0:00:01 > 0:00:04This programme contains some scenes which some viewers may find upsetting
0:00:04 > 0:00:07We think the best thing for you to do is to have an amputation.
0:00:07 > 0:00:10Around four million people in the UK have Type 2 diabetes.
0:00:10 > 0:00:13We need to talk about this and decide what to do.
0:00:13 > 0:00:16It's mostly preventable, but it can be deadly.
0:00:16 > 0:00:18It slowly came on, you see.
0:00:18 > 0:00:21The trigger, bad diet and lack of exercise.
0:00:21 > 0:00:25Half past four, going for more chocolate.
0:00:25 > 0:00:27The result, all too often...
0:00:27 > 0:00:28There's a blockage in the artery.
0:00:28 > 0:00:31..heart failure, kidney disease,
0:00:31 > 0:00:33feet and legs that must be amputated.
0:00:34 > 0:00:37Say yes to me when I'm touching your feet.
0:00:38 > 0:00:40Nothing? No, OK.
0:00:40 > 0:00:43So I will just cut it, leave it open.
0:00:43 > 0:00:47I will have performed two amputations alone today.
0:00:47 > 0:00:48It's an invisible illness.
0:00:48 > 0:00:51It basically rots your organs from the inside.
0:00:51 > 0:00:55It used to be a disease of the middle aged and elderly.
0:00:55 > 0:00:57How old are you now, then, Ameer?
0:00:57 > 0:00:5815.
0:00:58 > 0:01:02He's got a whole lifetime ahead of him with diabetes.
0:01:02 > 0:01:05Just as the disease slowly grips a patient,
0:01:05 > 0:01:09the costs are slowly strangling the NHS.
0:01:09 > 0:01:11We are in a crisis now.
0:01:11 > 0:01:15Panorama has spent six months at the sharp end of the battle
0:01:15 > 0:01:18against this rising epidemic.
0:01:18 > 0:01:20We are very much putting out the fires,
0:01:20 > 0:01:22and whilst that is my job to do that,
0:01:22 > 0:01:26I very much wish that these fires didn't exist in the first place.
0:01:35 > 0:01:37Hi, Martin Claridge, I'll see you there in a minute.
0:01:37 > 0:01:39Cheers. Thank you. Goodbye.
0:01:39 > 0:01:42The vascular ward at Heartlands Hospital in Birmingham deals with
0:01:42 > 0:01:46very severe, acute complications of diabetes every day.
0:01:47 > 0:01:51We'll give you some glucose as well in the bag of fluid.
0:01:51 > 0:01:53John Westwood is a Type 2 diabetic -
0:01:53 > 0:01:58he has gangrene in his foot and his life is in danger from infection.
0:02:00 > 0:02:02I was watching the television.
0:02:02 > 0:02:05And there was a radiator at the end of the seat.
0:02:05 > 0:02:08And I must've just pushed my feet against it.
0:02:08 > 0:02:10But it was cold.
0:02:10 > 0:02:13And then in the night they turn themselves on, you know.
0:02:15 > 0:02:17You should've seen my feet in the morning.
0:02:17 > 0:02:20Absolute blisters all over them.
0:02:20 > 0:02:21Oh, it was horrible.
0:02:23 > 0:02:27John's diabetes means he has lost sensation in his feet,
0:02:27 > 0:02:29and his wounds won't heal.
0:02:29 > 0:02:33Mr Westwood, nice to meet you. I'm Martin Claridge, vascular surgeon.
0:02:33 > 0:02:35I understand you've got a problem with your foot?
0:02:35 > 0:02:38I burnt it on a radiator.
0:02:38 > 0:02:43It was all blisters. Up to Friday, it was healing, no problem.
0:02:43 > 0:02:46Friday, I said, "There's something wrong."
0:02:46 > 0:02:49That's when we called the ambulance.
0:02:49 > 0:02:52All right. Is it OK if we have a look?
0:02:53 > 0:02:56OK. What, and this happened about three weeks ago, did it?
0:02:56 > 0:02:58- Yeah.- OK, thank you.
0:02:58 > 0:03:02With you, my friend, the infection is so much in the sole of your foot
0:03:02 > 0:03:06and so spread up your foot, that I can't save your foot, I'm afraid.
0:03:06 > 0:03:09So what you need to do is have an emergency operation to have
0:03:09 > 0:03:11your foot removed.
0:03:11 > 0:03:14It's what we call a guillotine amputation.
0:03:14 > 0:03:16So we take all the infected tissue away,
0:03:16 > 0:03:20and it allows the non-dead tissue that's only a little bit infected
0:03:20 > 0:03:24to settle down and then we can actually finish off the operation
0:03:24 > 0:03:26with what's called a below-knee amputation.
0:03:26 > 0:03:27If we don't do that,
0:03:27 > 0:03:31then what's going to happen is the infection is going to spread up your leg,
0:03:31 > 0:03:34and you'll end up losing much more of your leg.
0:03:34 > 0:03:38And ultimately, you would succumb from this, if we don't do this.
0:03:38 > 0:03:40So we have to get on and get this sorted out for you.
0:03:40 > 0:03:41Is that all right?
0:03:41 > 0:03:43Yes, it is all right.
0:03:43 > 0:03:45I've done my best, but I can't do any more.
0:03:45 > 0:03:49No, well, it's very difficult to do any more than you can with this situation,
0:03:49 > 0:03:50- so it needs some surgery now.- Yes.
0:03:53 > 0:03:55He needs an emergency amputation of his foot.
0:03:55 > 0:03:58If we don't get on and get this done in the next few hours,
0:03:58 > 0:04:01he's going to lose his leg or potentially his life.
0:04:02 > 0:04:06He doesn't moan. He doesn't moan, you see.
0:04:07 > 0:04:11When they tell you, you're in shock. You blank it out.
0:04:11 > 0:04:16When the injury happened, John and his wife Pat were away on a special trip.
0:04:18 > 0:04:21My son had paid for us to have a holiday in Cornwall
0:04:21 > 0:04:24for our 50th wedding anniversary.
0:04:24 > 0:04:26Things happen to him, knockbacks,
0:04:26 > 0:04:29but I'll tell you something, it's never got him down.
0:04:29 > 0:04:32And if he wasn't like that, I'd know there was something wrong.
0:04:32 > 0:04:34That's the reason I knew there was something wrong with him,
0:04:34 > 0:04:38when he wouldn't eat, and I thought, "That's not him."
0:04:39 > 0:04:43Type 2 diabetes means the body's natural insulin system
0:04:43 > 0:04:45stops working.
0:04:45 > 0:04:48The resulting high blood sugar levels clog up veins and arteries
0:04:48 > 0:04:51and that can lead to acute complications.
0:04:56 > 0:05:00Type 2 diabetes causes furring up of the really small blood vessels.
0:05:00 > 0:05:03This can rapidly escalate and cause gangrene,
0:05:03 > 0:05:06cause toes to be lost,
0:05:06 > 0:05:09cause foot loss and may result in amputations.
0:05:13 > 0:05:16Type 1 diabetes - the sort you're born with -
0:05:16 > 0:05:18accounts for just a tenth of cases.
0:05:18 > 0:05:22It's Type 2, mostly brought on by lifestyle, that's now flooding
0:05:22 > 0:05:25Heartlands Hospital with new patients.
0:05:26 > 0:05:30Birmingham has one of the highest levels of diabetes in the UK -
0:05:30 > 0:05:34an estimated one in ten people here has it.
0:05:35 > 0:05:39The hospital has spent £6 million building a dedicated centre
0:05:39 > 0:05:42to cope with the diabetes epidemic.
0:05:47 > 0:05:51This is our main reception area, where patients come in.
0:05:51 > 0:05:54We see about 8,000-9,000 patients every year.
0:05:56 > 0:06:00We deal with a huge range of problems resulting from diabetes,
0:06:00 > 0:06:04patients with damage to the nerves in their feet,
0:06:04 > 0:06:08patients requiring regular dialysis, patients having severe eye disease.
0:06:08 > 0:06:10Keep looking there.
0:06:10 > 0:06:14The prevalence of diabetes is rising so rapidly that it is three times
0:06:14 > 0:06:17the numbers of all the cancers combined together.
0:06:18 > 0:06:24Nine out of ten Type 2 diabetes patients are overweight or obese.
0:06:26 > 0:06:28Hi, Jonathan, how are you today?
0:06:28 > 0:06:29OK, how are you?
0:06:29 > 0:06:31- I'm all right, thank you.- Good.
0:06:31 > 0:06:34So, would you like to pop onto the scales?
0:06:34 > 0:06:38Jon O'Hagan was diagnosed with Type 2 diabetes when he was 32.
0:06:38 > 0:06:40He's now 40.
0:06:41 > 0:06:43OK, so it's 123.4.
0:06:45 > 0:06:48So your BMI is 41.7.
0:06:50 > 0:06:55With a body mass index of over 40, Jon is classed as severely obese.
0:06:55 > 0:06:59He's been told he needs to change his diet, but he's finding it hard.
0:07:02 > 0:07:04I probably do eat a bit too much in general.
0:07:04 > 0:07:07I could quite easily have four or five milkshakes a week,
0:07:07 > 0:07:10depending on opportunity as well.
0:07:10 > 0:07:13If I came to the weight management clinic on Monday,
0:07:13 > 0:07:16I could have one after that.
0:07:16 > 0:07:18But my big poison, if you like, is chocolate.
0:07:21 > 0:07:25Now Jon has to rely on medication to control his blood sugar levels.
0:07:28 > 0:07:31This is my daily diabetic medication.
0:07:31 > 0:07:35I have metformin, 500mg tablets.
0:07:35 > 0:07:38I have insulin in the form of an injection pen,
0:07:38 > 0:07:41I have 120 units every night.
0:07:41 > 0:07:47And I also have Victoza, which is this one.
0:07:47 > 0:07:49Where do you inject those?
0:07:49 > 0:07:53Into the legs, tops of the thighs or lower abdomen.
0:07:53 > 0:07:57I try and rotate the injection sites so it doesn't get sore or lumpy.
0:07:59 > 0:08:01The higher your blood sugar,
0:08:01 > 0:08:04the more invisible damage it is likely to be doing.
0:08:05 > 0:08:08Blood sugar is measured in millimoles per litre -
0:08:08 > 0:08:10ideally it should be below eight.
0:08:12 > 0:08:16We're now about half an hour, three quarters of an hour post-lunch.
0:08:19 > 0:08:20And it's 14.3.
0:08:20 > 0:08:22And you feel normal?
0:08:22 > 0:08:25I feel normal at the moment. That, for me, is not high.
0:08:25 > 0:08:30It's far too high for anybody, but it's not high that I'm unused to, unfamiliar with,
0:08:30 > 0:08:31it's just too high.
0:08:33 > 0:08:34Jon is a psychiatric nurse,
0:08:34 > 0:08:38caring for patients with serious mental health problems.
0:08:39 > 0:08:41Unfortunately, I work in a very stressful job
0:08:41 > 0:08:44and eating chocolate is my big sort of stress-relieving thing.
0:08:44 > 0:08:49I don't smoke, I rarely drink, I do go for chocolate.
0:08:49 > 0:08:52This is Saturday, it is quarter past five in the morning,
0:08:52 > 0:08:56I'm working a long day today, just about to have breakfast,
0:08:56 > 0:08:59four Weetabix topped up with Frosties with a pint of tea.
0:08:59 > 0:09:03We asked Jon to record a video diary of his regular eating habits.
0:09:03 > 0:09:08Thursday 30th June at 12.36.
0:09:08 > 0:09:13For lunch, I have just had a large bowl of tuna pasta salad.
0:09:14 > 0:09:18And two Ferrero Rocher, yummy.
0:09:18 > 0:09:2215.07 - feeling rather tired and jaded so I have just gone and bought
0:09:22 > 0:09:24a bottle of Diet Coke,
0:09:24 > 0:09:27500ml, and a Snickers bar.
0:09:27 > 0:09:32Half past four - feel tired, weary and going for more chocolate.
0:09:38 > 0:09:42I will just cut it, leave it open - open - with some gauzes on it
0:09:42 > 0:09:47for a few days until the circulation here relaxes.
0:09:47 > 0:09:52John Westwood is about to have his gangrenous foot amputated.
0:09:52 > 0:09:55There is a small risk you may die during the procedure,
0:09:55 > 0:09:56and the risk of that
0:09:56 > 0:09:59starts from around 5%.
0:09:59 > 0:10:02OK, do you have any more questions?
0:10:02 > 0:10:06No, I think you've explained everything beautifully.
0:10:06 > 0:10:10We need to mark this side just to show that it's the right leg.
0:10:10 > 0:10:12Please put your signature where the X is.
0:10:19 > 0:10:21OK, please don't eat anything now or drink...
0:10:23 > 0:10:27'When they go in, you think, "Well, are they going to come out?"
0:10:29 > 0:10:33'It's just that half of you is gone, you know, half of you ain't there.
0:10:33 > 0:10:37You're diabetic. And your last BM was 10.5.
0:10:37 > 0:10:42'I'd rather that happen to me, than to John.'
0:10:44 > 0:10:47We need to do an amputation but it's going to be a guillotine amputation,
0:10:47 > 0:10:52it's the best way to stop the infection and save the patient's life.
0:10:55 > 0:11:00Guillotine surgery is an emergency operation for the most urgent cases.
0:11:02 > 0:11:05The reality of amputation is brutal
0:11:05 > 0:11:08and watching it is not for the fainthearted.
0:11:08 > 0:11:11My name is Andreas. I'm the vascular surgeon.
0:11:11 > 0:11:13We're just going to do an open amputation.
0:11:13 > 0:11:16So it's just a guillotine. OK?
0:11:16 > 0:11:17Can we start?
0:11:23 > 0:11:25Do you have the saw?
0:11:25 > 0:11:26OK.
0:11:28 > 0:11:29OK.
0:11:36 > 0:11:37Good.
0:11:47 > 0:11:49It went quite well,
0:11:49 > 0:11:52I think we did well, now the patient is going to recover.
0:11:52 > 0:11:55This operation has saved this man's life?
0:11:57 > 0:12:03I think that it did, and let's hope that he goes well, as we think.
0:12:09 > 0:12:12But diabetics don't just face the risk of amputations.
0:12:16 > 0:12:19Sharon Barnett is 44.
0:12:19 > 0:12:22She was diagnosed with Type 2 nine years ago.
0:12:22 > 0:12:25She is worried about the damage the disease might be causing her eyes,
0:12:25 > 0:12:27kidneys, or heart.
0:12:27 > 0:12:29Hello.
0:12:29 > 0:12:33You can stop the disease progressing if you lose enough weight
0:12:33 > 0:12:35and change your lifestyle.
0:12:35 > 0:12:38But Sharon has tried many times and still weighs 18 stone.
0:12:38 > 0:12:42In three weeks, she will have weight-loss, or bariatric, surgery.
0:12:42 > 0:12:44She's here for a pre-op check.
0:12:44 > 0:12:46- Your full name. Sharon?- Sharon, yeah.
0:12:47 > 0:12:49'I just know I need to do it.'
0:12:49 > 0:12:54I know that I can't carry on, my health problems are probably
0:12:54 > 0:12:57just going to get worse if I don't do something about it.
0:12:57 > 0:12:59What do you do for your life?
0:12:59 > 0:13:01My work? I work in a call centre.
0:13:01 > 0:13:03- A call centre.- Yeah.
0:13:03 > 0:13:08'I weigh 119 kilos at the moment.
0:13:08 > 0:13:12'I'm now a health risk.'
0:13:12 > 0:13:14You know, I might not live as long as I could live
0:13:14 > 0:13:17because I've let myself be overweight.
0:13:17 > 0:13:19Thank you. Thank you very much.
0:13:24 > 0:13:27Obesity has crept up on Sharon.
0:13:27 > 0:13:29The result of too little exercise,
0:13:29 > 0:13:32and too many calories from carbohydrates or sugary foods.
0:13:36 > 0:13:38That's hideous.
0:13:39 > 0:13:44Oh, my God, where did that come from?! I look really old, I was 19!
0:13:44 > 0:13:48You've only got to go, probably, 300-400 calories a day over.
0:13:48 > 0:13:52And I just think it's gradually over the years, just gone on.
0:13:52 > 0:13:54That's me there.
0:13:54 > 0:13:56You were in all the teams and everything.
0:13:56 > 0:14:00Yeah, I played at school, I played rounders, netball, hockey, all them.
0:14:00 > 0:14:06When I left school, I stopped exercising. I just stopped completely.
0:14:06 > 0:14:09But I carried on eating the amounts I was eating.
0:14:16 > 0:14:20Right, hello, how are you getting on?
0:14:20 > 0:14:25After the amputation, John Westwood is doing well.
0:14:25 > 0:14:27You look a different man, you look an awful lot better.
0:14:27 > 0:14:30And you've got a smile and everything. That's really good.
0:14:30 > 0:14:33So it's a bit of a long haul over the next few days.
0:14:33 > 0:14:36I'll see you in a little bit, then, OK.
0:14:36 > 0:14:40Right. I'm going to join the Long John Silver impersonators!
0:14:40 > 0:14:44But I do feel 100%. No pain at all.
0:14:44 > 0:14:46It's absolutely amazing.
0:14:48 > 0:14:52All I'd say to you is what I told you before - if you're diabetic,
0:14:52 > 0:14:55keep on top of it. If you don't, you'll end up like this.
0:14:57 > 0:14:59It's a bad disease, it's a really bad disease.
0:15:03 > 0:15:06Could we have...?
0:15:06 > 0:15:09Vascular surgeons, who treat diseases of the veins
0:15:09 > 0:15:13and arteries, do all they can to avoid amputations.
0:15:13 > 0:15:16In the past, a large share of vascular problems
0:15:16 > 0:15:18were caused by smoking.
0:15:21 > 0:15:24Hello, how are you? How's your leg feeling?
0:15:24 > 0:15:27It used to be that it would perhaps be unusual to find
0:15:27 > 0:15:31a patient with diabetes, but now almost every patient I come across
0:15:31 > 0:15:33on the vascular ward has diabetes.
0:15:41 > 0:15:44The growing burden of Type 2 diabetes is having
0:15:44 > 0:15:47a big impact right across Heartlands Hospital.
0:15:49 > 0:15:52Diabetes just ravages most of the systems.
0:15:52 > 0:15:55It has effects on the heart, has effects on the blood vessels,
0:15:55 > 0:15:59has effects on the kidneys, and is just non-remitting, non-relenting.
0:15:59 > 0:16:01You know, it just carries on.
0:16:01 > 0:16:04At the back of your mind, you always think that they have a limited
0:16:04 > 0:16:08lifespan because there's only so much you'll be able to do for them.
0:16:10 > 0:16:12If you've got Type 2 diabetes,
0:16:12 > 0:16:16you're almost twice as likely to have a heart attack
0:16:16 > 0:16:19and over three times as likely to have kidney disease.
0:16:22 > 0:16:26- How are you getting on with the dialysis, you all right?- Yeah.
0:16:26 > 0:16:28Any problems with the fistula or anything?
0:16:29 > 0:16:33We probably get about 10 to 12 referrals a week.
0:16:33 > 0:16:38Probably five of them, five or six will be Type 2 diabetic.
0:16:38 > 0:16:43About 40% of our patients on dialysis are Type 2 diabetic.
0:16:47 > 0:16:51Annette visits patients at home to explain what lies ahead
0:16:51 > 0:16:54when they need kidney dialysis to keep them alive.
0:17:01 > 0:17:04It's quite difficult, walking in to somebody's house and they
0:17:04 > 0:17:08don't know what you're going to tell them. They're terrified.
0:17:08 > 0:17:09But at the end of the day,
0:17:09 > 0:17:12unfortunately the story is the same, really -
0:17:12 > 0:17:14that, you know, you're going to need to have dialysis
0:17:14 > 0:17:16and this is what it entails.
0:17:16 > 0:17:20Their whole life now is going to be monopolised by the renal failure.
0:17:22 > 0:17:24Annette's next visit is to John Jameson.
0:17:24 > 0:17:26Will we go that way?
0:17:26 > 0:17:29John has lost weight and controlled his blood sugar well
0:17:29 > 0:17:33since he was diagnosed with Type 2 12 years ago.
0:17:33 > 0:17:36But still, his kidney function has deteriorated.
0:17:38 > 0:17:39It is a bit tight now.
0:17:40 > 0:17:42Doesn't quite fit.
0:17:42 > 0:17:46That was meeting the Queen at Lord's. That was...
0:17:46 > 0:17:48- Which Test match was it?- That was...
0:17:48 > 0:17:52I was twelfth man at Lord's before I made my debut.
0:17:52 > 0:17:56John used to play cricket for Warwickshire and England.
0:17:58 > 0:18:01I was probably a little bit on the large side.
0:18:03 > 0:18:07But I was still reasonably quick between the wickets.
0:18:07 > 0:18:11But after I stopped playing, wasn't doing as much exercise
0:18:11 > 0:18:13as perhaps I should have done.
0:18:13 > 0:18:16And that's when diabetes set in.
0:18:16 > 0:18:20It was much of a surprise to me that I'd got Type 2 diabetes.
0:18:23 > 0:18:25At the end of the day, we're breaking bad news.
0:18:25 > 0:18:28You can almost see the cogs inside their head.
0:18:28 > 0:18:30They're not listening to what you've said,
0:18:30 > 0:18:31the one word is going around -
0:18:31 > 0:18:34"I'm going to die, I'm going to die, I'm going to die.
0:18:34 > 0:18:37"Oh, my God, oh, my God, I need dialysis, I need dialysis."
0:18:37 > 0:18:40We were chatting about Dr Thomas and the fact that he's referred you
0:18:40 > 0:18:43to the renal team because the kidneys are failing and
0:18:43 > 0:18:46there's a possibility you might need the dialysis.
0:18:46 > 0:18:49The diabetes, unfortunately, very common, diabetic.
0:18:49 > 0:18:51The first dialysis I'm going to talk to you
0:18:51 > 0:18:54a bit about is called peritoneal dialysis.
0:18:54 > 0:18:57You'd need a little procedure to put a catheter in.
0:18:57 > 0:18:59This is the catheter, OK?
0:19:02 > 0:19:03They're the dialysis bags,
0:19:03 > 0:19:06and basically all you're doing is connecting...
0:19:08 > 0:19:09..like that.
0:19:09 > 0:19:14Takes approximately 20 minutes, sat there watching your cricket,
0:19:14 > 0:19:15four times a day.
0:19:19 > 0:19:22So, have you got any other worries or concerns at this time?
0:19:22 > 0:19:25Not really, I just hope that it gets delayed as long as possible.
0:19:25 > 0:19:28Absolutely, and that's what we're there for.
0:19:28 > 0:19:31Just want to say thank you for your time, I appreciate it.
0:19:31 > 0:19:34- No, you're welcome.- Thank you. - Thank you for coming.
0:19:36 > 0:19:40I've cut down on meals. Basically, I'm only having one meal a day.
0:19:40 > 0:19:43Might have a little bit of snack in the evening or that sort of thing,
0:19:43 > 0:19:46but that's basically to keep the weight off.
0:19:46 > 0:19:49Obviously I want to try and avoid that.
0:19:49 > 0:19:50And, erm...
0:19:52 > 0:19:55Whether one can do more exercise or not...
0:19:55 > 0:19:58But it's a bit difficult when you've got a...to help the kidney function,
0:19:58 > 0:20:03they've got a catheter fitted - you can't exactly go running.
0:20:03 > 0:20:06Do what you can when you can and enjoy life when you can.
0:20:20 > 0:20:22But the Type 2 epidemic is now affecting people
0:20:22 > 0:20:24much earlier in life.
0:20:24 > 0:20:28Just 16 years ago, there had never been a single case of a child
0:20:28 > 0:20:32being diagnosed with Type 2 diabetes in the UK.
0:20:33 > 0:20:36I didn't quite believe it. It wasn't in any of our medical text books,
0:20:36 > 0:20:39we didn't get it taught it in medical school,
0:20:39 > 0:20:41so we didn't expect to see it as an issue.
0:20:41 > 0:20:42We just didn't think it was...
0:20:42 > 0:20:44We thought it was an American problem.
0:20:44 > 0:20:47But in the year 2000, we saw the first cases in the UK
0:20:47 > 0:20:48here in Birmingham.
0:20:59 > 0:21:01Ameer is 15.
0:21:01 > 0:21:05He was diagnosed with Type 2 when he was just 13.
0:21:05 > 0:21:07- Hello, Ameer, are you OK?- Yeah.
0:21:08 > 0:21:11People of South Asian origin are twice as likely
0:21:11 > 0:21:16to have Type 2 diabetes, and the disease runs in his family.
0:21:16 > 0:21:19Ameer must check his blood sugar at least four times a day.
0:21:21 > 0:21:24- That's OK. Thank you, Ameer. - That's all right, Miss.
0:21:24 > 0:21:26Ever since I've been diagnosed,
0:21:26 > 0:21:30every day before lunch, I'd come down, check my sugars.
0:21:30 > 0:21:34At first it was annoying and I can admit that I never used to come
0:21:34 > 0:21:38because, you know, it was kind of hard for me to come down,
0:21:38 > 0:21:41check my sugars, people asking questions.
0:21:41 > 0:21:44But then once I told them that, you know, it could happen to anyone
0:21:44 > 0:21:48and everyone, they were actually quite calm at first.
0:21:48 > 0:21:50- See you on Monday.- See you, bye-bye.
0:21:50 > 0:21:52No-one asks questions and they understand,
0:21:52 > 0:21:55so I kind of feel happy about that now.
0:21:55 > 0:21:59Being diagnosed young means life-threatening complications
0:21:59 > 0:22:01are likely to occur earlier in life.
0:22:01 > 0:22:04But as long as his blood sugar is well controlled,
0:22:04 > 0:22:07Ameer can keep the disease at bay.
0:22:07 > 0:22:09I am quite rebellious when it comes to, like,
0:22:09 > 0:22:11"You can't have this, you can't have that."
0:22:11 > 0:22:13Like, I'd go to the shops, like, my mum gives me money.
0:22:13 > 0:22:15She says, "You've got to spend it on your lunch,
0:22:15 > 0:22:18"you're not going to the shops to get chocolates or crisps
0:22:18 > 0:22:21"or sugary drinks," and sometimes I'd get small chocolate bars.
0:22:21 > 0:22:23But then when it comes to checking my sugars, I'm like,
0:22:23 > 0:22:25"Oh, my God, I need to drink a lot of water."
0:22:31 > 0:22:36Ameer and his mum, who also has Type 2, have to come regularly
0:22:36 > 0:22:40to the hospital where his condition is being closely monitored.
0:22:41 > 0:22:42Hello.
0:22:44 > 0:22:48Hello, how are you doing? Nice to see you, nice to see you.
0:22:48 > 0:22:49Nice to see you too.
0:22:50 > 0:22:52'It's been three weeks since I saw him last.'
0:22:52 > 0:22:55The glucose level for somebody who doesn't have diabetes would be
0:22:55 > 0:23:00between about 3.5 and about 7.8, something like that.
0:23:00 > 0:23:03We're trying to get him to manage his glucose between 4 and 7,
0:23:03 > 0:23:05and once it's over about 14, actually,
0:23:05 > 0:23:07it's much higher than we'd like to see.
0:23:07 > 0:23:10So we're going to need to do a glucose check today, all right?
0:23:10 > 0:23:11Yeah, OK.
0:23:12 > 0:23:13OK?
0:23:15 > 0:23:16- 18!- 18?
0:23:16 > 0:23:19So that's way too high, isn't it?
0:23:19 > 0:23:2118 is a very high level.
0:23:24 > 0:23:27Any reason why you think your sugar was so high this morning?
0:23:27 > 0:23:30- I don't know. - What did you have to eat last night?
0:23:31 > 0:23:34Normal chapati and curry.
0:23:34 > 0:23:36OK.
0:23:36 > 0:23:40The problem is, Ameer, is that if we carry on like this at 15,
0:23:40 > 0:23:43by the time you get to 25 you'll get eye damage.
0:23:43 > 0:23:46And you've already had gout and stuff in your feet as well
0:23:46 > 0:23:49and you will get these other bits of damage.
0:23:49 > 0:23:52So I'm sure you're eating healthier, which would be great,
0:23:52 > 0:23:54but you need to eat less.
0:23:55 > 0:23:56OK.
0:23:56 > 0:23:58'I'm worried in the long term
0:23:58 > 0:23:59'because we're not winning at the moment,'
0:23:59 > 0:24:02either in terms of his weight, which is static,
0:24:02 > 0:24:04or his glucose control, which if anything it's got worse
0:24:04 > 0:24:06than it has been before.
0:24:06 > 0:24:07Thank you. Thank you, doctor.
0:24:07 > 0:24:09All right, thank you, then. Thank you, Ameer.
0:24:09 > 0:24:11'I think he's at a bit of a crossroads.
0:24:11 > 0:24:14'He's got a whole lifetime ahead of him with diabetes.'
0:24:14 > 0:24:16I'm quite gutted, actually.
0:24:16 > 0:24:19I mean, this is what I've been banging on about to Ameer
0:24:19 > 0:24:21when he's missed his dosage.
0:24:21 > 0:24:23He'll go into his own bubble.
0:24:23 > 0:24:27He's a nice lad. I think he finds it difficult to motivate himself.
0:24:27 > 0:24:31He's still eating more calories than he's burning off in exercise.
0:24:31 > 0:24:34I've just got to try even harder than I did before.
0:24:40 > 0:24:43Ameer has to cut out even occasional lapses.
0:24:47 > 0:24:50- INTERVIEWER:- Is there sugar in your Ribena, Ameer?
0:24:51 > 0:24:52I think there is.
0:24:52 > 0:24:55Erm...
0:24:55 > 0:24:56Yeah, look, it says here.
0:24:57 > 0:24:59It's got 26g.
0:24:59 > 0:25:0229% sugar.
0:25:02 > 0:25:04Oh, God.
0:25:04 > 0:25:05- You're going to be in trouble now. - Oh, no.
0:25:05 > 0:25:07You're going to be in trouble.
0:25:07 > 0:25:09You did say to me, "Pick up any drink,"
0:25:09 > 0:25:13and I just thought, "Ribena, it's rich in Vitamin C."
0:25:15 > 0:25:17He's sneaky.
0:25:17 > 0:25:20Like, he'll get snacks and not make it aware to everyone that
0:25:20 > 0:25:22he's got them.
0:25:22 > 0:25:25And then we'll just find wrappers and we'll be like,
0:25:25 > 0:25:26"I didn't have that."
0:25:26 > 0:25:28My brother will be like, "Well, I didn't,"
0:25:28 > 0:25:30and my mum will be flipping. "Who's had it? Who's had it?"
0:25:30 > 0:25:34And then we'll find out it was him. Hiding upstairs, he had it.
0:25:34 > 0:25:38There are now over 500 children in the UK diagnosed with
0:25:38 > 0:25:44Type 2 diabetes and the number of new cases is rising alarmingly fast.
0:25:45 > 0:25:49Every new diagnosis of Type 2 diabetes in children
0:25:49 > 0:25:53has been analysed by Ameer's doctor and academic colleagues.
0:25:53 > 0:25:55It was August last year, so he would have been 15.
0:25:55 > 0:25:57Definitely got diabetes - see the random glucose.
0:25:57 > 0:26:01We're seeing twice as many children developing Type 2 diabetes
0:26:01 > 0:26:03than we were in 2004, 2005.
0:26:03 > 0:26:06A striking number of the children have evidence of
0:26:06 > 0:26:10fatty infiltration of their liver and abnormal liver function tests.
0:26:10 > 0:26:12An 11-year-old, a 12-year-old.
0:26:12 > 0:26:14I saw a child last week who is actually developing
0:26:14 > 0:26:16cirrhosis of the liver.
0:26:17 > 0:26:21Type 2 diabetes in children may be a different disease to
0:26:21 > 0:26:22Type 2 diabetes in adults.
0:26:22 > 0:26:23So adults who get this at the age of 50
0:26:23 > 0:26:26may not necessarily get these other complications.
0:26:26 > 0:26:28But the children we're seeing with Type 2 seem to have got
0:26:28 > 0:26:31a more aggressive progress, and they're getting these complications
0:26:31 > 0:26:32earlier than you would expect.
0:26:37 > 0:26:40As greater numbers of children are being diagnosed with Type 2,
0:26:40 > 0:26:44the financial implications for the NHS in the future are grave.
0:26:49 > 0:26:53Jon O'Hagan lives with his wife Severine and their two children.
0:26:53 > 0:26:57He is still struggling to control his sugar intake.
0:26:57 > 0:26:58Behave yourself, shorty!
0:26:58 > 0:27:00Elle a mange toutes les carottes!
0:27:02 > 0:27:07It's 6.45 on Friday 1st July.
0:27:07 > 0:27:09I've just had breakfast.
0:27:09 > 0:27:13Four Weetabix topped up with Frosties
0:27:13 > 0:27:14and a pint of tea.
0:27:14 > 0:27:17And I've also had a huge amount of the chocolate slab
0:27:17 > 0:27:18that I was bought yesterday.
0:27:21 > 0:27:24Over many years Jon has been unable to beat his compulsion
0:27:24 > 0:27:28to eat chocolate, even though it threatens to devastate his health.
0:27:31 > 0:27:36This I've had to buy because this was the chocolate that was in
0:27:36 > 0:27:40the fridge this morning which my wife bought for our children.
0:27:41 > 0:27:45And basically, I've stolen the children's chocolate
0:27:45 > 0:27:48and I've now had to replace what I've stolen.
0:27:50 > 0:27:54I can't have anything in cupboards on show because I know that
0:27:54 > 0:27:56if I go out, it wouldn't be there.
0:27:56 > 0:27:59- INTERVIEWER:- Do you make a habit of hiding treats and snacks?
0:27:59 > 0:28:01Yes, yes, all the time,
0:28:01 > 0:28:06and he's very good at finding my secret places.
0:28:06 > 0:28:08I'm like a bloodhound for chocolate.
0:28:08 > 0:28:10I know!
0:28:10 > 0:28:12Have you tried to change him?
0:28:12 > 0:28:13I've stopped, really.
0:28:13 > 0:28:17You know, I've got two children to sort of try to give
0:28:17 > 0:28:21a good diet to and he's an adult.
0:28:21 > 0:28:24You know, he's got to do it himself.
0:28:26 > 0:28:28And I know it's hard.
0:28:28 > 0:28:32And he's got no will, because he sniffs some chocolate and that's it.
0:28:33 > 0:28:35- Let me go!- Shh.
0:28:36 > 0:28:39- Louis, shush.- What?
0:28:39 > 0:28:41- It's purple.- No, it's pink. - All right, it's pink.
0:28:43 > 0:28:45That's pink.
0:28:45 > 0:28:47You're right, it is pink.
0:28:47 > 0:28:50I couldn't see it when you had it thrust halfway up my nose.
0:28:51 > 0:28:54I've suffered depression an awful long time.
0:28:54 > 0:28:57My first episode that I know of I was 15.
0:28:57 > 0:28:58So...
0:28:58 > 0:29:00- That's young.- Yeah.
0:29:01 > 0:29:04My mother and grandmother both showed
0:29:04 > 0:29:07a lot of their love and affection through food.
0:29:07 > 0:29:08So there was always lots to eat.
0:29:08 > 0:29:11Mum was a fantastic cook.
0:29:11 > 0:29:14So my brothers and I used to compete for the mixing bowl...
0:29:15 > 0:29:17..erm, which was never light on sugar.
0:29:17 > 0:29:21A lot of people self-medicate depression with booze.
0:29:21 > 0:29:23I don't do that.
0:29:23 > 0:29:26A lot of people with depression will smoke heavily.
0:29:26 > 0:29:27I don't do that any more.
0:29:27 > 0:29:28Erm, I eat.
0:29:30 > 0:29:37Even though you know that that bingeing and being overweight
0:29:37 > 0:29:39are damaging you?
0:29:39 > 0:29:41In the same way that George Best knew that when he was on his
0:29:41 > 0:29:45second liver, the drink was still going to kill him eventually.
0:29:45 > 0:29:46It didn't stop him drinking.
0:29:51 > 0:29:52You sit in Maman's chair.
0:29:52 > 0:29:54Right, I've made you both far too much.
0:29:54 > 0:29:57Eat what you can, don't worry if you have to leave some.
0:30:04 > 0:30:07Jon has decided he can't beat his addiction on his own.
0:30:07 > 0:30:08123.6.
0:30:10 > 0:30:14So it's gone up from when I was I was last seen in clinic.
0:30:14 > 0:30:17He too has opted for irreversible weight loss surgery.
0:30:19 > 0:30:24I feel quite awful that I need to seek surgery
0:30:24 > 0:30:26to affect the changes I need to affect,
0:30:26 > 0:30:28but I've tried every other means and failed.
0:30:30 > 0:30:31Thank you, baby.
0:30:33 > 0:30:38Things have got to change now because I have two children...
0:30:39 > 0:30:42..and I want to make sure I'm around to see them grow up,
0:30:42 > 0:30:45I want to be part of their lives for as long as I can.
0:30:45 > 0:30:48If I don't look after my diabetes,
0:30:48 > 0:30:52I face the prospect of vascular problems, dementia, strokes,
0:30:52 > 0:30:56heart disease and my life expectancy reduces dramatically.
0:30:58 > 0:31:00I don't want that to happen.
0:31:00 > 0:31:04It's as simple as that, I don't want to miss out on their lives.
0:31:08 > 0:31:09Good girl.
0:31:30 > 0:31:33Sharon's weight loss operation is imminent.
0:31:33 > 0:31:37But the surgery will only go ahead if she completes a strict,
0:31:37 > 0:31:39four-week crash diet in the run-up.
0:31:41 > 0:31:44Until my surgery, it's 16 days.
0:31:44 > 0:31:47I've got to stick to less than 1,000 calories...
0:31:50 > 0:31:52..a day. So, it's...
0:31:53 > 0:31:56And I'm trying to just still eat normally,
0:31:56 > 0:32:00but obviously just eat a lot less than what I would normally do.
0:32:00 > 0:32:03If my liver isn't looking good -
0:32:03 > 0:32:06which is what the diet's all about, it shrinks your liver -
0:32:06 > 0:32:09they might not do it, they might just say, "No, sorry.
0:32:09 > 0:32:12"You've not followed the diet, we're not going to do the surgery."
0:32:12 > 0:32:14And I would just be devastated if that happened.
0:32:16 > 0:32:22I do actually feel, in some ways, ashamed that I've let myself...
0:32:22 > 0:32:23Let this happen to me.
0:32:23 > 0:32:24SHE WHISTLES
0:32:27 > 0:32:30I'm never going to be a stick insect, am I?
0:32:30 > 0:32:34As long as it gets rid of the diabetes and makes me
0:32:34 > 0:32:39more healthy... I just want to be able to be more active and do stuff,
0:32:39 > 0:32:41even going and having a dance and things...
0:32:41 > 0:32:44- Nothing stops you from having a dance, though, Sharon!- I know!
0:32:44 > 0:32:45THEY LAUGH
0:32:52 > 0:32:56Diabetes can have a catastrophic, long-term effect on patients...
0:32:56 > 0:32:58There's a blockage in the artery.
0:32:58 > 0:33:02..but it's also creating a potential catastrophe for the NHS.
0:33:03 > 0:33:08All aspects of health care that are affected by Type 2 diabetes
0:33:08 > 0:33:11are straining at the seams, bursting at the seams, trying to manage
0:33:11 > 0:33:14this increasing number of patients with these complications.
0:33:14 > 0:33:17Each time one of these episodes occur,
0:33:17 > 0:33:20each time the patients come into hospital, there is a huge price tag
0:33:20 > 0:33:24in terms of economic cost and mobilisation of staff and resources.
0:33:27 > 0:33:31The NHS spends nearly a billion pounds a year on foot ulcers
0:33:31 > 0:33:34and amputations caused by Type 2 diabetes.
0:33:37 > 0:33:41That's almost 1% of the entire NHS budget.
0:33:43 > 0:33:46We now probably need around double the number of beds that we used
0:33:46 > 0:33:50to have in vascular surgery to help with this influx of the disease.
0:33:53 > 0:33:54Nice glass of port.
0:33:57 > 0:33:59- I pretend it's port. - You pretend it's port?
0:33:59 > 0:34:02John Westwood has had more surgery.
0:34:02 > 0:34:05Doctors have constructed a stump that they hope will be robust
0:34:05 > 0:34:07enough to support a prosthetic limb.
0:34:11 > 0:34:15It's just traumatic, you know.
0:34:15 > 0:34:19He knew what was going to happen
0:34:19 > 0:34:20and I didn't.
0:34:21 > 0:34:23I thought he'd be all right, you know.
0:34:23 > 0:34:27I knew he'd lose his toe, but not the lot, not like that.
0:34:27 > 0:34:32You get a pain here, and you're sitting thinking, "God, that hurts,"
0:34:32 > 0:34:36and then you think, "But there's nothing there, so what's hurting?"
0:34:36 > 0:34:38It's ever so weird, I tell you.
0:34:38 > 0:34:41It's because the brain's trying to find the other foot, you see.
0:34:46 > 0:34:50John's two operations cost the NHS about £18,000.
0:34:50 > 0:34:54Rehabilitation will cost a further £20,000.
0:34:56 > 0:35:00But some Type 2 patients require even greater levels of care,
0:35:00 > 0:35:02to give them a chance against the disease.
0:35:05 > 0:35:09Norma Edmonds has already lost both her feet to Type 2 diabetes.
0:35:09 > 0:35:12Now she's back in hospital with an infection which is tracking
0:35:12 > 0:35:14up her leg and threatening her life.
0:35:17 > 0:35:21First, it was my toe, and I had to have that amputated,
0:35:21 > 0:35:25and then it went into the bone so I had to have another operation.
0:35:25 > 0:35:28And then it went onto the other foot.
0:35:28 > 0:35:35So, you know, within two years, I had both feet amputated.
0:35:35 > 0:35:37- You're in your 50s still, aren't you?- Yeah.
0:35:37 > 0:35:39- How old are you now?- 56.
0:35:39 > 0:35:41- You're 56 years old.- Yeah.
0:35:41 > 0:35:42PHONE RINGS
0:35:42 > 0:35:45- Can I answer that?- Course you can.
0:35:47 > 0:35:50Can I ring you back because I've got somebody with me?
0:35:50 > 0:35:53All right. I'll see you in a bit. Bye. Love you.
0:35:55 > 0:35:56That's my better half.
0:36:01 > 0:36:02Norma got married at 19.
0:36:04 > 0:36:06We've been married, erm...
0:36:07 > 0:36:10..37 years now.
0:36:10 > 0:36:15We was in the pub and he went down on his knee
0:36:15 > 0:36:17and said, "Will you marry me?"
0:36:17 > 0:36:19and I thought he was joking at first.
0:36:22 > 0:36:24I was so happy that day.
0:36:24 > 0:36:26I look so nice there as well.
0:36:28 > 0:36:31Norma gradually put on weight in her 20s
0:36:31 > 0:36:34and began to hit acute problems in her 40s.
0:36:34 > 0:36:38So far, doctors have managed to preserve some mobility for her.
0:36:38 > 0:36:39This time, it'll be harder.
0:36:44 > 0:36:48Unfortunately, the infection is not really settling,
0:36:48 > 0:36:51so we would have to go back and take out more muscle,
0:36:51 > 0:36:57more skin, more bone from her leg below the knee.
0:36:57 > 0:37:01Even if we did that, it's quite likely that wound would never
0:37:01 > 0:37:06heal, so she would never get back a leg that was useful to her
0:37:06 > 0:37:07that she'd be able to walk on.
0:37:07 > 0:37:10The alternative is to do an amputation above the knee.
0:37:10 > 0:37:12The old curtains were much easier.
0:37:12 > 0:37:15Most patients who have an above-the-knee amputation
0:37:15 > 0:37:17will never walk again
0:37:17 > 0:37:19and will need costly ongoing care.
0:37:19 > 0:37:23- Hi, Norma, how are you? - I'm fine, thank you.
0:37:23 > 0:37:26- Do you understand what we're going to be doing?- Yeah.
0:37:26 > 0:37:28Amputation, yes.
0:37:28 > 0:37:31So, as you know, you came into hospital with a lot of infection
0:37:31 > 0:37:33- in the leg, in the left leg.- Yes.
0:37:33 > 0:37:37We agree that probably the best way of getting you out of hospital
0:37:37 > 0:37:41as quickly as possible would be to amputate the leg above the knee...
0:37:41 > 0:37:42Yeah.
0:37:42 > 0:37:45..which is obviously a big step and a big decision
0:37:45 > 0:37:48but I think that's what you... You were quite clear in your own mind,
0:37:48 > 0:37:49that's what you wanted.
0:37:49 > 0:37:53- That's still your view now?- Yes. - That's what you'd like us to do?
0:37:53 > 0:37:55That's what I'd like you do to, yes.
0:37:55 > 0:37:57- OK, see you later. Bye. - Yeah, see you later. Bye.
0:38:07 > 0:38:09Seven and a half, please, Tom.
0:38:12 > 0:38:14OK, watch your fingers.
0:38:18 > 0:38:19That's the leg free.
0:38:27 > 0:38:32We like it to look symmetrical and neat and tidy,
0:38:32 > 0:38:36as much as an amputation stump can ever look nice.
0:38:36 > 0:38:39I think having a good shape is important.
0:38:44 > 0:38:46I'm happy, happy with the way it's gone. Thanks.
0:38:49 > 0:38:53Norma won't be strong enough to leave Heartlands for nearly a month.
0:38:54 > 0:38:58And the average cost of a single night in hospital is £400.
0:39:06 > 0:39:12When all the costs to the NHS of Type 2 diabetes are added together,
0:39:12 > 0:39:16the total is an estimated £10.3 billion.
0:39:17 > 0:39:22That's nearly 10% of the entire NHS budget
0:39:22 > 0:39:24and is set to continue rising sharply.
0:39:29 > 0:39:32One way to save Type 2 patients from the worst consequences
0:39:32 > 0:39:36of the disease is bariatric surgery.
0:39:36 > 0:39:39It could also save the NHS money in the long run.
0:39:39 > 0:39:42- Hi, Jon.- How are you? - I'm good, thank you.
0:39:42 > 0:39:46Jon will have gastric bypass surgery in four weeks,
0:39:46 > 0:39:48as long as he can stick to the pre-op diet.
0:39:48 > 0:39:54Right, Jon, the principles are to create a small stomach,
0:39:54 > 0:39:56and that should reduce how much portions...
0:39:56 > 0:39:58how much food you can eat in one go.
0:39:58 > 0:40:00And part of that is physical, mechanical
0:40:00 > 0:40:05and part of that is hormonal because certain hormones will be released
0:40:05 > 0:40:07which will encourage you to feel full.
0:40:07 > 0:40:10So you can actually walk away from a small plate of food
0:40:10 > 0:40:14- feeling quite satisfied and not hungry.- That'll be nice.
0:40:14 > 0:40:17- You've got to go on a very low-calorie diet.- Yes, I'm aware.
0:40:17 > 0:40:21800 to 1,000 calories a day, maximum.
0:40:21 > 0:40:23This is not a punishment for you, Jon!
0:40:23 > 0:40:25THEY LAUGH
0:40:25 > 0:40:28- The reason why we're doing this is to shrink your liver down...- Yes.
0:40:28 > 0:40:31..and this will definitely help.
0:40:31 > 0:40:33How do you feel you're going to get on with this?
0:40:33 > 0:40:36It's going to be horrendous. I'm going to struggle,
0:40:36 > 0:40:39but I have to do it, so I'm going to do the best I can.
0:40:42 > 0:40:44- Thank you.- See you soon.- Bye now.
0:40:44 > 0:40:47Jon hopefully will get a good result.
0:40:47 > 0:40:52Diabetes resolution after gastric bypass surgery
0:40:52 > 0:40:54is quite an amazing thing to see.
0:40:56 > 0:40:59Within six weeks or so, we can get them off insulin.
0:41:00 > 0:41:03But if you feel like you suddenly want to go out
0:41:03 > 0:41:05and have a large meal, that's not going to be possible
0:41:05 > 0:41:08without you either being sick or feeling pain
0:41:08 > 0:41:13and there is a finality to that that people have to mentally be prepared for.
0:41:16 > 0:41:19Sharon has completed her crash diet
0:41:19 > 0:41:23and her bariatric surgery will go ahead today.
0:41:23 > 0:41:26The main part of her stomach will be cut out,
0:41:26 > 0:41:29leaving only a narrow tube with much less space for food.
0:41:32 > 0:41:35Sometimes, we have noticed the tube is too narrow
0:41:35 > 0:41:37for some of the patients.
0:41:37 > 0:41:40If this happens, we may need to re-operate on you long-term.
0:41:40 > 0:41:44If you're happy, I would like please to ask for your signature here.
0:41:44 > 0:41:47- Print your name underneath and the date first.- Yeah.- Thank you.
0:41:47 > 0:41:51The risk of serious complications is low,
0:41:51 > 0:41:54but the impact on Sharon's life will be huge.
0:41:54 > 0:41:56- Thank you.- Thank you very much.
0:41:56 > 0:42:00See you in theatre. OK, thank you. Thank you very much.
0:42:00 > 0:42:04Today is the start of a new life, really.
0:42:04 > 0:42:05Hopefully.
0:42:07 > 0:42:10And hopefully a better one, not a worse one.
0:42:11 > 0:42:15It's not something that you say, "Well, I can always have it reversed
0:42:15 > 0:42:16"if it doesn't suit."
0:42:16 > 0:42:18It's a complete life change, so she's going to have
0:42:18 > 0:42:21to eat differently now for the rest of her life,
0:42:21 > 0:42:25which I know is the whole idea.
0:42:25 > 0:42:27I can't even imagine what that will be like.
0:42:27 > 0:42:31Someone said to me the other day, "But it suits you, being big,
0:42:31 > 0:42:35"that's you, that's who you are, and that's your personality."
0:42:35 > 0:42:37And everyone knows me as me, you know.
0:42:37 > 0:42:43You know, as Sharon, she's the big girl, she's, you know...
0:42:43 > 0:42:46Yes, I'm quite bubbly and stuff like that.
0:42:46 > 0:42:50I'm thinking, if I'm just a normal, average, slim person,
0:42:50 > 0:42:52will I just be insignificant?
0:42:52 > 0:42:54Do you know what I mean? Will I lose me?
0:42:54 > 0:42:58And then I need to find myself a nice gorgeous hunk of a man, then.
0:43:08 > 0:43:10We're going on the ground floor.
0:43:12 > 0:43:15'Doors closing. Lift going down.'
0:43:15 > 0:43:19- I feel a bit sick now. - Do you? Getting a bit nervous?
0:43:19 > 0:43:22- You'll be fine. We'll take good care of you.- I know, I know, I know.
0:43:24 > 0:43:25SHE EXHALES
0:43:27 > 0:43:30'It's just that putting yourself through surgery,
0:43:30 > 0:43:32'which I know is a risk,
0:43:32 > 0:43:36'when really, if I just had willpower and self-control,
0:43:36 > 0:43:38'it wouldn't be necessary.'
0:43:38 > 0:43:39There you go.
0:43:39 > 0:43:43'You know, they're cutting half of your stomach away.'
0:43:53 > 0:43:56We'll do four very small cuts across the top part
0:43:56 > 0:43:58of the abdomen of the patient.
0:43:58 > 0:44:02We're going to remove the main part of the body of the stomach.
0:44:04 > 0:44:06Nearly nine in ten Type 2 patients
0:44:06 > 0:44:09see dramatic improvements after surgery.
0:44:09 > 0:44:12Recent evidence suggests bariatric surgery
0:44:12 > 0:44:14not only makes people eat less,
0:44:14 > 0:44:18but it can also kick-start the body's ailing insulin system.
0:44:18 > 0:44:20Yeah, yeah. Wait there, wait there, wait there for us.
0:44:20 > 0:44:21Wait there for us.
0:44:21 > 0:44:25We know that we can treat diabetes with bariatric surgery.
0:44:25 > 0:44:29It is a cure. We have hard evidence now to use this phrase.
0:44:29 > 0:44:32It is a cure. At the moment,
0:44:32 > 0:44:36bariatric surgery is the only way to control the current problem.
0:44:36 > 0:44:38One more clip, please.
0:44:40 > 0:44:43Sharon's bariatric surgery cost around £5,000,
0:44:43 > 0:44:45but it should prevent her from developing
0:44:45 > 0:44:47complications in the future.
0:44:47 > 0:44:50This could save the NHS money in the long run,
0:44:50 > 0:44:54and many doctors think more patients should be offered the treatment.
0:44:54 > 0:44:57It's an investment the NHS has to make,
0:44:57 > 0:45:00so the resources have to be moved from somewhere else
0:45:00 > 0:45:03towards bariatric surgery, and that's not always easy.
0:45:09 > 0:45:11- We have the clip on here.- Yeah.
0:45:12 > 0:45:15Just the dog-ear at the end. Be careful of the dog-ear.
0:45:29 > 0:45:30Specimen.
0:45:31 > 0:45:34This is a life-changing operation.
0:45:34 > 0:45:37We removed part of the stomach.
0:45:37 > 0:45:40It looks like a narrow tube, but actually when we are eating
0:45:40 > 0:45:43and drinking, this part of the stomach can really expand
0:45:43 > 0:45:46and accommodate several litres of volume.
0:45:46 > 0:45:48Very happy with the result.
0:45:49 > 0:45:52In the whole of England, there are just 6,000
0:45:52 > 0:45:55weight-loss operations a year, down on previous years.
0:45:55 > 0:45:58But if the NHS met the European average,
0:45:58 > 0:46:00it would do nearer 50,000,
0:46:00 > 0:46:03enough to make a small dent in the epidemic.
0:46:03 > 0:46:07I think it needs to be far more well understood
0:46:07 > 0:46:10within the health care system. At the moment, I'm not sure whether
0:46:10 > 0:46:13everybody understands those benefits correctly.
0:46:13 > 0:46:16- INTERVIEWER:- Within the NHS, there's been a reluctance
0:46:16 > 0:46:18to embrace bariatric surgery.
0:46:18 > 0:46:19I wouldn't call it reluctance.
0:46:19 > 0:46:22I don't know whether that is the right word,
0:46:22 > 0:46:24but I think the transition
0:46:24 > 0:46:28has been very slow and a lot more people working in the NHS
0:46:28 > 0:46:31need to be made aware of the benefits of bariatric surgery.
0:46:31 > 0:46:33Once that is done, perhaps we would start seeing
0:46:33 > 0:46:36more people preferring bariatric surgery as a treatment
0:46:36 > 0:46:38and more people being offered surgery as a treatment.
0:46:41 > 0:46:45For Sharon, the effects of surgery are immediate.
0:46:45 > 0:46:47I came home last night, and I feel as though
0:46:47 > 0:46:49I've pottered around today
0:46:49 > 0:46:51and I feel quite bright and chirpy, really,
0:46:51 > 0:46:53considering it was only three days ago.
0:46:53 > 0:46:57I think I'm going to try some oxtail soup.
0:46:58 > 0:47:00I'm not thrilled by the look of it.
0:47:07 > 0:47:08Hmm.
0:47:11 > 0:47:12Six.
0:47:14 > 0:47:16Six. Six teaspoons of soup.
0:47:23 > 0:47:27The NHS does have a plan to tackle the epidemic.
0:47:27 > 0:47:30The idea is to intervene earlier to prevent
0:47:30 > 0:47:33Type 2 patients ever needing expensive hospital treatment.
0:47:33 > 0:47:37The hope is that hospitals, community services and GPs
0:47:37 > 0:47:39will work more closely together.
0:47:44 > 0:47:46But right now, many GPs
0:47:46 > 0:47:49in the front line of the new prevention strategy
0:47:49 > 0:47:52say they are already stretched to capacity.
0:47:52 > 0:47:55Sorry about the wait this morning. Have a seat.
0:47:56 > 0:47:58Six years ago, we maybe had just over 200 people
0:47:58 > 0:48:01who had Type 2 diabetes. Now we've got over 400.
0:48:01 > 0:48:06Absolutely huge amount of our time as a practice
0:48:06 > 0:48:11is spent caring for people with Type 2 diabetes.
0:48:11 > 0:48:13Are there any vegetables that you do like?
0:48:14 > 0:48:17I don't mind, er...sprouts.
0:48:17 > 0:48:20Within primary care, we are limited
0:48:20 > 0:48:23in the resource that we are allocated.
0:48:23 > 0:48:29I think that having to try and provide a good quality of care
0:48:29 > 0:48:33for all the people on our books who have diabetes
0:48:33 > 0:48:38that we see in our practice, of all age groups, is very difficult.
0:48:40 > 0:48:42Say yes to me when I'm touching your feet.
0:48:52 > 0:48:53Nothing.
0:48:53 > 0:48:56No. OK, well, we knew that anyway, didn't we?
0:48:59 > 0:49:03- Are you able to do any exercise at the moment?- No, not really.- OK.
0:49:05 > 0:49:10- It's inevitable that we struggle. - We're not coping now,
0:49:10 > 0:49:15and my main concern is unless there is a real injection of resource
0:49:15 > 0:49:18that is targeted into the problem,
0:49:18 > 0:49:22that we will not really meet the challenge of Type 2 diabetes at all.
0:49:28 > 0:49:32In a cash-strapped NHS, it will be hard to put enough money
0:49:32 > 0:49:34into prevention and GP care,
0:49:34 > 0:49:39while limited resources have to be spent on life-threatening cases.
0:49:40 > 0:49:43I think I'm in a dip here.
0:49:43 > 0:49:47Norma has been at an NHS rehabilitation centre
0:49:47 > 0:49:48for seven weeks.
0:49:48 > 0:49:51With help, she has learned to move from bed to chair.
0:49:51 > 0:49:53- How does that feel? - Lovely, thank you.
0:49:53 > 0:49:55Thank you, Caroline.
0:49:55 > 0:49:57It's getting better every day, sort of thing.
0:49:57 > 0:50:00Sometimes I've got annoyed with myself
0:50:00 > 0:50:02cos I can't do stuff that I want to do.
0:50:02 > 0:50:07You know, getting in the car, going out for a drive,
0:50:07 > 0:50:11going the shops... that's going to take some time.
0:50:14 > 0:50:16John Westwood is out of hospital too.
0:50:20 > 0:50:23After weeks of physiotherapy,
0:50:23 > 0:50:26the NHS is gradually helping him to walk again.
0:50:27 > 0:50:30One, two, three and...stand.
0:50:31 > 0:50:34OK. And then start to take a step forward.
0:50:34 > 0:50:36Take a step with it, small step,
0:50:36 > 0:50:38then take half your weight through it.
0:50:38 > 0:50:41And then step forward with the left. Lovely.
0:50:42 > 0:50:44I'll move out of the way in a minute
0:50:44 > 0:50:46so you can see yourself in the mirror.
0:50:46 > 0:50:49OK. Right through there. Brilliant. How does it feel?
0:50:49 > 0:50:51Magic.
0:50:51 > 0:50:54To me, it means everything. I'm going to walk! Fantastic.
0:50:54 > 0:50:56You wouldn't believe what I could...
0:50:56 > 0:50:59You know, it's over the moon, innit, you know?
0:51:01 > 0:51:03Well, the surgeon that did it, he said,
0:51:03 > 0:51:05"Don't worry, it's not the end."
0:51:05 > 0:51:07And, you know, it stuck with me, that did.
0:51:09 > 0:51:10That's a big one.
0:51:18 > 0:51:20I could have lost him, and that's...
0:51:20 > 0:51:23I'm grateful for the fact that I ain't going to lose him.
0:51:29 > 0:51:33For 50 years, apart from being at work, when we were at work,
0:51:33 > 0:51:35never been shopping without one another,
0:51:35 > 0:51:37we've never been on holiday without one another,
0:51:37 > 0:51:39we never went out anywhere without one another.
0:51:39 > 0:51:41Never ever.
0:51:41 > 0:51:43And we've been married 50 years.
0:51:44 > 0:51:46Well, I've got him and that's it.
0:51:46 > 0:51:48And whatever he wants to do, we'll do,
0:51:48 > 0:51:51and whatever I want to do, we'll do.
0:51:51 > 0:51:52It won't stop us.
0:51:55 > 0:51:59Stopping the Type 2 diabetes epidemic is a daunting task.
0:51:59 > 0:52:01It could still be achieved
0:52:01 > 0:52:05if bad diets and unhealthy lifestyles changed.
0:52:05 > 0:52:07Have you some stickers somewhere?
0:52:08 > 0:52:11Charities like Diabetes UK are doing their best.
0:52:13 > 0:52:15This is five pounds of fat.
0:52:15 > 0:52:17Now, if you're on a diet,
0:52:17 > 0:52:20that is realistically what you could probably lose in a month.
0:52:22 > 0:52:26Would you like to do a free Type 2 risk assessment?
0:52:26 > 0:52:29Would you be interested in finding out your risk of Type 2 diabetes?
0:52:29 > 0:52:33Would you be interested in finding out your risk of Type 2 diabetes?
0:52:35 > 0:52:38It can be very frustrating walking down the high street
0:52:38 > 0:52:42and seeing all the high-fat, high-sugar,
0:52:42 > 0:52:45high-calorie, cheap food on offer.
0:52:45 > 0:52:49There does seem to still be a huge resistance to looking at changes.
0:52:50 > 0:52:56I do feel that a lot of what we do is such a waste of time and resource
0:52:56 > 0:53:00and does leave patients very damaged and disabled.
0:53:02 > 0:53:03You can still find out your risk.
0:53:03 > 0:53:06Would you like to come on board and find out your risk?
0:53:14 > 0:53:18The Government has proposed a sugar tax on soft drinks
0:53:18 > 0:53:21and published a childhood obesity strategy,
0:53:21 > 0:53:24but many doctors think it needs far tougher action
0:53:24 > 0:53:27to have any chance of making a difference.
0:53:29 > 0:53:33The childhood obesity strategy has fallen short of
0:53:33 > 0:53:35what many people would have hoped.
0:53:35 > 0:53:41We know that this is a disease that is unrelenting, unforgiving.
0:53:43 > 0:53:45We are in a crisis now,
0:53:45 > 0:53:48and it can't be left for health care professionals
0:53:48 > 0:53:51such as ourselves to endlessly pick up the pieces.
0:53:56 > 0:53:59It's Jon O'Hagan's first week without chocolate.
0:53:59 > 0:54:03If he sticks with his diet, his surgery will go ahead soon.
0:54:03 > 0:54:06It'll be worth it when I get the surgery
0:54:06 > 0:54:08and I won't be able to eat and binge.
0:54:08 > 0:54:10Right now, it's just awful.
0:54:10 > 0:54:12It's now ten to six.
0:54:12 > 0:54:14I'm eating my porridge.
0:54:14 > 0:54:16My next meal will be an apple...
0:54:18 > 0:54:20..in four hours and nine minutes.
0:54:30 > 0:54:33By improving his diet and keeping on top of his medication,
0:54:33 > 0:54:37Ameer has got his diabetes under better control.
0:54:37 > 0:54:41A month ago his blood sugar levels were as high as 18.
0:54:41 > 0:54:44It's not that high, but it is in double figures,
0:54:44 > 0:54:46so I'd say it's above average.
0:54:46 > 0:54:49High, but not as high as you'd expect,
0:54:49 > 0:54:51so I'm happy, kind of, with it, so...
0:54:51 > 0:54:56My goal is trying to get a 6.5, because that is...
0:54:56 > 0:54:57That's perfection.
0:54:57 > 0:55:00I was reading it, that is the best sugar reading you can get.
0:55:00 > 0:55:03See, I like that dress, I like that dress...
0:55:03 > 0:55:06The NHS has given Sharon a new start.
0:55:06 > 0:55:08It's not one you'd go out in,
0:55:08 > 0:55:10it's what you'd wear to go to work and stuff in.
0:55:10 > 0:55:14Three months after surgery, she's lost three stone,
0:55:14 > 0:55:17and her blood sugar is down to normal non-diabetic levels
0:55:17 > 0:55:19without medication.
0:55:19 > 0:55:21Feel fab, feel fab.
0:55:22 > 0:55:24'I haven't really got diabetes now.'
0:55:24 > 0:55:30And I feel like I've sort of had a lucky escape from it, you know.
0:55:30 > 0:55:35In ten years' time, who knows what would have been happening to me?
0:55:42 > 0:55:48There are now four million in the UK with Type 2 diabetes.
0:55:48 > 0:55:52In ten years, there will be a million more.
0:55:52 > 0:55:55The fear is that without fundamental changes,
0:55:55 > 0:55:58the NHS will not be able to survive
0:55:58 > 0:56:00the rising costs of this deadly epidemic.
0:56:01 > 0:56:04In a way, you feel helpless.
0:56:04 > 0:56:05With the way things are going,
0:56:05 > 0:56:08it's probably going to get worse rather than better.
0:56:08 > 0:56:1110% of the NHS' money is quite a lot.
0:56:11 > 0:56:13If it continues at the current rate, certainly,
0:56:13 > 0:56:15it will not be sustainable.
0:56:16 > 0:56:18The consequences are stark.
0:56:18 > 0:56:22Either the NHS will have to make some hard choices...
0:56:22 > 0:56:26I am worried the NHS will have to decide what conditions it does
0:56:26 > 0:56:30or does not treat, and that is a very difficult decision to make.
0:56:30 > 0:56:32How are you doing there, sir?
0:56:32 > 0:56:35..or it will simply run out of money.
0:56:36 > 0:56:39Diabetes will have a tremendous burden
0:56:39 > 0:56:42on our National Health Service which is probably unaffordable,
0:56:42 > 0:56:45and it would be much cheaper to actually change lifestyles now
0:56:45 > 0:56:48and prevent people developing these complications
0:56:48 > 0:56:50than to try and pay for it through the NHS.
0:56:55 > 0:56:57Right. Where next, then?
0:56:58 > 0:56:59How are you getting on?
0:56:59 > 0:57:01Nice to see you.
0:57:04 > 0:57:06'Very resilient, we Brummies are.'
0:57:08 > 0:57:10You know, get knocked down, you just pick yourself up,
0:57:10 > 0:57:12carry on with life, don't you?