a childhood obesity strategy,

but many doctors think it needs far tougher action

to have any chance of making a difference.

The childhood obesity strategy has fallen short of

what many people would have hoped.

We know that this is a disease that is unrelenting, unforgiving.

We are in a crisis now,

and it can't be left for health care professionals

such as ourselves to endlessly pick up the pieces.

It's Jon O'Hagan's first week without chocolate.

If he sticks with his diet, his surgery will go ahead soon.

It'll be worth it when I get the surgery

and I won't be able to eat and binge.

Right now, it's just awful.

It's now ten to six.

I'm eating my porridge.

My next meal will be an apple...

..in four hours and nine minutes.

By improving his diet and keeping on top of his medication,

Ameer has got his diabetes under better control.

A month ago his blood sugar levels were as high as 18.

It's not that high, but it is in double figures,

so I'd say it's above average.

High, but not as high as you'd expect,

so I'm happy, kind of, with it, so...

My goal is trying to get a 6.5, because that is...

That's perfection.

I was reading it, that is the best sugar reading you can get.

See, I like that dress, I like that dress...

The NHS has given Sharon a new start.

It's not one you'd go out in,

it's what you'd wear to go to work and stuff in.

Three months after surgery, she's lost three stone,

and her blood sugar is down to normal non-diabetic levels

without medication.

Feel fab, feel fab.

'I haven't really got diabetes now.'

And I feel like I've sort of had a lucky escape from it, you know.

In ten years' time, who knows what would have been happening to me?

There are now four million in the UK with Type 2 diabetes.

In ten years, there will be a million more.

The fear is that without fundamental changes,

the NHS will not be able to survive

the rising costs of this deadly epidemic.

In a way, you feel helpless.

With the way things are going,

it's probably going to get worse rather than better.

10% of the NHS' money is quite a lot.

If it continues at the current rate, certainly,

it will not be sustainable.

The consequences are stark.

Either the NHS will have to make some hard choices...

I am worried the NHS will have to decide what conditions it does

or does not treat, and that is a very difficult decision to make.

How are you doing there, sir?

..or it will simply run out of money.

Diabetes will have a tremendous burden

on our National Health Service which is probably unaffordable,

and it would be much cheaper to actually change lifestyles now

and prevent people developing these complications

than to try and pay for it through the NHS.

Right. Where next, then?

How are you getting on?

Nice to see you.

'Very resilient, we Brummies are.'

You know, get knocked down, you just pick yourself up,

carry on with life, don't you?