Enough with the alarmist diabetes warnings
‘This exercise is anxiety-mongering, and will cost the taxpayer £80m over the next five years’
There is no more important and necessary task for doctors than to reassure the apprehensive, and certainly avoid burdening them with alarmist warnings about their future health.
Here, the current enthusiasm for diagnosing prediabetes, as mentioned in this column a fortnight ago, and railroading patients into taking part in a diabetes prevention programme is the antithesis of good medicine.
To recap: by current criteria, a third of adults in Britain are supposedly prediabetic; that is, that their Hba1c level (a marker for long-term blood sugar levels) is in the upper range of normal. By definition, they have neither the symptoms of diabetes nor are at risk of its complications of impaired eyesight, kidney function, etc.
But, the argument goes, 10 per cent will progress to develop diabetes proper, therefore it is only sensible that all participate in the programme of weekly two-hour sessions over several months, promoting regular exercise and instructions on a healthy diet.
Now there is a glimmer of truth in this for, as all know, the overweight with type-2 diabetes can reverse the condition by losing the extra pound… and the same logically applies if they are “prediabetic”. But this certainly does not apply to the vast majority who are generally fit, active, of normal weight (or even just pleasantly plump), as the chance of their progressing to true diabetes is minuscule.
Still, rather than being reassured on this score, they find themselves automatically enrolled in the programme, with dire threats if they fail to comply. “I politely declined,” writes one reader, “and was told ‘You will probably go blind and your feet will be amputated’.
Meanwhile, those who are informed they have prediabetes need to inquire specifically about the blood test result, which, another reader reports, proved on inquiry to be well below the diagnostic range (39-46).
This exercise is anxietymongering, and will cost the taxpayer £80 million over the next five years. “Money down the toilet,” as one sceptical GP observes.
Diuresis diagnoses
There are several candidates for the prize offered by a reader to anyone who could come up with an explanation of his puzzling symptoms: on alternate days, he passes prodigious amounts of urine with, the following day, symptoms of dehydration (dry mouth, raging thirst) and feeling “utterly miserable”.
It could be, it is suggested by several, that he is experiencing bouts of paroxysmal atrial fibrillation, which stimulates the release of atrial natriuretic peptide, a hormone, from the heart muscle. This acts on the kidneys to cause a vigorous diuresis, with the excretion of copious amounts of salt. His general gloominess and lack of energy will thus be due to salt depletion.
Retired surgeon Tony Harrison points out that several other factors influence the volume of urine including dietary quirks (fondness for liquorice) and impaired functioning of the pituitary gland at the base of the brain.
This clearly warrants further investigation.
Tale of the tape
Finally, my thanks to a reader for passing on a simple, if rather unusual, home remedy that may be of interest. Suspecting his recurrent sore throats may be related to mouth-breathing while sleeping, he has, for the past 20 years, taped it shut on retiring with a vertical piece of 25mm micropore.
“This is perfectly safe,” he writes, as long as there is no nasal obstruction. It has had the further benefit, besides preventing his sore throats, of virtually eliminating his snoring, which his son, an anaesthetist, attributes to the effect of the tape in lifting the lower jaw, thus altering the aerodynamics at the back of the throat.
Quite by chance, he recently discovered that, back in the Seventies, the professor of orthodontics at Guy’s Hospital commended the same procedure to protect the teeth and gums by preventing the drying out of saliva from mouth-breathing at night.