24/10/2016 Inside Out East Midlands

in our special diabetes programme.

New figures suggest the health service will struggle to cope

with what the experts are calling an epidemic.

We are certainly looking at a crisis in diabetes,

which does threaten to bankrupt the NHS, if we continue

with these current trends.

Also tonight, where you're from can affect your risk,

as this Leicester family knows all too well.

as this Leicester family knows all too well.

This is my family.

Here's my father, he is diabetic.

We are really worried, actually, because maybe I will have it

as well, or my sister.

And how tapping into a virtual network is helping

patients feel better.

The stories that matter, closer to home.

I'm Lukwesa Burak and this is Inside Out for the East Midlands.

Well, first tonight, nearly 4.5 million people in the UK

now have diabetes.

Most of them have type 2 diabetes, which is linked to lifestyle,

and so is largely preventable.

Diabetic care already costs the NHS ?10 billion a year

and that is nearly 10% of its entire budget.

Well, new figures seen by the BBC show that those costs are likely

to spiral before the city continues to rise.

-- if obsesity continues.

The BBC's health correspondent Dominic Hughes reports.

And a warning that this report

does contain images you might find disturbing.

Today, I'd like to invite you to a shoe shop with a difference.

So what we've got here is 140 shoes and they represent 140 amputations

that take place in England every week due to complications

associated with diabetes.

So people losing toes or lower limbs.

Cor, quite shocking.

That's a lot of limbs are being lost.

We set up this shoe shop to show just how serious

type 2 diabetes can be.

It's really sad.

Has that sort of shocked you?

Yeah, quite a lot, yeah.

Most diabetics have type 2.

Where you come from, and your family history,

can increase your risk, but doctors say most

of it is down to obesity.

Now, new data, given exclusively to the BBC by Public Health England,

estimates there will be an extra quarter of a million people

with type 2 diabetes by 2035, if we continue to get fatter.

It's not just amputations.

Diabetics are at risk of kidney failure, blindness,

even premature death.

And the NHS is spending ?10 billion a year on diabetic care.

That's nearly 10% of its entire budget.

As things stand, we are certainly looking at a crisis in diabetes,

which does threaten to bankrupt the NHS, if we continue

with these current trends.

One of our shoes belongs to Steven Woodman.

We caught up with him as he arrived at the Royal Shrewsbury Hospital for

an appointment with his podiatrist.

How's things? Not too bad, not too bad.

Like 90% of diabetics, Steven has the type 2 version,

which is linked to lifestyle and so largely preventable.

But diagnosed as a young man, he ignored his GP's advice.

I was in denial, I guess, I never took it that seriously,

and I carried on leading the lifestyle that I was.

I was a lot younger, this was over 25 years ago.

I was out going to the pub and doing all the things that

people of my age did and, of course, now I know do different.

Not too bad. Well, I was in hospital last week.

Like many diabetics, Steven developed an ulcer on his toe.

Look away now if you're squeamish.

The ulcer wouldn't heal and, in the end, he had to have

this toe amputated.

He's lost two more since then.

My surgeon did say to me, when he was taking my third toe off,

um, "It's only a matter of time before you lose that one."

He said it was inevitable that will go the same way.

I've become an old man very, very quickly and, inside,

I don't feel old.

I'll go on for ever, I thought.

Patients with type 2 diabetes are not just losing their toes.

Some have had to have a foot amputated or even a lower leg.

It's life-changing and very expensive.

It's approximately ?20,000 for the first six months

following a patient who requires an amputation.

There's the limb fitting.

And even a basic prosthesis costs thousands of pounds.

All of those aspects mean that it's a very expensive

process for the state.

Nick Nex is the health economist who worked out the current

cost of diabetes care - that ?10 billion figure.

Most of that is spent on complications.

Foot ulcers and amputations cost nearly ?1 billion a year.

Kidney failure isn't far behind.

Then there is sight loss and nerve damage.

But the biggest cost of all is for heart

attacks and strokes.

With both obesity and type 2 diabetes affecting more and more

of us, costs for diabetic care are expected to increase

to ?17 billion by 2035.

There is a fixed amount of money for the NHS, so clearly,

if one disease area like diabetes is taking up a more considerable

amount of that cost, then there is less money to spend

on other disease areas, like cancer, so it's really important

that the policymakers and local commissioners of care think

about the way in which those costs can be mitigated over the next

few years, because clearly, that isn't going to be

enough money to go around.

I'm just taking all the measures we need to do

to make up the footwear.

Back at the Royal Shrewsbury Hospital,

Steven is getting his feet measured.

Losing three toes means he has to have specially-made shoes.

They don't come cheap.

Just out of interest, how much is a pair of boots

like that going to cost?

Um, because the boots will be custom-made to fit your feet,

they will cost approximately ?400- ?500.

Whoa! Yeah.

Really?

We are facing a diabetic epidemic and we really need to try and find

ways of preventing those patients from reaching surgeons,

because the cost to the patient and to the NHS is skyrocketing.

A new problem is expected to put even more

financial pressure on the NHS.

16-year-old Aisha is one of a small but growing number of children

with type 2 diabetes.

I developed type 2 diabetes by having a sweet tooth, mostly.

I used to try out every new sweet and I used to drink quite

a lot of sugary drinks.

When I was taken to the hospital, when the doctor told me

I was diagnosed with type 2 diabetes, it hit me then,

cos I started crying and it was shock.

Aisha now has to rely on medicine to control her condition,

but she's managed to lose a stone in weight and those fizzy drinks

are a thing of the past.

It's been really hard at times, but you can only have helped once

and you can't really buy your health, you have to keep...

You have to keep changing your diet plan to whatever it is and also

keeping fit and healthy.

New research shows the number of children like Aisha with type 2

diabetes has nearly doubled in the last ten years

and they're likely to develop complications much earlier.

People who are getting type 2 diabetes when they are 15

or 16 are going to have significant problems,

or likely to have significant problems, maybe at the age of 35-36

and that's really much younger than you'd expect, because these

are things like renal failure and heart attacks and strokes

and it's going to have a huge impact for them.

Ultimately, tackling the rise in type 2 diabetes will depend

on reducing our waistlines.

I believe we're facing a crisis and, in calling this a crisis,

we really need concerted action right across society for us to fund

more research, to provide the best possible care and treatment

and crucially to prevent so many cases of type 2

diabetes in the future.

We need to stem the tide, otherwise, yeah,

we could see crisis, um...

And there are issues of sustainability for the NHS

if we do nothing differently.

Let's go together.

Steven's diabetes has stabilised, but it's too late to save his job.

Unsteady on his feet after losing his toes,

he's been told by his employer he's no longer fit for work.

Given everything you've been through, Steve,

what would your advice be to other people who are being diagnosed now

with type 2 diabetes?

For god sake, take it seriously!

Don't make the mistake I did.

It's the biggest regret I've ever made, you know, in my entire life.

It's a dreadful, nasty disease.

It takes no prisoners.

It's a terrible thing.

Well, here in Leicester, where diabetes often runs

within the family, the city actually has the third worst

rate in the country.

And so, diabetes charities are now taking their message

to the heart of the community.

Sarah Sturdey has the report.

Hi, Mum.

Hi. Hi.

There is some okra. Yeah.

At home in Leicester, the Akramuls monitor the family shop,

especially Tabassuma.

Cake from Aldi. It's not for you.

It's not good. Too much sugar.

This is for us.

This is my dad and this is my mum.

My dad has been diagnosed with diabetes type 2 in 2007,

and my mum, maybe she is at risk to have it, because her mum has it.

No wonder Tabassuma's worried.

Her dad's diagnosis nine years ago wasn't a surprise.

Type 2 diabetes runs in the family.

This is my family.

Here's my father, he's 82, he is diabetic.

Here's my brother, he has also diabetes.

My sister, she has diabetes.

And my wife's mum, she has also diabetes.

We are really worried, actually, because maybe

I will have it as well, or my sister, my brother,

they can have it as well.

Hoque Akramul, who was born in Bangladesh, is one of more

than 20,000 people in Leicester who are diagnosed every year.

The city has one of the highest rates in the country.

The Leicester Diabetes Centre is internationally

renowned for its research.

Tabassuma wants to know why people originally from South Asia

are more at risk.

OK, Tabassuma, we devised this simple risk score,

and what it will do is identify people who are at high risk

without them having a blood test.

And then, if they are high risk on the risk score,

then they would go on to have a blood test.

Professor Kamlesh Khunti, a Leicester GP, co-founded

the centre, which devised the online risk assessment.

More than 1 million people have taken the test.

No-one exactly knows the exact reasons for this increased risk,

but there does seem to be interplay between the genetic

and the environmental factors.

And they are very simple questions regarding age,

sex and, the most important one that we've devised and it's important

for the UK communities, because it is a multiethnic

population, there is a question regarding your ethnic background.

So, for example, you and I would click South Asian.

Straightaway, they would put us at a much higher risk.

Evolutionary-wise, what happened was we think South Asians

stored their food more within the abdomen.

But now, we are in an era where food is abundant,

there's lots of it, and so this is playing against them now.

But within South Asians, Bangladeshis have the highest risk.

It seems like, in my dad's family, it's genetic.

Yes.

So, South Asians don't tend to exercise as much, food

is in abundance and South Asians do have a double whammy...

In fact, they have a triple whammy, because they have the genetics

against them, they need to do more exercise, which they don't do,

and when they do do exercise, they need to do double the amount

of exercise to get the same benefits as a white European person.

It's a PTA fun day in Leicester.

We've done how to talk with people, how to talk with people

about diabetes, what is diabetes.

They have to take care about it,

because otherwise it will create other conditions.

Well, I think it's really important that we help people

identify what the risks are, so that...

Tabassuma is helping Khrishna from Diabetes UK to reach

those people who are most at risk.

As a De Montfort University student champion, she has been trained to

get the charity's message across.

There's an element of genetics, there is an element

of diet, culture,

lifestyle.

A diet that is rich in carbohydrates and in saturated fats

and also rich in sugars.

You combine all of that with the

lifestyle that doesn't require much physical activity,

you've got a pretty

toxic combination.

The number of people diagnosed in the city is

almost a third more than the national average but there are

thought to be thousands who don't know they have it.

There is sugar in there.

Your food and your evercise is so important.

In this community, it is a laissez faire attitude.

My uncle's got it, my dad's got it, what's

the big deal?

I'll pop a pill and it will control my glucose.

Very rarely do they hear the bad side of this

condition which is all the complications, the cardiovascular,

the amputations.

Cola is the highest and it has nine sugar cubes.

Pure orange juice, four.

You can do an online test, it is called Know

your Risk.

I would advise you as your dad is diabetic and you are Asian.

It's within our individual control to prevent it so why don't we do

things to actually prevent it?

Back home, Tabassuma's dad has had to make big changes

to manage his diabetes and prevent serious complications.

You have to change some diet, you have to go

every day half an hour walking, so it is important thing.

Don't take any sugar.

Now we are going to do a questionnaire.

But Tabassuma is worried about her mum.

This is an online simple questionnaire that you can

find simply at home.

The nagging has worked and she has agreed to see how likely

she is to develop diabetes.

It says that you have a high risk.

Are you happy to do a proper diabetes blood

test?

You're happy?

Yes, that's really good.

Across in Melton Mowbray, there is a mobile testing unit in

town for the day.

The charity, Silver Star, has two units in

Leicestershire, one in London and one in India.

A simple pinprick test will tell her whether she is really

at risk.

We're just going to wait now.

Five seconds left.

Borderline.

It's a test that takes...

It is 99% accurate and it is showing your

blood for the last three months.

This test shows here that it is like prediabetic now

so I would advise you to take a second test with your

GP.

This is your letter where you go to show your GP and say that you

had a test here with us.

You are at high risk, you have time because

you're borderline so you still have time to decrease your risk.

A few days later, it is the Leicester

Mela, a great opportunity for Tabassuma and her

student friends to spread

the word right next to the food stands.

Meanwhile, her mother has decided it's time to learn more about

diabetes.

Now it is mum's task.

I will help her.

I must regularly exercise.

Which doesn't mean just going to the gym, she can do normal

things at home like hoovering more, gardening, just

more movement rather than

just sitting and watching TV.

It will help dad, he is already diabetic,

obviously it will help us to lower risk to have it the future.

While Tabassuma prescribes herself a large dose of

exercise, her mum she knows she now has to follow suit.

If you'd like to learn more about the steps being taken to

tackle diabetes right around the country, why not head to our

website.

Living with diabetes can be an isolating and it can be a lonely

experience but now, a virtual community

based right here in the

Midlands is aiming to tackle that.

Diabetes.co.uk is Europe's largest Internet forum

for people living with

diabetes.

David Gregory has been to find out how everyday it helps

people that have been diagnosed with the disease.

I was diagnosed when I was nine, so 11 years ago now.

It's all OK now.

I was diagnosed in 1992 and how I feel about my diabetes at

the moment, I'm happy with where I am.

I was four years old when I was

diagnosed with type one diabetes.

I'm 28 now, I'm in a good place.

I've had diabetes for 53 years and I don't

think I've ever got used to it.

For people who know nothing about the disease,

what's a normal day like?

Managing diabetes, for someone with type one, there is a lot of

decisions going on that other people just can't see.

Testing your blood sugar before eating, injecting

after eating, counting carbs,

working out how much insulin you

have to give yourself, doing a lot of maths!

It's a bit of a headache.

Around ten blood tests a day and around five injections a day.

Generally, it's very well controlled.

Making sure blood sugar is in range, treating a hypo,

treating high blood sugar, drinking enough water,

there's a lot to it.

At what point did you might realise you might have

another problem?

I've always been on the bigger side but managed to keep

it under control.

I'm not really sure what happened but I got to the

stage that I got really large and every time

I thought about dieting, I started binge eating.

Packets of cakes, packets of biscuits, large

packets of crisps, it was almost as if I never

thought about the sugar that was in the cakes and buns.

I wanted them, so I had them.

Is it hard to spot when someone with diabetes also has a problem with

food?

One of the problems we have is that we suspect there are quite a

lot of people with diabetes who have an eating disorder that hasn't been

recognised.

They often say that the diabetes, to them, has become a

chore.

It is something they have to do and they often find this really

difficult, trying to stick to regimes and trying to look after

themselves.

We know that if you have diabetes, you are much more likely

to develop an eating disorder than if you don't.

The risk is probably at

least double.

We don't know exactly why that is but certainly one of the

possibilities is that when you have diabetes,

there's a lot of emphasis on food, on having the right amount

of food and the right types of food.

Other possibilities include the fact that it is quite stressful to have

diabetes and we know that stresses can precipitate eating disorders.

The minute I started thinking about a

diet, then I wanted to eat more.

I just did eat more until I stopped thinking about it.

That really is what led us to set up this clinic because

we recognised that to help people effectively who had diabetes and an

eating disorder, we need to have a team of professionals who understand

enough about both sides of the coin.

I think one of the biggest things was having Lynette to talk to.

Hi, it's lovely to see you, how are you

doing?

Not too bad at all.

It's good to be back with you for awhile.

It was definitely a mind thing, for me anyway.

It was just a matter of clearing out the garbage and getting

down to the nitty-gritty, if you like, of getting back into a

sensible eating regime.

How does that make you feel?

They did the hard work, I only guided them!

It's great to see people leaving the clinic

with their eating under control, taking their insulin, diabetes well

managed and just getting on with their lives.

Diabulimia is just a hugely sad condition and the prevailance of it

has become extremely common in the last few years.

It is important that you don't bottle up what you

are feeling because the more you bottle it up, the more likely you

are to become more and more sad.

What we find is that on the forum, because it's people who live with

diabetes day-to-day and have this blanket of understanding, somebody

with diabulimia can feel comfortable to open up and that is

often the first step in actually dealing with it.

People have been living with it, struggling with it

for a number of years, feeling embarrassed or scared

to talk about it and the forum is one of the places you can talk

about it.

When people are talking about it on the forum, is it all

diabetes, medical?

We don't always have diabetes related questions.

We can have anything from relationships

to sex to just ranting about your best friend.

We have a gardening forum and people put up pictures of

their gardens and stuff and it's really nice.

It's not just about diabetes, it is a community, we are

like one big family across the world.

How big is diabetes.co. Uk?

It's huge, we're pushing 220,000 members.

It's necome the biggest community in Europe with

people with diabetes.

It is very useful to have the website.

People will have questions about their

diabetes and so many of us, we turn to the Internet to get answers here

and now.

It's a platform for people to connect all the way across the

world to just talk to each other about anything

and it's really interesting

because you have someone in Australia talking to someone in

Ireland and you get these completely different life

experiences and they have

this connection through diabetes so it's really

constructive, not only

just health care but in terms of friendship and support.

So, does diabetes stop you doing anything?

No, not at all.

I definitely try to not let it stop me doing anything

because I like to go out with my friends and eat junk

food and I just know

that I have to take more insulin and keep an eye

on my blood sugars.

For me, not really.

Maybe if I wanted to go deep sea diving, but no,

it doesn't get in the way of me at all these days.

It used to.

Of course you can live a happy life with

diabetes.

We have some of the bubbliest people here who live with

diabetes every day.

There's nothing to say that diabetes can hold you

back at all.

You are what you are and sometimes things happen in your

life and it's not something to regret, it's something that shapes

and moulds you as a person.

People go through things in life but they

shouldn't take them back, it's what makes you stronger

and that is one thing I noticed in the forum, these

people come to us, even if they are there in their darkest moments,

these are the strongest individuals that we come across every single

day.

Happy with that, that's really good!

If you're worried about diabetes, we've put together some

really useful links for you.

All you need to do is head over to this

website.

That's it from us for this week.

Here's what we've got planned for next Monday.

What's the future for children's heart surgery in the

East Midlands?

Consultants in Leicester are worried.

They are endangering children's lives.

This is not a sound bite, not a cliche,

this is the fact.

We are very, very concerned.

Hello, I'm Riz Lateef with your 90 second update.