Insulin's a cop-out for the lazy
I read Dr Malcolm Kendrick's article questioning how we treat diabetes with interest.
It echoes my feelings that we need a fundamental rethink on how we approach diabetes.
After nearly 20 years of managing type 2 diabetes in an inner-city practice, as far as I'm concerned, there is no mystery to the cause of this condition.
It's a combination of over-eating and not exercising. But the only way of proving this scientifically would be to imprison - for a few years - a group of people and force them to exercise and control their diet by restricting them to a Mediterranean or vegetarian diet.
I fear that getting the funding and ethical approval for such a research study would fail - unless the trial could be based in North Korea.
Diabetes can't be prevented without addressing these behavioural and social causes.
I tell my patients that too much food is, effectively, a slow-acting poison that after many years manifests as these diseases, at which point we turn to using medication to ameliorate the damage done by such long-term abuse.
This is exactly why Dr Kendrick's eloquent arguments make so much sense. The tragedy is that the medical profession is complicit in conspiring with big pharma to peddle the myth that it's okay to be a couch potato and eat in a completely unrestrained way as long as you take a few shots of insulin daily.
I worry that mine is an increasingly lone voice in eschewing the pressure (such as bribes otherwise known as enhanced services for diabetes) on GPs to lower their threshold for commencing type 2 diabetes patients on insulin.
I have often challenged diabetologists to cite studies that prove insulin treatment improves the prognosis of patients with type 2 diabetes in the long-term.
I am yet to receive a convincing response - yet they continue to urge us GPs to increasingly use insulin as a treatment.
Dr Vidhu Mayor, Sparkbrook, Birmingham