Intended for healthcare professionals

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Endgames Case Review

A patient request for some “deprescribing”

BMJ 2015; 351 doi: (Published 03 August 2015) Cite this as: BMJ 2015;351:h4023

Rapid Response:

Re: A patient request for some “deprescribing”

I am 42 years old, wife and mother of two children, aged 13 and 10 years. We live in Scotland. I have been Type 1 diabetic (insulin dependent) for 25 years, with a history of diabetes running through my father’s side of the family. In my early years of diagnosis, I was determined the condition was not going to stop me doing the things my friends were doing and as a result I possibly didn’t test my blood glucose often enough and ran with very high blood glucose levels, which for years averaged 9.5. I was never discouraged from consuming foods that were high in sugar but was educated on how to cover them with insulin and was frequently reliant on them to correct a low blood glucose reading (hypoglycaemic), which usually came on the back of an over correction from a high blood glucose (hyperglycaemic). While running with this high level of HBA1c I had a couple of operations stemming from infections caused by high blood glucose levels. I was also aware of losing some of the feeling in my toes and feet and was constantly bother with restless legs.

Hypos were a daily issue, with friends and family at least weekly having to intervene, sometimes catching the symptoms early enough and just suggesting “you need to do a blood sugar test” which I would correct but at least monthly I’d have hypos where I was unable to test therefore relying on friends or family to test me and force me to have something sugary.

After meeting my husband and deciding to have children, our social life calmed down considerably and realising to try and avoid complication it was essential to reduce my HBA1c. During my first pregnancy I managed to get my HBA1c down to 7.0 and was advised by the diabetes clinic I was one of their best patients at this time I was also diagnosed with retinopathy and required laser surgery in both eyes, this has been followed up with further laser eye surgery. It was also around this time I became aware of insulin pumps, which I bought, this did helped with control. After lowering my HBA1c from an average of 9.5 to averaging 7.5 my hypos were more frequent and more severe, my husband once coming home from work and I was unconscious beside my baby daughter. Over a number of years my husband required ambulance assistance with me having unresponsive hypos a number of times. Despite this and inspired by my young family I have been determined to lower my HBA1c to help prevent the common complications associated with diabetes, which I have since discovered many of the risk factors for these complications multiply dramatically above HBA1c levels of 5.5.

Since becoming a mother and in pursuit of improving my health and lowering HBA1c levels I have tried different methods, dieting and extreme exercise regimes which caused more severe hypos, these worked to an extent and noticeably reduced insulin requirements, however over a long period of time proved incompatible with family life. I was resigned to waiting on a cure to improve my health and give me a “normal” life span.

The lowest HBA1c I achieved was around 6.2, that is until 18 months ago when I was sent a web link of a presentation by Dr. Troy Stapleton speaking at a convention in Melbourne, he had recently been diagnosed T1 diabetic. Through his frustration of the blood glucose roller coaster and extensive research he discovered that disregarding the global diabetes advice that is: ensuring carbohydrates form a significant part of every meal, he changed his bodies main energy source to fat through a process called ketosis, this is achieved by restricting the consumption of carbohydrates to less than 30 grams per day and by doing this he was able to prevent blood glucose spikes and reduce insulin requirements, resulting in lowering his HBA1c to around 5.0. This way of eating he discusses is called Low Carb High Fat (LCHF). In his presentation he listed many books and sources of information, both current and historic, many of which I was able to check out online that day.

The following day I along with my husband’s support followed the dietary guidance, within two weeks we were both in ketosis and felt great for it, my insulin requirements dropped by around 50% and my HBA1c dropped within three months from 7.6 to 5.7 and has gradually continued to reduce to the most recent reading of 4.9. Hypos are virtually a thing of the past, which I believe is due to the fat metabolism, as my brain is no longer solely reliant on glucose for energy therefore I am always aware and able to respond and function at low blood glucose levels. As well as having higher energy levels I now have the feeling back in my toes and feet and I no longer suffer from restless legs.

I am immensely grateful for the education I received via online presentations and online medical publications as well as the support I have had from medical professionals via email and through social media groups, without whom I would still be high risk for all the associated “diabetes complications” and inevitably have be prone to a number of them as well as having dangerous hypos weekly/monthly.

It is my belief all diabetics should be given the same dietary information and health education to help them make the logical decision to prevent the complications that I once believed to be inevitable. Unfortunately I am left frustrated by my own diabetes clinic, the NHS and Diabetes UK’s reluctance to embrace and promote the life changing / healthy outcome that is possible through such a simple dietary change. Billions are being wasted on treatment while waiting for a cure and diabetics are losing limbs, sight and dying from complications, this is no longer acceptable, the low carb high fat dietary advise needs to become mainstream education for anyone diabetic or at risk of becoming diabetic.

Competing interests: No competing interests

01 September 2015
Nikki Milne