05 April 2006
Minister of State at the Department of Health and Children (Mr. S. Power): I thank Members for the opportunity to address the House on the important issue of diabetes. It is a chronic, progressive metabolic disease...
Dr. Henry: I thank Senator Browne for allowing me to speak ahead of him. I also thank the Minister of State for his comprehensive statement but I was struck by the absence of certain things in it.
Haemochromatosis, as the Minister of State knows, is a genetic condition which is very common in this country. Approximately one in 300 people have it and one in 20 is a carrier. The gene must be present in both the mother and father for a person to develop full blown haemochromatosis. In my innocence, I thought the Vikings had brought it to Ireland but the Celtic curse, as it is sometimes called, is, in fact, a mutation which probably took place in the west of Ireland thousands of years ago. Wherever we have sent people, such as the ladies who went to Scandinavia with the Vikings or the Irish who emigrated to north America, we have spread the disease.
We have the highest levels of the disease in the world. In the US only 10% are carriers and Scandinavia has levels between the US and Ireland. It is a problem about which we must be vigilant because a number of people with haemochromatosis present first as diabetics. This is because it is a disease where people absorb more iron than they should. The excess iron is laid down in organs like the liver, where it causes cirrhosis, the kidney, which can give rise to serious kidney disease, and the pancreas, which can lead to diabetes. It can affect the joints where it leads to a condition resembling gout. It is important to keep it uppermost in our mind because we are the people most likely to suffer from it.
Often a person is diagnosed with diabetes and some years later undergoes a test for their level of blood ferritin, an iron-binding protein which reaches 300 in people who have haemochromatosis, and only then somebody decides they should be tested for the disease. At that stage they may have cirrhosis of the liver and cardiac irregularities, which are another common reason for presentation. We have the highest incidence of the disease in the world, a fact I would like to be stressed more in the diabetes strategy.
It is also important for the families of anyone who is found to have haemochromatosis after diagnosis of diabetes to be screened. Brothers and sisters will have a one in four chance of having it. It is very important to catch them because the treatment is quite easy. It is only necessary to take blood from sufferers every few weeks. The disease does normally not present until the complications arise and a person is in their 40s or 50s. Frequently those with cirrhosis of the liver are told they drank too much and do not get too much sympathy, but if there was a little more investigation and more thoughtful examination of their condition we might diagnose more people with haemochromatosis before they suffer the organ damage which causes diabetes, cirrhosis and cardiac irregularities.
If the family is checked for the disease or for being carriers insurance companies can become a bit unpleasant. We must be careful to monitor insurance companies in such cases. If it is good to diagnose the condition early, so that people can receive early treatment and avoid later problems such as diabetes, then insurance companies should not be allowed to penalise people. It will only deter them from being tested.
We also need to monitor food and food supplements for sufferers, particularly those referred to as "natural food products" because their labelling may not be as careful as we would like. It is bad enough for a person to retain iron without taking in even more in this way.
I am pleased the Minister of State linked the cardiovascular strategy to the diabetes strategy because it is very important. I was very proud this week to be on a radio advertisement, though I did not hear myself, for the Irish Heart Foundation, encouraging people to call a confidential helpline if they have a concern and do not want to visit a doctor. We should encourage people to ask questions early and the cardiovascular strategy has helped with that.
We must also be very careful about health promotions. We know from large surveys in the US that low-fat diets have not been very effective. It would have been preferable for people to have reduced their carbohydrate intake. It is important for people to realise that eating low-fat products is not the answer and that by so doing they might be fooling themselves.
The presentation in men and women with cardiovascular conditions is often different. Women are inclined to present with cardiovascular disease somewhat later than men. I believe it is because women do not complain so much. We in the medical profession do not think of cardiovascular disease affecting women in their 40s and 50s and are too ready to accept the protective effect of oestrogens, but we may have fooled ourselves on that score. It is important that the medical profession raises its sights and is not confined to what it thought in the past.
Obesity is a significant problem and the Minister of State has given prominence to it, in which everybody will support him. I have been on a diet for 40 years. I have not lost any weight but I try to walk a lot. Though I have a sore ankle at the moment, described as having occurred from too much walking, plenty of walking keeps one's blood sugar down, which is very important with regard to diabetes. If a person is overweight it is even more important to walk regularly because doing so has a protective effect. I hope the strategy promotes that as well.
I will return to podiatry. Has the Department managed to settle this ongoing row?
Mr. S. Power: I knew I should have left it out of the speech.
Dr. Henry: The Minister of State should put his best foot forward to settle it.
I was recently told by a diabetologist that virtually the only reason apart from serious accident or malignancy that a person in this country has a leg amputated is diabetes, and that is really dreadful. We have managed to cut down on smoking and other causes, and we must now get at this problem and make people realise how important it is that they look after their feet. They will have to be spared top-up fees and be able to see podiatrists more than twice a year. Once someone gets an ulcer on his or her foot, that person ends up in serious bother, being sent to hospital, which costs a fortune. I have been told that it takes at least six weeks in an acute bed before the person can be discharged. The Minister of State should imagine how many people he could have got off the trolleys in that time if he had managed to keep that person out of hospital. He can now make his name by doing so.
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