Guardian 'diabetes is biopsychosocial'

I think we need a picture with lots more tripe for this one...

 

Cynically, diabetes management is coming under the IAPT banner, so this prepares the way.

 

The full uncut version then?

 

Ok - that’s really revolting....!

 

Yeah I just lost whatever appetite I had, my stomach is still rumbling with hunger while also queasy with revulsion. .

 

Someone made the same comment elsewhere on the forum recently:

If all you have is a hammer, everything looks like a nail.

 

Also dangerous to the people who will be mistreated because of it.

 

Hypothalamus = brain = BPS to a psychiatrist

I think that is the bottom line.

But I just don’t think there is any evidence that conscious thought can influence chemical processes, anywhere in the body. Is there?

 

I'm waiting for the headline: "Biopsychosocial Attribution Found to be a Biopsychosocial Condition."

 

BPS is a way of seeing health/illness/disability. It is a general model.

So as a comparison you have the Social Model of Disability and the Medical Model of Disability. People who agree with the Social Model see all Disability through that lens, which is about a lot of the difficulties disabled people face being located in Society (lack of adaptations, prejudice, but tending to neglect the bodily impairment itself). In contrast, Medical model people see Disability as located in the faulty bodies of individuals, it can be quite a paternalistic approach (the approach which led to lots of disabled people forced to live in large institutions).

People don’t tend to apply different models to different conditions, it’s a way of seeing the medical/disability world.

BPS is a lens like this, so it is predictable that BPS proponents will tend to think that it applies to everything (cancer and diabetes as well as ME). What probably varies is the emphasis on the different aspects (bio vs psych vs social) and the plausibility of pushing the psych side. In ME it’s clearly applied as bioPSYCHOsocial but in cancer it’s probably BIOpsychosocial. I’m not up to date on how they’re applying it to cancer, but social aspects are plausible- eg the laws/acceptability around smoking, asbestos and tanning beds.

There’s definitely an element of patient blaming with diabetes and decision making in terms of diet choices means a psychosocial side can be brought out and importantly the public will buy it. Patient blaming is the major flaw of the BPS lens (especially if there are political and financial biases). The complexity the BPS approach should have brought in could have been an advance on how we understand health. Unfortunately it is cheaper and easier to get the individual to do CBT and make different diet choices than to invest in biomedical advances or address complex society level issues

[Also, while on this topic, none of the current models of health/illness/disability seem to be a good fit for our experience as people with ME or other Spoonie conditions. Which also means the professionals we interact with likely don’t see us through an appropriate lens]

 

This is actually what some of the key BPS protagonists look like (when they remove their human skin suits). They’ve been living with us for some time now, but really they are a race of aliens that resemble a cows stomach.

They use a completely different language and don’t have brains, just slimy nodes on their various body segments ...this makes complex thought quite difficult for them and scientific experimental design near on impossible to fathom. However they are tenacious and they feed on political power and have many acolytes to their cause.

They are quite easy to detect since they are surrounded by a strong whiff of bovine manure and leave an unpleasant taste in the mouth the moment you encounter them.

Scientists are currently working on a way of irradiating the aliens using up to date scientific methods, but they are a tough race to eliminate....we just need a bit more time and more scientists recruited to the cause.

In the meantime vigilance is required to ensure their plans for a complete takeover of the medical system and government doesn’t succeed.

 

ah, you watched Dark Skies in the 90's as well

 

Loved that series also pod people from invasion of the body snatchers and V with a bit of Doctor who thrown in

 

I know a young (mid 20s) type 1 diabetic. She works full time and in her spare time she plays & teaches some sports. She was diagnosed aged 4.

Insulin treatment /dosage protocols have improved since her diagnosis. New drugs like fast and slow acting insulin gave her much better control. However, being sporty, she has to monitor it a lot.

She has enquired about an insulin pump. They are expensive to buy, but we are all prepared to chip in to get her one. The snag is the cartridges and therefore the ongoing expense of having it are too high for her. Her local health authority won't give her those on prescription, even if we fund the pump.

The reason she has been given for the refusal to prescribe is that she already manages her diabetes too well. If her blood test results weren't as good then they would pay. Obviously, she's not going to risk her health by mismanaging her condition. Plus she doesn't want to risk her job and her place on the sports team by needing to take time off because she's not well. In addition her (provisional) driving licence is reviewed every 3 years - she doesn't want to lose that either.

However, the pump would give her much better control in the long run and reduce the risks, and possibly the severity, of diabetes related complications later on in life. Thus improving her quality of life and saving the NHS lots of money.

I am sure she'll be delighted to find herself sitting in the IAPT waiting room, looking forward to her course of CBT, which perhaps will be designed to make her less demanding....

 

I know a 21 yer old lad with diabetes. His pump was taken off him when he went to Kings because his control was not good enough! He was diagnosed aged 9 and had terrible trouble controlling his glucose levels thro his teens etc.

He was also training as a chef. Not an ideal career, as he was often not getting meal breaks on work experience etc, but his choices were limited by dyslexia/time off school due to diabetes.

He's had a rocky few years, had to change jobs a few times due to health issues. To help, his parents are buying glucose sensors so he can see more easily how his sugars are responding to food/exercise/stress. These cost over £50 per month, which they cannot afford in the medium term.

Kings said initially, that as his glucose levels were improving so well with the sensors, he would definitely be a good candidate for getting them on prescription asap. Now they are saying that his control has to reach a certain level (HbA1c <10) before he can get them!!

 

They seem to lack a grasp of the obvious, despite discussions about how disease diagnoses are cultural phenomenon.

 

But this is very common it's because of hormone surges and fluctuations that are part and parcel of puberty. Puberty affects the demands for insulin and can increase insulin resistance.

So this poor lad is seeing some improvement thanks to using these sensors (that his family pay for), but I'll bet you a tenner when he gets his HBA1C below 10 they'll claim he doesn't need them because his control is too good.

The young lady I was referring was heart set on a particular career. She put in a lot of time doing related activities and voluntary stuff in her spare time throughout her early and mid teens and was then told she wouldn't be allowed to do it because she's diabetic.

Like the young lad you know she adapted, found an alternative and carries on. Despite the Kafkaesque rules around what the NHS will/won't pay for.

I'm sure the nice lady in the blue cardigan will help them adjust their attitudes and become good little patients.

 

What does hba1c below 10 mean?

I understood that an ideal hba1c reading was 42mmol/mol, or lower.

A reading of '10' doesn't seem to make sense to me unless it's a finger prick Blood Glucose reading, a different test, with a different scale, where 10 would be high enough, as a one off, to diagnose diabetes, at least by some GPs, and definitely doesn't suggest good control, good control would be 4.5-6.5 - essentially a non diabetic reading,

Or perhaps the meaning of good depends on whose paying and how much?