00:00:00
you need to talk about this to decide
00:00:01
what to do it's mostly preventable but
00:00:04
it can be deadly it slowly came on you
00:00:07
see the trigger bad diet and lack of
00:00:10
exercise half-assed for going for more
00:00:13
chocolate the results
00:00:15
all too often there's a blockage in the
00:00:17
artery heart failure kidney disease feet
00:00:21
and legs that must be amputated so yes
00:00:24
to me when I'm touching your feet
00:00:27
nothing so we'll just cut it leave it
00:00:32
open
00:00:33
I'll perform two amputations alone today
00:00:36
it's an invisible illness and it
00:00:38
basically rots your organs from the
00:00:40
inside it used to be a disease of the
00:00:42
middle-aged and elderly 15 he's got a
00:00:48
whole lifetime ahead of him with
00:00:50
diabetes just as the disease slowly
00:00:53
grips our patient the costs are slowly
00:00:56
strangling
00:00:57
the NHS we are in a crisis now panorama
00:01:01
has spent six months with the sharp end
00:01:03
of the battle against this rising
00:01:06
epidemic we are very much putting out
00:01:08
the fires and whilst that is my job to
00:01:11
do that I would very much wish that
00:01:13
these fires didn't exist in the first
00:01:14
place
00:01:24
hi Martin touch see only miniatures
00:01:27
don't keep away the vascular ward
00:01:29
Heartland hospital in Birmingham deals
00:01:32
with very severe acute complications of
00:01:34
diabetes every day John Westwood is a
00:01:42
type 2 diabetic he has gangrene in his
00:01:45
foot and his life is in danger from
00:01:47
infection I was watching a television
00:01:50
and there was a radiator at the end of
00:01:53
the site and you know I almost had just
00:01:56
pushed my faith against it but he was
00:01:58
cold and then in the night the 10 cells
00:02:01
on you know John's diabetes means his
00:02:15
lost sensation in his feet and his
00:02:16
wounds won't heal mr. West at how nice
00:02:20
to meet you I'm Marcin carrot Rosco
00:02:22
surgeon Ronson you go up on with your
00:02:24
foot up to Friday that's when we call
00:02:37
the ambulance right okay all right okay
00:02:40
we have a look when this happens all
00:02:45
about three weeks ago did it yeah okay
00:02:47
thank you with you my friends
00:02:49
the infection is so much in the sole of
00:02:51
your foot and so spread up your foot
00:02:53
that I can't save your throat I'm afraid
00:02:55
so what you need to do is have an
00:02:57
emergency operation to have you removed
00:02:59
so it was what we call a guillotine
00:03:02
amputation so we take all the infected
00:03:04
tissue away and then it allows the non
00:03:08
dead tissue there's only a little bit
00:03:09
infected to settle down and then we can
00:03:11
actually finish off your operation I'm
00:03:13
up with what's called a below knee
00:03:15
amputation if we don't do that then
00:03:17
what's going to happen is the infection
00:03:19
is going to spread up your leg and
00:03:21
you'll end up losing much more of your
00:03:22
leg and ultimately you would succumb
00:03:25
from this if we don't do this and so we
00:03:27
have to get on and get this all filled
00:03:28
out for you
00:03:29
he was alright yes it is a little tight
00:03:32
I'll do my best for us as I can't do it
00:03:35
no it's very difficult to do anything
00:03:36
more many come with this situation yeah
00:03:38
so he needs it needs we need some
00:03:39
surgery though yeah he needs an
00:03:43
emergency amputation of his foot if we
00:03:45
don't get on and get on get this done in
00:03:47
the next few hours he's going to lose
00:03:48
his leg or potentially his life it's bad
00:03:55
when they tell you you're in shock
00:03:59
you blanked off when the injury happened
00:04:02
John and his wife Pat were away on a
00:04:05
special trip our son had paid for his
00:04:08
table a holiday in Cornwall for our 50th
00:04:11
wedding anniversary
00:04:12
things aren't doing and knock backs but
00:04:16
I tell you something he's never got him
00:04:17
down and if he wasn't like that I'd know
00:04:20
there was something wrong that's the
00:04:22
reason I know there was something wrong
00:04:23
with him when he wouldn't eat Nussle
00:04:26
that's not him
00:04:28
type-2 diabetes means the body's natural
00:04:31
insulin system stops working the
00:04:34
resulting high blood sugar levels clog
00:04:36
up veins and arteries and that can lead
00:04:39
to acute complications
00:04:45
time to new diabetes causes fairing off
00:04:48
of the really small blood vessels this
00:04:50
can rapidly escalate and caused gangrene
00:04:52
cause toes to be lost cause foot loss
00:04:57
and may result in amputations type 1
00:05:03
diabetes the sort you're born with
00:05:05
accounts for just a tenth of cases it's
00:05:08
type 2 mostly brought on by lifestyle
00:05:11
that's now flooding Hartman's hospital
00:05:13
with new patients Birmingham has one of
00:05:17
the highest levels of diabetes in the UK
00:05:19
an estimated 1 in 10 people here has it
00:05:24
the hospital has spent 6 million pounds
00:05:27
building a dedicated center to cope with
00:05:30
the diabetes epidemic
00:05:36
this is our main reception area where
00:05:39
patients come in we see about eight to
00:05:42
nine thousand patients every year we
00:05:46
deal with a huge range of problems
00:05:48
resulting from diabetes patients with
00:05:50
damage to the nerves in the feet
00:05:53
patients requiring follicular dialysis
00:05:55
patients having severe eye disease the
00:05:59
prevalence of diabetes is increasing so
00:06:01
rapidly that it is three times the
00:06:04
number of all the cancers combined
00:06:06
together nine out of ten type-2 diabetes
00:06:10
patients are overweight or obese okay
00:06:18
how are you Johnny Hagen was diagnosed
00:06:25
with type 2 diabetes
00:06:26
when he was 32 he's now 14 okay so it's
00:06:31
one two three point four so your BMI is
00:06:35
41 points nothing with a body mass index
00:06:40
of over 40 but John is classed as
00:06:43
severely obese he's been told he needs
00:06:45
to change his diet but he's finding it
00:06:48
hard
00:06:51
I probably do eat a bit too much in
00:06:53
general I could quite easily have four
00:06:55
or five milkshakes a week depending on
00:06:58
opportunity as well if I came to the
00:07:01
weight management clinic on Monday I
00:07:03
could have one after the Hat but my big
00:07:06
boys in the few life is his chocolate
00:07:10
now John has to rely on medication to
00:07:13
control his blood sugar levels this is
00:07:18
my daily diabetic medication
00:07:20
I have metformin 500 milligram tablets
00:07:24
I have insulin in form of the injection
00:07:27
pen I have 120 units every night and I
00:07:31
also have quick tozer which is this one
00:07:36
where do you into the legs tops of the
00:07:40
thighs or lower abdomen I try and rotate
00:07:43
the injection site so it doesn't get
00:07:44
sore limping the higher your blood sugar
00:07:50
the more invisible damage it is likely
00:07:52
to be doing blood sugar is measured in
00:07:56
many moles per liter ideally it should
00:07:58
be below 8 we're now about half an hour
00:08:03
equals an hour post learning and it's 14
00:08:09
point free but you feel I feel normal at
00:08:12
the moment that for me is not high it is
00:08:14
far too high for anybody but it's not
00:08:16
higher I'm on you Ste unfamiliar with
00:08:19
it's just too high
00:08:21
John it's a psychiatric nurse caring for
00:08:25
patients with serious mental health
00:08:27
problems
00:08:29
unfortunately work in a very stressful
00:08:31
job and eating chocolate is my big sort
00:08:33
of stress relieving thing I don't smoke
00:08:35
I rarely drink I didn't go for chocolate
00:08:38
this is Saturday it is for the past 5:00
00:08:41
in the morning I'm working a long day
00:08:42
today just about to have breakfast for
00:08:45
Weetabix totally Frosty's and a fighter
00:08:48
tee we asked John to record a video
00:08:50
diary of his regular eating habits
00:08:52
Thursday d-34 June at 12:36 for lunch I
00:08:58
have just had a large bowl of tuna pasta
00:09:02
salad and two Ferrero Rocher yummy
00:09:07
15:07 feeling rather tired and jaded so
00:09:10
I have just gone and bought a bottle of
00:09:12
Diet Coke
00:09:14
five hundred mils and a Snickers bar
00:09:16
about half past four
00:09:18
feel tired weary and going for more
00:09:21
chocolate
00:09:24
I will just cut it leave it open open
00:09:30
with some gauzes on it for a few days
00:09:32
until the circulation here relaxes John
00:09:36
Westwood is about to have his gangrenous
00:09:39
foot amputated there is a small risk
00:09:43
that you may die during the procedure
00:09:44
and the risk of that starts from around
00:09:47
5% okay do you have any more persons now
00:09:51
I will tell you to explain everything so
00:09:55
sudden we need to mark the side just to
00:09:58
show that it's the right leg please put
00:10:00
my signature with the exes
00:10:08
okay please don't eat anything now drink
00:10:12
when they go away you think well are
00:10:15
they gonna come out
00:10:17
it's just that awfully is gone you know
00:10:21
our you ain't there
00:10:22
you're diabetic and you must be a
00:10:25
mistake point five I'd rather that
00:10:29
happen to me then too John
00:10:32
we need to go computation but it's going
00:10:35
to be a guillotine amputation it's the
00:10:38
best way to stop the infection and save
00:10:41
the patient's life guillotine surgery is
00:10:46
an emergency operation for the most
00:10:48
urgent cases
00:10:52
the reality of amputation is brutal and
00:10:54
watching it is not for the faint-hearted
00:10:57
my name is andreas Amavasya citizen
00:10:59
we're just gonna do an open amputation
00:11:02
so it's just a guillotine okay and I see
00:11:06
ya can we start okay
00:11:25
okay good okay
00:11:36
welfare quite well I think with this
00:11:39
world another patient is going to
00:11:41
recover this information has saved his
00:11:44
plans version I think that I did
00:11:49
let's hope that the he goes well
00:11:58
but diabetics don't just face the risk
00:12:01
of amputations Sharon Barnett is 44 she
00:12:08
was diagnosed with type 2 9 years ago
00:12:11
she is worried about the damage the
00:12:13
disease might be causing her eyes
00:12:15
kidneys or heart you can stop the
00:12:20
disease progressing if you lose enough
00:12:22
weight and change your lifestyle but
00:12:24
Sharon has tried many times and still
00:12:26
weighs 18 stone in three weeks she will
00:12:29
have weight loss or bariatric surgery
00:12:31
she's here for a pre-op check her friend
00:12:34
named Sharon Sharon I just know I need
00:12:38
to do it I know that I can't carry on it
00:12:41
my health problems are probably just
00:12:44
going to get worse and worse if I don't
00:12:45
do something about it
00:12:47
what do you do for your life my work I
00:12:49
work in a call center constant yeah I
00:12:53
weigh 119 kilos at the moment I'm now a
00:13:00
health risk you know I might not live as
00:13:03
long as I could live because I've let
00:13:04
myself be overweight
00:13:13
obesity has crept up on Sharon the
00:13:16
result of too little exercise and too
00:13:19
many calories from carbohydrates and
00:13:20
sugary foods oh my god where did that
00:13:30
come from
00:13:31
I'm not really old or was only nineteen
00:13:33
you've only got to go probably you know
00:13:36
three or four hundred calories a day
00:13:37
over and I just think it's gradually
00:13:40
over the years just gone on that's me
00:13:42
there you know all the teams and
00:13:45
everything yeah I played like at school
00:13:47
I played rounders netball hockey all
00:13:50
them when I left school I stopped
00:13:52
exercising
00:13:53
I just stopped completely but I carried
00:13:56
on eating the amounts I was eating
00:14:09
after the amputation John Westwood is
00:14:12
doing well small don't know that's
00:14:18
really good so it's been a bit of a roll
00:14:20
all over the next few days
00:14:22
I see a little bit that okay awesome
00:14:25
I'm gonna join the Long John Silver in
00:14:27
post Thanks
00:14:29
well I don't feel 100% no pain at all
00:14:34
it's absolutely miser joe wallace IQ is
00:14:38
what i told you before if you're
00:14:40
diabetic keep on top of it if you don't
00:14:44
get it what this it's a bad disease a
00:14:47
really bad to say
00:14:52
if you have the information typically
00:14:55
vascular surgeons who treat diseases of
00:14:58
the veins and arteries do all they can
00:15:01
to avoid amputations in the past a large
00:15:04
share of vascular problems were caused
00:15:07
by smoking how's your leg feeling he
00:15:14
used to be that perhaps to be unusual to
00:15:17
find a patient with diabetes but now
00:15:19
almost every patient I come across on
00:15:21
the vascular ward has diabetes the
00:15:31
growing burden of type 2 diabetes is
00:15:34
having a big impact right across
00:15:35
heartland hospital
00:15:38
diabetes ravages most of the systems it
00:15:42
has effects on the heart has effects on
00:15:44
the blood vessels has effects on the
00:15:46
kidneys and it's just non remitting
00:15:48
unrelenting you know it just carries on
00:15:50
the back of your mind you always think
00:15:52
that they have a limited lifespan
00:15:53
because there's there's only so much
00:15:56
you'll be able to do for them
00:15:59
if you got type 2 diabetes
00:16:02
you're almost twice as likely to have a
00:16:04
heart attack and over three times as
00:16:06
likely to have kidney disease how you
00:16:12
getting on with the dialysis you all
00:16:14
right
00:16:14
many problems the fish tiller and then
00:16:17
whether you have we probably get about
00:16:20
10 to 12 hours a week probably 5 then 5
00:16:24
or 6 will be diver type 2 diabetic about
00:16:27
40% of our patients on dialysis are type
00:16:31
2 diabetic Annette visits patients at
00:16:38
home to explain what lies ahead when
00:16:40
they need kidney dialysis to keep them
00:16:42
alive
00:16:50
it's quite difficult walking into
00:16:52
somebody's mouth and they don't they
00:16:55
don't know what you're going to tell
00:16:56
them they're terrified but at the end of
00:16:58
the day unfortunately the story is the
00:17:00
same really that you know you're going
00:17:02
to need to have dialysis and this this
00:17:04
is what it entails
00:17:05
you know the whole life now is going to
00:17:07
be monopolized by the renal failure
00:17:11
Annette's next visit is to John James
00:17:15
John has lost weight and controlled his
00:17:18
blood sugar well since he was diagnosed
00:17:20
with type-2 twelve years ago but still
00:17:23
his kidney function has deteriorated
00:17:30
that was meeting the Queen at Lourdes
00:17:35
that was my debut John used to play
00:17:43
cricket for Warwickshire and England I
00:17:47
was probably a little bit on the loud
00:17:50
side I was still reasonably quick
00:17:56
between the wicked but after I stopped
00:17:58
playing wasn't doing as much exercise as
00:18:01
perhaps I should have done and that's
00:18:03
when diabetes said he and it was much of
00:18:06
a surprise to me that I had got type 2
00:18:09
diabetes
00:18:12
the end of the day we're breaking bad
00:18:14
news you can almost see the cogs inside
00:18:17
their head they're not listening to what
00:18:19
you've said that's the one word is going
00:18:21
around I'm going to die I'm going to die
00:18:22
and the die on the board oh my god they
00:18:24
need dialysis new dialysis we were
00:18:28
talking about dr. Thomas and the fact
00:18:29
that he's referred you to the renal team
00:18:31
because the kidneys are failing
00:18:32
there's a possibility money the dialysis
00:18:35
the diabetes are unfortunately very
00:18:37
common diabetic the first alysus I'm
00:18:40
going to talk to you a bit about is
00:18:41
called peritoneal dialysis you'd need a
00:18:44
little procedure to put the catheter
00:18:46
this is the catheter okay no dialysis
00:18:52
bags and basically all you're doing is
00:18:55
connecting takes approximately 20
00:19:00
minutes we sat there watching your
00:19:03
cricket four times a day so if you've
00:19:08
got any other worries or concerns it's
00:19:12
time not really so I say thank you for
00:19:19
your time no you are cruciate thank you
00:19:25
they'll cut down on meals basically I'm
00:19:28
only having one meal a day I might have
00:19:31
a little bit of a snack in the evening
00:19:32
or that sort of thing but that's
00:19:33
basically to keep the weight off
00:19:35
obviously I want to try and avoid that
00:19:37
and whether one can do more exercise
00:19:44
enough but is it difficult when you
00:19:45
better to help the kidney function
00:19:48
they've got a catheter if you can't
00:19:50
exactly go ready do what you can when
00:19:53
you can and enjoy life when you can
00:20:09
but the type 2 epidemic is now affecting
00:20:11
people much earlier in life just 16
00:20:14
years ago there had never been a single
00:20:17
case of a child being diagnosed with
00:20:19
type 2 diabetes in the UK I didn't quite
00:20:23
believe it it wasn't in any of our
00:20:25
medical textbooks we didn't get taught
00:20:27
it in medical school so we didn't expect
00:20:29
to see it as as an issue we just didn't
00:20:31
think it was all as an American problem
00:20:32
but in the year 2000 we saw the first
00:20:35
cases in the UK here in Birmingham
00:20:48
amia is 15 he was diagnosed the type 2
00:20:52
when he was just 13 people of South
00:20:58
Asian origin are twice as likely to have
00:21:01
type 2 diabetes and the disease runs in
00:21:04
his family Aamir must check his blood
00:21:07
sugar at least four times a day thank
00:21:12
you ever since I've been diagnosed every
00:21:16
day out before lunch
00:21:17
I've come down check my sugars at first
00:21:20
it was annoying and I can admit that I
00:21:22
never used to come because that you know
00:21:24
it was it was kind of hard for me to you
00:21:27
know calm down check my shoulders people
00:21:29
asking questions but then once I told
00:21:31
them that you know it can happen to
00:21:33
anyone and everyone they were actually
00:21:36
you know quite calm at first Co one day
00:21:39
like no one asks questions and they
00:21:41
understand so I kind of feel happy about
00:21:44
that now being diagnosed young means
00:21:47
life-threatening complications are
00:21:48
likely to occur earlier in life but as
00:21:51
long as his blood sugar is well
00:21:53
controlled and Mia can keep the disease
00:21:55
at bay I am quite rebellious when it
00:21:58
comes to like oh you can't have this
00:22:00
click on that like I'd go to the shops
00:22:02
like mommy when she said you got to
00:22:04
spend it on your lunch you're not going
00:22:05
to shops to get chocolates or crisps or
00:22:07
sugary drinks and sometimes I was like
00:22:09
I'd get like small chocolate bars but
00:22:11
then when it comes to chicken with sugar
00:22:12
is awesome we're gonna need it in Kalama
00:22:20
Amir and his mum who also has tagged to
00:22:24
have to come regularly to the hospital
00:22:26
where his condition is being closely
00:22:28
monitored
00:22:39
in three weeks as I saw him last the
00:22:42
glucose level for somebody who doesn't
00:22:43
have diabetes would be between about
00:22:45
three point five in about seven point
00:22:47
eight something like that we're trying
00:22:50
to get him to manage his glucose is
00:22:51
between four and seven once it's over
00:22:53
about fourteen actually it's much higher
00:22:55
than we'd like to see so we're gonna
00:22:57
need to do a glucose check today
00:23:05
18:13 so that's great advice is it 18 is
00:23:09
a very high level any reason why do you
00:23:15
think you should it was so high this
00:23:16
morning to eat last night normal to
00:23:22
Patti and Clooney okay the problem is I
00:23:26
mean is that it if we carry on like this
00:23:28
at 15 my tummy is 25 you'll get 9 damage
00:23:32
and you've already had gout and stuff in
00:23:35
your feet as well and you will get these
00:23:37
obliviously damage
00:23:39
I'm sure you're eating healthier which
00:23:41
would be great but usually less okay
00:23:45
I'm worried in the long term because
00:23:47
we're not winning at the moment either
00:23:49
in terms of his weight which is static
00:23:51
or his glucose control it's just if
00:23:53
anything is hit worse than it has been
00:23:54
before I think he's at a bit of a
00:23:59
crossroads he's got a whole lifetime
00:24:01
ahead of him with diabetes Oh what did
00:24:05
that today I mean I this is what I've
00:24:07
been banging on about to Mia everybody's
00:24:09
missed his doses you're going to his own
00:24:12
bubble he's a nice lad I think he finds
00:24:14
it difficult to motivate himself he's
00:24:16
still eating more calories than he's
00:24:19
burning off in exercise I've got to try
00:24:21
even harder than I did before
00:24:29
Aamir has to cut out even occasional
00:24:32
lapses dinner yeah it's got 26 rounds
00:24:49
29% sugar I'm gonna be in trouble now
00:24:56
you did say to me people belied room can
00:24:59
I just saw Roy be nights which I mean
00:25:02
see he'll sneaky like he'll get snacks
00:25:08
and not make it away to everyone that
00:25:10
he's got them and then we'll just find
00:25:12
matters and we'll be like I didn't have
00:25:15
that my brother like well I did it I'm a
00:25:17
mother with flipping who's Heidi who's
00:25:19
hiding in there we'll find out in with
00:25:21
him
00:25:21
hiding upstairs he had it there are now
00:25:24
over 500 children in the UK diagnosed
00:25:28
with type 2 diabetes and a number of new
00:25:31
cases is rising alarmingly fast
00:25:34
every new diagnosis of type 2 diabetes
00:25:37
in children has been analyzed by amazed
00:25:40
doctor and academic colleagues it was
00:25:43
August last year so you'd have been 50
00:25:44
definitely got diabetes - the random
00:25:46
photos missing twice as many children so
00:25:49
I've been type 2 diabetes than we were
00:25:51
in 2005 a striking number of the
00:25:53
children have evidence of fatty
00:25:56
infiltration of their liver and abnormal
00:25:58
liver function tests eleven year old
00:25:59
twelve year old that I saw a child last
00:26:02
week is actually developing cirrhosis of
00:26:04
the liver Tyler Beede some children may
00:26:09
be a different disease - type 2 diabetes
00:26:11
in adults so I'd also get this at the
00:26:12
age of 50 whatever may not necessarily
00:26:14
get these other complications but the
00:26:16
children we're seeing with tights who
00:26:17
seem to have got a more aggressive
00:26:18
progress and they're getting these
00:26:20
complications earlier than you would
00:26:21
expose
00:26:26
as greater numbers of children are being
00:26:28
diagnosed with type 2 the financial
00:26:31
implications for the NHS in the future
00:26:33
are grave john O'Hagan lives with his
00:26:40
wife Severine and their two children he
00:26:43
is still struggling to control his sugar
00:26:44
intake
00:26:46
behave yourself shorty it's 6:45 on
00:26:54
Friday the 1st of July
00:26:56
I've just had breakfast for Weetabix
00:26:59
topped up with Frosty's and a point of
00:27:03
tea and I've also had a huge amount of
00:27:05
the chocolate slab that I was bought
00:27:07
yesterday over many years John has been
00:27:12
unable to beat his compulsion to eat
00:27:14
chocolates even though it threatens to
00:27:17
devastate his health this I've had to
00:27:22
buy because this was the chocolate that
00:27:25
was in the fridge this morning which my
00:27:28
wife had bought for our children and
00:27:31
basically I've stolen the children's
00:27:33
chocolate and I've now had to replace
00:27:36
what I've stolen I don't have anything
00:27:40
in cupboards on show because I know that
00:27:43
if I go out it wouldn't be there do you
00:27:45
make a habit of hiding treats and snacks
00:27:48
yes yes all the time
00:27:50
and he's very good at finding my my
00:27:54
secret places like a third hand for
00:27:57
chocolate I know have you tried to
00:28:00
change him
00:28:01
I've stopped really you know I got I've
00:28:03
got two children she sort of tried to
00:28:06
give a good diet too and he's an adult
00:28:10
no he's got he's got to do it himself
00:28:13
I mean if it's hard and he's got never
00:28:18
will because there's Smiths and
00:28:20
chocolate and that's it
00:28:26
noe sure it's purple bars Bing Bing
00:28:34
you're right it is pink I couldn't see
00:28:37
it when you had it first halfway my nose
00:28:40
I've suffered depression an awful long
00:28:42
time my first episode I know I was 15 so
00:28:48
yeah my mother and grandmother both
00:28:52
showed a lot of elleven affection free
00:28:55
food so it was always lot sweet mum was
00:28:58
a fantastic cook so my brothers and I
00:29:01
used to sort of compete for the for the
00:29:02
mixing bowl which is never lie on sugar
00:29:06
a lot of people self medicate depression
00:29:10
with booze I don't do that a lot of
00:29:13
people in depression will smoke heavily
00:29:15
I don't do that anymore
00:29:16
and I eat that binging and being a
00:29:26
damaging in the same way that George
00:29:30
best knew that when he was on his second
00:29:31
liver the drink was still gonna kill him
00:29:33
eventually didn't stop him drinking so
00:29:40
you see in my Ma's chair I've made you
00:29:42
go far too much needs eat but you can
00:29:45
don't worry if you have to leave some
00:29:53
john has decided he can't beat his
00:29:55
addiction on his own 123 point six so
00:29:59
he's gone up from when I was last seen
00:30:01
in clinic he too has opted for
00:30:05
irreversible weight loss surgery I feel
00:30:09
quite awful that I need to sink surgery
00:30:13
to affect the change that I need to
00:30:14
affect but I've tried every other means
00:30:16
and failed mm-hmm
00:30:22
things have got to change now because I
00:30:25
have two children and I want to make
00:30:30
sure I'm around to see them grow up I
00:30:31
want to be a part of their lives for as
00:30:33
long as I can if I don't look after my
00:30:36
diabetes I face the prospect of vascular
00:30:39
problems dementia strokes heart disease
00:30:42
my life expectancy reduces drastically I
00:30:47
don't have to happen and it's as simple
00:30:51
as I'd I don't want to miss out on their
00:30:53
lives
00:31:19
Sharon's weight-loss operation is
00:31:21
imminent but the surgery will only go
00:31:24
ahead if she completes a strict four
00:31:27
week crash diets in the run up until my
00:31:31
surgery it's sixteen days I've got to
00:31:34
stick to less than a thousand calories a
00:31:39
day so it's and I'm trying to just still
00:31:45
eat normally but obviously just eat a
00:31:47
lot less than what I would normally do
00:31:49
if my liver isn't looking good
00:31:52
which is what the diets all about it
00:31:54
shrinks you liver they might not do it
00:31:57
they might just say no sorry you've not
00:31:59
followed the diet we're not going to do
00:32:00
the surgery and I would just be
00:32:02
devastated if that happened I do
00:32:06
actually feel in some ways ashamed that
00:32:10
I've let myself let let this happen to
00:32:12
me
00:32:17
I'm never gonna be a stick insect I'm I
00:32:19
don't Italy really if it gets rid of the
00:32:22
diabetes and makes me more healthy I
00:32:25
just want to be able to be more active
00:32:27
and do stuff even going to having a
00:32:29
dance and things
00:32:41
diabetes can have a catastrophic
00:32:43
long-term effect on patients but it's
00:32:48
also creating a potential catastrophe
00:32:50
for the NHS all aspects of a health care
00:32:55
that are affected by type 2 diabetes are
00:32:57
straining at the seams bursting at the
00:32:59
seams from trying to manage this an
00:33:01
increasing number of patients with this
00:33:02
complication each time one of these
00:33:05
episodes occur each time the patients
00:33:07
come in tousle there is a huge price tag
00:33:09
in terms of economic cost and
00:33:11
mobilization of staff and resources the
00:33:17
NHS spends nearly a billion pounds a
00:33:19
year on foot ulcers and amputations
00:33:22
caused by type 2 diabetes
00:33:26
that's almost one percent of the entire
00:33:29
NHS budget we now probably need around
00:33:34
double the number of beds that we used
00:33:36
to have in vascular surgery to help with
00:33:37
this influx of the disease Northcott
00:33:43
support I pretend it's port John
00:33:49
westward has had more surgery doctors
00:33:52
have constructed a stump that they hope
00:33:54
will be robust enough to support a
00:33:55
prosthetic limb it's just romantic it's
00:34:03
you know do you know what was been
00:34:07
around and I didn't I thought if you uh
00:34:11
you know I knew he'd lose his turn
00:34:16
you're gonna pioneer it
00:34:21
god I hate but there's nothing there so
00:34:24
what's her timid it's over so where that
00:34:26
tell you it's who is the brains trying
00:34:29
to find here the focus head
00:34:35
John's two operations cost the NHS about
00:34:38
18,000 pounds rehabilitation will cost a
00:34:42
further 20,000 pounds
00:34:46
but sometime to patients require even
00:34:48
greater levels of care to give them a
00:34:50
chance against the disease Norma Edmonds
00:34:55
has already lost both her feet to
00:34:57
diabetes now she's back in hospital with
00:35:00
an infection which is tracking up her
00:35:02
leg and threatening her life
00:35:06
first it was my table I had heard that
00:35:09
amputated and then it went into the bone
00:35:12
saw herself another operation and then
00:35:15
it went on to the other foot so you know
00:35:18
within the two-year I had done both wait
00:35:22
I'm yours you're in your fifties yeah
00:35:29
yeah yeah can I ring you back cause I've
00:35:38
got somebody with mine all right seeing
00:35:41
the big boy love you the super to her
00:35:50
Norma got married at 19
00:35:53
we've been married 37 years now so it
00:36:00
was in the pub and he went down on his
00:36:04
knee and says will you marry me and I
00:36:07
thought he was joking up for us
00:36:11
I'm so happy that they are looks so nice
00:36:15
there as well Norma gradually put on
00:36:18
weight in her 20s and began to hit acute
00:36:21
problems in her 40s so far doctors have
00:36:25
managed to preserve some mobility for
00:36:27
her this time it'll be harder
00:36:33
unfortunately the infection is not
00:36:36
really settling so we would have to go
00:36:39
back and take out more muscle more skin
00:36:42
more bone from her leg below the knee
00:36:46
and even if we did that it's quite
00:36:49
likely that that wound would never heal
00:36:51
and so she would never get back a leg
00:36:54
that was useful to her that she would be
00:36:56
able to walk on the alternative is to do
00:36:58
an amputation above the knee most
00:37:02
patients who have an above-the-knee
00:37:03
amputation will never walk again and
00:37:06
we'll need costly ongoing care i norma
00:37:09
how are you so do you understand so as
00:37:18
you know you came into hospital with a
00:37:19
lot of infection in the leg we agree
00:37:24
that probably the best way of getting
00:37:25
you at hospital and as quickly as
00:37:28
possible would be to amputate her leg
00:37:29
above above the knee which is obviously
00:37:32
a big step yeah and a big decision that
00:37:34
I think that's what you you were quite
00:37:36
clear in your own line that's what you
00:37:38
wanted in in that still your view now
00:37:41
that's what you'd like to do okay
00:37:56
based on
00:38:01
okay what's your fingers that's the leg
00:38:08
free
00:38:16
we liked it to look symmetrical and a
00:38:19
neat and tidy as much as I missed it at
00:38:22
the amputations thump can never look
00:38:24
nice I think having a good shape is is
00:38:28
important happy happy with the way it's
00:38:34
gone thanks Norma won't be strong enough
00:38:40
to leave Heartland for nearly a month
00:38:42
and the average cost of a single night
00:38:45
in hospital is 400 pounds
00:38:55
when all the costs to the NHS of type 2
00:38:59
diabetes are added together the total is
00:39:02
an estimated ten point three billion
00:39:05
pounds
00:39:06
that's nearly ten percent of the entire
00:39:09
NHS budget and is set to continue rising
00:39:12
sharply one way to save type 2 patients
00:39:20
from the worst consequences of the
00:39:22
disease is bariatric surgery it could
00:39:26
also save the NHS money in the long run
00:39:28
hi John hi I'm good thank you John will
00:39:32
have gastric bypass surgery in four
00:39:34
weeks as long as he can stick to the
00:39:37
pre-op diet all right John the
00:39:39
principles there are to create a small
00:39:42
stomach and that should reduce how much
00:39:45
portions how much food you can eat one
00:39:47
go part of that is physical mechanical
00:39:50
and part of that is hormonal because
00:39:52
certain hormones which will we will be
00:39:54
release which will encourage you to feel
00:39:56
full so you can actually walk away from
00:39:58
the small plate of food feeling quite
00:39:59
satisfied and not hungry you've got to
00:40:04
go on a very low-calorie diet
00:40:05
yes I'm aware eight hundred to a
00:40:07
thousand calories a day maximum this
00:40:11
this is not a punishment for you John
00:40:13
the reason the reason why we're doing
00:40:15
this is to shrink your liver down yes
00:40:17
and this will this will definitely help
00:40:20
how do you feel you're gonna get on with
00:40:21
this it's gonna be horrendous if I'm
00:40:24
gonna struggle but I have to do it so
00:40:27
I'm gonna do the best I can yeah yeah
00:40:31
thank you
00:40:32
Susannah Jon hopefully we'll get a good
00:40:35
result
00:40:36
diabetes resolution after gastric bypass
00:40:40
surgery is quite an amazing thing to see
00:40:45
within six weeks or so we can get them
00:40:47
off insulin but if you feel like you
00:40:52
want to suddenly go out and have a large
00:40:53
meal that's not going to be possible
00:40:55
without you either being sick or feeling
00:40:57
pain and there is a finality to that
00:40:59
that people have to mentally be prepared
00:41:02
for
00:41:05
Sharon has completed her crash diet and
00:41:08
her bariatric surgery will go ahead
00:41:10
today the main part of her stomach will
00:41:14
be cut out leaving only a narrow tube
00:41:17
with much less space for food sometimes
00:41:22
you have noticed that the tube is too
00:41:24
narrow for some of the patients if this
00:41:27
happens you may need to operate on you
00:41:29
long term if you're happy of like this
00:41:32
choice for your signature she has pretty
00:41:33
much anything to date for us thank you
00:41:37
the risk of serious complications is
00:41:39
loans but the impact on Sharon's life
00:41:42
will be huge today is the start of a new
00:41:52
life really hopefully so and hopefully a
00:41:57
better one no but not worse or it's not
00:42:00
something that you say well I can always
00:42:03
have it reversed if it doesn't suit it's
00:42:06
a complete life change so she's going to
00:42:08
have to eat differently now for the rest
00:42:10
of her life which I know is the whole
00:42:11
idea I can't even imagine that will be
00:42:16
like someone said to me the other day
00:42:19
but it suits you being big that's you
00:42:21
that's who you are in that your
00:42:23
personality and everyone knows me as as
00:42:26
me you know Sharon who she's the big
00:42:31
girl she's you know yes I'm quite bubbly
00:42:34
and stuff like that and I'm thinking if
00:42:36
I'm just a normal average slim person
00:42:39
will I just be insignificant you know
00:42:41
will I lose me you know then I need to
00:42:44
find myself a nice gorgeous hunk of a
00:42:46
moment yeah
00:43:16
it's just that pointy self through
00:43:19
surgery which I know is a race when
00:43:22
really if I just had willpower and
00:43:24
self-control it wouldn't be necessary
00:43:29
you never come to half of you stomach
00:43:32
away
00:43:42
we will do four verse one cuts across
00:43:45
the top part of the abdomen of the
00:43:46
patient we are going to remove may main
00:43:50
part of the body of the stomach nearly 9
00:43:55
in 10 type 2 patients see dramatic
00:43:57
improvements after surgery recent
00:43:59
evidence suggests bariatric surgery not
00:44:02
only makes people eat less but it can
00:44:04
also kick-start the bodies ailing
00:44:06
insulin system where they are where they
00:44:09
are where we are for us were there for
00:44:10
us we know that we can treat diabetes
00:44:13
with palliative surgery it is a cure we
00:44:16
have hard evidence now to use this
00:44:18
phrase it is a cure at the moment
00:44:21
bariatric surgery is the only way to
00:44:24
control the current problem Sharon's
00:44:29
matric surgery cost around five thousand
00:44:32
pounds but it should prevent her from
00:44:34
developing complications in the future
00:44:36
this could save the NHS money in the
00:44:39
long run and many doctors think more
00:44:42
patients should be offered the treatment
00:44:43
it's an investment that the NHS has to
00:44:46
make so the resources have to be moved
00:44:48
from somewhere else
00:44:49
towards bariatric surgery and it's not
00:44:52
always easy
00:44:59
yeah
00:45:02
mr. dog here at the end be careful the
00:45:04
doggy Amato
00:45:19
specimen this is a life-changing
00:45:23
operation we remove part of the stomach
00:45:26
it looks like a narrow tube but actually
00:45:28
when we are eating drinking this part of
00:45:31
the stomach can really expand and
00:45:33
accommodate several liters of volume
00:45:36
result in whole of England there are
00:45:40
just six thousand weight loss operations
00:45:43
a year down on previous years but if the
00:45:46
NHS met the European average it would do
00:45:48
near a fifty thousand enough to make a
00:45:51
small dent in the epidemic I think it
00:45:53
needs to be far more well understood
00:45:56
than within the healthcare system at the
00:45:58
moment I'm not sure whether everybody
00:46:00
understands those benefits correctly
00:46:02
within the NHS there's been a reluctance
00:46:05
to embrace bariatric surgery I wouldn't
00:46:08
call it her lectins I don't know whether
00:46:09
that is the right word but I think it is
00:46:12
I think the transition has been very
00:46:14
slow and a lot more people working in
00:46:17
and I just need to be made aware of the
00:46:19
benefits of bariatric surgery once that
00:46:21
is done perhaps we would start seeing
00:46:23
more people preferring bariatric surgery
00:46:25
as a treatment and more people being
00:46:26
offered surgery as a treatment for
00:46:30
Sharon the effects of surgery are
00:46:33
immediate came home last night and I
00:46:36
feel as though of pottered around today
00:46:38
and feel quite bright and chirpy really
00:46:41
considering it was only three days ago I
00:46:43
think I'm going to try some oxtail soup
00:46:47
I'm not thrilled by the look of it
00:47:03
six-six-six teaspoons of soup the NHS
00:47:14
does have a plan to tackle the epidemic
00:47:16
the idea is to intervene earlier to
00:47:19
prevent type 2 patients ever needing
00:47:21
expensive Hospital treatment the hope is
00:47:24
that hospitals Community Services and
00:47:26
GPS will work more closely together
00:47:34
but right now many GPS in the front line
00:47:36
of the new prevention strategy so they
00:47:39
are already stretched to capacity we're
00:47:42
gonna sorry about the way this morning
00:47:43
overseas
00:47:45
six years ago we maybe have just over
00:47:47
two hundred people who had type 2
00:47:49
diabetes never got over 400 absolutely
00:47:52
the huge amount of our time as a
00:47:55
practices spent became for people with
00:47:59
type 2 diabetes any vegetables that you
00:48:02
do like don't mind again sprouts within
00:48:08
primary care we are limited in the
00:48:11
resource that we are allocated I think
00:48:14
that having to try and provide a good
00:48:18
quality of care for all the people on
00:48:21
our books who have diabetes that we see
00:48:24
in our practice of all age groups is
00:48:26
very difficult so yesterday when i
00:48:31
touching your feet
00:48:41
nothing no we knew that anyway are you
00:48:49
able to do any exercise at the moment
00:48:52
okay it's inevitable we struggle
00:48:57
we're not coping now and my main concern
00:49:01
is that unless there is a real injection
00:49:04
of resource that is targeted into the
00:49:07
problem that we will not really meet the
00:49:09
challenge of type 2 diabetes at all
00:49:17
in a cash-strapped NHS it'll be hard to
00:49:21
put enough money into prevention and GP
00:49:23
care while limited resources have to be
00:49:26
spent on life-threatening cases a deep
00:49:32
pillar
00:49:33
Norma has been at an NHS rehabilitation
00:49:36
center for seven weeks with health she's
00:49:39
learned to move from bed to chair thank
00:49:42
you
00:49:43
it's getting better every day I sorta
00:49:46
think sometimes I've got a knowledge of
00:49:48
myself because I can't do stuff that I
00:49:51
want to do you know getting in the car
00:49:54
or going out for a drive going the shops
00:49:58
that's going to take some time
00:50:03
John Westwood is out of hospital too
00:50:10
after weeks of physiotherapy the NHS is
00:50:13
gradually helping him to walk again
00:50:21
and then starts to take a step forward I
00:50:24
can stay with it small step and take
00:50:26
half you wait through it take a step and
00:50:28
then step forward with the left I'll
00:50:32
tell them about the way in a minute
00:50:33
sequence it's nothing then where does it
00:50:38
feel to me means everything I'm gonna
00:50:42
walk fantastic you wouldn't believe what
00:50:44
could you know you tell with the moon in
00:50:48
it you know well the surgeon that did it
00:50:52
they said don't worry it's not the end
00:50:54
and you know wait stop with you loved it
00:50:58
that's a big one
00:51:07
I could've lost him and that's that I'm
00:51:10
grateful for the fact that I ain't gonna
00:51:12
lose him
00:51:18
450 years apart from being at work one
00:51:21
was at work never been shopping out when
00:51:24
are the word reference our ala Deary at
00:51:25
one another one never went out anywhere
00:51:28
without one another
00:51:29
never ever and we've been married 50
00:51:32
years well I've got him in that set and
00:51:36
wherever he wants to do will do and
00:51:38
whatever I want to do will do much stuff
00:51:41
was stopping the type 2 diabetes
00:51:46
epidemic is a daunting task it could
00:51:50
still be achieved if bad diets and
00:51:52
unhealthy lifestyles changed
00:51:58
charities like Diabetes UK are doing
00:52:00
their best this is 5 pounds of fat if
00:52:05
you're on a diet that is realistically
00:52:08
what you could probably lose in a month
00:52:12
would you like to know free time to
00:52:13
which professor
00:52:15
would you be interested in fighting at
00:52:17
your risk of type 2 diabetes would you
00:52:19
be interested in finding out your risk
00:52:20
of type 2 diabetes
00:52:24
it can be very frustrating walking down
00:52:27
the high street and seeing all the high
00:52:30
fat high sugar high calorie cheap food
00:52:33
on offer that seems to still be a huge
00:52:36
resistance to looking at changes I do
00:52:40
feel that that a lot of what we do is
00:52:42
such a waste of time and resource and
00:52:45
leave patients very damaged and disabled
00:52:51
don't find out you're rich
00:52:53
would you like to come on board and find
00:52:54
out your wrist
00:53:03
the government has proposed a sugar tax
00:53:06
on soft drinks and published a childhood
00:53:09
obesity strategy but many doctors think
00:53:12
it needs far tougher action to have any
00:53:14
chance of making a difference
00:53:19
childhood business strategy has fallen
00:53:22
short of what many people would have
00:53:24
hoped we know that this is a disease
00:53:27
that is unrelenting unforgiving we are
00:53:33
in a crisis now and it can't be left for
00:53:37
health care professional sort of herself
00:53:38
to endlessly pick up the pieces it's
00:53:46
John O'Hagan's first week without
00:53:48
chocolates if he sticks with his diet
00:53:50
his surgery will go ahead soon it'll be
00:53:54
worth it when I get the surgery and I
00:53:56
won't be able to eat and binge right now
00:53:58
it's just awful it's now ten to six I to
00:54:02
my porridge my next meal will be an
00:54:05
apple in four thousand nine minutes
00:54:19
by improving his diet and keeping on top
00:54:22
of his medication amia has got his
00:54:25
diabetes under better control a month
00:54:27
ago his blood sugar levels were as high
00:54:29
as 18 it's not that high but it is
00:54:32
blocking double-figure soul
00:54:34
I taste a book I'm rich high but not as
00:54:36
high as you'd expect so I'm happy kind
00:54:40
of with it so my god was trying to get a
00:54:43
6.5 because that is that perfection
00:54:46
because I was reading it no the best
00:54:48
should be reading you can get see I like
00:54:50
that dress I like that dress the NHS has
00:54:53
given Sharon a new start three months
00:55:01
after surgery she's lost three stone and
00:55:03
her blood sugar is down to normal
00:55:05
non-diabetic levels without medication
00:55:11
I haven't really got diabetes now and I
00:55:15
feel like I've sort of had a lucky
00:55:18
escape from it you know that could have
00:55:20
you know in ten years time who knows
00:55:23
what would have been happening to me
00:55:32
there are now 4 million people in the UK
00:55:35
with type 2 diabetes in 10 years there
00:55:40
will be a million more the fear is that
00:55:42
without fundamental changes the NHS will
00:55:46
not be able to survive the rising costs
00:55:48
of this deadly epidemic in a way you
00:55:51
feel helpless with the way things are
00:55:55
going it's probably gonna get worse
00:55:56
rather than better ten percent of the
00:55:59
NHS money is quite a lot if it continues
00:56:01
that the current rate certainly do not
00:56:03
be sustainable the consequences are
00:56:07
stark either the NHS will have to make
00:56:10
some hard choices
00:56:11
I am worried the NHS will have to decide
00:56:15
what conditions it does or does not
00:56:16
treat and that is very difficult
00:56:18
decision to make
00:56:21
or it will simply run out of money
00:56:26
diabetes will have a tremendous burden
00:56:28
on our National Health Service which is
00:56:31
probably unaffordable and it'd be much
00:56:33
cheaper to actually change lifestyles
00:56:35
now and prevent people developing these
00:56:37
complications than to try and pay for it
00:56:38
through the NHS
00:56:47
now you're going on watch the city
