Type 2 Diabetes: Who is at risk and can you beat it?
Airdate: 
Tuesday, March 1, 2016 - 20:30
Channel: 
SBS

The facts about diabetes in Australia are alarming.

280 Australians develop diabetes every day. That’s one new person with diabetes, every five minutes.

It is estimated there are up to 500,000 Australians living, undiagnosed, with diabetes. Around 1.7 million are living with the disease.

Every year, diabetes racks up a financial toll of around $14.6 billion.

Of the two types of diabetes, Type 2 is the most prevalent and can come in unexpected sizes, at unexpected ages and with unexpected consequences. Across the country, young, old, thin, obese, male, female, Caucasian, Indigenous, and migrant Australians are crippled by this disease. 

Science journalist Michael Mosley, whose work on health includes numerous investigations into weight loss, and popularising the 5:2 diet, will be joining the show to discuss his shock at being diagnosed with Type 2 diabetes and his thoughts on how it can be prevented.

Because that’s the good news: it is thought diabetes can be delayed or prevented in 58 percent of Type 2 cases.

But how do we do this? What are the best methods for preventing and treating, even reversing, Type 2 diabetes? Which diets work, which foods raise our blood sugar, and who is most at risk?

Insight investigates the increasing prevalence of Type 2 diabetes and its growing, but largely silent, impact on the Australian population.

 

Credits:

Join the discussion by using the #insightsbs hashtag on Twitter, or posting our Facebook page. 

 

Diabetes information 

 

What does 800 calories look like? 

Insight guests Professor Roy Taylor and Michael Mosley advocate an 8-week diet of roughly 800 calories a day for newly-diagnosed T2 diabetics. They cite research showing that such a diet can help diabetics lose weight quickly and start to reverse the effects of the disease. 

But what exactly does 800 calories a day look like, in food?  

More recipes like this can be found here and here

 

Low-fat products 

There is ongoing debate about the best way to treat, manage and prevent T2 diabetes, and a significant player in this discussion is low-fat food products.

On their “What should I eat?” web page, Diabetes Australia recommends that in order to help manage diabetes, people should “eat a diet lower in fat, particularly saturated fat.”

This includes choosing reduced or low-fat milk, yoghurt, cheese, ice-cream and custard. 

On the other hand, these products are often high in sugar – as seen in this Choice investigation - and some believe this makes them worse than full-fat products in treating diabetes. 

Insight guest Michael Mosley points to a Swedish study which found eating more dairy products was associated with a reduced risk of Type 2 diabetes.

In particular, of the 27,000 middle-aged Swedes involved in the study, those who ate the most high-fat dairy products had a 23 per cent lower risk of developing Type 2, when compared with those who ate the least amount of fat. 

So are things like low-fat yoghurt and milk – two of the most common low-fat food products available – actually good for us? How much sugar do they contain?

Comparing the labels between full-fat milk and skim milk, there is a minimal difference in sugar content.

This breakdown of nutritional information from Dairy Farmers shows there is only 0.4g difference between their full-fat milk and their low-fat range. 

Yoghurt, however, can vary widely in sugar and fat content.

On Insight’s 'Beating Diabetes' episode, Jenny Brockie and Michael Mosley compared full-fat, natural, Greek yoghurt with berries, to a berry-flavoured, low-fat yoghurt.

The full-fat yoghurt contained only 4.8g of sugar per 100g compared to almost triple the amount in the low-fat variety: 13.8g of sugar per 100g. On the other hand, the full-fat yoghurt had about five times as much fat as the low-fat option - 10g of fat per 100g and 1.9g, respectively.

For more information about the yoghurts compared, head here and here

More information about low-fat dairy in general can be found in this article, but if you’re ever confused about what to eat, flip over the product and read the label.

Not all low-fat food products should be excluded from our diets. However, the more processed the product, the more likely it is to contain larger amounts of additional sugar and ingredients. 

If you have T2 diabetes, consult your GP before making significant changes to your diet.  

Transcript

JENNY BROCKIE:   Welcome everyone, and tonight a special guest, Michael Mosley who is probably best known as the 5/2 guy. His 5/2 diet based on intermittent fasting to lose weight and to improve health became quite a thing worldwide, now the doctor and the BBC science broadcaster is tackling type 2 diabetes with a plan to prevent and possibly reverse it. Michael Mosley, welcome.

MICHAEL MOSLEY: Thank you.

JENNY BROCKIE:  When you look at this photo of yourself that was taken about eight years ago, what do you - what do you… 

MICHAEL MOSLEY:  Ooh. It sits proudly in my mother's kitchen for reasons best known, that's not a face or a body anyone other than a mother could find love. 

JENNY BROCKIE:   Look, now I don't see it that badly but you clearly do? 

MICHAEL MOSLEY:  I do. 

JENNY BROCKIE:   What do you see? 

MICHAEL MOSLEY: I see quite a fat guy there and this was about eight years ago, but if you'd asked me and indeed I pointed that photograph out to my wife.  She said she never see saw me as fat. I think it's probably the camera angle or something like that. 

JENNY BROCKIE:   So you don't look that big to me in that photo? 

MICHAEL MOSLEY:   No. 

JENNY BROCKIE:  How much extra weight were you carrying? 

MICHAEL MOSLEY:   About 10 to 11 kilos more than I am now and I was still pretty much within the healthy range but at that point I was, what was once described as a toffee, thin on the outside and fat inside. 

JENNY BROCKIE:   Okay, you had a scan taken for a BBC documentary you were making on weight loss in 2009? 

MICHAEL MOSLEY:   Yes. 

JENNY BROCKIE:   What did that scan show?  

MICHAEL MOSLEY:   Well that showed something rather nasty which was essentially that, this is my scan. Can you see that lovely green stuff? That is all fat, basically that is, I can’t even remember the amount of fat the expert said was in there but it's casing my internal organs. 

JENNY BROCKIE:  And none of it should about been there? 

MICHAEL MOSLEY:   It should have been minimal. What I was carrying was an awful lot of visceral fat and I guess, he said to me at the time look, if you go on like this, they you are at high risk of developing type 2 diabetes and having heart disease and so he gave me a very sobering talking to. 

JENNY BROCKIE:   Now once you'd seen that scan what did you do? 

MICHAEL MOSLEY:   I went home and I talked to my wife about it and I started on a low fat diet because that seemed to be the right thing to do and I also started exercising pretty vigorously for a while. 

JENNY BROCKIE:   And how long did that last? 

MICHAEL MOSLEY:   About six months and then I just got really, really bored and somehow or other I allowed it to slip away, slip away, slip away. 

JENNY BROCKIE:   This really interests me because you're a doctor. 

MICHAEL MOSLEY:  Yeah. 

JENNY BROCKIE:   You're a science broadcaster? 

MICHAEL MOSLEY:   Yes, I know. 

JENNY BROCKIE:   You make health documentaries for the BBC and after six months you gave up? 

MICHAEL MOSLEY:   Yeah, absolutely, and it's just really tough. Losing weight is really, really hard, even when you massively motivated and you follow the best advice that's sort of available to you at the time and my father had died of diabetes related illnesses really very young at the age 74 and I saw his deterioration because he developed type 2 diabetes at pretty much exactly the age I was when I had the scan. So I had all the reasons in the world to do something about it and I genuinely did try really, really hard. 

JENNY BROCKIE:   So four years later? 

MICHAEL MOSLEY:   Yeah. 

JENNY BROCKIE:   You went back to the doctor, thinking you had a melanoma? 

MICHAEL MOSLEY:  Yes. 

JENNY BROCKIE:   What happened? 

MICHAEL MOSLEY:   Well, she took a sample, she said this doesn't look like a melanoma, it's not typical, that's fine, let's take a blood test and then she rang me up to say I have bad news, you are a type 2 diabetic and she said let's start you on medication because that's the kind of thing you do, particularly in the UK. 

JENNY BROCKIE:   How did you react when you were told given that your father died?

MICHAEL MOSLEY:   Yeah, I was really upset, you know I was really upset.  I went back and talked about it with Clare and then I decided I would see if there was something else. So fortunately I was working at the time with a science team, some very clever people from the Horizon science series, so I said, you know, can you find out something else and they went and kind of scoured the literature and they said let's have a go at intermittent fasting which I'd never heard of. 

JENNY BROCKIE:   And that's how the 5, the whole 5/2 diet started.

MICHAEL MOSLEY:   Yeah, that's how the 5/s thing began, yeah.  The evidence is pretty strong that if you go on some form of intermittent fasting you can improve your insulin sensitivity and you will also lose body fat, particularly visceral fat.  So that's kind of what I did. 

JENNY BROCKIE:   Now this was flying in the face of the messaging that was around at the time about what diet should be? 

MICHAEL MOSLEY:   Indeed. 

JENNY BROCKIE:  I mean what were you told you should be doing diet wise? 

MICHAEL MOSLEY:  Well essentially it was the low fat diet. I mean we've known since the '80s and '70s, and probably earlier than that, that the central message is low fat diet and it probably works for some people but it doesn't work for an awful lot of people. I had no, almost no interest in diet before that because at medical school we were really taught nothing about diet.  My son is at medical school, he's taught almost nothing about diet.  We learn about exotic diets, we learn about Hashimoto disease, we learn about deficiency diseases, but not what happens when somebody who is overweight comes and sits in front of you and says what should I do?

JENNY BROCKIE:  Okay, we're going to get onto diabetes because that's what we're here to talk about and the specific diabetes diet. But before we do I want to meet a few people who've come along tonight because I know you're all interested in type 2 diabetes. Lou, you were diagnosed with type 2 when you were 27?

LOU VICKERS-WILLIS:  Yeah. 

JENNY BROCKIE:   Five years ago.   What did your doctor say when he told you you had diabetes? 

LOU VICKERS-WILLIS:  So it wasn't my doctor, it was my diabetes educator when I went in to see him. He said you're not fat enough to have type 2 diabetes.  That was a bit awkward obviously.  You don't occupy two chairs, you're not fat enough to have type 2, it's not type 2. 

JENNY BROCKIE:   Was this because you suspected you had it or had it been proven? 

LOU VICKERS-WILLIS:  I had been diagnosed with type 2, yep. 

JENNY BROCKIE:   Were you overweight at all? 

LOU VICKERS-WILLIS: I was overweight, yeah. 

JENNY BROCKIE:   Much? 

LOU VICKERS-WILLIS:  Not by much, no. 

JENNY BROCKIE:   What sort of things were you eating? 

LOU VICKERS-WILLIS: Very healthy foods, trying to anyway. Was eating a normal, what I could see was a healthy diet, yeah. 

JENNY BROCKIE:   Such as? 

LOU VICKERS-WILLIS: Salads, meat, fruit, veg, I was walking every day, just very healthy diet. 

JENNY BROCKIE:   Did you any symptoms? 

LOU VICKERS-WILLIS: Was going to the bathroom a lot, drinking a lot, and when I was eating I was eating a lot of food. So I wasn't just eating a normal size, I was eating two portions and was still feeling hungry. 

JENNY BROCKIE:   Okay, so things like sandwiches, for example, how many were you..

LOU VICKERS-WILLIS: Yeah, used to have two or three sandwiches at work. 

JENNY BROCKIE:   For lunch? 

LOU VICKERS-WILLIS: Yeah. 

JENNY BROCKIE:  Okay, was diabetes on your radar at all? 

LOU VICKERS-WILLIS: No, not at all. 

JENNY BROCKIE: Family history? 

LOU VICKERS-WILLIS: I'm adopted so I had no family history that I knew at the time. 

JENNY BROCKIE:   And have you found out since? 

LOU VICKERS-WILLIS: I've recently found my biological mother and she does have type 2 diabetes. 

JENNY BROCKIE:   Okay. We know that being overweight puts you at risk of type 2 diabetes, how big a factor is family history? 

MICHAEL MOSLEY:   It's strong, it's not the strongest.  Age is probably the strongest and you're very young and very unlucky I have to say to be a type 2 diabetic because normally when you're over 50, over 60, that's kind of when it tends to kick in. Gender as well, you know, it would be more likely if you were male. If you're non Caucasian then that's also a risk factor.  If you're you know Asian or you're from, you know, other ethnic minority groups, you're much more at risk. 

JENNY BROCKIE:   Muriel, you were also adopted so that makes a family history thing difficult to find as well? 

MURIEL SPEEDEN: Yeah. 

JENNY BROCKIE:   Was diabetes on your radar when you were diagnosed thirteen years ago? 

MURIEL SPEEDEN: Not at all, it was almost by accident. My doctor, I think I had, yeah, I was in Australia then and my GP said you know, I'll give you, I'll give you a blood test for anything, you know, and I was my early 50's and came back and she said you know, you're type 2 diabetes. And in those days, you know, we just thought alright, take medication and that would solve it. We don't know as much as we do now and my diet was like not that bad, although as Asians we eat a lot of rice and noodles, yeah?  We didn't realise then that carbo was a big thing, you know.  We thought oh, just cut out the sweets and that's what I did and well, you know, it's, it's been thirteen years.

JENNY BROCKIE:   Do many people you know have diabetes? 

MURIEL SPEEDEN: Yes, most of my class, ex-classmates who are back in Malaysia have diabetes. 

MICHAEL MOSLEY:   And the generation previously perhaps they wouldn't have. It seems to have sort of suddenly appeared from nowhere, doesn't it? 

MURIEL SPEEDEN: Yes, yeah. 

JENNY BROCKIE:   Maxine, do you know many people with type 2 diabetes? 

MAXINE RISK-SUMNER:  I reckon just about the majority of Aboriginal people got it. Aboriginal people know of that word, that word is so common out there, type 2 diabetes, but they don't know what it is. 

JENNY BROCKIE:   Or what it means? 

MURIEL SPEEDEN: Or what it means. 

JENNY BROCKIE:   Well I think the broad community often doesn't know what it means and how dire the consequences can be of it. 

MURIEL SPEEDEN: And you know, when I was diagnosed I wasn't like a shock, horror, so?  All Aboriginal people get it. 

JENNY BROCKIE:   Is that how you felt? 

MURIEL SPEEDEN: That's how I felt. 

JENNY BROCKIE:   So were you resigned to it in a sense? 

MURIEL SPEEDEN: Yeah, you're going to get it sooner or later. 

JENNY BROCKIE:   Michael? 

MICHAEL MOSLEY:   Yes, no it's very depressing, isn't it? It's depressing how common it is and it's really depressing how common it's becoming in places like Malaysia, China, Vietnam.  And you say in your community it's up to 50 percent, isn't it? 

MURIEL SPEEDEN: Yeah, it's sky rocket, it's become an epidemic out there. Like I was diagnosed about seven years ago with it and I got rid of it and I was just like, why aren't we educating people around it? 

JENNY BROCKIE:  How did you get rid of it? 

MURIEL SPEEDEN: Well, there was two things that made me get rid of it. One, when the doctor said to me your people find it hard. I went what? 

JENNY BROCKIE:  It was a challenge? 

MURIEL SPEEDEN: And I thought…

JENNY BROCKIE:   That's a terrible thing to say? 

MURIEL SPEEDEN: Your people find it hard, but I'll send you to a diabetic educator. I went what's that? What do they do for a living, you know? And my diabetic educator made me feel culturally safe in her presence.  She start from, she started explaining to me the simplest things, she didn't use jargon or academic language or medical jargon or anything like that.  She started, I asked her one question. I said: "So what does chronic mean?" She said:  "Maxine, it's life threatening." "So are you saying it could kill me?  Well I get better start doing something about it." 

JENNY BROCKIE:   Okay, we'll talk a little bit later about what you actually did do about it but this is a very important point because I think some people watching this might be aware of just how life threatening it is. Can you give an indication of how life threatening it is? 

MICHAEL MOSLEY:   Yes, I'm sure you all know, don't you, the statistics?   At some level doctors like to cushion it because actually the facts are extremely uncomfortable which is if you are a type 2 diabetic, then it is one of the leading causes of blindness. It is probably the leading cause of impotence.  It will double your risk of heart disease.  It probably doubles your risk of dementia, it probably also cuts ten years off your life.

JENNY BROCKIE:   And do we know why particular ethnic groups are more inclined to get it? 

MICHAEL MOSLEY:   No, not that I'm aware of.  I don't know if you're aware of, we have one of the leading experts here, is there any explanation? 

JENNY BROCKIE:  Paul? 

PROFESSOR PAUL ZIMMET, INTERNATIONAL DIABETES INSTITUTE:  It's interesting that someone from, with a Maltese background, Malaysian background, these groups appear actually to have a heightened susceptibility genetically.  And certainly Asian, Indian, our Australian indigenous community appear to have a heightened susceptibility when they're facing the, what we call the obesogenic environment.

JENNY BROCKIE:  Mahbub your parents, you're from Bangladesh, you're parents in Bangladesh have it? 

MAHBUB HASSAN:  Yes, they live in Bangladesh, yes. 

JENNY BROCKIE:   And is it widespread in Bangladesh? 

MAHBUB HASSAN: I think it is.  It's quite, it's becoming quite uncommon to find an auntie or uncle who's over 50 years of age and doesn't have it.  I did a test two years back. That time, I mean nothing was found, everything was okay except that I have a body mass a bit, I mean not normal, but otherwise I think it's, I mean nothing was found. 

JENNY BROCKIE:   So are you doing anything at all to try and head, like given that you know family history can be a problem and it's widespread, are you doing anything to try and keep it at bay? 

MAHBUB HASSAN:  I think that family history, having that family history I'm scared to test. 

JENNY BROCKIE:  Ha, ha, well that's understandable.  Yeah, but I mean this really interesting because I mean Michael's done it. We've all done it. You know, we've all known that maybe, you know, we're carrying a bit too much weight or there's something or other that we should be fixing and we don't do anything about it, and you're clearly in that category Mahbub? 

MAHBUB HASSAN:  I am and I mean, from my mum's side and dad's side most of the, like people who are around 50 have it.  So I kind of, I kind of, I know that I have to test.

JENNY BROCKIE:   Ted, you're Anglo background? 

TED HARTLEY:  That's right.

JENNY BROCKIE:   When did you realise you had type 2 diabetes? 

TED HARTLEY:  I went to see a doctor, one of my very rare visits to doctors and it was when he asked me questions about when have you had a test for your blood sugar level, what's your cholesterol like, that I had to admit I hadn't been tested, even though I had brother that died of diabetes. And it was then, after going to the doctor, that I found out that I had diabetes and it was quite a surprise to me because even though I had, I was calorie enhanced I, I had…

JENNY BROCKIE:   A whole new lexicon we're developing. 

TED HARTLEY:  Because I didn't eat much food that contained sugar I thought how I can be diabetic? But at the same time, I like starchy foods like breads and things, I love meats with all the fats and I really wasn't doing the best for my body. 

JENNY BROCKIE:   So you weren't eating, you know, sweets? 

TED HARTLEY:  No. 

JENNY BROCKIE:  But you were eating other things and you thought you therefore weren't eating sugar? 

TED HARTLEY:  I lived alone so, you know, I tended to enjoy fast foods, a very bad mistake.

JENNY BROCKIE:   How are you though now with your weight and with fast food? 

TED HARTLEY:  Well controlled but I do lapse occasionally because I like meats and red wine. I've got to be honest about that, so my weight can go up and down but generally I know that it's, it's entirely up to me to do what I can to be in good health, yeah. 

JENNY BROCKIE:   Michael, you mentioned that your father was diagnosed? 

MICHAEL MOSLEY:   Yes. 

JENNY BROCKIE:  With type 2 diabetes when you were training as a doctor, what advice did you give him at the time about what to eat and what not to eat? 

MICHAEL MOSLEY: Well broadly I told him he should go on a low foot diet which was the standard advice at the time and that he should plenty of starchy foods. 

JENNY BROCKIE:   And what do you think of that advice now?

MICHAEL MOSLEY:   I think it's probably not the right advice. 

JENNY BROCKIE:   Michael, tell us how you think we can get those numbers down? 

MICHAEL MOSLEY:   Well I think probably changing the diet. I mean I think it's going to be really complex, really difficult because there are enormous challenges, but I think perhaps changing what people eat and then teaching them more about the risks they face. 

JENNY BROCKIE:   Now you are proposing this idea of an eight week 800 calorie a day diet. How does it work? 

MICHAEL MOSLEY:   This is based on the work of Professor Roy Taylor,  the idea is that essentially it's kind of what it says on the tin. It's 800 calories a day pursued for eight weeks, possibly longer, and the goal is to lose at least 10 percent of your body weight, possibly more, during that period. 

JENNY BROCKIE:   Is that the sole goal?  Does it matter what you eat for those 800 calories? 

MICHAEL MOSLEY:   I think for long term maintenance afterwards as well switching to a more Mediterranean style diet will prove easier for more people. The honest truth is that the best diet is the diet you can stick to and what we know again about Mediterranean diet is on the whole when people are randomly allocated to it, they're much more likely to stick it to than they are to a low fat diet. They just find it tastier. 

JENNY BROCKIE:   Roy Taylor, Michael is the one popularising your science, if you like.  I wonder if you can tell us a little bit about what you found that's led to this idea of this eight week diet.

PROFESSOR ROY TAYLOR, NEWCASTLE UNIVERSITY:  Sure, what I was trying to do was not find a cure for type 2 diabetes, I was trying to understand the nature of the condition. Now there was a very important observation made back in 2006 which related to bariatric surgery.  And so the exciting thing then was the observation that glucose levels went back to normal very soon after the operation. Seven days, now when I looked at that I could see exactly what was going on.

I could see that with a sudden reduction of calories, the body would use up the excess fat within the liver but would allow the liver to function normally and the same might happen in the pancreas and cause it to wake up and go back to normal. And that's where the 800 calorie diet came from. I needed to try and test that idea. We tested it and to my surprise it was very strikingly correct. 

JENNY BROCKIE:   Okay, so this is, we're talking about quite sudden weight loss here with a diet like this.  I mean bariatric surgery for people who have it, who are obese and who want to lose that weight, I mean that's sudden weight loss that you're talking about.  Are you saying it can reverse diabetes? 

PROFESSOR ROY TAYLOR:  Absolutely back to normal. The important matter to grasp is the extent of what is required. We heard for instance from Lou earlier on as she gave a beautifully clear description of getting type 2 diabetes, not very heavy and at the age of 27. That's outrageous but unfortunately Lou has just got a constitution which is at risk. For Lou to get rid of her diabetes then she needs to lose probably about 15 percent of her body weight of where she started. 

JENNY BROCKIE:  Have you tried to do that Lou? 

LOU VICKERS-WILLIS: No. 

JENNY BROCKIE:   Would you try to do that? 

LOU VICKERS-WILLIS: My endocrinologist said that I could possible reverse my type 2 diabetes, it would take a lot of work. I work in hospitality, I'm on my feet the whole time. I eat at weird hours, that's just my life at the moment. I don't, it's not viable for me. 

JENNY BROCKIE:   So are you happier to be on medication than you would be to go off medication and do the hard work you have to do to get there? 

LOU VICKERS-WILLIS: Yep. 

JENNY BROCKIE:   Okay, what do you think of that Michael? 

MICHAEL MOSLEY:   It's a strategy I'm not sure it's a very good strong term strategy.

JENNY BROCKIE:   Roy, how strong is the science around this?  I mean I think that's what a lot of people want to know because diet, you know, there are diets everywhere, they come and they go. You know, they're found to be wonderful one minute and completely debunked the next. How strong is the science that's supporting what you're saying around doing a diet over eight weeks of 800 calories? 

PROFESSOR ROY TAYLOR:  Well Jenny, since we proved the original hypothesis was correct, that was 2011, we've worked consistently to try and put the science in place and what we can say now is that type 2 diabetes is due to accumulation of fat in the liver and in the pancreas and if that fat is shifted then the body can go back to normal at least in the early stages of type 2 diabetes, say the first ten years.

JENNY BROCKIE:   Okay. Let's have a look at what 800 calories looks like. 

MEAL VIDEO PLAYED. 

JENNY BROCKIE:   Lara, you have type 2 diabetes, you're in week 3 of this eight week 800 calorie a day diet. How are you finding it? 

LARA JARZABEK:  I'm very hungry. 

JENNY BROCKIE:   All the time? 

LARA JARZABEK:  No, for about two hours after I eat I'm okay and then I start feeling hungry again, yeah. 

JENNY BROCKIE: How much were you eating before, before you started doing it, how much more were you eating a day?  

LARA JARZABEK:  At least three times more I would say. 

JENNY BROCKIE:   Three times more? 

LARA JARZABEK:  Probably, yeah. 

JENNY BROCKIE:   So about two and a half thousand calories? 

LARA JARZABEK:  Yeah, probably. 

JENNY BROCKIE:   Now your weight so far has only come down one kilo but your waist has come down and your blood sugar's down, is that right, after three weeks? 

LARA JARZABEK:  Yes, actually today I was down two kilos my weight so that's good. My blood sugar's come down a huge amount. 

JENNY BROCKIE:   By how much? 

LARA JARZABEK:  By 4 points.  My blood sugar, actually no, it's now, from 12 when I began it's now 7.8 this morning was my fasting blood sugar in three weeks, that's fantastic. 

JENNY BROCKIE:   Paul, Lara's results with the test she's doing just over the three weeks, is that an impressive result? 

PROFESSOR PAUL ZAMMET:  It's good, the point is a fasting blood sugar of greater than 7 is the diagnostic test for diabetes and there is a three month accumulation of blood sugar, we call it the haemoglobin A1C test.  I think the aim there would be to have your blood sugars 5 or 6 millimoles per litre, so to speak, and perhaps two hours after eating a level under 8, for example.

JENNY BROCKIE:   Penn, you were diagnosed with type 2 diabetes six years ago.  You've been on this diet for three weeks as well. How's it going for you? 

PENN HSIANG:  Well, initially it was very hard.  I've never been on a diet before, my wife has never been on a diet. It, I've gotten used to it and it's amazing how the body can adjust. 

JENNY BROCKIE:   What sort of, have you tested your results at all? I mean what's it done to your body, have you lost weight? 

PENN HSIANG:  Yes, I've lost weight.  The blood sugar seems to have improved but I expected that to improve anyway with the loss of weight. So it wasn't, it wasn't a real surprise or anything. 

JENNY BROCKIE:   You don't sound very enthusiastic to me Penn. 

PENN HSIANG:  Well I'll be very happy when I come off this diet. This was terrible timing in a lot of ways because it was having to start this when the Luna New Year celebrations were on, having to… 

JENNY BROCKIE:   Well I mean this is valid stuff, people have things to do, places to go. 

MICHAEL MOSLEY:  I suspect if you weren't about to appear on the television program you might have shifted it to a more convenient time. I do not for a moment underestimate the problems or how challenging it is to lose weight by any means. It is tough. 

PENN HSIANG:  Yeah. 

MICHAEL MOSLEY:   I do think it's worth it, I honestly do believe, I do believe…

PENN HSIANG:  Yes, I do believe, I do believe. 

JENNY BROCKIE:   Well you believe it can actually reverse? 

MICHAEL MOSLEY:   Well, I mean asked Professor Taylor. 

JENNY BROCKIE:   Is reversal, because this is a contentious word reverse, I know in this world. 

MICHAEL MOSLEY:   Absolutely. 

JENNY BROCKIE:  To talk about that idea. I mean is it appropriate to say that it can in some people reverse type 2 diabetes, Roy? 

PROFESSOR ROY TAYLOR:  Yes, absolutely. Let me put some figures on that to explain where I'm coming from. In the first study we studied eleven people who are all reversed. They all had relatively short term diabetes, less than four years from diagnosis. In the second study, which is just about to be published, we studied 29 people, they had a mixture of short and long duration diabetes. Now of the people with diabetes of less than ten years, we found that about 80 percent of them would reverse their diabetes completely.

JENNY BROCKIE:   And where does exercise fit into all this?  We've talked all about food, where does exercise fit in? 

PROFESSOR ROY TAYLOR:   That's a really important point Jenny. During the weight loss phase exercise is nowhere. Please do not increase your exercise whilst you're trying to lose weight. And the reason is the majority of people who've eaten their way into being too fat for their bodies really cannot undertake the sustained exercise that's necessary to shift weight. However, once the eight week period is over and the weight has been lost, then exercise plays a really important part in the long term of keeping weight off.  So two very different messages. 

JENNY BROCKIE:   Okay, Paul? 

PROFESSOR PAUL ZIMMET:  I guess the first play is to be looking at what you've said and that is the importance that the person will follow a diet, having a good diet.  I've heard about 100 diets in my history, you know, time in diabetes, having the socio economic circumstances to be able to do it. So it's a dream that we can reverse everyone's diabetes but we can do a hell of a lot of good for about 60 percent at least. 

JENNY BROCKIE:   Okay, Greg Johnson, what do you think of the eight week 800 calorie a day diet? 

GREG JOHNSON, DIABETES AUSTRALIA:  Well I think we're talking about people with type 2 diabetes so you know, significant caloric restriction does work and there's no question. It's the GP guidelines we have in Australia identify that that is a therapeutic alternative for people with type 2 diabetes. So there's no question and then having a Mediterranean style diet combined with physical activity and having your mind in the right place to sustain that works. So there's no fundamental problem with that and severe caloric restriction does work. 

The real issue I think is two things. One is it's just not doable for a lot of people and we shouldn't, we don't want to paint, put people in a position of being failures. Already people are failures in diabetes too often. They get told they've failed their treatment, they've failed this, they're not able to achieve something the system imposes on them and that's a real problem for their mental health and wellbeing and their ability to cope. 

JENNY BROCKIE:   Roy?

PROFESSOR ROY TAYLOR:   Let's just talk about reverse for the moment. Reversing, yes, we're talking people off medication, including blood pressure medication, so the number of tablets they're taking is going down to zero in many cases. My longest duration patient personally is eleven and a half years. Now eleven and a half years with normal blood glucose control I would suggest to you is reversed.

JENNY BROCKIE:  Alright. This, this is all well and good if you know about food. 

MICHAEL MOSLEY:   Yes. 

JENNY BROCKIE:   Let's talk about food. We've got a whole lot here.

MICHAEL MOSLEY:   Yes. 

JENNY BROCKIE:   And I just wonder how, you know, clear people are about what they actually should be eating or what's appropriate to eat. So let's, I'll start with you Muriel actually, how much rice and bread would you eat if you could? 

MURIEL SPEEDEN: Well …

JENNY BROCKIE:   How important a part of your diet has it been? 

MURIEL SPEEDEN: At the moment, not very important. 

JENNY BROCKIE:   But in the past? 

MURIEL SPEEDEN: In the past, yes, because, you know, with the Asian diet you need to have rice, you can't eat curry without rice, you know.  You can't eat spicy food without rice. 

JENNY BROCKIE:  So are you finding it hard to try and cut back on those things? 

MURIEL SPEEDEN: Not now by I used to, yeah. 

JENNY BROCKIE:   Okay, why does she have to cut back on those things?  What does, you know, a bowl of rice or a whole lot of bread do to a person's body if they have diabetes? 

MICHAEL MOSLEY:  Essentially what's happening here, with the foods which have quite a lot of sugar, even bread, bread has quite a lot of sugar in it, it also has easily digestible carbs, what happens is your body breaks it down very fast, you get a big spike in your blood sugar levels, your pancreas pumps out the insulin that will drive the blood sugar levels down again but unfortunately it often over compensates so you get a bit of a crash and so a couple of hours later you feel like,  you know, having another snack. 

JENNY BROCKIE:  But these turn into sugar?

MICHAEL MOSLEY:   These all turn into sugar. 

JENNY BROCKIE:   Rice, pasta, bread, potatoes? 

MICHAEL MOSLEY:   Yeah, pretty damn fast.  So these things all pump up your blood sugars pretty fast because they're readily digestible, they have very little fibre in them and bread, clearly it's better if it has more nuts in it, has more, less digestible stuff in it. 

JENNY BROCKIE:   If it's brown? 

MICHAEL MOSLEY:   Brown often, brown bread often is just white bread dyed. That's what they do, they just dye it and then they add extra sugar to it.  So many brown breads are just white bread in disguise. You're shaking your head, you're nodding exactly.  So if you really want brown bread then you're best off going for rye, something which is really dense and you kind of look at the side of it. 

JENNY BROCKIE:  Now all carbohydrates, these are all carbohydrates? 

MICHAEL MOSLEY:   Yeah. 

JENNY BROCKIE:   They're not all equal though? 

MICHAEL MOSLEY:   Absolutely not. 

JENNY BROCKIE:   There are very good carbohydrates and bad carbohydrates? 

MICHAEL MOSLEY:   Pretty much everything on this table is a carbohydrate in its different life forms, if you like.  You've got orange juice over here, you think to yourself orange juice, it has to be good, it comes from an orange, yeah? We're thinking orange juice is good, unfortunately orange juice is also, you know that amount of orange juice there probably has about the equivalent of about three or four teaspoons of sugar in it. It's a sugar delivery system. 

JENNY BROCKIE:   Now this is fresh orange juice? 

MICHAEL MOSLEY:   Yeah. 

JENNY BROCKIE:   What about a nice big milky coffee? 

MICHAEL MOSLEY:   Sadly, I mean I love nice big milky coffees but they have a lot of sugar in the milk which you should be aware of. The danger as well is if you go into the coffee shop to get the nice milky coffee you will also get a muffin while you're there because it will be sitting calling to you, I know. 

JENNY BROCKIE:   So let's break this down, I mean we've got 400 mls of milky coffee? 

MICHAEL MOSLEY:   Yes. 

JENNY BROCKIE:   In a big container like that? 

MICHAEL MOSLEY:   That's about five teaspoons. 

JENNY BROCKIE:   That's about five teaspoons, so count again?

MICHAEL MOSLEY:   One, two, three, four, five. 

JENNY BROCKIE:   That's without adding any sugar to it, that's just the milky coffee.  Can we talk about yoghurt? 

MICHAEL MOSLEY:   Yoghurt's basically, so we've got full fat and we've got…

JENNY BROCKIE:   We've got full fat, and we've got - we've got full fat here so that's about 150 grams I think of yoghurt each? 

MICHAEL MOSLEY:   Yes. 

JENNY BROCKIE:   That's one's full fat with fresh berries? 

MICHAEL MOSLEY:   Yes. 

JENNY BROCKIE:   That one's low fat with berry flavour? 

MICHAEL MOSLEY:   Which do you prefer? You're going for the one on left?  I'm going for the one on the left as well. Fat, you know, yeah, got fatter but frankly it's got more flavour in it and this one has, who knows what it's got in it.  I really, really don't want to, doesn't smell that great either. 

JENNY BROCKIE:   And what about low fat products in general? 

MICHAEL MOSLEY:   I wouldn't touch them. Generally I think they're junk. 

JENNY BROCKIE:   Why? 

MICHAEL MOSLEY:   Manufacturers are just using them as a way to sell us stuff which is really unhealthy. 

JENNY BROCKIE:   Why is it unhealthy?  Why do you think low fat products are, how can you generalise that much? 

MICHAEL MOSLEY:   Broadly speaking, because, you know, when they take the fat out it tastes terrible so they just pump all sort of other rubbish in. It's mainly sugar but there are all sorts of other products. There are very few processed foods which are low fat. As I said, the famous low fat muffin, you could buy a low fat muffin a few years ago where the number of calories was probably about 10 percent more than the full fat muffin and people thought because it was low fat that meant it was low calorie, which was obviously a complete and clear deception.  But it was feeding on people's gullibility and that's what food manufacturers do, they basically try and persuade people that what they're buying, which is actually a piece of processed junk, is somehow good for them. 

JENNY BROCKIE:   I like the way you're so measured in your assessment of these things. What about things that are sweet but not bad for you? 

MICHAEL MOSLEY:   These actually are very good. Berries on the whole, strawberries, raspberries, things like that.

JENNY BROCKIE:   And just finally, is this just unmitigated goodness over here? 

MICHAEL MOSLEY:   This is pretty much unmitigated goodness over here, yeah. So cauliflower actually makes quite a decent rice, white rice unfortunately very high glycaemic index, very high glycaemic load, so if you can, and cauliflower is relatively cheap so I'm a big fan, all this stuff over here is kind of good. 

JENNY BROCKIE:   Greg, on the Diabetes Australia website you headline the importance of a low fat diet recommending that people choose things like low fat milk, yoghurt, cheese, ice cream and custard. Why?  Why do you recommend those low fat products? I mean it's clearly a difference of opinion here because Michael's saying, you described low fat foods as rubbish, didn't you? 

MICHAEL MOSLEY:   Yes, sorry. 

JENNY BROCKIE:   So why are you advocating low fat foods on the Diabetes Australia website? 

GREG JOHNSON:  Well I think that's just selective looking at our website at the moment. If you look at what we recommend firstly in the guidelines that we co-brand with the College of General Practice we recommend a Mediterranean style diet. I mean it depends on what you're talking about. Firstly, we have to think are we giving advice to people who've got type 2 diabetes? Are we giving advice to people who may be low risk or high risk with pre-diabetes.  You know, our challenge is we've got a big audience here, right? You saw the numbers. In Australia right now there's a million people who are diagnosed with type 2 diabetes as we speak and growing every day. 

JENNY BROCKIE:   But I guess what I'm wondering, what I'm wondering though is why you're recommending low fat products and not saying at the same time just be careful because a lot of them have, or some of them have added sugar? 

GREG JOHNSON:  That's general.  The advice that's given goes into our programs and if you go and look at our programs and then we tailor the advice and certainly our advice we give to people who are diagnosed with type 2 diabetes is start with weight reduction and start with good individualised advice from a health professional about how you're going to get weight reduction and how you're going to sustain that.  And I think I totally agree with Michael's book that you know, if you head towards a Mediterranean style diet with good physical activity and having your mind in the right place. 

JENNY BROCKIE:   But I'm interested, I mean I had a really good look at your website and there are things, and I'm not saying one or other of you is right but I'm interested in you having a conversation with one another because you did headline low fat. You know, choose low fat products, it's right up the top of the website, it's one of the first things that you recommend, and you also emphasise the role, the important role that carbohydrates play in our diet, that's headlined as well. And you say that pasta is low GI and you know, Michael's got it in the bad category over here. So I'm just trying to work out how the average person makes sense of all of this. I mean Michael you've seen the Diabetes Australia website, what do you think? 

MICHAEL MOSLEY:   I have and I do sympathise, you're facing a very broad thing and I also think you’re facing a major cultural shift which is a move from low fat to something different.

GREG JOHNSON:  There's no question that the low fat movement over the past, you know, whatever time it is, twenty years, has become an industry, a lot of foods are presented and marketed as low fat but they're high in added sugar, high in added salt. 

JENNY BROCKIE:   So why don't you say that on the website? 

GREG JOHNSON:  Because that's complicated. And we do that, we're very active in that. I tell you, I sat on for two years on the government, lobbying the government to introduce front of pack labelling so people would know how much added fat, added sugar and added salt was in the foods that they buy, just like you've gone through now.  So we've worked very hard at that. 

JENNY BROCKIE:   And Michael, my challenge to you is around this idea of the 800 calories a day for eight weeks diet, I mean how, how can we know, given that we know people's metabolisms are different and everything else, that you know, people aren't going to cling to this and it think it's going to be my saviour when it might not be, probably doesn't work for everybody? 

MICHAEL MOSLEY:   Over to Roy? 

PROFESSOR ROY TAYLOR:  Well that's a very good point. I think it's very important that we identify what we know and what we don't know. What we know is that motivated volunteers given the 800 calorie diet a pre-packed liquid formula diet will reliably lose weight.  The evidence is accumulating. The scientific basis, picking up Jenny's point, is very clear. The way in which we use it and what doctors say to patients, that is still being developed and so you understand that there a lag phase just now in applying simple science to really what we advise people in clinical practice. 

JENNY BROCKIE:   Maxine, did you know all of this about food when you were diagnosed with diabetes eight years ago? 

MAXINE RISK-SUMNER:  You know, I look at what I'm hearing today is very confusing because, and the reason being is I've been on that journey of having type 2 diabetes, I've made a huge big transformation of weight loss. 

MICHAEL MOSLEY:   How much did you lose? 

MAXINE RISK-SUMNER:  I lost about 35 kilos. 

MICHAEL MOSLEY:   Wow. 

JENNY BROCKIE:   And what period of time Maxine? 

MAXINE RISK-SUMNER:  This proves to me that I lost it. I used to wear this and I couldn't even do the buttons up on it. 

MICHAEL MOSLEY:   Blimey? 

MAXINE RISK-SUMNER:  And I just…

JENNY BROCKIE:   So how did you do it, how did you do it, how did you lose the weight? 

MAXINE RISK-SUMNER:    In a nutshell I changed all that bready stuff. I will not eat a loaf of bread, a slice of bread now, I'm fearful of it. I've, I don't eat any dairy products. That's what I used to have full cream milk with cereal. 

JENNY BROCKIE:   So what do you eat now? 

MAXINE RISK-SUMNER:   I eat five vegies, six vegies. 

JENNY BROCKIE:   How helpful was your doctor? 

MAXINE RISK-SUMNER:  He didn't tell help me at all. He just said, he just referred me to a diabetic educator, something I didn't even know existed. 

JENNY BROCKIE:   How do you think you get those messages across to other Aboriginal people in Australia? 

MAXINE RISK-SUMNER:  Well I'm getting it across now, they come up to me and they go hey sister, how did you get like that? What diet are you on? I go I'm not on a diet, I'm on a life change journey, I've changed all my bad habits of bowls of ice cream, thick shakes, McDonald's, all that quick fix food, quick fix, I want a quick fix I go and get McDonald's, I've changed all that. 

PROFESSOR PAUL ZIMMET:  Could I just make a comment and it would be a pity if anyone left here any thinking any specific diet was greater than another. We've known for forty years if people lose weight they can actually lose their diabetes, but if they put the weight back on it comes. I think Michael will agree with that and I think that's the important thing. There are a lot of diets around, there's hundreds of them around, you need the behavioural issue to want to follow a diet, even Weight Watchers or any others. 

JENNY BROCKIE:   Michael, you've had diabetes for about fourteen years, what toll has it taken on your body? 

MICHAEL CROUCHER:  Quite a big one really. I suppose when I first found out about it I didn't really take very good care of my diabetes and in 2007 I ended up getting like a blister on the bottom of my right foot and so one day I basically kind of, my foot was swollen and started kind of progressing up my leg so I went to see the doctor.  He said take these antibiotics, if it's no better tomorrow come back.  So it wasn't any better tomorrow, I went back, he said basically well, pack a bag, go to casualty. So I went there, drove myself up there thinking, you know, oh I'll just be on IV antibiotics for a couple of days, and that was on a Wednesday. Come Sunday morning I ended up having my three smaller toes amputated as well as then a lot of the skin behind that area and that then led to, it was quite traumatic.  I mean I never kind of expected it was, you know, when I was going into hospital that I was could going to come out of it missing parts really. 

JENNY BROCKIE:   So you knew you had diabetes at this point? 

MICHAEL CROUCHER:  Yes. 

JENNY BROCKIE:   Yeah, your vision is affected as well? 

MICHAEL CROUCHER:  Yep. 

JENNY BROCKIE:   How is it affected? 

MICHAEL CROUCHER:  Well I know that it's getting worse, it's deteriorating so you know, I see my optometrist regularly. I mean  I was only there last week getting checked and things like that and my peripheral vision is okay but I need, I found over the years that I need to get stronger contact lenses going from like to multi-focal lenses and things like that as well. 

JENNY BROCKIE:   How much medication are you taking? 

MICHAEL CROUCHER:  Quite a lot. 

JENNY BROCKIE:   How much a day? 

MICHAEL CROUCHER:  So I take two tablet of like Diform and Diabex metformin of a night time, but probably seven injections of insulin a day. 

JENNY BROCKIE:   And have you tried to lose weight more weight? 

MICHAEL CROUCHER:  Oh not seriously, no. 

JENNY BROCKIE:   Why? 

MICHAEL CROUCHER:  Just a lack of motivation I suppose, even though I know what the effects can be. I mean my father was diabetic as well too, he had a heart attack, died of a stroke a few years ago when he was only 71.  But I think you've got to find that kind of motivation within yourself, that that desire to want to lose weight, to improve. 

JENNY BROCKIE:   Why do you think you haven't found it? 

MICHAEL CROUCHER:  Um, I think that it's kind of life situation as well. I mean I think that diabetes probably brings a bit of depression as well to people and I find that it's difficult to kind of, because of that get myself motivated to go out and walk and I suppose it's also that problem, because of having less toes and also the arrangement of my foot structure as well too, means that for me going for a walk could result in getting an ulcer and I've been into the, into the hospital too many times I can even count and I became on first name basis with the nurses because I was in and out of the same ward at the RPA so many times.

JENNY BROCKIE:   So this is the kind of spiral isn't it? 

MICHAEL CROUCHER:  Yes. 

JENNY BROCKIE:   That when you find yourself in to these situations you suddenly find as you get more sick you're more limited in what you can do? 

MICHAEL CROUCHER:  That's right.

JENNY BROCKIE:   And what do you think with what you've heard tonight?  I mean is it changing your thoughts about food at all? 

MICHAEL CROUCHER:  I think a lot of the stuff that we've said is kind of common sense. I think that most people realise that this is the bad stuff and that's the really good stuff. But I think as well too though that knowing that there's a plan, like there's 800 calorie diet plan that I can follow, that would be certainly better for me because I tend to be fairly organised and I like making lists and I like making a plan and so if I know what's coming up, then I think that it's going to be easier to follow. 

MICHAEL MOSLEY:   Okay, you're on. So we will get in contact, yes? 

MICHAEL CROUCHER:  Yeah. 

MICHAEL MOSLEY:  Okay. 

JENNY BROCKIE:   Would you give it a go? 

MICHAEL CROUCHER:  Absolutely, yeah, yes. 

JENNY BROCKIE:   You will give it a go? 

MICHAEL CROUCHER:  Yeah. 

JENNY BROCKIE:   Interesting. 

MICHAEL MOSLEY:   I can also introduce you to a community of people who have been in exactly your place, if you like, who will help you with it.

JENNY BROCKIE:  Which leads me to ask about something like Michael, I mean we're talking about, you know, we've talked about people, obviously people who are prone to diabetes, who might have a spike in blood sugar, who have diabetes, but what about somebody who's got advanced diabetes like this, can losing weight have a significant impact on someone like Michael? 

MICHAEL MOSLEY:   I do believe it will.  I do believe that actually the exercise component is relatively unimportant compared to the weight loss. I absolutely understand why walking is a huge problem for you at the moment. It is possible that you know, your diabetes is sufficiently advanced that you may not achieve full remission or something like that but I have no doubt whatsoever that if you lost significant amounts of weight you would feel better and you'd feel better about yourself as well which I think is a hugely important part of it. 

JENNY BROCKIE:   Yes? 

MAHBUB HASSAN:  What happens after the eight weeks?  Do we need to do something about it? 

MICHAEL MOSLEY:   Unfortunately you cannot return to your old way because if you return to your old ways you will simply put the weight back on. As Professor Taylor was saying, at that point you will probably need to significantly raise the amount of exercise you do because exercise is a terrible way of losing weight but it's a fantastic way of keeping weight off. I still think that switching to a Mediterranean style, my wife is a GP, she sees a lot of Asian patients where she works and obviously Mediterranean is not quite the same if you're Indian. 

MAHBUB HASSAN: Yes. 

MICHAEL MOSLEY:  She says the biggest challenge is persuading them not to eat chapattis because there is no good alternative. 

MAHBUB HASSAN: Chapattis is not so bad but you know, for us no meal is complete without rice.  You have to have a bed of rice and you put whatever. 

MICHAEL MOSLEY:   Try cauliflower. Honestly, try cauliflower, you're not convinced I can tell. 

JENNY BROCKIE:   He does not look convinced one little bit. 

MAHBUB HASSAN:  Even with cauliflower, you know the portions that you showed me those are the side issues and then you have to have to bed of rice, normally it's…

MICHAEL MOSLEY:   I'm afraid this is going to be a significant shift. Your plate is going to need to have lots of vegetables on it. It can have modest amounts of rice, it can have meat but it is going to require those things.

JENNY BROCKIE:   Paul, just quickly, are there some people if there's a family history who are just going to get diabetes no matter what they do? 

PROFESSOR PAUL ZIMMET:   Yes, I think Roy will agree with me, there are lean people who are not obese, who've got a very high genetic susceptibility within the family and they'll get diabetes and the diet may help reduce their cholesterol and other risk factors for heart disease. There is a definite group who will benefit with what we've heard tonight. There are others who, for other reasons, high genetic susceptibility, being on medications which can aggravate diabetes rather than cause it, for example, but that's the score. 

JENNY BROCKIE:  Roy, just very quickly? 

PROFESSOR ROY TAYLOR:  Yes. Of course Paul and I agree on just about everything and have done for a long time, but I would say the group of people who have such a genetic burden that the amount of fat in the body doesn't matter is really very small, about 1 percent. Everybody else with type 2 diabetes has become too fat for their bodies and we see this in populations.

JENNY BROCKIE:   Michael, we have to, we do have to wrap up. What if it turns out that the idea of an eight week 800 calorie a day diet is in five or six years as out of date as low fat diets are, or the other medical advice that you were given when you were a medical student, what then? 

MICHAEL MOSLEY:   It's always possible, I think it's unlikely. I think that calorie restriction in one form or another is likely to form a basis of any sort of weight loss program. I think it's widely unlikely in five years’ time we're going to discover that eating chocolate is the cure for eating obesity or anything like that, sad but probably sure. So I think what's going to be interesting is that Roy's studies will come out within a couple of years, we'll learn more, we're learning more all the time. The main thing I guess I'm trying to do is say look, there is a massive threat here.  There is a great big threat which most people are not aware and it's not just people with type 2 diabetes, it's all those other people with pre-diabetes who are heading towards a fate which they can do something about now. I mean I do applause the efforts of the Australian Diabetes Association and everybody else who is screaming and shouting this is a real threat, we must act. 

JENNY BROCKIE:   Good note to end on, thank you all very much for joining us tonight and that is all we have time for here but I'm sure you're going to want to keep talking about this on Twitter and on Facebook. Thanks everyone.