Letters Bad medicine: the way we manage diabetes

How we manage diabetes is like Tantalus in the underworld

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3248 (Published 28 May 2013) Cite this as: BMJ 2013;346:f3248
  1. Jonathan D Sleath, general practitioner1
  1. 1Kingstone Surgery, Hereford HR2 9HN, UK
  1. jonathan.sleath{at}nhs.net

I am glad that I’m not the only one bewildered by the obsession with glucose control in type 2 diabetes,1 which often makes the diabetes worse, not better. The general consensus is that type 2 diabetes is a complex multifaceted metabolic disorder characterised by insulin resistance, obesity, and often hyperinsulinaemia. Driven by the target mentality, and fuelled by pressure from drug companies and pundits, what do we do with our obese patients with type 2 diabetes who we cannot “control” with other agents? We give them insulin, which takes glucose from the blood and stores it as fat. These patients then become fatter and need more insulin to reach the target. So we give them more insulin, and they become even fatter and, like Tantalus in the underworld, as we reach for the prize it only moves further away.


Cite this as: BMJ 2013;346:f3248


  • Competing interests: None declared.


View Abstract

Sign in

Log in through your institution

Free trial

Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial