Dr David Unwin & Dr Jen Unwin - Success For People With Diabetes In Primary Care And Beyond

so it's absolute delight and pleasure to introduce dr. David Unwin my adorable husband some of you know him and some of you know that this year he's one NHS innovator of the year for his work for patients with diabetes and prediabetes um David's always been passionate about helping his his family his friends his colleagues and his patients and that's one of his absolute best qualities he another fantastic quality is a little bit like Zoe but maybe not quite as much this that when he when he looks into a subject he he he really looks into it so we're just all glad that he's not talking today about British moths but today and most days and really some nights recently he's going to be talking about sugar hello it's my great pleasure to include dr. Jennifer Unwin and she's also had a very successful year this is Jen winning best in village show last October as and she is best in show best wife in show but apart from that I'm very lucky because she's a clinical health psychologist and really a lot of what we need to do is change behavior and if we're going to change behavior we need to ask an expert in behavioural change and really they're called psychologists she spent her entire life wondering about how to change behavior her particular interest is the aspect of hope so what difference does hope make for patients in terms of outcome and she's a lot of research and published on that and say that just as I talk about sugar all the time Jen talks about hope in family life with colleagues with patience with your neighbors and she rolls that out into our lives completely thank you right three years ago we had a little conversation it went a little bit like this which was David what what are your best hopes we actually talk like this spits up what are your best hopes for our you know their twilight years of your general practice and we we actually had a conversation about that and David's best hopes were to go out with a bang and not with a fist and to really make a difference so I hope we're going to show that those things have been achieved my best hopes was just to work with David because I still have be loads of fun and we haven't was something we haven't done and we've never presented before either so those were our best hopes three years ago interest for me obviously I'm an older GP now and for decades I'd watched the health of my patients deteriorate so people were getting fatter and fatter really whole families I just watched it as the decades and I tried ever so hard to make a difference by telling them off and lecturing them and starving them and nothing ever worked nothing worked at the same time I noticed that the diabetics were presenting decades earlier so that in 1986 when I started as a GP people were presenting as a type-2 diabetic maybe they were 70 when they presented 30 years later they were presenting age 45 something has changed in my time as a doctor something has changed and I would became interested what has changed and can we make a difference so here we are this is what we've been doing and this is the again adorable team at Norwood surgery you'll see their partners their practice nurses and some of the admin team quite a lot of them are now low-carb I think those of you that do know that it's a bit like a virus isn't it you kind of catch it or other people there's now that the partners used to so generously buy biscuits for the staff and actually actually for those don't get that normally in their niches but they don't do that now okay so so here they are and we're going to be talking today obviously in more detail about the project and how we did it yeah we love those people they've worked with us for years each of them has become a patient expert and works now in the practice with the group advising other people how they did it and giving hope onwards we haven't lost a single person from the beginning they all stick with us and enjoy it and still losing and some of them are still losing the first guy you saw he's come off all his medication he he was on everything he was on stuff for chronic pain he was on stuff for mood he was on stuff there his blood pressure and he was on stuff for his diabetes and he doesn't need any of it and he's now joined a gym he has a completely different life so just going back to the where we are now so the there are two things to look at one is a number of people are volunteered within the practice to join a study group these are people I follow up more regularly and more intensively and they form the basis of the publications that some of you may have seen but we're also moving ahead as a whole practice so we're a practice of 9,000 patients there are five partners and we have results as a whole practice as well as the study group so if we just go through the study group first these are people who on average have been on the low-carb diet for 19 months that's an average so some of them of course are lessons some are more if you look at average diabetic control when they begin they're pretty pretty average really where the hemoglobin a1c this is in millimoles per mole so 52 is fairly average for a kind of not too badly controlled type-2 diabetic but if you look where they end at 42 that is very nearly completely normal on average so we've nearly got if you think that's an average figure actually the great majority were either in remission or reversed I don't know what it is but that's where they are and many of them had come off medications as you'll hear later next time yes of course many of them did lose weight you heard from some of the big weight losses but the average weight loss on that is about a stone and a half or probably about nine kilos which is very good really and they do keep it off so I've now I bit like my Moss collection I also keep matter I can graphs of our patients have done brilliantly and I think I've got about 50 patients now who weigh the least they've weighed in the last 12 years and that's a lot really it is a lot the next one now I don't know do we worry about cholesterol or don't we I worry about it because of the doctors watch what I do and at the beginning the patients were very concerned about cholesterol so I said okay we'll measure it loads of times and just see what happens now the interesting fact is for the 50 on the study group whether it's bad or not the cholesterol fail they just did and so did the ratio so the cholesterol whether that's an improvement or a deterioration but they fell and the patients found that very reassuring particularly their families were worried about who you're eating eggs the full fat you'll die eating full fat yogurt that kind of thing so that that calmed us all down and kept my partner's off my back really if we go on to the whole the practice population so at the beginning the prevalence of obesity in our practice was about average for the for the nation but as you've seen it's come down now so the average for the nation is nine point four percent of a gp's practice ours is down to seven point five percent so that's quite if you're dealing with thousands of patients that takes quite a lot of doing and it's because all the other partners are doing this now and both our practice nurses yes and of course GPS were kind of fascinatingly paid for good results in diabetes isn't why we did this at all but actually our diabetics as you see so the national standard national quality that we should aim for is that your patient should have a hemoglobin a1c of less than 59 millimoles per mole we were average at the beginning and the national average is about sixty one point five percent of your patients achieve that standard we achieved that standard now in 69 percent of our patients so that obesity's down on the whole practice the quality of diabetic control is up and now this is the thing i am most proud of how much money every doctor spends on drugs is monitored and these figures are available to anybody that wants to look and this shows these they spend in our area for every practice in the South port and Formby area on drugs for diabetes and insulin and as you can see there is a pink practice and yes that's as the pink practice and we spend the least so we're getting these great results and we're spending so much less money than other practices and if you calculate it out we're actually spending forty five thousand pounds per year less on drugs for diabetes and insulin than his average in my area but we're getting better results and I was so when I saw that I was really well it was champagne time okay come with me now on a little argument as to why we needs more psychology and in healthcare doesn't have to be delivered by psychologists but maybe we can do some training you know I think we were talking about education it's really key to this and it's really key to helping the people the frontline people to to bring what they can to this fight really so chronic disease David going up or down help okay what happens to well-being when chronic disease goes up David's very good great he's very good pupil okay but here's the interesting fact and this is a very robust fact that the amount of objective disease that an individual has my friends does not correlate with well-being okay so you could have two people with exactly the same amount of objective disease on any marker you want to look at and you'll find that that actually doesn't correlate it's not a predictor of it's not a predictor of their well-being State I've got patients with very severe osteoarthritis of the knees and some of them are around the golf course their line dancing all sorts of things and I have other people with according to the x-rays very very similar a degree of disease and they are very unhappy that their pain and their lives are ruined so I just agree with Jen there again okay so if disease objective disease factors aren't predicting well-being what is predicting an individual sense of well-being with a condition or more generally you'd life what you know how they how are they adjusting to this challenge which we know is a challenge because overall the the burden of chronic disease if you have a chronic disease it does challenge your well-being okay so what what predicts how you what level of individual well-being you have with that well it's probably not a surprise that I'm gonna say it's the psychological factors it's how people make sense of that condition that's what knowledge they have it's what they know about other people got that condition it's what the doctors tell them it's about people's interpretation and belief around the illness they have so if you if you think that the pain you have maybe going to kill you as a belief then you probably feel worse if that pain is something I don't know like childbirth you probably take it on the chin better if you think there's a good outcome so people's belief about illness and the way we talk about illness actually affects well-being okay so we're quite interested in well-being we're like well-being it's nice that people feel well they feel happy and they feel they're getting on with their lives they have a sense of feeling good okay so I think we're probably all agreed that it's as good if people have well-being but there's some actual hard kind of really important reasons why it's important to help people who have chronic conditions particularly to keep to maintain their sense of well-being with that condition and that's because and again these are hard findings all of these things go down if people have higher well-being okay so medication taking particularly pain medications consulting rates morbidity in terms of like how many symptoms people are experiencing and reporting and even even mortality so happy people live longer okay so that's that's really really robust so it's kind of important is now and I think we need to bring that into our work you can this this can in on an individual level be improved you there's lots of things that you could can do to help people maintain their sense of well-being and some of those things are things that we put into the project so well-being psychological factors it's it's I do go on up quite a lot about hope but so it's it's my thesis that if we conceptualize people who've got high well-being as hopeful individuals and what do we mean by hope you know it's one of those kind of motherhood and apple pie kind of words isn't it and how are we going to integrate that in our artists hope is about anticipating a good a good future having a sense of optimism about the future we've got a word for hope in medicine already I don't know if anyone wants to take a guess what it is for the seer oh thank you Bozak's yes and no not Prozac definitely not Prozac we've got a word that kanojo Swedish so we've got a whole we've got a we've got him it's hope in medicine is the placebo effect we know it's so powerful because we take it out by doing randomized control trials using you know kind of dummy drugs it's so powerful we have to take it out to prove that our drugs are more powerful than it the placebo effect can be 30% 50% of the outcome so that people report it's a massive effect there's loads of fascinating studies on the please oh it's a whole nother lecture its massive we take it out we forget to put it back in so the things that I'm going to talk about about how to rock the placebo in your practice whack it back in get 30 to 50% more effectiveness just to go over the placebo effect so if somebody's in pain and I give them a red little jelly thing and say you know take these they're great that's going to help the pain if you use a green capsule it doesn't work as well somehow the placebo works better if it's a red capsule but that placebo has given the patient hope that they're going to feel better anticipating hope is all part of feeling better in a different way of course if you have a disease and you feel like a hopeless victim of that disease and it's just going to take you over you feel worse if you believe that you can change your life and and improve outcomes you develop a hopeful state and that hopeful state is effective right across it helps with cancer it helps with pain it helps with depression and we should be using it more very powerful and you can get it in there quick it doesn't take long okay so I'm a little um the same way that some of us here are slightly maverick in our own worlds I'm slightly slightly Maverick as a clinical psychologist because I believe it's really important to really simplify these psychological ideas so that we can hand them out and apologies to anyone who's ever spoke to a psychologist and hasn't had a word one know what they're talking about at all so my next little bit is to simplify how to rock the placebo effect in your practice but also in your lives so you can use this on your husbands and wives and families and so on just I'm going to introduce four sort of new metaphor for metaphors that hopefully will will illustrate what we've done in this project but also be useful to people and if you want to find out more I can talk to you more about it or I can point you to the worlds of positive psychology and social focused baptism okay so number one and this is arguably the most important thing is people's best hopes and I'm representing that by this kind of beacon it's not a lighthouse drawing you onto the rocks it's a beacon drawing you to the harbor of what better would be what success would look like what you're hoping for in your life personally okay it makes a little oh no it doesn't it's supposed to make a seagull noise but I've broken it by doing it so many times so here's that here's our here's our beacon of hope and we had a conversation about best hopes three years ago so my best look where we've landed okay always really important to start with a person's best hopes it's really good to know what those are and you can get alongside them okay so that's that that's my first component my second component is represented by this rather natty measuring thing that I'm gonna actually make stay out okay so if this is where I'm oh this is where I'd really like to be it's really good to have an idea of where I am isn't it and where we're up to and of course this applies a lot - medicine doesn't it if this is this is where we want to be in terms of your results you know David was talking about measuring with people and feedback where are we now and also if we know that if we know that then we know probably something about this it's tiny step that's going to get us a little bit nearer to where we want to be consultation if I've established what the patient's goal is and those goals can convey a doctors have we have our own goals but really it works far better to start with the patient's goals so the patient's they have goals for instance like breathing better having more energy being able to play with my grandchildren or one of the people in the group her personal goal was she'd always worn black because she weighed 20 stone and she wore the sort of acne fat concealing things and her goal was a red dress for a party and she came to the to the group in this dress she'd achieved her goal yeah well - yeah so patient patient's goals really matter because they will and do change but they're not as interested in my goals they're not as interested in their hemoglobin a1c or the blah-dee-blah but they're very interested in their lives and then as Janice said if I'm talking to people can we agree on a small step towards the goal now that small step might be a medical intervention but at least it's a small step that we've agreed on towards an agreed joint goal so my thesis as well is that if you're finding your patient hasn't got motivation that's not because the patient hasn't got motivation it's because you you haven't understood what their goal is okay so number two that was number two okay number number three then number three or four is okay so um my advisors Lisa's actually is that people actually already have the capabilities to get to where they want to go they've just forgotten or they've kind of busy thinking about other things so the third thing is what what what cleverness is that they have what skills what resources whose porting them what else do they know what previous successes have they've had I could go on and on it's basically what's in their toolbox as well as what's in your toolbox but exploring really what their expertise is and what they can bring to this this goal that you can kind of work on together so that's represented by the toolbox of resources starred in there I think one of the things that is always worth looking for is resilience patients have already survived decades of whatever was in their lives they've survived somehow they've survived violence they've survived all of us have survived things and have resilience and it's worth reflecting upon that resilience what is in their toolbox what how do they cope because talking about that might lead also to some next next steps if it's working perhaps you could do why don't you do more of it absolutely and the final thing to tell you about is represented by the magnifying glass and the magnifying glass it's to do with the power of attention again there's a whole nother lecture on this but what what are we actually focusing work on and what are they focusing on and it's my thesis that it's more useful to look forwards than back because as we always see on Facebook and Twitter that's not the way we're going we're tronic where are we going we're going we're going this way and as a lovely colleague of mine always says it's a very long day on the golf course if you don't know where the hole is you're heading you're heading that way okay so what we know - saying that that's already better what we noticing about what's going well what's working let's do more of that noticing people's strengths complimenting thing people on things probably the kinds of things that we sometimes forget to do when we're talking to patients just thinking about if you've only got 10 minutes with a patient how are we going to spend it let's think about depression so I could take anybody in this room let's talk about how depressed you are and when was the last really bad day and how did that bad day make you feel and did you feel suicidal and did you feel low and I'm beginning it depressed already or actually you could also talk about well when was the last happy day and what did you do that brings forward a different kind of discussion on goals what how what you're going to focus attention on they already came to you with how bad it was unfortunately we're all programmed to notice the bad if you can reprogram a bit and notice the good so over the decades I've been doing this approach for 15 years at least and my patients now come to me with their successes because they know I'm interested if we train people to moan well they will and they're the pain the pain the pain but actually mine come in and say guess what I've joined a gym though I've done stuff so this idea of attention is very powerful yeah okay you don't have to do them in that order but just repeat just just do that and repeat what are your best hopes and comes out am I gonna talk about it some more and we hope to do a demo as well if we get time we're hoping to get a demo so just just to quickly quickly summarize my bit then so hope really important we know it accounts for a lot of outcomes and a lot of how people cope with stuff hoped for people do better okay so in terms of diabetes what is our shared direction of travel let's go on this amazing journey together like you guys like saving Jace has been an amazing journey and that's what we've done with the patient but it's somewhere they wanted to go it's about small steps in that direction let's focus on that what's already working what you're bringing who's helping you what you spent some resources and also what are we celebrating what are we noticing what are we kind of focusing on right that's enough of me for now so I haven't managed to talk about sugar at all and I can't keep silence any longer so we're gonna talk a bit about sugar but some other things as well what's the first oh yeah so I'm very interested in where does where does sugar come from that's the first thing we'll go into that in more detail in a minute I really like actually the idea of green stuff and for patients the idea of replace your white stuff with some more green stuff they understand that and they do it they do it it works protein yeah that's good stuff have some of that have some protein right next one the facts well we've we've talked about fats I thought that was so yeah have some good fats for me we've lost sight when I was a young doctor we were taught the diabetes was about sugar and in fact old people still call it sugar diabetes now because somehow we don't talk about the sugar and it's quite a simple message really so what next one yeah so I would say people with type 2 diabetes struggle to metabolize sugar and with so much talk about moderation which makes me cross so sugar in moderation for somebody with type 2 diabetes leaves them moderately poisoned I don't accept moderate health or being moderately poisoned if I had diabetes I'd want to be properly well and I would not be moderate with sugar so where where is this sugar coming from so the next thing I like the idea of a sugar spectrum because you got to know where you begin where are you on the sugar spectrum do you know where you are some people do and they say straight away to me yes you know it's three spoonfuls of sugar in each tea and coffee throughout the day and I eat biscuits and all the rest of it other people are totally mystified as to where the sugar comes from the next slide so sorry this is a bit busy but it's because I've become obsessed with where sugar comes from this is going to appear I've got a publication coming out in insulin resistance which is Jason funds he's the editor of this and so I'm really seriously looking at how can we communicate the amount of sugar in different foods I got together with Geoffrey Livesey who's OE has already mentioned because he's an international expert on carbohydrate and we came up with the idea of could you represent different foods in terms of teaspoons for gram teaspoons of sugar and of course you can you can do the calculations so that I can tell you for 800 different foods I could tell you how many spoonfuls per portion that would represent in terms of the effect over two hours on your blood glucose so that's what this is about so if we look first you know where does sugar come from well I've divided it into three there's naturally occurring sugars so if you look at a banana a small banana that would affect your blood glucose over to there is a small banana that would affect your blood glucose over two hours to the same extent of having 4.9 teaspoons of table sugar so you see this information if you're making choices this is about free choice people can make choices with information and that's what I don't tell you what to do but hey you might like to know this stuff so we've got naturally occurring sugars and then we've got foods with added sugars so how about those digestive biscuits 100 grams of digestive biscuits I think it's probably about 3 that's going to affect your blood glucose to the same extent as 8.8 teaspoons of sugar again it's useful information and you can swap foods through the thing you can eat something else and I could tell you how that might affect you the next group and this is the group that interests me most if so many people say well I've cut out sugar so I'm a totally mystery why I'm diabetic because I don't have sugar I'm told that every single day that is a total mystery but if we look on the right this is my sort of starch is sugar category so foods that break down they're not sugar but they break down into sugar so here we've got bread spaghetti french fries potatoes these nothing but look at the brown bread and if you look a hundred grams is three small slices of brown bread and that will affect your blood glucose to the same extent as ten point eight teaspoons of sugar so important that people know that you'll see in the new scientists there that a small bowl of cornflakes without sugar or even milk still affect your blood sugar the same as I think it's eight teaspoons of sugar so you could see how the sugar may be there after all for very many people and they need to know this they need to know this yeah okay so we used the Jeffrey leaves he was part of he developed the glycemic index so we know you you that's how you do the calculations because we know the glycemic index or the glycemic load of any portion of food and we know the glycemic load of a four gram teaspoon of sugar so the calculations are not that mysterious as to how you get from any food into equivalence of four grams of table sugar and so that's how he did it okay so moving on a bit more to the nuts and bolts of what we actually did in the practice to bring about the changes that you saw so we did it in two ways actually depending on what the patients wanted we did it as one to one which was me or the practice nurses all the other partners and as you see we were thinking about Jen what she taught me we went through personal health goals past successes very important to ask who is cooking who is shopping and would they like to come to an appointment so often we are dealing with the monkey and not the organ grinder so do bring the organ grinder along to the next thing and then the local there low carb information that is based on what I just showed you so they given infamous I don't make them do stuff they want to so their choice I'm not telling people what to do very important to establish where you are a lot of measuring particular like waist measuring very much and what you weigh and then of course that forms the basis of what you hope is cheerful honest sincere feedback giving people's they doctors don't always say to patients wow you've done amazing you you are amazing but if we start saying you are amazing it really it's just good it's it's good medicine it's good medicine because then you do more of it hooray it's fun oh right another another point is we say that some people don't do well for a while and how do you deal with with people who are not doing well I believe there is they don't fail it's not a failure you just talk in terms of yes you've gained some weight I wonder why I'm also interesting what you're going to do different in the next week so they haven't failed at all it's all about moving forwards and then Jen's going to talk about the groups that we run she was oh yeah yep so so we we started off by with the first study group we ran a group over about five weeks but now what we do is actually only meet every eight weeks which doesn't seem very often but people from the original group are still coming and we do a lot of the same things because the principles are the same I think what's added into the group is the kind of magic the group magic which is where people are identifying with each other they're encouraging each other they're sharing tips about where you can get the cheapest almonds you know - down to Aldi they're only so much which is really really nice and obviously the people have been going there for a while act as an absolute inspiration and beacon of hope to those people who are just joining because you if you see people bring their before and afters and they talk about they're off all their medication that's inspirational and it and it's hopeful for the people coming in so I think the group does have that extra magic and of course there's always dr. on wins three minutes soup demo or I tend to bring in stuff for people to try and share so it's lots of fun we have a lot of fun with it we're doing yeah okay this is just to reassure the nervous practitioners amongst you that we are actually now working with nice guidelines array as from last December you'll see we are supposed to encourage high fiber low glycemic index sources of carbohydrates in the diet so it's great after years and years of hiding I can come out because it's there in the guidelines fair enough also we are supposed to individualize recommendations for carbohydrate I think I'll do that good idea one thing is just to say when you're looking at low glycemic index sources of carbohydrate there's just about no breads that have a low glycemic index just about non so breads kind of out really wholemeal whatever you bits in it no bits they all have a lot of sugar in there next thing people often want to corner me into how many grams of carbohydrates do I make my patients eat and why aren't we measuring and I get things from people saying tell me you know what do I tell my patients to do the point is the important point is that motivated people with information don't need telling they can make their own minds up and they do so all I can tell you that given that information the results are what you see how patients achieve this is very individual because each of them lives in a very different environment and they have to tailor my information according to their lives so handing out leaflets with details of what you should eat that's why it doesn't work so well because people have to interpret it in terms of their own lives right so a bit more yeah graphs I love graphs I really really love graphs so the the II miss the GPE miss computer system generates graphs easily and this is a great source of feedback for my patients and they go home with these there must be thousands of these graphs all over South port on fridge doors so here we here we have one of one of our patients and this guy was 43 and he presented last June and he's consented for me to talk about his case now he was 43 and his goal if we're talking goals was he was very overweight and lacked the energy to play with his children and though that was his goal he wasn't interested in his diabetes he was interested in being a good dad but what was great is he can find a joint shared goal because for him to play with his children he needed to breathe better and for him to breathe better he need to weigh less and for him to have more energy we needed to get his blood sugar down and when I'd established that we that we could work together on that yes he did it he did it and there you'll see he went in a few months so his diabetes was so severe I was just on the verge of insulin so I said to him we've kind of got a choice here we're looking at insulin or maybe you might work with me and look how well he did because he went all the way from nearly on to insulin down there and his hemoglobin a1c his diabetic control now is in the early pre-diabetic phase and he's given up his metformin and his chronic pain relief so many things he's given up it and he's playing with his children hooray so we got to his goal through my medical interference but he was well motivated well motivated and you saw his cholesterol dropped as well if that matters maybe I should worry now I don't know this is a this is him and I just want to illustrate the idea I like the idea of him you've heard of meta sort of meta analyses where a lot of different things are looked at I like the idea of a meta intervention where you do one thing and loads of things happen so this guy here we are he's lost he went on the low-carb diet and all the graphs look a bit the same they're all coming down but the different things so we have he has lost weight and it can breathe better his diabetes has improved but look at the bottom - that's liver function he had really bad fatty liver disease and that went as well at the same time as his blood pressure improved lots of things improved for that fellow it was a meta intervention get his diet right and he's a healthy animal loads of things you don't have to give the separate medication for the pain and the depression and the dirt the dirt da da if you can get a meta intervention he has a life back and I think is I hope what that shows right this is this is a different patient can I just ask can you hear me at the back you can hear me right so this old speedy top she's tell me to speed right hurry up right speed it up and speed right this this patient illustrates loads loads of different things so a point was the question mark there that was years before he knew me what did he do he was doing something great there what was it moving along move along he did the low-carb diet it worked and then it didn't work that isn't a crisis what did he learn what did he want to do and then the second time he learnt it properly and he's now the lightest for twenty years so it wasn't a disaster because that's the beginning of learning moving on yes god this is the role okay yeah do it now okay I'd love to be really quick okay quick quick gonnigan was saying um you can't do this stuff in ten minutes so we're not going to do it in ten minutes we're not gonna do it in five minutes we're gonna do it in Turnus yes right quickly what we're gonna do is contrast on what David would have been doing three years ago with what he does now and go I was speeding it up I thought she said Speak Up yeah like we spinning it was going more slowly the years have gone by the patient's coming in she's gonna meet doctor Unwin and and it's about diabetes so here we go hello mrs. Jones okay you know that we've done your blood tests and I'm sorry to tell you you've got type 2 diabetes yeah and I know that might be a bit of a blow but don't worry we will sort it out we will sort it out can I ask first what do you understand by type-2 diabetes yeah well you and on the mum what it is yeah well I think the point is you know I don't think your mom took her tablets properly and I know you you will take those tablets and it didn't end well but you know with Anne even if the tablets don't work at the beginning stick with it we will monitor you will check stuff and I've got other tablets as well and you know so if the tablet I have others and then there's insulin so that we could help you we really really could help you but you know and unlike you see your mother she didn't come when her feet you know she come earlier so please come early if your feet start going any different color and also your vision your vision watch out your vision and don't hesitate if there's a problem with your vision because I will link you in with an optician you will have yearly vision checked and we will be looking at your feet so we will see these things early it will be and I will refer you I will refer you on just one question do you have much sugar in your diet well you know that happens with some people they don't have sugar in their diabetic so you know I don't know but I will refer you to to to a dietitian and let's start with men okay that's the end of that one degree forward in time yeah we're back we now we're now mrs. Jones in you come well mrs. Jones you know we've done the blood tests and I have to tell you they have shown that you've got early type-2 diabetes but don't worry we can work this out I promise you it's gonna be fine there's nothing that you can't sort out I'm sure of it yeah just one question what do you understand by diabetes that's a complete mystery because as you know you know me I'm really healthy yeah exercising and following the guidelines about eating following the guidelines yeah so is the sugar in your diet I mean let me just ask one question okay that would help me understand where you are what do you have to be a breakfast right oh I have that you know that I'll pen without the sugar in seriously like a banana on that with the skim milk yeah lots of orange juice well that she gives me hope because you don't know it but there is loads of sugar going in in that breaking yeah and if we cut that back because diabetes is about sugar we can reverse this it's not probably you just need a bit more information work it through hmm I do have an alternative I mean we could use medication what is your personal feeling we could do the medication or you could maybe try the dog that's really prefer to try anything else okay yeah right okay I think that's enough you've got it didn't you really speed work okay so just just quickly then because we call the the talk about Norwood and and beyond how does this stuff roll out oh this was a little nervy moment at the BMJ Awards this year David had his pointy finger out and you want to be where when the pointy finger and he was pointing at Simon Stephens who's who's got his eyes shut actually I don't I don't know what that means michael mosley looking a bit defensive there and some extremist was saying oh yeah but it's all the doctor on win effect you know it won't roll out will it so does it roll out are you going to do this one you know this one so yeah it's infectious so this is friends and family you've got them all there there's my son-in-law he's lost a ghost oh he's gone that's my son-in-law he lost the stone I think in a month because he want to be fairly small there's a neighbor up there the top he's amazing the guy underneath he's a friend he was on insulin six times a day he's not on interest at all and these are just people around us in the village and there's paleo family aren't they adorable down there grandchildren hooray right on yeah so um and perhaps we're most proud of we know the saving dad people are here today well what about that saving mom David's mom's here today stand up mom this is save it's amazing mom who's eight years old she's off her met form and she lives the most amazing active life and Vicki who's also here who's a who's a dietitian and between the three of us I think well she didn't she need that much saving and she saved herself a lot as well but I hope we've we've encouraged her and this is her winning the family prank off come on Peggy I'll get you this year okay so that's her and then quickly we're nearly there now intimately titled this of the of this is sort of diabetes and Beyond and the beyond here actually is Malaysia so nafisa can't stand up nafisa is right at the back of the room and she is a professor she's standing she's she is a Dean of a medical school and a professor and her brother read our paper way over in Malaysia he was very overweight on the Left diabetic and so we say it's the sort of dr. Amin magic no it isn't he just read the thing took action look again on the right he's lost a third of his body weight in Malaysia he's off his drugs he feels great result and nafeez has got all the details of his case and she's very happy to talk to any about that moving on it on Tom's next right I'll just up next yeah just to say that what again is it is it just some sort of personal magic no it's not personal magic so we work with diabetes Co dot uk' to produce an online thing that anybody can have for free and do if you want and then the point is a hundred and twenty eight thousand people chose to do this since last November so the interest in this is massive absolutely massive and the next presentation is far more about what happened to those people so we don't need to talk anymore about okay so it's yeah low carbon diet and hope we think it's a really effective and cheerful way to way to work with people and we hope you've all taken away some useful thing that you can take back to your own practice and we're around if you want to know more there's some of our references if anyone wants to ask us more about any of it we're around you I think that's us thank you thank you

Channel: Public Health Collaboration

Views: 6,715

Keywords: health, doctor, public health, gp, general practitioner, nutrition, diet, fat, carbohydrate, protein

Id: ft_HC1h8Ris

Length: 47min 10sec (2830 seconds)

Published: Mon Jun 27 2016