Episode 9 | Diabetes

Hi Everyone,

In this episode we are chatting about diabetes. We try and keep the inevitable chat over coronavirus to a minimum in these episodes, but it’s well and truly everywhere throughout this one. There have been some significant links between coronavirus deaths and diabetes and this has understandably changed the way that insurers are offering cover.

We chat through potential insurance terms for diabetics pre-covid, during lockdown and what we hope will happen post coronavirus.

Our 3 key takeaways,

1. 1 in every 15 people in the UK has diabetes.

2. The importance of self-knowledge and engagement with medical advice, in determining the potential terms of insurance.

3. Case study client that was able to have life insurance and income protection, with a number of medical conditions including type 1 diabetes.

We always love to hear from you, please do let us know your thoughts of the podcast and if you like what we are doing. In the next episode we will have another guest on with us and we will be chatting about insurance and people living with HIV.

Kathryn:       Hi everyone, this is episode nine and today we are going to be focusing on diabetes.  I’m Kathryn.

Andrew:       I’m Andrew.  Welcome to the Practical Protection podcast.  So Kathryn, how are you doing this lovely sunny morning?

Kathryn:       I’m good thank you.  I’m jealous that I’m not obviously – we’ve recorded this on the Bank Holiday Monday so this is just saying to everyone how dedicated we are to the podcast and it’s lovely – lovely and sunny outside but I have to say that I’ve done something Andrew.  I’ve got a bit of a surprise for you that I’ve hidden.

Andrew:       Okay.

Kathryn:       And so I think – what is the best thing to do is for you to describe to people what’s coming up on screen.  And just to explain to everybody that I am not getting stripped off or anything like that.  Everything is very, very legitimate but you’re going to think I’m insane.

Andrew:       Da, da, da.  I’m now trying to get you back because I’ve been looking at all diabetes stuff and hiding your face.

Kathryn:       Oh thanks.

Andrew:       Let me –

Kathryn:       Have you seen what I’ve got?  Are you going to describe to people what I’ve got in front of me?

Andrew:       I haven’t – I haven’t got there yet.  Right, right, right.

Kathryn:       What are you –  How many tabs have you got up on your screen?  Honestly.

Andrew:       Oh there we go!  Oh wow, that’s amazing! [both laugh]  It’s a cake with a unicorn candle.

Kathryn:       It is, it is [both laugh].  And the reason being is there’s a lot of stuff going into this.  When we first started the podcast, I saw something when I was doing the research about podcasts.  Yay, I’ve blown the candle out.

Andrew:       It’s my – it’s my Dad’s birthday today.  I assume that’s –

Kathryn:       Oh, even better.

Andrew:       There you go.

Kathryn:       Right, well happy Dad’s birthday.  The reason being is that apparently most podcasts don’t get to episode nine and it’s episode nine.  So since we’ve started this, I’ve had this in my diary – a special thing in my diary saying ‘Do a candle.  Do a cupcake and candle.’

Andrew:       Oh it’s a very nice – it’s a very nice cake.

Kathryn:       Yes it is.  It’s a kiddies – obviously – it’s literally melted chocolate with Rice Krispies in it, bit of porridge in it as well.  It’s literally got anything in it that I could find.  But there you go, so that’s the surprise.  So anyway –

Andrew:       I feel bad now.  I’m in that awkward position.  One of my friends once managed to completely forget his wife’s birthday

Kathryn:       Oh.

Andrew:       And wasn’t – didn’t realise until him and his three kids turned up at her parents’ house for lunch that day when her parents said ‘Happy birthday’ and she turned to him.  So –

Kathryn:       No.

Andrew:       I – I don’t feel that bad.  I feel like I should have got something for you.  I’m now frantically trying to think of the equivalent of –

Kathryn:       It’s not like I’m passing you the cake though.  There isn’t one turning up at your doorstep or anything.  I’ve not had one shipped to you.  But no, that was just my little – that was something that’s been giggling in the back of my mind for the last nine episodes.

Andrew:       Well, well done us.  Congratulations to us.

Kathryn:       Yay.  So yeah, so I’ve had a brilliant weekend and obviously even better morning giggling to myself getting that ready.  How have you been?

Andrew:       Yeah I’ve been alright.  I’ve been alright thanks.  Yes it’s – well, what, it’s half term this week isn’t it?  So that means no difference at all other than nothing from teachers to try and muddle through days for a week.

Kathryn:       Absolutely.

Andrew:       So – so, yeah, it’s – we’re okay.  We’re – we’re settling into a new home office so we’ve got – managed to have that built through the last few weeks.  So basically yeah, our – we’re moving work stuff out of the house into that which feels quite good although also means lots of going through old boxes and old things and yes – so kind of in that busy – busy head space of having 10 years of your life kind of in front of you in various forms of paper which is always interesting.

Kathryn:       Yes.  It’s the kind of thing you’re always putting off because there’s always something so much –

Andrew:       Yes, exactly.

Kathryn:       Anything is so much more better to do but I think that’s really important that I did some training with the mental health charity Rethink on – last week, and one of the things was like how to better your home environment and everything during lockdown.  And there was that thing of, you know, really trying to make sure that you have a divide between –

Andrew:       Yeah.

Kathryn:       You know, where your work space is and where your home space is and it was even – even if you are stuck in a room and it has to be that your living space is your work space or your bedroom is your work space, like specifically doing stuff so that when it’s bedtime that you’re not looking in the direction of your work set-up is –

Andrew:       Yes.

Kathryn:       And when you’re working, you’re not looking at where you’re sleeping.  You know, so it’s being able to do that, I think that’s really nice that you’ve got that opportunity to –

Andrew:       Yeah.

Kathryn:       Like separate.

Andrew:       I’m still insisting I’m going to walk out the front door and round to our back gate and then go into our back garden but yeah.

Kathryn:       If it makes you feel better.

Andrew:       Yeah.

Kathryn:       ‘I’m going out the front door.’

Andrew:       Yes, that’s kind of – we’ll see how long that lasts.

Kathryn:       Absolutely.

Andrew:       Move on.  Yes, so anyway, on to today’s theme.

Kathryn:       On to today’s theme.

Andrew:       Oh sorry, oh sorry we have to do the lie – we have to do the last week’s truth or lie right?

Kathryn:       Yeah.  So last week was all about favourite games.  We don’t obviously have Kara with us today but she got involved last week.  So I said that my favourite family favourite game was Taboo.  Yours was –

Andrew:       Mario Kart.

Kathryn:       Mario Kart and Kara said hers was Twister.  So again for everybody who I know is dying to know this answer, the answer is that Kara was lying and I have to say we had quite a bit of a giggle I believe before the episode about how much she is detesting Twister at the moment.  I think, you know, as a full-grown adult with a child, trying to do Twister together isn’t the easiest of things at times and when that child is just at that borderline age of not being able to reach kind of any of the things that they need to reach as well, it just makes it all – yeah, I think that was something that she kind of said through gritted teeth.

Andrew:       Yes.  Yeah, I think – so unlike you, maybe Kara and I aren’t uber-bendy people as it transpired.  So – so –

Kathryn:       I don’t have strength so I’m rubbish at it.

Andrew:       I sometimes have to do Cosmic Kids yoga, have you –

Kathryn:       Oh yes, I love that.

Andrew:       Yes so that’s – yeah, no, give me Joe making me run up and down on the spot for half an hour any day.  But my Cosmic Kids’ training is still – doesn’t make me Twister-ready so I entirely sympathise with Kara.

Kathryn:       I was going to say though – I’m just imagining you at Twister.  I kind of imagine you’d be awesome because I just imagine you’d be like a downward dog yoga pose and then everyone else would just be moving underneath you.  You’re that tall but you’re just kind of like –

Andrew:       Yeah, that works until I accidentally squash any number of children.  That’s not a good look.

Kathryn:       Yeah, we’ll try and avoid that.  Avoid crushing of children.  Anyway right, so diabetes.

Andrew:       Yes.

Kathryn:       So I think, you know, just to explain to everyone straight away that there’s just no way that we can avoid talking about corona virus in this at the moment because it’s had such an impact upon the offering for diabetes.  So what we’re going to do is we are going to try and talk generally about diabetes and I will also talk a little bit of post-corona virus things that are available but it – I think it is very, very important, as you do Andrew as well, that we talk about it as in ‘This is the reality of what’s happening right now.’  Because this is a very specific group that are being affected when it comes to insurance applications.  So – so it’s Type I, well sorry, Type I?  With diabetes there are a number of different versions.  When I was doing the research for this, I was surprised at how many versions there were as well that I don’t know about or haven’t come across the names before.

So I think typically we generally think of Type I diabetes and Type II diabetes.  So Type I is more sort of an auto-immune condition that somebody is born and lives with their entire life.  Type II diabetes is more – is diagnosed – is generally obviously due to some lifestyle choices.  You then have gestational diabetes which is – occurs during pregnancy.  But then a couple of others that sort of like popped up as well, sort of like intrigued me with their name as well – Wolfram Syndrome and Alström Syndrome and then Type IIIc diabetes.  And I think in a number of those, like the Wolfram Syndrome there’s quite a few different ones within that as well and that kind of surprised me as to how many different ones there were that I wouldn’t necessarily immediately from the name think were diabetes anyway.  So, with Type I diabetes, you’ve got – about 8 percent of diabetics in the UK have Type I diabetes.  Type II, there is – roughly 90 percent of diabetics in the UK have that one.

And I went onto Diabetes UK and I was just sort of like pulling up some stats just for everybody and for myself to know a bit more about it.  So there’s roughly 4.7 million people in the UK that currently have diabetes and someone is diagnosed with it every two minutes.  And that roughly comes down to sort of saying about one in 15 people have diabetes and it was these next statistics that I got that actually really shocked me.  And I say, this is from Diabetes UK and it was saying that every week due to diabetes there are 169 amputations, 680 strokes, 530 heart attacks and 2,000 heart failures due to diabetes within the UK.  And there are also 500 premature deaths due to diabetes.  And those ones really, really shocked me.  I think there was part of me that was just surprised that there were so many but then there was a big part of me that was thinking of how many critical illness claims there could potentially be if people had had these contracts in place and that really, really surprised me.

So from your point of view Andrew, underwriter head and everything like that, talk to us about diabetes.

Andrew:       So – so you’re right in this increasing number and distinction between different kinds of diabetes.  I mean it is fair to say, I think underwriters still largely think in terms of Type I diabetes, Type II diabetes and gestational diabetes and I think it is worth talking about gestational diabetes a bit as we go through for a – an area where there can often be confusion and challenges between advisers, underwriters and clients.  But yeah, Type I as you say largely happens – is largely diagnosed at much earlier ages and it is where the body isn’t producing any insulin at all.  So there’s a lot more – typically that’s almost an underwriting issue or that’s often an underwriting issue whereas Type II is sometimes an underwriting issue and sometimes, as you described there, because it’s coming on at older ages and is a mix of genetic and lifestyle factors, then what’s often – sometimes we underwrite that but often it’s coming in more at claim stage, whether that’s income protection claim, critical illness claim, life insurance claim.

So a lot – a lot of claims as you describe are claims where people genuinely didn’t have diabetes or certainly weren’t aware that they had high blood sugar at time of application but by time of claim then we can see that that’s been a factor.  And I think that drives some of the ideas and push around improved – I guess products and propositions from insurers to play a part in people’s health, you know, bluntly it’s in both insurers’ and individuals’ interests if they can do that through products so we see that from – from some insurers around mental health things but also I think increasingly insurers are looking at that, around physical health too.

Kathryn:       Yeah.

Andrew:       Yeah and then Type II diabetes specifically – so as you’ve said, the vast majority of people who have diabetes have Type II diabetes.  That does increase by age so I think it’s about a million people under 60 have diabetes and kind of the rest or about three million over 60 have diabetes.  So that is where – I think that’s where certainly you’ve already mentioned corona virus, I think that’s where trying to pull out the different things that are going on with corona virus is often very difficult and diabetes kind of was already – already in that place –

Kathryn:       Yeah.

Andrew:       Of you have those huge numbers but actually understanding why an 85-year old dies is always – is almost always not a very simple case.  You know, there’s almost always two or three things going on.

Kathryn:       Yeah.

Andrew:       So –

Kathryn:       Was that what you were saying though in the case of – you know, because we’re hearing  a lot of different things.  I was hearing around 25 percent of deaths due – with corona virus were people who had diabetes.  We’re hearing obviously that’s there’s a very significant amount are older people as well so like you say, people over the age of 60, over the age of 80, you know, it’s – it is kind of the fact of, you know, these statistics I think can come out of it but in some ways it kind of seems as if we’re reading a bit too much into those statistics and that correlation because it’s kind of a case of ‘Well yes it is a lot of people but with – who are, you know, there’s been a lot of people who are diabetic who have unfortunately passed but they were – they were part of that age group as well.’  So it’s not necessarily the diabetes, it’s the fact that they were maybe – that it’s maybe the age but then at the same point that it could be the diabetes, it may not be the age or it kind of – I think all of us in a bit of a standstill as to what to know at the moment.

Andrew:       Yeah.  And I think we are beginning to come out of that phase.  So there was – so last week – so where are we now?  We’re recording this May 25th, so May 20th I think there’s the first study that I’ve seen kind of – sorry the largest global study come out last week which came out from NHS England on – so it’s called ‘Type I and Type II diabetes and Covid-19 related mortality in England.  A whole population study.’  So that was looking at – I think it was kind of the first two months of corona virus deaths and that’s where between a quarter and a third have – of people who have died having had the Covid-19 test in hospital –

Kathryn:       Yeah.

Andrew:       Have also had diabetes.  That did then – within that report – within that study, try – or well it did – it stripped out other factors like age, like race, like socioeconomic depravation status and did some postcode analysis and after that it kind of flipped the importance of Type II and Type I diabetes and after all of that it said that if you’re a Type I diabetic you have a three and a half times risk –

Kathryn:       Right.

Andrew:       Of dying from corona virus in hospital and you –  To someone who doesn’t have diabetes –

Kathryn:       Right.

Andrew:       If you’re Type II diabetic, you’ve got a two times – a doubling of the risk.  Now there’s still bits recognised in there that it doesn’t fully take into account other medical conditions and things like that.  And certainly for the Type II diabetes, that two times risk and for both really it’s not that dissimilar to probably the kind of extra risk that we would expect from a diabetic anyway.

Kathryn:       Okay.

Andrew:       So it doesn’t necessarily mean there has to be a huge rethinking of underwriting risk, you know, it probably is just another multiple but it does seem that there’s something going on and it can’t just be explained away by, you know, all of these other things.

Kathryn:       Yeah.

Andrew:       And certainly I think that is the point we’re at so I guess more generally, clearly underwriters – underwriters are asked to look at a 25-year risk, you know, that snapshot from an application form and possibly a GPR and then predict –

Kathryn:       Yeah.

Andrew:       What will happen in the next 25 years.  With this, we’ve had two months’ experience but we are now beginning and genuinely, sadly because of the numbers of people affected by this, we are beginning to see credible things where kind of an initial blanket approach should and can be challenged really condition by condition, especially for these big conditions and that will mean that for some conditions there are more conservative approaches that need to be taken and for others there can be alternative approaches taken rather than it just being a – an overall case of corona virus plus existing medical condition equals bad.

Kathryn:       Yeah.

Andrew:       That there clearly will be some conditions which are more affected than others and I think we – we, you know, recognising this could go on for a while yet, we need to – and underwriters are looking at those individually rather than just a – on the whole scale.

Kathryn:       I think it’s, you know, I think everybody can with a sensible sort of like view on it, from the adviser’s point, not saying that this wouldn’t be – it wouldn’t, you know, as a client, like I say, it’s going to suck no matter what but, you know –

Andrew:       Yeah, absolutely.

Kathryn:       From an adviser’s and an underwriter’s point of view – and I think everybody can understand that if there’s something that’s being seen as from the statistics and from medical information that there is only that two months kind of data that’s there.  If there’s something that’s really standing out as potentially even more so of a risk then I think everybody will understand that there has to be – well insurers are going to want to take a little bit of extra caution for at least the current time being.

Andrew:       Yeah.

Kathryn:       So – sorry.

Andrew:       To be clear, to be clear when we say there’s a two times – so for Type II diabetes when this study says it’s a two times extra risk of dying from Covid, that’s – that doesn’t mean they’ve got a two times extra risk of dying of everything, it’s just from Covid.  So that, you know, that doesn’t automatically mean you double the rates or anything like that.

Kathryn:       Yeah.

Andrew:       It’s just that.  So I think still with those numbers, although it clearly does show that there is an increased risk as I say, I don’t think it’s out of proportion to the kind of risk that we would look to insure normally.

Kathryn:       Yeah.  Okay.  So, probably have a bit of a chat –

Andrew:       Sorry we’ve got deep into deep sell there.

Kathryn:       Yes.

Andrew:       Once you open the door –

Kathryn:       I know but I’m thinking to myself, I want to chat now about like the ace inhibitors like the medication that’s –

Andrew:       Yeah, let’s do that.

Kathryn:       Potentially been linked to it as well.  And I’m thinking ‘No, we know we’re trying to – we’re trying really hard not to do like our usual hour and a half.’ [both laugh]  So no, so I think it’s a good idea to have a little bit of a chat about the things that we need to know.  So these are the things we always need to know, so this is pre- and post-corona virus.  But I want to chat a little bit – just on the off chance that hopefully things will return to what they were.  Just sort of like a bit of a chance to chat as to what we would typically have seen if we didn’t have corona virus staring us all in the face.  So –

Andrew:       Sorry, sorry Kathryn – I think, yeah, I think on this it – all of the research so far shows the same risk factors are still relevant.  So I don’t think the underwriting questions will change.  So all of this stuff is still absolutely relevant today, mid-2020 as it was in 2019 and hopefully it will be in 2021, 2022.

Kathryn:       Yeah.  No, no, I fully appreciate – yeah, I get that.  I think my concern – not concern but my thought is that maybe if diabetes is being seen as such a specific risk that maybe if we – when we are starting to return to pre-corona virus kind of offerings for insurance, that maybe diabetes may take a little longer to go back to where it was.

Andrew:       Yeah.

Kathryn:       So that – that’s kind of like my mindset is with it. But no, so what we’d need to know at any point for somebody with diabetes is you’d need to know when it was diagnosed, the type that they were diagnosed with, their medication especially if anything like metformin is currently in use or has been in use, any other forms of treatment, if there’s been any surgery, any – also known as a hypo – known as a hypo – it’s a hypoglycaemic kind of event which is when the blood sugar drops seriously low and the person can potentially lose consciousness or fit.  You need to know their blood pressure readings, their cholesterol readings and the latest one for me, which it really gets me, it’s HbA1c level.  I mean that is absolutely key.  Without the HbA1c level, there’s no way as an advisor you can speak to the insurer and have a sensible conversation about what the terms could be because nobody’s going to know.

But now, sort of like, so you hit the level of being diabetic when the reading is at 48 or 6.5 and that really gets to me now because I’m obviously now especially old school, I’m all about the 6.5.  I don’t really get the new numbers of 48 and that’s really, really thrown me.  But now I’m thinking ‘Right, as long as I know those two numbers,’ and I’m sure I’m probably not the only adviser who’s got that kind of a thing where I’m thinking ‘Why have they changed it?  It was fine originally.’

Andrew:       I’m glad because, right, we present ourselves as the cutting edge – do we?  As the cutting edge front of protection.  And I – and I’m exactly the same –

Kathryn:       Yay!

Andrew:       As you, but it wasn’t until doing my crash course in revision for this this morning that it kind of – I think it says it changed in 2009, the official preference –

Kathryn:       What?

Andrew:       From percentages to millimoles per mol.

Kathryn:       Really?  I’ve only really seen it the last couple of years.

Andrew:       Which, even when I do – so absolutely – this is exactly right, Kathryn.  We can back each other up on this.

Kathryn:       Yeah.

Andrew:       To go – I’m sure it takes a while to get through the NHS and doctors and so on and so on but it’s – yeah, I can kind of see it in black and white as on – I think it was on one of the charity websites going, ‘Yeah, basically, the – if you still think in percentages, you know, who are you?’  So I – I still – I still very much start in percentages and then work to the other.  But as you say, 48 and 6.5 – forget the science, forget anything behind it, below those are good, either you don’t have diabetes or it’s well controlled and then as you go above that you enter more – more worrying territory which with it comes extra risk for you and, from my side, for the insurer.

Kathryn:       Absolutely.  I think it’s a good idea as well to mention – so you’ve got pre-diabetes and borderline diabetes.  Now I think these are quite difficult ones because people, for me as an advisor, it can be quite difficult because people often come to us and say ‘Well I’m pre-diabetic, I’m borderline diabetic.’  And then you have to explain to them that obviously for some insurers and depending on – it’s very much depending upon that HbA1c reading – they will in – they can potentially be classed in a sense underwriting-wise as diabetic because of the potential of how high that reading is.  Everything, the other factors, the height and weight, any other complications that there are and it’s – it can be very, very hard because, you know, it’s kind of that thing of, I think someone if they are maybe borderline diabetic or pre-diabetic, it’s kind of – not an achievement but it’s kind of like a thing for them where they’re kind of like ‘Well I’m not diabetic yet.  I am okay and I’m working hard on this to not become diabetic.’

And then you’re having to say to them ‘Well yes but unfortunately insurers kind of think of you as diabetic.’  And, you know, that can be really, really hard that conversation and I have actually had one person – it was very, very difficult.  I had one person who was actively really trying to be very pushy to me to non-disclose on their application – which obviously I didn’t do.  I couldn’t do the application with the person.  But, you know, very actively well – just – ‘My blood sugar’s fine now so it won’t matter.’  And then it’s a case of ‘Well I know your blood sugar’s fine now but obviously in the last five years, your blood sugar hasn’t been fine and we’re going to need to tell them and it could affect things.’  And I think, you know, I think the majority of people are fine but I think there is kind of like a little bit of sensitivity sometimes around this that can be – I don’t think – I think – sorry, not to be blasé and sort of like think ‘Oh it’s absolutely fine, there won’t be any issues because it’s pre-diabetes or borderline diabetes, just not actually diabetes.’

You know, be – try and be very careful with the wording and make sure that people that are applying for the insurance realise that it could affect the application just as much as having diabetes could.

Andrew:       Yeah, absolutely.  I don’t know if this is the right analogy but almost, you know, in the – as we talk a lot about in mental health terms, everyone has mental health.  Everyone has blood sugar levels.  HbA1c is – basically gives you an average of your last two or three months’ worth of – of blood sugar.  So it’s a – it’s an accurate reading that kind of isn’t just a snapshot and it gives you that longer term reading and therefore if you’re in that borderline diabetes or pre-diabetes stage, then typically as you say, you’re kind of given a, you know, ‘Well do these things to improve your lifestyle, improve your diet and come back.’  Yeah, they’re difficult times to underwrite because obviously you kind of have to take the cautious approach and –

Kathryn:       Yeah.

Andrew:       Throughout with diabetes, as with other conditions, what the underwriter wants to see is an – but even more so with diabetes, is an understanding of the condition, compliance with what you’re being advised by medical professionals whether that is compliance with medication or compliance with diet and lifestyle and especially that early stage.  Just the volatility in different outcomes is huge.  So absolutely let’s pluck a number out of the air.  Eighty percent of people with borderline diabetes will listen, will comply, will either end up not ever entering full diabetes or entering it in a very controlled way but some people won’t and some people will at that point – that’s where things can frankly go wrong very quickly, either if you don’t listen or just as the body’s getting use to, you know, those extremes are being reached, very different things happen.

Kathryn:       Yeah.

Andrew:       So I totally understand it’s difficult.  Again, I think – I think from a practical perspective it is dealing with that each situation at that time and for many individuals it may be right that they get that cover at that point but then in another couple of years or whenever that they come back and look again and doubtless that is what you and others would do in that situation.

Kathryn:       Yeah.  So when it comes to the actual insurances as well – so life insurance generally is – unless there’s some really readings there, like some extreme complications, life insurance in itself is pretty – pretty okay to get set up for someone with diabetes.  What we find as well is – we find IP.  So income protection is much easier to get than critical illness cover.  And one of the things that always sort of like enters our minds, and I’m assuming it’s quite the same for a few other advisers as well, is that in a sense there are so many people obviously with diabetes in the UK.  Surely there must be some kind of business case for insurers to be offering – or more insurers to be offering critical illness contracts.  You know, a bit like what Bupa used to do and, you know, maybe something where it’s a specific one – you know, it just feels really harsh that people with diabetes can’t easily get a contract that would maybe protect them if they were to be diagnosed with cancer or something like that.

Or if they were suddenly diagnosed with Parkinson’s or something.  There’s a lot of conditions in there which – I could be wrong, obviously I’m not medical-trained but that don’t scream out that diabetes would necessarily be a cause for them to be – obviously bearing in mind what we said before, you know, so yes, you know heart attacks would probably – well definitely would need to be excluded.  You would need to have loss of limbs excluded.  You’d need to have strokes excluded which – I know that cancer, stroke and heart attack are the main things.  But it just – yeah, it just feels really, really harsh that there’s just – same as like for people who are living with HIV, that there’s not some way that we can, you know, do some kind of a contract that would be, you know, if people are willing to buy it – I suppose that’s the question as well for me.  A big one is that I know insurers sort of like don’t like to offer these things because they sort of say ‘Well there may not be a market for it and it’s not fair to offer this and not offer everything in the contract to somebody.  It’s just not fair.’  But I’m wondering have they actually asked people?

Andrew:       Yeah.  So I think it’s –

Kathryn:       Sorry for putting that on you, Andrew.

Andrew:       No, no, no.  I think – I think the reality is – is probably things – if it’s going to happen, the huge advantage from a commercial interest for an insurer is bluntly the number of diabetics.  So it’s much easier to consider doing something like this specifically for people who have diabetes than for people who have some other conditions which simply aren’t as prevalent.  So – and I know insurers therefore do look at this, the obvious challenge for diabetes, as you said, is not so – is partly the number of significant conditions it can end up manifesting itself in but also just, you know, how closely do they overlap with traditional critical illness conditions?  But to your last point of well, ‘Have you ever actually asked people?’  I think the answer is less – probably less than people would admit.  And still, if you start from that three, four, five million number of diabetics and go ‘Well even if only 10 percent of them said –’

Kathryn:       Yeah.

Andrew:       ‘Yes, actually that – that does mean something for me,’ then that’s a, you know, in – in a world – whether we like it or not, dominated by numbers and large numbers etcetera, then that still leaves quite a lot of people.  So yeah, I – I have tremendous sympathy with that.  I – I can’t tell you why and as always happy – very happy to be told that I’m wrong but I can’t tell you why you couldn’t have a cancer plan for example for people who have diabetes that, you know, if they are also worried about as – why wouldn’t they?  Why wouldn’t you be?  About the risk of cancer and you kind of take that – take that view, then I – I couldn’t tell you why you couldn’t have that and if – and if actually people wanted the 20 of the 50 conditions or whatever it is, then again, I couldn’t tell you that aren’t impacted by diabetes and I couldn’t tell you why from a technical insurance perspective you couldn’t do that.  So I think that does come down to assumptions about customers and assumptions about advisers that may or may not be valid.

Kathryn:       Yeah.  I think it kind of – there’s part of me as well thinking does it make it more – there’s maybe a thought that it would make it more complicated at claim stage or something because, you know, there’d be an extra line of what kind of policy is it?  Does it fit within this?  Is there a –?  But to me that’s – that’s kind of the same as like with anything because, you know, if – it’s always a case of well, when this person’s got this contract, was their contract specifically covering this condition at this time for this month and year, you know, so no matter what there’s always that level of scrutiny that has to go into the – sort of like the claim of it.  But I can’t see – there’s a lot of people who come to us with diabetes who would want critical illness cover and unfortunately a lot of the time, you know, we can give options but, you know, there’s some that are obviously – they may be priced too high or some of them come with exclusions and I think it’s very different to sort of saying to somebody ‘Oh well this is a policy that – but it will come with exclusions for XYZ,’ rather than just saying ‘Well this is a specific policy that offers you cover for cancer.’

You’re not saying all the exclusions that are there, you’re saying about what is there and it’s just a slight mindset change in how you present it and I think, you know, you’re going from a positive – sorry, I’m reading a self-care book at the moment, which is all about positive language and everything so it’s sticking in my head.  It’s all about how you positively frame things and so you don’t have that kind of – even subtle negative connotation that can happen with some of the language that’s used.

Andrew:       Yeah.  No, no that actually makes sense.

Kathryn:       So then looking at post-corona virus.  So just – I’m assuming I’m just going to be preaching exactly what a lot of advisers are experiencing at the moment.  So Type I at the moment – Type I diabetes is difficult to arrange.  A lot of the time, the length of diagnosis – so as you said, someone with Type I diabetes is generally diagnosed at a very young age.  I have somebody that I know that wasn’t diagnosed until her – sort of like her mid to late twenties, was a close friend of mine.

Andrew:       Right, okay.

Kathryn:       And, you know, the length of the diagnosis will take them past the maximum loading sort of like limits that have been put on by a lot of insurers which is quite unfortunate I think, especially because – I think like with Type I diabetes it’s inherent that they’re going to be way beyond that length of diagnosis really.  And the – sorry, were you going to say something there to that?

Andrew:       Yeah, I just – probably just to emphasise on that – so typically the shape of loadings that are put on for diabetes are as – as that – as you suggest there – are that certainly from when you’ve been through that initial getting it under control phase, that that’s the best time to buy insurance.  A, because you’re youngest and so the premium’s lower anyway and B because you’re earlier in – in the progression of the disease so the rating’s not just because of your age but also because the additional ratings tend to increase kind of every five or 10 years that you’ve had the condition.  Which, as you say, when some insurers will put in maximum ratings and at some point whether that’s 15 or 20 years in –

Kathryn:       Yeah.

Andrew:       Then you’ll increasingly fall over and as you’ve described with corona virus, I think people are – insurers are reducing those maximums.

Kathryn:       Yeah.  So just a random thought that sort of like popped into my head then.  Just again – probably putting you on the spot a little bit, sorry.  Is – what about though – if you have someone who is Type I diabetic and they were diagnosed at like five and they are now, what is it, 30 or something, then they’ve had 25 years which could well put them past the timeframe to be able to get the insurances right now.  But say take the case of my friend.  She would potentially have been diagnosed for five years but then she’s had 25 years of an uncontrolled medical condition in her body doing whatever it wants to do to her with no, you know, so to me the person – to me the person who is less risk is the person who was diagnosed at age five years who’s been – had the medication, been able to monitor and to be able to adapt and control their health to probably make them in some ways possibly even healthier than a lot of people because they’re monitored that much.

And that just kind of – it kind of seems like one of those things sometimes where it’s a bit of a blanket approach that could maybe do every now and then with that ability to be able to give it a specific eye over it, to say ‘Well hang on a minute.  Yeah, let’s not just bundle everyone who’s had this diagnosis for 25 years into the same category.’

Andrew:       Yes, I agree [both laugh].

Kathryn:       Yeah, moving on, wonderful.

Andrew:       I think the one thing I would say, not in defence but I guess in support of your friend and people like her, is for her not to be diagnosed for that long.  I mean ultimately, if she was getting insurance then probably you’d see her GP record and if she – if she hasn’t had significant – I mean, there are two situations there right?  There’s the incompetent GP who just hasn’t spotted what’s going on.

Kathryn:       Yeah.

Andrew:       Or in which case then absolutely – she’s –

Kathryn:       It won’t be on the medical records then so it’s fine.

Andrew:       Absolutely, she’s in theory at additional risk or there’s the ‘She’s got a milder, you know, type of –’

Kathryn:       Version, yeah.

Andrew:       And that’s – but absolutely.  It – it’s utterly – yeah, utterly wrong to reward someone for not being diagnosed earlier.

Kathryn:       Yeah.

Andrew:       And – or to punish someone for being treated well.

Kathryn:       Yeah.  Brilliant, I’m glad you agree.  There’s also the extra thing as we said, like as if someone’s had the retinopathy, the neuropathy, higher readings, that can quickly push people beyond the maximum loadings that you would usually have found in a sense quite – probably quite easy to – to get through for terms previously.  For Type II diabetes, we’re probably seeing about roughly the same kind of things – the difference being is that obviously someone who – as we say with Type I diabetes would have been diagnosed much longer which means that they generally, even if their readings are very good, it potentially does put them beyond those maximum – those maximum ratings that insurers are offering.  And the other complication with a lot of Type II diabetics is that they have that combination a lot of the time of the higher BMI which again could start to just – it’s the little – it’s sort of like the little loadings that can all add up to very quickly put people past – past the maximum loadings that are available at the moment.

And then also, it’s always difficult to get cover for somebody who’s had a heart attack and also has diabetes.  It’s doable, it’s definitely something we can do but now it is even more restrictive than it was before so – so there are options out there.  It’s just, yeah, possibly it may be that people do need to start signposting on some occasions just to sort of get that extra bit of support.  So don’t assume that it’s not possible.  It just may be that it needs to go to very sort of targeted insurers.

Andrew:       Yeah, and I think that overlap between conditions is really important.  So, I guess starting in particular with Type II diabetics where it’s important for the underwriter, for the system, if it’s an underwriting system at play and for the adviser to understand that A, if you have someone who is a diabetic who’s on medication for high blood pressure and who’s borderline obese, then those three risks very much overlap.  So you shouldn’t be in a case where you’re adding up plus 50, plus 50, plus 50 to make 150 extra loading.  You should be saying that, well ‘These are – they’re all interrelated and the cause goes down.’  There’s a lot of different systems within different insurers and reinsurers to try and assess that risk and I think that’s why for diabetes you can get very different ratings coming out of insurers and reinsurers compared to some other conditions because of that interaction and how that’s evaluated and how the kind of insurers put together their risk.

As we’ve said, I think that only – that only increases in the current situation but doing that fairly and almost not being surprised that a diabetic is on medication for high blood pressure is – is key in that case.  But generally, I think as I’ve said as we’ve gone through, that what the underwriter is really looking for in an ideal situation is – is that kind of level of control and a – a time period over which to see that things aren’t fluctuating around.  And that becomes really, really important.  So as I say, if you’re an adviser who’s got someone who’s diabetic and is trying to work out how straightforward the process is going to be, I think – I think A, for the person to know the answers to the kind of questions you’ve highlighted is really important.  More important than product conditions, it’s not just important for efficiency in a way that for example knowing what stage of cancer you have, whilst it kind of makes the process go quicker but actually, you know, from an underwriter’s perspective, if you’ve got someone who doesn’t know their latest HbA1c or answers to some of the other questions, what medication they’re on maybe, then that is of itself worrying for this condition because it is so much about control and compliance.

So I think there’s, you know, it does become even more important here.  Obviously, if you’re an adviser, it’s your job to help – help get that information.

Kathryn:       Yeah.

Andrew:       But if – you know, in an ideal joined-up process, I’d much rather – I would much rather accept the person who that first time you asked them, knows those 10 things without a – without a pause rather than the person who takes – takes a couple of months to find – to find the notes.

Kathryn:       Absolutely.  I think I’ve maybe forgot as well that the hypos – that, you know, if people have had the hypos, that’s incredibly important as well.  So that could be –

Andrew:       Yeah.

Kathryn:       If they’re regularly experiencing their blood sugar dropping quite low, as you say, that kind of the managing it in a sense, making sure that they’re keeping their blood sugar levels quite consistent with their diet and different things and I think that there is quite – something quite specific as well from memory from clients as well but there can be things on the night time I think.  Sometimes – there can be sometimes hypoglycaemic attacks during the night and they can sometimes become a bit of a pattern of having those.  So again it comes down to monitoring and managing the condition as well.  And I think – I think most people find that quite acceptable as well to sort of like think ‘Well yes, I’ve got this condition and if I’m monitoring it and controlling it, just with anything, because if I’m doing the advice of the doctors and I’m taking all steps possible to me to be able to better my health,’ as any of us do with or without health conditions, then – then I think most people would be understanding, hopefully.

Andrew:       Yeah and there’s been a huge investment – again for obvious reasons in – in medications and courses and controls and things like that that people go on.  And I think again that’s where it can often be frequent conversations between customers, advisers and insurers because, you know, people will have done absolutely everything right.  There will be people who will have been on the latest course and I think a challenge for underwriters is looking at – and insurers just looking at UK specific data and UK specific courses and seeing which of those are coming in are having more impact and again in theory, rewarding people who – who are on those sort of good pathways rather than those more disengaged.

Kathryn:       Yeah.  So I think there was another thing I was going to suggest.  There is – there are obviously the insurances as well where people do take out the insurance and they have diabetes.  If they do better, their HbA1c level readings and their BMIs and stuff, they can get in a sense rewarded with improved terms, you know, after a set period of time if they’re sort of like doing this thing and they can prove, as you say, this engagement and this – this sort of like bettering of their health – it can be sometimes quite a good option to look at.

Andrew:       Yeah, so I think – I mean it’s worth stressing because there is always the frustration that we gloss over the good bits and I mean for life, if you – if you – certainly if you’re a Type II diabetic who hasn’t had other major incidents, then you definitely ought to be able to get life insurance cover at a – at a small extra premium at most.  But, notwithstanding that there are companies and, you know, cards on the table, I was heavily involved with one who have developed this idea that rather than underwriting someone once and just setting them off into the wild for 25 years and seeing what happens [both laugh], then they would re-underwrite every year basically, dependent on results.  With minimal changes to the premium – so one proposition premium only ever goes down, it can’t go up and the other it goes up or down a little bit but depending on your compliance.  And obviously the theory behind that is to say that it rewards the good customer, the people who are continuing to engage and do all the right things and it should mean that we can – as insurers, we can accept more people at outset and at better terms.

But there’s obviously, you know, the downside is that it means ongoing engagement with your insurer.  It means a lack of total certainty about what you’ll be paying.  So –

Kathryn:       Yeah.

Andrew:       There’s clearly up and downsides to that.

Kathryn:       We’ve seen it as being very positive for some people, you know, some people really, really want to do it.  And then, you know, you’ve also – we’ve also seen people who’ve turned round and said that they don’t want to do it like that, you know.  They just said ‘I can’t,’ you know, basically – you know, especially the one where it’s potential to go up a bit, you know, they’ve said ‘Well, I just can’t guarantee that I’m going to be able to exercise at this level or do this or do that for the next year or so.’  And I think it’s very important to just be – as with anything as an adviser, you know, you advise clients, you give them – you put on the table what’s available and you help to in a sense guide them but you need to be very blunt and honest with it as well and say ‘Look this one will be really good if you can keep doing this and you can keep doing what you’re planning or you start doing all those bootcamps you’re thinking of doing.  Brilliant, ‘cos you could bring your premium down but at the same point, if you’re not sure you’re going to commit that, the premium may go to this.  So, you know, is that right for you?  So should you maybe just go for this one over here that’s a set premium forever as kind of like in between – in between the higher that it may go to with the original one?’

So I’ve got a case study and this one is a case study from – from not too long ago, pre-corona virus.  Well, I say pre-corona virus, I’ll chat about it.  It was bordering into corona virus territory.  So it was – it’s a person with diabetes.  So a 40-year old male, non-smoker.  He has Wolff-Parkinson-White Syndrome that was diagnosed nine years ago.  That is a heart condition.  He has Type I diabetes that was diagnosed 29 years ago.  He uses an insulin pump.  His reading is 47 so that is very well controlled and he also has some potential background retinopathy.  He is somebody who is very fit though.  He does triathlons and he wanted life insurance and income protection.  So, we managed to get both for him which is brilliant.  But this one was a little bit strange in the sense of – so with the income protection, I’ll chat about this one quite specifically.  So we – he wanted – well we got him £3,000 worth of income protection.  It was per month so 13-week deferred period, two-year claim period and it ran to age 65 and that came to £55 per month.

Now, what – the interesting thing about this one especially in regards to corona virus is that we’d given this person the terms and they were doing the thing – as some clients do where they’re kind of umming and aahing and deciding whether or not they wanted it or didn’t want it and we’d had to do a thing before corona virus which had the terms revised because time frame since – you know, obviously having the terms issued to them considering it and we did all this just before everything happened with corona virus and he came back and the loading that was going to be on the policy was a lot less than we expected and so when that happened, we were chatting with him and everything and he was just like ‘Well I’d like to see the price of it to – for – not at the two year max claim period.  I want to have it to end – to age 65.’  So no limit on the claim, and that came back at a price that absolutely he wanted to go ahead with and then corona virus struck and the annoying thing about it was that we couldn’t reissue the terms so we’ve had to – and he’s – I’m mean he’s happy, he’s got the cover, but he’s now – he has the policy.

Obviously he’s very happy having an income protection policy but it is at that two-year maximum but because if we’d had the terms reissued then because of corona virus and the changes and everything, there’s just no way we would have been able to get him the cover.  So that’s something that’s quite frustrating.  It’s something that obviously we were trying to encourage him to have the higher level of cover but as with anything, there’s only so much that you can – and especially for us when we’re not pushy at all in the slightest, but you don’t necessarily have that foresight to go ‘Well you know what’s going to happen next week?  This thing called corona virus is going to hit and we really want to get these terms reissued now,’ and everything like that.  But I think it’s potentially – without scaremongering, it’s potentially a bit of a kind of like a wise tale sometimes to be able to maybe use and say to clients and just say ‘Look, we never know what is around the corner.  And obviously absolutely don’t rush into a decision but some things can sometimes drastically happen which can really change what we can do so just try and get all the options there available as quickly as you can.’

We also arranged for him and his partner – and his partner also has some medical conditions but I won’t go into that because they weren’t diabetes-related, and we got them decreasing – joint decreasing life insurance of £380,000 over 25 years for £65 per month which we were quite pleased really to be able to get all that because there was potentially – obviously some complications there.  We had the heart condition, we had the diabetes, potentially a little bit of background retinopathy and we were really impressed that we managed to get that through.

Andrew:       Yeah, I think it’s still – well yeah, no, there’s lots of really good tales in there aren’t there?  I think the income protection bit is – is often surprising to people that you can get more – as much more – that you can than for critical illness for diabetes and that is all down to the stuff we talked about.  But yeah, I think – and as you say, the general ‘You don’t know when something’s going to happen to you or as we now understand to the whole of the country,’ I would hope would be one of those, you know, minor but significant positive changes in the future to all of our kind of approaches to things.  That you don’t – that you really, really don’t know what’s around the corner.  Yeah.

Kathryn:       Absolutely.  Do you have any extras?  I know we have like a little extras section that we often – that you just have a moment –

Andrew:       Well I think I jumped in throughout this week [both laugh] so I guess for me the key bit is to encourage this – this – I think, as for other conditions and as we’ve mentioned at the top, although diabetes starts off very simple, Type I, Type II diabetes that’s it, I think over the next five or ten years it – you’ll see more and more segmentation within that from a medical point of view and clearly there will be winners and losers in that.  So I think if – if you are a protection adviser then yeah, staying on top of this is going to be really important.  Just a quick one on gestational diabetes because I promised that I’d talk about that and we haven’t.  I think that is – I guess the headline on that is just there is – truly gestational diabetes which comes – impacts people really quite severely at times during pregnancy but then doesn’t have any long-lasting effect or any long-lasting kind of increased chance of diabetes – other types of diabetes in the long term.

Kathryn:       Because it disappears, doesn’t it, after the pregnancy?

Andrew:       Yeah.

Kathryn:       Yeah.

Andrew:       Yeah absolutely and – and you are at no extra risk of getting Type II diabetes thereafter.  There are others where – and I’m not even going to hazard an opinion as to whether it’s truly gestational diabetes in the first place, I haven’t done enough reading to know that – but there are others who – what is originally diagnosed as gestational diabetes sort of transforms or doesn’t go away after pregnancy and they end up having a form of diabetes diagnosed which I – my understanding is that that’s more because they probably already had the diabetes, it just happened to be diagnosed in pregnancy.

Kathryn:       Oh right.

Andrew:       But again, I think that is an area – if – if you go back to times when people go to buy life insurance, it tends to be when you’re moving house, when you’re having – when you’re having a family etcetera, so it’s a disproportionately big issue within underwriting because quite often, you will have someone who’s either pregnant or –

Kathryn:       Yeah.

Andrew:       Just been – and so it’s a recent thing in their history so it can cause quite a lot of head scratching.  Again, the reality is, is if you’ve – if you’re post-pregnancy, if you had gestational diabetes and since you haven’t had any problems then you should be fine for all covers.

Kathryn:       Yeah.

Andrew:       But yeah, if you’re in the middle of it then you can – then the more cautious approach would be taken.

Kathryn:       That’s really interesting as well because I – I’m sure I’ve mentioned it before, I – with my final pregnancy with Zachary almost three years ago, I afterwards developed postpartum thyroiditis so I became – oh I’m going to get it completely – so I became – got to try and think about it – so I became hyper – hang on, there’s hyperthyroidism – I get confused.  Right, underactive, overactive, I’m just going to say overactive.

Andrew:       Yeah, yeah, yeah.

Kathryn:       I developed an overactive thyroid and they had no idea what was wrong with me because obviously originally it was a case of it, it was that thing of like ‘I’ve got three kids, I’ve got a baby, I’m breastfeeding, it’s the middle of summer, I’m shattered,’ and it – but something just wasn’t right.  So like ‘Ooh you’ve developed an overactive thyroid, this is really strange because you’ve never had – obviously your thyroid has always been fine.’  And then on the – as instantly I had like these tests done over three months.  So I had one test which showed I was absolutely and very, very much an overactive thyroid.  A test about – I think it was about eight weeks later suddenly showed that I’d flipped to an underactive thyroid and very much – a very specifically underactive thyroid and nobody knew what was going on.  So I was doing research which showed this thing called postpartum thyroiditis.

So I started having to have medication after another three months of waiting because they won’t give you medication until you’ve actually proven that you are definitely – and it’s meant to potentially go away after 12 to 18 months but now Zachary’s three and it’s still not gone away so I think I’m – I’m underactive thryoided for life now.  Which leads me in very nicely to the next truth and lie.

Andrew:       Yes.

Kathryn:       Dum, dum-dum.  So one of the things I’ve been wanting to do very specifically is really trying to be healthy in lockdown.  I’m trying really hard to eat healthy.  Anyone who follows me on social media realises that I made chocolate cinnamon monkey bread at the weekend which basically was not healthy whatsoever, but it was amazing [both laugh].  So I’m trying really hard.  I’m exercising a lot more than I have been doing.  Obviously with the kids being around me, I don’t feel as guilty if I suddenly – whereas usually I’d have to sort of go off to exercise whereas now I’m just exercising at home with virtual sessions and everything which is quite nice.  But I’m going to share a truth about myself.  And you have to guess whether it’s the truth or not.  But so I’m trying to be really, really healthy and everything but I’m going to share that I’ve been reflecting on the past and everything like that and that I used to be UK size 22 and I was around 96 kilograms which is about 15 stone.  And just in case anyone wonders, I am six foot.  So that is – that was my sizing and everything when I was younger.

Andrew:       Yeah, so I can do – I – this isn’t my truth or lie but I’m about 96 kilograms now but I’m six foot six, so that’s – that’s allowed.  For an underwriter, I’m still in the club.  Yes, but on the healthy theme, so I live in Chelmsford where Mike Adams, one of our previous guests – we reminisced about the McDonalds that is directly opposite his office and that was –

Kathryn:       You’ve not been, you’ve not been that person in the queue have you?  Like an hour’s worth of queue?

Andrew:       So slightly depressingly, Chelmsford was one of the places to open five of our McDonalds last week.  Five of the 15 McDonalds that got opened last week were in Chelmsford.

Kathryn:       Oh wow.

Andrew:       But my truth or lie is that I, on the first day post-lockdown went to McDonalds with my children, whether it makes it –

Kathryn:       Oh no –

Andrew:       I will reveal –

Kathryn:       So hang on, was that – was this when they’ve reopened or was this when you said post-lockdown?  Was this like two months ago or was this like –

Andrew:       No sorry, now.

Kathryn:       Oh.

Andrew:       No, so yeah – well are we post-lockdown or not?

Kathryn:       Yeah.

Andrew:       The first day –

Kathryn:       Post-lockdown, yeah, I think after yesterday – I think –

Andrew:       Yeah, I was going to say.

Kathryn:       Don’t mention Cummings.

Andrew:       Exactly.

Kathryn:       No.

Andrew:       Yes.  A Freudian slip [both laugh].  We were there, in the queue.

Kathryn:       Oh I saw a Twitter video of like a long like line of cars going into like – it was like an hour’s worth of cars backing up and I was just thinking ‘I cannot believe I know somebody in that –’ [both laugh]  I was like –

Andrew:       Well we made it to nine – we made it to nine episodes right?  We had to –

Kathryn:       Ah –

Andrew:       Creative differences.

Kathryn:       Ah, but not McDonalds.  I’m that terrible parent that my eldest child didn’t have a McDonalds or anything like that until he was five.  I’m terrible.  I’m like – now obviously the third child it’s just like ‘Yeah, you can have it for breakfast.  It’s fine.  Whatever you want.  Eat off the floor, it’s fine.’

Andrew:       Yeah.

Kathryn:       Well thank you everybody for listening.

Andrew:       Yeah, and we’ll be back in a fortnight and if you’d like a reminder of the next episode where we’ll be chatting about HIV with a new special guest, then please do let us know.  We’re on social media in all the usual places or come to our website at www.practical-protection.co.uk.  Thank you for listening, bye.

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Episode 9 | Diabetes

Hi Everyone,

In this episode we are chatting about diabetes. We try and keep the inevitable chat over coronavirus to a minimum in these episodes, but it's well and truly everywhere throughout this one. There have been some significant links between coronavirus deaths and diabetes and this has understandably changed the way that insurers are offering cover.

We chat through potential insurance terms for diabetics pre-covid, during lockdown and what we hope will happen post coronavirus.

Our 3 key takeaways,

1. 1 in every 15 people in the UK has diabetes.

2. The importance of self-knowledge and engagement with medical advice, in determining the potential terms of insurance.

3. Case study client that was able to have life insurance and income protection, with a number of medical conditions including type 1 diabetes.

We always love to hear from you, please do let us know your thoughts of the podcast and if you like what we are doing. In the next episode we will have another guest on with us and we will be chatting about insurance and people living with HIV.

Kathryn:       Hi everyone, this is episode nine and today we are going to be focusing on diabetes.  I’m Kathryn.

Andrew:       I’m Andrew.  Welcome to the Practical Protection podcast.  So Kathryn, how are you doing this lovely sunny morning?

Kathryn:       I’m good thank you.  I’m jealous that I’m not obviously – we’ve recorded this on the Bank Holiday Monday so this is just saying to everyone how dedicated we are to the podcast and it’s lovely – lovely and sunny outside but I have to say that I’ve done something Andrew.  I’ve got a bit of a surprise for you that I’ve hidden.

Andrew:       Okay.

Kathryn:       And so I think – what is the best thing to do is for you to describe to people what’s coming up on screen.  And just to explain to everybody that I am not getting stripped off or anything like that.  Everything is very, very legitimate but you’re going to think I’m insane.

Andrew:       Da, da, da.  I’m now trying to get you back because I’ve been looking at all diabetes stuff and hiding your face.

Kathryn:       Oh thanks.

Andrew:       Let me –

Kathryn:       Have you seen what I’ve got?  Are you going to describe to people what I’ve got in front of me?

Andrew:       I haven’t – I haven’t got there yet.  Right, right, right.

Kathryn:       What are you –  How many tabs have you got up on your screen?  Honestly.

Andrew:       Oh there we go!  Oh wow, that’s amazing! [both laugh]  It’s a cake with a unicorn candle.

Kathryn:       It is, it is [both laugh].  And the reason being is there’s a lot of stuff going into this.  When we first started the podcast, I saw something when I was doing the research about podcasts.  Yay, I’ve blown the candle out.

Andrew:       It’s my – it’s my Dad’s birthday today.  I assume that’s –

Kathryn:       Oh, even better.

Andrew:       There you go.

Kathryn:       Right, well happy Dad’s birthday.  The reason being is that apparently most podcasts don’t get to episode nine and it’s episode nine.  So since we’ve started this, I’ve had this in my diary – a special thing in my diary saying ‘Do a candle.  Do a cupcake and candle.’

Andrew:       Oh it’s a very nice – it’s a very nice cake.

Kathryn:       Yes it is.  It’s a kiddies – obviously – it’s literally melted chocolate with Rice Krispies in it, bit of porridge in it as well.  It’s literally got anything in it that I could find.  But there you go, so that’s the surprise.  So anyway –

Andrew:       I feel bad now.  I’m in that awkward position.  One of my friends once managed to completely forget his wife’s birthday

Kathryn:       Oh.

Andrew:       And wasn’t – didn’t realise until him and his three kids turned up at her parents’ house for lunch that day when her parents said ‘Happy birthday’ and she turned to him.  So –

Kathryn:       No.

Andrew:       I – I don’t feel that bad.  I feel like I should have got something for you.  I’m now frantically trying to think of the equivalent of –

Kathryn:       It’s not like I’m passing you the cake though.  There isn’t one turning up at your doorstep or anything.  I’ve not had one shipped to you.  But no, that was just my little – that was something that’s been giggling in the back of my mind for the last nine episodes.

Andrew:       Well, well done us.  Congratulations to us.

Kathryn:       Yay.  So yeah, so I’ve had a brilliant weekend and obviously even better morning giggling to myself getting that ready.  How have you been?

Andrew:       Yeah I’ve been alright.  I’ve been alright thanks.  Yes it’s – well, what, it’s half term this week isn’t it?  So that means no difference at all other than nothing from teachers to try and muddle through days for a week.

Kathryn:       Absolutely.

Andrew:       So – so, yeah, it’s – we’re okay.  We’re – we’re settling into a new home office so we’ve got – managed to have that built through the last few weeks.  So basically yeah, our - we’re moving work stuff out of the house into that which feels quite good although also means lots of going through old boxes and old things and yes – so kind of in that busy – busy head space of having 10 years of your life kind of in front of you in various forms of paper which is always interesting.

Kathryn:       Yes.  It’s the kind of thing you’re always putting off because there’s always something so much –

Andrew:       Yes, exactly.

Kathryn:       Anything is so much more better to do but I think that’s really important that I did some training with the mental health charity Rethink on – last week, and one of the things was like how to better your home environment and everything during lockdown.  And there was that thing of, you know, really trying to make sure that you have a divide between –

Andrew:       Yeah.

Kathryn:       You know, where your work space is and where your home space is and it was even – even if you are stuck in a room and it has to be that your living space is your work space or your bedroom is your work space, like specifically doing stuff so that when it’s bedtime that you’re not looking in the direction of your work set-up is –

Andrew:       Yes.

Kathryn:       And when you’re working, you’re not looking at where you’re sleeping.  You know, so it’s being able to do that, I think that’s really nice that you’ve got that opportunity to –

Andrew:       Yeah.

Kathryn:       Like separate.

Andrew:       I’m still insisting I’m going to walk out the front door and round to our back gate and then go into our back garden but yeah.

Kathryn:       If it makes you feel better.

Andrew:       Yeah.

Kathryn:       ‘I’m going out the front door.’

Andrew:       Yes, that’s kind of – we’ll see how long that lasts.

Kathryn:       Absolutely.

Andrew:       Move on.  Yes, so anyway, on to today’s theme.

Kathryn:       On to today’s theme.

Andrew:       Oh sorry, oh sorry we have to do the lie – we have to do the last week’s truth or lie right?

Kathryn:       Yeah.  So last week was all about favourite games.  We don’t obviously have Kara with us today but she got involved last week.  So I said that my favourite family favourite game was Taboo.  Yours was –

Andrew:       Mario Kart.

Kathryn:       Mario Kart and Kara said hers was Twister.  So again for everybody who I know is dying to know this answer, the answer is that Kara was lying and I have to say we had quite a bit of a giggle I believe before the episode about how much she is detesting Twister at the moment.  I think, you know, as a full-grown adult with a child, trying to do Twister together isn’t the easiest of things at times and when that child is just at that borderline age of not being able to reach kind of any of the things that they need to reach as well, it just makes it all – yeah, I think that was something that she kind of said through gritted teeth.

Andrew:       Yes.  Yeah, I think – so unlike you, maybe Kara and I aren’t uber-bendy people as it transpired.  So – so –

Kathryn:       I don’t have strength so I’m rubbish at it.

Andrew:       I sometimes have to do Cosmic Kids yoga, have you –

Kathryn:       Oh yes, I love that.

Andrew:       Yes so that’s – yeah, no, give me Joe making me run up and down on the spot for half an hour any day.  But my Cosmic Kids’ training is still – doesn’t make me Twister-ready so I entirely sympathise with Kara.

Kathryn:       I was going to say though – I’m just imagining you at Twister.  I kind of imagine you’d be awesome because I just imagine you’d be like a downward dog yoga pose and then everyone else would just be moving underneath you.  You’re that tall but you’re just kind of like –

Andrew:       Yeah, that works until I accidentally squash any number of children.  That’s not a good look.

Kathryn:       Yeah, we’ll try and avoid that.  Avoid crushing of children.  Anyway right, so diabetes.

Andrew:       Yes.

Kathryn:       So I think, you know, just to explain to everyone straight away that there’s just no way that we can avoid talking about corona virus in this at the moment because it’s had such an impact upon the offering for diabetes.  So what we’re going to do is we are going to try and talk generally about diabetes and I will also talk a little bit of post-corona virus things that are available but it – I think it is very, very important, as you do Andrew as well, that we talk about it as in ‘This is the reality of what’s happening right now.’  Because this is a very specific group that are being affected when it comes to insurance applications.  So – so it’s Type I, well sorry, Type I?  With diabetes there are a number of different versions.  When I was doing the research for this, I was surprised at how many versions there were as well that I don’t know about or haven’t come across the names before.

So I think typically we generally think of Type I diabetes and Type II diabetes.  So Type I is more sort of an auto-immune condition that somebody is born and lives with their entire life.  Type II diabetes is more – is diagnosed – is generally obviously due to some lifestyle choices.  You then have gestational diabetes which is – occurs during pregnancy.  But then a couple of others that sort of like popped up as well, sort of like intrigued me with their name as well – Wolfram Syndrome and Alström Syndrome and then Type IIIc diabetes.  And I think in a number of those, like the Wolfram Syndrome there’s quite a few different ones within that as well and that kind of surprised me as to how many different ones there were that I wouldn’t necessarily immediately from the name think were diabetes anyway.  So, with Type I diabetes, you’ve got – about 8 percent of diabetics in the UK have Type I diabetes.  Type II, there is – roughly 90 percent of diabetics in the UK have that one.

And I went onto Diabetes UK and I was just sort of like pulling up some stats just for everybody and for myself to know a bit more about it.  So there’s roughly 4.7 million people in the UK that currently have diabetes and someone is diagnosed with it every two minutes.  And that roughly comes down to sort of saying about one in 15 people have diabetes and it was these next statistics that I got that actually really shocked me.  And I say, this is from Diabetes UK and it was saying that every week due to diabetes there are 169 amputations, 680 strokes, 530 heart attacks and 2,000 heart failures due to diabetes within the UK.  And there are also 500 premature deaths due to diabetes.  And those ones really, really shocked me.  I think there was part of me that was just surprised that there were so many but then there was a big part of me that was thinking of how many critical illness claims there could potentially be if people had had these contracts in place and that really, really surprised me.

So from your point of view Andrew, underwriter head and everything like that, talk to us about diabetes.

Andrew:       So – so you’re right in this increasing number and distinction between different kinds of diabetes.  I mean it is fair to say, I think underwriters still largely think in terms of Type I diabetes, Type II diabetes and gestational diabetes and I think it is worth talking about gestational diabetes a bit as we go through for a – an area where there can often be confusion and challenges between advisers, underwriters and clients.  But yeah, Type I as you say largely happens – is largely diagnosed at much earlier ages and it is where the body isn’t producing any insulin at all.  So there’s a lot more – typically that’s almost an underwriting issue or that’s often an underwriting issue whereas Type II is sometimes an underwriting issue and sometimes, as you described there, because it’s coming on at older ages and is a mix of genetic and lifestyle factors, then what’s often – sometimes we underwrite that but often it’s coming in more at claim stage, whether that’s income protection claim, critical illness claim, life insurance claim.

So a lot – a lot of claims as you describe are claims where people genuinely didn’t have diabetes or certainly weren’t aware that they had high blood sugar at time of application but by time of claim then we can see that that’s been a factor.  And I think that drives some of the ideas and push around improved – I guess products and propositions from insurers to play a part in people’s health, you know, bluntly it’s in both insurers’ and individuals’ interests if they can do that through products so we see that from – from some insurers around mental health things but also I think increasingly insurers are looking at that, around physical health too.

Kathryn:       Yeah.

Andrew:       Yeah and then Type II diabetes specifically – so as you’ve said, the vast majority of people who have diabetes have Type II diabetes.  That does increase by age so I think it’s about a million people under 60 have diabetes and kind of the rest or about three million over 60 have diabetes.  So that is where – I think that’s where certainly you’ve already mentioned corona virus, I think that’s where trying to pull out the different things that are going on with corona virus is often very difficult and diabetes kind of was already – already in that place –

Kathryn:       Yeah.

Andrew:       Of you have those huge numbers but actually understanding why an 85-year old dies is always – is almost always not a very simple case.  You know, there’s almost always two or three things going on.

Kathryn:       Yeah.

Andrew:       So –

Kathryn:       Was that what you were saying though in the case of – you know, because we’re hearing  a lot of different things.  I was hearing around 25 percent of deaths due – with corona virus were people who had diabetes.  We’re hearing obviously that’s there’s a very significant amount are older people as well so like you say, people over the age of 60, over the age of 80, you know, it’s – it is kind of the fact of, you know, these statistics I think can come out of it but in some ways it kind of seems as if we’re reading a bit too much into those statistics and that correlation because it’s kind of a case of ‘Well yes it is a lot of people but with – who are, you know, there’s been a lot of people who are diabetic who have unfortunately passed but they were – they were part of that age group as well.’  So it’s not necessarily the diabetes, it’s the fact that they were maybe – that it’s maybe the age but then at the same point that it could be the diabetes, it may not be the age or it kind of – I think all of us in a bit of a standstill as to what to know at the moment.

Andrew:       Yeah.  And I think we are beginning to come out of that phase.  So there was – so last week – so where are we now?  We’re recording this May 25th, so May 20th I think there’s the first study that I’ve seen kind of – sorry the largest global study come out last week which came out from NHS England on – so it’s called ‘Type I and Type II diabetes and Covid-19 related mortality in England.  A whole population study.’  So that was looking at – I think it was kind of the first two months of corona virus deaths and that’s where between a quarter and a third have – of people who have died having had the Covid-19 test in hospital –

Kathryn:       Yeah.

Andrew:       Have also had diabetes.  That did then – within that report – within that study, try – or well it did – it stripped out other factors like age, like race, like socioeconomic depravation status and did some postcode analysis and after that it kind of flipped the importance of Type II and Type I diabetes and after all of that it said that if you’re a Type I diabetic you have a three and a half times risk –

Kathryn:       Right.

Andrew:       Of dying from corona virus in hospital and you –  To someone who doesn’t have diabetes –

Kathryn:       Right.

Andrew:       If you’re Type II diabetic, you’ve got a two times – a doubling of the risk.  Now there’s still bits recognised in there that it doesn’t fully take into account other medical conditions and things like that.  And certainly for the Type II diabetes, that two times risk and for both really it’s not that dissimilar to probably the kind of extra risk that we would expect from a diabetic anyway.

Kathryn:       Okay.

Andrew:       So it doesn’t necessarily mean there has to be a huge rethinking of underwriting risk, you know, it probably is just another multiple but it does seem that there’s something going on and it can’t just be explained away by, you know, all of these other things.

Kathryn:       Yeah.

Andrew:       And certainly I think that is the point we’re at so I guess more generally, clearly underwriters – underwriters are asked to look at a 25-year risk, you know, that snapshot from an application form and possibly a GPR and then predict –

Kathryn:       Yeah.

Andrew:       What will happen in the next 25 years.  With this, we’ve had two months’ experience but we are now beginning and genuinely, sadly because of the numbers of people affected by this, we are beginning to see credible things where kind of an initial blanket approach should and can be challenged really condition by condition, especially for these big conditions and that will mean that for some conditions there are more conservative approaches that need to be taken and for others there can be alternative approaches taken rather than it just being a – an overall case of corona virus plus existing medical condition equals bad.

Kathryn:       Yeah.

Andrew:       That there clearly will be some conditions which are more affected than others and I think we – we, you know, recognising this could go on for a while yet, we need to – and underwriters are looking at those individually rather than just a – on the whole scale.

Kathryn:       I think it’s, you know, I think everybody can with a sensible sort of like view on it, from the adviser’s point, not saying that this wouldn’t be – it wouldn’t, you know, as a client, like I say, it’s going to suck no matter what but, you know –

Andrew:       Yeah, absolutely.

Kathryn:       From an adviser’s and an underwriter’s point of view – and I think everybody can understand that if there’s something that’s being seen as from the statistics and from medical information that there is only that two months kind of data that’s there.  If there’s something that’s really standing out as potentially even more so of a risk then I think everybody will understand that there has to be – well insurers are going to want to take a little bit of extra caution for at least the current time being.

Andrew:       Yeah.

Kathryn:       So – sorry.

Andrew:       To be clear, to be clear when we say there’s a two times – so for Type II diabetes when this study says it’s a two times extra risk of dying from Covid, that’s – that doesn’t mean they’ve got a two times extra risk of dying of everything, it’s just from Covid.  So that, you know, that doesn’t automatically mean you double the rates or anything like that.

Kathryn:       Yeah.

Andrew:       It’s just that.  So I think still with those numbers, although it clearly does show that there is an increased risk as I say, I don’t think it’s out of proportion to the kind of risk that we would look to insure normally.

Kathryn:       Yeah.  Okay.  So, probably have a bit of a chat –

Andrew:       Sorry we’ve got deep into deep sell there.

Kathryn:       Yes.

Andrew:       Once you open the door –

Kathryn:       I know but I’m thinking to myself, I want to chat now about like the ace inhibitors like the medication that’s –

Andrew:       Yeah, let’s do that.

Kathryn:       Potentially been linked to it as well.  And I’m thinking ‘No, we know we’re trying to – we’re trying really hard not to do like our usual hour and a half.’ [both laugh]  So no, so I think it’s a good idea to have a little bit of a chat about the things that we need to know.  So these are the things we always need to know, so this is pre- and post-corona virus.  But I want to chat a little bit – just on the off chance that hopefully things will return to what they were.  Just sort of like a bit of a chance to chat as to what we would typically have seen if we didn’t have corona virus staring us all in the face.  So –

Andrew:       Sorry, sorry Kathryn – I think, yeah, I think on this it – all of the research so far shows the same risk factors are still relevant.  So I don’t think the underwriting questions will change.  So all of this stuff is still absolutely relevant today, mid-2020 as it was in 2019 and hopefully it will be in 2021, 2022.

Kathryn:       Yeah.  No, no, I fully appreciate – yeah, I get that.  I think my concern – not concern but my thought is that maybe if diabetes is being seen as such a specific risk that maybe if we – when we are starting to return to pre-corona virus kind of offerings for insurance, that maybe diabetes may take a little longer to go back to where it was.

Andrew:       Yeah.

Kathryn:       So that – that’s kind of like my mindset is with it. But no, so what we’d need to know at any point for somebody with diabetes is you’d need to know when it was diagnosed, the type that they were diagnosed with, their medication especially if anything like metformin is currently in use or has been in use, any other forms of treatment, if there’s been any surgery, any – also known as a hypo – known as a hypo – it’s a hypoglycaemic kind of event which is when the blood sugar drops seriously low and the person can potentially lose consciousness or fit.  You need to know their blood pressure readings, their cholesterol readings and the latest one for me, which it really gets me, it’s HbA1c level.  I mean that is absolutely key.  Without the HbA1c level, there’s no way as an advisor you can speak to the insurer and have a sensible conversation about what the terms could be because nobody’s going to know.

But now, sort of like, so you hit the level of being diabetic when the reading is at 48 or 6.5 and that really gets to me now because I’m obviously now especially old school, I’m all about the 6.5.  I don’t really get the new numbers of 48 and that’s really, really thrown me.  But now I’m thinking ‘Right, as long as I know those two numbers,’ and I’m sure I’m probably not the only adviser who’s got that kind of a thing where I’m thinking ‘Why have they changed it?  It was fine originally.’

Andrew:       I’m glad because, right, we present ourselves as the cutting edge – do we?  As the cutting edge front of protection.  And I – and I’m exactly the same –

Kathryn:       Yay!

Andrew:       As you, but it wasn’t until doing my crash course in revision for this this morning that it kind of – I think it says it changed in 2009, the official preference –

Kathryn:       What?

Andrew:       From percentages to millimoles per mol.

Kathryn:       Really?  I’ve only really seen it the last couple of years.

Andrew:       Which, even when I do – so absolutely – this is exactly right, Kathryn.  We can back each other up on this.

Kathryn:       Yeah.

Andrew:       To go – I’m sure it takes a while to get through the NHS and doctors and so on and so on but it’s – yeah, I can kind of see it in black and white as on – I think it was on one of the charity websites going, ‘Yeah, basically, the – if you still think in percentages, you know, who are you?’  So I – I still – I still very much start in percentages and then work to the other.  But as you say, 48 and 6.5 – forget the science, forget anything behind it, below those are good, either you don’t have diabetes or it’s well controlled and then as you go above that you enter more – more worrying territory which with it comes extra risk for you and, from my side, for the insurer.

Kathryn:       Absolutely.  I think it’s a good idea as well to mention – so you’ve got pre-diabetes and borderline diabetes.  Now I think these are quite difficult ones because people, for me as an advisor, it can be quite difficult because people often come to us and say ‘Well I’m pre-diabetic, I’m borderline diabetic.’  And then you have to explain to them that obviously for some insurers and depending on – it’s very much depending upon that HbA1c reading – they will in – they can potentially be classed in a sense underwriting-wise as diabetic because of the potential of how high that reading is.  Everything, the other factors, the height and weight, any other complications that there are and it’s – it can be very, very hard because, you know, it’s kind of that thing of, I think someone if they are maybe borderline diabetic or pre-diabetic, it’s kind of – not an achievement but it’s kind of like a thing for them where they’re kind of like ‘Well I’m not diabetic yet.  I am okay and I’m working hard on this to not become diabetic.’

And then you’re having to say to them ‘Well yes but unfortunately insurers kind of think of you as diabetic.’  And, you know, that can be really, really hard that conversation and I have actually had one person – it was very, very difficult.  I had one person who was actively really trying to be very pushy to me to non-disclose on their application – which obviously I didn’t do.  I couldn’t do the application with the person.  But, you know, very actively well – just – ‘My blood sugar’s fine now so it won’t matter.’  And then it’s a case of ‘Well I know your blood sugar’s fine now but obviously in the last five years, your blood sugar hasn’t been fine and we’re going to need to tell them and it could affect things.’  And I think, you know, I think the majority of people are fine but I think there is kind of like a little bit of sensitivity sometimes around this that can be – I don’t think – I think – sorry, not to be blasé and sort of like think ‘Oh it’s absolutely fine, there won’t be any issues because it’s pre-diabetes or borderline diabetes, just not actually diabetes.’

You know, be – try and be very careful with the wording and make sure that people that are applying for the insurance realise that it could affect the application just as much as having diabetes could.

Andrew:       Yeah, absolutely.  I don’t know if this is the right analogy but almost, you know, in the – as we talk a lot about in mental health terms, everyone has mental health.  Everyone has blood sugar levels.  HbA1c is – basically gives you an average of your last two or three months’ worth of – of blood sugar.  So it’s a – it’s an accurate reading that kind of isn’t just a snapshot and it gives you that longer term reading and therefore if you’re in that borderline diabetes or pre-diabetes stage, then typically as you say, you’re kind of given a, you know, ‘Well do these things to improve your lifestyle, improve your diet and come back.’  Yeah, they’re difficult times to underwrite because obviously you kind of have to take the cautious approach and –

Kathryn:       Yeah.

Andrew:       Throughout with diabetes, as with other conditions, what the underwriter wants to see is an – but even more so with diabetes, is an understanding of the condition, compliance with what you’re being advised by medical professionals whether that is compliance with medication or compliance with diet and lifestyle and especially that early stage.  Just the volatility in different outcomes is huge.  So absolutely let’s pluck a number out of the air.  Eighty percent of people with borderline diabetes will listen, will comply, will either end up not ever entering full diabetes or entering it in a very controlled way but some people won’t and some people will at that point – that’s where things can frankly go wrong very quickly, either if you don’t listen or just as the body’s getting use to, you know, those extremes are being reached, very different things happen.

Kathryn:       Yeah.

Andrew:       So I totally understand it’s difficult.  Again, I think – I think from a practical perspective it is dealing with that each situation at that time and for many individuals it may be right that they get that cover at that point but then in another couple of years or whenever that they come back and look again and doubtless that is what you and others would do in that situation.

Kathryn:       Yeah.  So when it comes to the actual insurances as well – so life insurance generally is – unless there’s some really readings there, like some extreme complications, life insurance in itself is pretty – pretty okay to get set up for someone with diabetes.  What we find as well is – we find IP.  So income protection is much easier to get than critical illness cover.  And one of the things that always sort of like enters our minds, and I’m assuming it’s quite the same for a few other advisers as well, is that in a sense there are so many people obviously with diabetes in the UK.  Surely there must be some kind of business case for insurers to be offering – or more insurers to be offering critical illness contracts.  You know, a bit like what Bupa used to do and, you know, maybe something where it’s a specific one – you know, it just feels really harsh that people with diabetes can’t easily get a contract that would maybe protect them if they were to be diagnosed with cancer or something like that.

Or if they were suddenly diagnosed with Parkinson’s or something.  There’s a lot of conditions in there which – I could be wrong, obviously I’m not medical-trained but that don’t scream out that diabetes would necessarily be a cause for them to be – obviously bearing in mind what we said before, you know, so yes, you know heart attacks would probably – well definitely would need to be excluded.  You would need to have loss of limbs excluded.  You’d need to have strokes excluded which – I know that cancer, stroke and heart attack are the main things.  But it just – yeah, it just feels really, really harsh that there’s just – same as like for people who are living with HIV, that there’s not some way that we can, you know, do some kind of a contract that would be, you know, if people are willing to buy it – I suppose that’s the question as well for me.  A big one is that I know insurers sort of like don’t like to offer these things because they sort of say ‘Well there may not be a market for it and it’s not fair to offer this and not offer everything in the contract to somebody.  It’s just not fair.’  But I’m wondering have they actually asked people?

Andrew:       Yeah.  So I think it’s –

Kathryn:       Sorry for putting that on you, Andrew.

Andrew:       No, no, no.  I think – I think the reality is – is probably things – if it’s going to happen, the huge advantage from a commercial interest for an insurer is bluntly the number of diabetics.  So it’s much easier to consider doing something like this specifically for people who have diabetes than for people who have some other conditions which simply aren’t as prevalent.  So – and I know insurers therefore do look at this, the obvious challenge for diabetes, as you said, is not so – is partly the number of significant conditions it can end up manifesting itself in but also just, you know, how closely do they overlap with traditional critical illness conditions?  But to your last point of well, ‘Have you ever actually asked people?’  I think the answer is less – probably less than people would admit.  And still, if you start from that three, four, five million number of diabetics and go ‘Well even if only 10 percent of them said –’

Kathryn:       Yeah.

Andrew:       ‘Yes, actually that – that does mean something for me,’ then that’s a, you know, in – in a world – whether we like it or not, dominated by numbers and large numbers etcetera, then that still leaves quite a lot of people.  So yeah, I – I have tremendous sympathy with that.  I – I can’t tell you why and as always happy – very happy to be told that I’m wrong but I can’t tell you why you couldn’t have a cancer plan for example for people who have diabetes that, you know, if they are also worried about as – why wouldn’t they?  Why wouldn’t you be?  About the risk of cancer and you kind of take that – take that view, then I – I couldn’t tell you why you couldn’t have that and if – and if actually people wanted the 20 of the 50 conditions or whatever it is, then again, I couldn’t tell you that aren’t impacted by diabetes and I couldn’t tell you why from a technical insurance perspective you couldn’t do that.  So I think that does come down to assumptions about customers and assumptions about advisers that may or may not be valid.

Kathryn:       Yeah.  I think it kind of – there’s part of me as well thinking does it make it more – there’s maybe a thought that it would make it more complicated at claim stage or something because, you know, there’d be an extra line of what kind of policy is it?  Does it fit within this?  Is there a –?  But to me that’s – that’s kind of the same as like with anything because, you know, if – it’s always a case of well, when this person’s got this contract, was their contract specifically covering this condition at this time for this month and year, you know, so no matter what there’s always that level of scrutiny that has to go into the – sort of like the claim of it.  But I can’t see – there’s a lot of people who come to us with diabetes who would want critical illness cover and unfortunately a lot of the time, you know, we can give options but, you know, there’s some that are obviously – they may be priced too high or some of them come with exclusions and I think it’s very different to sort of saying to somebody ‘Oh well this is a policy that – but it will come with exclusions for XYZ,’ rather than just saying ‘Well this is a specific policy that offers you cover for cancer.’

You’re not saying all the exclusions that are there, you’re saying about what is there and it’s just a slight mindset change in how you present it and I think, you know, you’re going from a positive – sorry, I’m reading a self-care book at the moment, which is all about positive language and everything so it’s sticking in my head.  It’s all about how you positively frame things and so you don’t have that kind of – even subtle negative connotation that can happen with some of the language that’s used.

Andrew:       Yeah.  No, no that actually makes sense.

Kathryn:       So then looking at post-corona virus.  So just – I’m assuming I’m just going to be preaching exactly what a lot of advisers are experiencing at the moment.  So Type I at the moment – Type I diabetes is difficult to arrange.  A lot of the time, the length of diagnosis – so as you said, someone with Type I diabetes is generally diagnosed at a very young age.  I have somebody that I know that wasn’t diagnosed until her – sort of like her mid to late twenties, was a close friend of mine.

Andrew:       Right, okay.

Kathryn:       And, you know, the length of the diagnosis will take them past the maximum loading sort of like limits that have been put on by a lot of insurers which is quite unfortunate I think, especially because – I think like with Type I diabetes it’s inherent that they’re going to be way beyond that length of diagnosis really.  And the – sorry, were you going to say something there to that?

Andrew:       Yeah, I just – probably just to emphasise on that – so typically the shape of loadings that are put on for diabetes are as – as that – as you suggest there – are that certainly from when you’ve been through that initial getting it under control phase, that that’s the best time to buy insurance.  A, because you’re youngest and so the premium’s lower anyway and B because you’re earlier in – in the progression of the disease so the rating’s not just because of your age but also because the additional ratings tend to increase kind of every five or 10 years that you’ve had the condition.  Which, as you say, when some insurers will put in maximum ratings and at some point whether that’s 15 or 20 years in –

Kathryn:       Yeah.

Andrew:       Then you’ll increasingly fall over and as you’ve described with corona virus, I think people are – insurers are reducing those maximums.

Kathryn:       Yeah.  So just a random thought that sort of like popped into my head then.  Just again – probably putting you on the spot a little bit, sorry.  Is – what about though – if you have someone who is Type I diabetic and they were diagnosed at like five and they are now, what is it, 30 or something, then they’ve had 25 years which could well put them past the timeframe to be able to get the insurances right now.  But say take the case of my friend.  She would potentially have been diagnosed for five years but then she’s had 25 years of an uncontrolled medical condition in her body doing whatever it wants to do to her with no, you know, so to me the person – to me the person who is less risk is the person who was diagnosed at age five years who’s been – had the medication, been able to monitor and to be able to adapt and control their health to probably make them in some ways possibly even healthier than a lot of people because they’re monitored that much.

And that just kind of – it kind of seems like one of those things sometimes where it’s a bit of a blanket approach that could maybe do every now and then with that ability to be able to give it a specific eye over it, to say ‘Well hang on a minute.  Yeah, let’s not just bundle everyone who’s had this diagnosis for 25 years into the same category.’

Andrew:       Yes, I agree [both laugh].

Kathryn:       Yeah, moving on, wonderful.

Andrew:       I think the one thing I would say, not in defence but I guess in support of your friend and people like her, is for her not to be diagnosed for that long.  I mean ultimately, if she was getting insurance then probably you’d see her GP record and if she – if she hasn’t had significant – I mean, there are two situations there right?  There’s the incompetent GP who just hasn’t spotted what’s going on.

Kathryn:       Yeah.

Andrew:       Or in which case then absolutely – she’s –

Kathryn:       It won’t be on the medical records then so it’s fine.

Andrew:       Absolutely, she’s in theory at additional risk or there’s the ‘She’s got a milder, you know, type of –’

Kathryn:       Version, yeah.

Andrew:       And that’s – but absolutely.  It – it’s utterly – yeah, utterly wrong to reward someone for not being diagnosed earlier.

Kathryn:       Yeah.

Andrew:       And – or to punish someone for being treated well.

Kathryn:       Yeah.  Brilliant, I’m glad you agree.  There’s also the extra thing as we said, like as if someone’s had the retinopathy, the neuropathy, higher readings, that can quickly push people beyond the maximum loadings that you would usually have found in a sense quite – probably quite easy to – to get through for terms previously.  For Type II diabetes, we’re probably seeing about roughly the same kind of things – the difference being is that obviously someone who – as we say with Type I diabetes would have been diagnosed much longer which means that they generally, even if their readings are very good, it potentially does put them beyond those maximum – those maximum ratings that insurers are offering.  And the other complication with a lot of Type II diabetics is that they have that combination a lot of the time of the higher BMI which again could start to just – it’s the little – it’s sort of like the little loadings that can all add up to very quickly put people past – past the maximum loadings that are available at the moment.

And then also, it’s always difficult to get cover for somebody who’s had a heart attack and also has diabetes.  It’s doable, it’s definitely something we can do but now it is even more restrictive than it was before so – so there are options out there.  It’s just, yeah, possibly it may be that people do need to start signposting on some occasions just to sort of get that extra bit of support.  So don’t assume that it’s not possible.  It just may be that it needs to go to very sort of targeted insurers.

Andrew:       Yeah, and I think that overlap between conditions is really important.  So, I guess starting in particular with Type II diabetics where it’s important for the underwriter, for the system, if it’s an underwriting system at play and for the adviser to understand that A, if you have someone who is a diabetic who’s on medication for high blood pressure and who’s borderline obese, then those three risks very much overlap.  So you shouldn’t be in a case where you’re adding up plus 50, plus 50, plus 50 to make 150 extra loading.  You should be saying that, well ‘These are – they’re all interrelated and the cause goes down.’  There’s a lot of different systems within different insurers and reinsurers to try and assess that risk and I think that’s why for diabetes you can get very different ratings coming out of insurers and reinsurers compared to some other conditions because of that interaction and how that’s evaluated and how the kind of insurers put together their risk.

As we’ve said, I think that only – that only increases in the current situation but doing that fairly and almost not being surprised that a diabetic is on medication for high blood pressure is – is key in that case.  But generally, I think as I’ve said as we’ve gone through, that what the underwriter is really looking for in an ideal situation is – is that kind of level of control and a – a time period over which to see that things aren’t fluctuating around.  And that becomes really, really important.  So as I say, if you’re an adviser who’s got someone who’s diabetic and is trying to work out how straightforward the process is going to be, I think – I think A, for the person to know the answers to the kind of questions you’ve highlighted is really important.  More important than product conditions, it’s not just important for efficiency in a way that for example knowing what stage of cancer you have, whilst it kind of makes the process go quicker but actually, you know, from an underwriter’s perspective, if you’ve got someone who doesn’t know their latest HbA1c or answers to some of the other questions, what medication they’re on maybe, then that is of itself worrying for this condition because it is so much about control and compliance.

So I think there’s, you know, it does become even more important here.  Obviously, if you’re an adviser, it’s your job to help – help get that information.

Kathryn:       Yeah.

Andrew:       But if – you know, in an ideal joined-up process, I’d much rather – I would much rather accept the person who that first time you asked them, knows those 10 things without a – without a pause rather than the person who takes – takes a couple of months to find – to find the notes.

Kathryn:       Absolutely.  I think I’ve maybe forgot as well that the hypos – that, you know, if people have had the hypos, that’s incredibly important as well.  So that could be –

Andrew:       Yeah.

Kathryn:       If they’re regularly experiencing their blood sugar dropping quite low, as you say, that kind of the managing it in a sense, making sure that they’re keeping their blood sugar levels quite consistent with their diet and different things and I think that there is quite – something quite specific as well from memory from clients as well but there can be things on the night time I think.  Sometimes – there can be sometimes hypoglycaemic attacks during the night and they can sometimes become a bit of a pattern of having those.  So again it comes down to monitoring and managing the condition as well.  And I think – I think most people find that quite acceptable as well to sort of like think ‘Well yes, I’ve got this condition and if I’m monitoring it and controlling it, just with anything, because if I’m doing the advice of the doctors and I’m taking all steps possible to me to be able to better my health,’ as any of us do with or without health conditions, then – then I think most people would be understanding, hopefully.

Andrew:       Yeah and there’s been a huge investment – again for obvious reasons in – in medications and courses and controls and things like that that people go on.  And I think again that’s where it can often be frequent conversations between customers, advisers and insurers because, you know, people will have done absolutely everything right.  There will be people who will have been on the latest course and I think a challenge for underwriters is looking at – and insurers just looking at UK specific data and UK specific courses and seeing which of those are coming in are having more impact and again in theory, rewarding people who – who are on those sort of good pathways rather than those more disengaged.

Kathryn:       Yeah.  So I think there was another thing I was going to suggest.  There is – there are obviously the insurances as well where people do take out the insurance and they have diabetes.  If they do better, their HbA1c level readings and their BMIs and stuff, they can get in a sense rewarded with improved terms, you know, after a set period of time if they’re sort of like doing this thing and they can prove, as you say, this engagement and this – this sort of like bettering of their health – it can be sometimes quite a good option to look at.

Andrew:       Yeah, so I think – I mean it’s worth stressing because there is always the frustration that we gloss over the good bits and I mean for life, if you – if you – certainly if you’re a Type II diabetic who hasn’t had other major incidents, then you definitely ought to be able to get life insurance cover at a – at a small extra premium at most.  But, notwithstanding that there are companies and, you know, cards on the table, I was heavily involved with one who have developed this idea that rather than underwriting someone once and just setting them off into the wild for 25 years and seeing what happens [both laugh], then they would re-underwrite every year basically, dependent on results.  With minimal changes to the premium – so one proposition premium only ever goes down, it can’t go up and the other it goes up or down a little bit but depending on your compliance.  And obviously the theory behind that is to say that it rewards the good customer, the people who are continuing to engage and do all the right things and it should mean that we can – as insurers, we can accept more people at outset and at better terms.

But there’s obviously, you know, the downside is that it means ongoing engagement with your insurer.  It means a lack of total certainty about what you’ll be paying.  So –

Kathryn:       Yeah.

Andrew:       There’s clearly up and downsides to that.

Kathryn:       We’ve seen it as being very positive for some people, you know, some people really, really want to do it.  And then, you know, you’ve also – we’ve also seen people who’ve turned round and said that they don’t want to do it like that, you know.  They just said ‘I can’t,’ you know, basically – you know, especially the one where it’s potential to go up a bit, you know, they’ve said ‘Well, I just can’t guarantee that I’m going to be able to exercise at this level or do this or do that for the next year or so.’  And I think it’s very important to just be – as with anything as an adviser, you know, you advise clients, you give them – you put on the table what’s available and you help to in a sense guide them but you need to be very blunt and honest with it as well and say ‘Look this one will be really good if you can keep doing this and you can keep doing what you’re planning or you start doing all those bootcamps you’re thinking of doing.  Brilliant, ‘cos you could bring your premium down but at the same point, if you’re not sure you’re going to commit that, the premium may go to this.  So, you know, is that right for you?  So should you maybe just go for this one over here that’s a set premium forever as kind of like in between – in between the higher that it may go to with the original one?’

So I’ve got a case study and this one is a case study from – from not too long ago, pre-corona virus.  Well, I say pre-corona virus, I’ll chat about it.  It was bordering into corona virus territory.  So it was – it’s a person with diabetes.  So a 40-year old male, non-smoker.  He has Wolff-Parkinson-White Syndrome that was diagnosed nine years ago.  That is a heart condition.  He has Type I diabetes that was diagnosed 29 years ago.  He uses an insulin pump.  His reading is 47 so that is very well controlled and he also has some potential background retinopathy.  He is somebody who is very fit though.  He does triathlons and he wanted life insurance and income protection.  So, we managed to get both for him which is brilliant.  But this one was a little bit strange in the sense of – so with the income protection, I’ll chat about this one quite specifically.  So we – he wanted – well we got him £3,000 worth of income protection.  It was per month so 13-week deferred period, two-year claim period and it ran to age 65 and that came to £55 per month.

Now, what – the interesting thing about this one especially in regards to corona virus is that we’d given this person the terms and they were doing the thing – as some clients do where they’re kind of umming and aahing and deciding whether or not they wanted it or didn’t want it and we’d had to do a thing before corona virus which had the terms revised because time frame since – you know, obviously having the terms issued to them considering it and we did all this just before everything happened with corona virus and he came back and the loading that was going to be on the policy was a lot less than we expected and so when that happened, we were chatting with him and everything and he was just like ‘Well I’d like to see the price of it to – for – not at the two year max claim period.  I want to have it to end – to age 65.’  So no limit on the claim, and that came back at a price that absolutely he wanted to go ahead with and then corona virus struck and the annoying thing about it was that we couldn’t reissue the terms so we’ve had to – and he’s – I’m mean he’s happy, he’s got the cover, but he’s now – he has the policy.

Obviously he’s very happy having an income protection policy but it is at that two-year maximum but because if we’d had the terms reissued then because of corona virus and the changes and everything, there’s just no way we would have been able to get him the cover.  So that’s something that’s quite frustrating.  It’s something that obviously we were trying to encourage him to have the higher level of cover but as with anything, there’s only so much that you can – and especially for us when we’re not pushy at all in the slightest, but you don’t necessarily have that foresight to go ‘Well you know what’s going to happen next week?  This thing called corona virus is going to hit and we really want to get these terms reissued now,’ and everything like that.  But I think it’s potentially – without scaremongering, it’s potentially a bit of a kind of like a wise tale sometimes to be able to maybe use and say to clients and just say ‘Look, we never know what is around the corner.  And obviously absolutely don’t rush into a decision but some things can sometimes drastically happen which can really change what we can do so just try and get all the options there available as quickly as you can.’

We also arranged for him and his partner – and his partner also has some medical conditions but I won’t go into that because they weren’t diabetes-related, and we got them decreasing – joint decreasing life insurance of £380,000 over 25 years for £65 per month which we were quite pleased really to be able to get all that because there was potentially – obviously some complications there.  We had the heart condition, we had the diabetes, potentially a little bit of background retinopathy and we were really impressed that we managed to get that through.

Andrew:       Yeah, I think it’s still – well yeah, no, there’s lots of really good tales in there aren’t there?  I think the income protection bit is – is often surprising to people that you can get more – as much more – that you can than for critical illness for diabetes and that is all down to the stuff we talked about.  But yeah, I think – and as you say, the general ‘You don’t know when something’s going to happen to you or as we now understand to the whole of the country,’ I would hope would be one of those, you know, minor but significant positive changes in the future to all of our kind of approaches to things.  That you don’t – that you really, really don’t know what’s around the corner.  Yeah.

Kathryn:       Absolutely.  Do you have any extras?  I know we have like a little extras section that we often – that you just have a moment –

Andrew:       Well I think I jumped in throughout this week [both laugh] so I guess for me the key bit is to encourage this – this – I think, as for other conditions and as we’ve mentioned at the top, although diabetes starts off very simple, Type I, Type II diabetes that’s it, I think over the next five or ten years it – you’ll see more and more segmentation within that from a medical point of view and clearly there will be winners and losers in that.  So I think if – if you are a protection adviser then yeah, staying on top of this is going to be really important.  Just a quick one on gestational diabetes because I promised that I’d talk about that and we haven’t.  I think that is – I guess the headline on that is just there is – truly gestational diabetes which comes – impacts people really quite severely at times during pregnancy but then doesn’t have any long-lasting effect or any long-lasting kind of increased chance of diabetes – other types of diabetes in the long term.

Kathryn:       Because it disappears, doesn’t it, after the pregnancy?

Andrew:       Yeah.

Kathryn:       Yeah.

Andrew:       Yeah absolutely and – and you are at no extra risk of getting Type II diabetes thereafter.  There are others where – and I’m not even going to hazard an opinion as to whether it’s truly gestational diabetes in the first place, I haven’t done enough reading to know that – but there are others who – what is originally diagnosed as gestational diabetes sort of transforms or doesn’t go away after pregnancy and they end up having a form of diabetes diagnosed which I – my understanding is that that’s more because they probably already had the diabetes, it just happened to be diagnosed in pregnancy.

Kathryn:       Oh right.

Andrew:       But again, I think that is an area – if – if you go back to times when people go to buy life insurance, it tends to be when you’re moving house, when you’re having – when you’re having a family etcetera, so it’s a disproportionately big issue within underwriting because quite often, you will have someone who’s either pregnant or –

Kathryn:       Yeah.

Andrew:       Just been – and so it’s a recent thing in their history so it can cause quite a lot of head scratching.  Again, the reality is, is if you’ve – if you’re post-pregnancy, if you had gestational diabetes and since you haven’t had any problems then you should be fine for all covers.

Kathryn:       Yeah.

Andrew:       But yeah, if you’re in the middle of it then you can – then the more cautious approach would be taken.

Kathryn:       That’s really interesting as well because I – I’m sure I’ve mentioned it before, I – with my final pregnancy with Zachary almost three years ago, I afterwards developed postpartum thyroiditis so I became – oh I’m going to get it completely – so I became – got to try and think about it – so I became hyper – hang on, there’s hyperthyroidism – I get confused.  Right, underactive, overactive, I’m just going to say overactive.

Andrew:       Yeah, yeah, yeah.

Kathryn:       I developed an overactive thyroid and they had no idea what was wrong with me because obviously originally it was a case of it, it was that thing of like ‘I’ve got three kids, I’ve got a baby, I’m breastfeeding, it’s the middle of summer, I’m shattered,’ and it – but something just wasn’t right.  So like ‘Ooh you’ve developed an overactive thyroid, this is really strange because you’ve never had – obviously your thyroid has always been fine.’  And then on the – as instantly I had like these tests done over three months.  So I had one test which showed I was absolutely and very, very much an overactive thyroid.  A test about – I think it was about eight weeks later suddenly showed that I’d flipped to an underactive thyroid and very much – a very specifically underactive thyroid and nobody knew what was going on.  So I was doing research which showed this thing called postpartum thyroiditis.

So I started having to have medication after another three months of waiting because they won’t give you medication until you’ve actually proven that you are definitely – and it’s meant to potentially go away after 12 to 18 months but now Zachary’s three and it’s still not gone away so I think I’m – I’m underactive thryoided for life now.  Which leads me in very nicely to the next truth and lie.

Andrew:       Yes.

Kathryn:       Dum, dum-dum.  So one of the things I’ve been wanting to do very specifically is really trying to be healthy in lockdown.  I’m trying really hard to eat healthy.  Anyone who follows me on social media realises that I made chocolate cinnamon monkey bread at the weekend which basically was not healthy whatsoever, but it was amazing [both laugh].  So I’m trying really hard.  I’m exercising a lot more than I have been doing.  Obviously with the kids being around me, I don’t feel as guilty if I suddenly – whereas usually I’d have to sort of go off to exercise whereas now I’m just exercising at home with virtual sessions and everything which is quite nice.  But I’m going to share a truth about myself.  And you have to guess whether it’s the truth or not.  But so I’m trying to be really, really healthy and everything but I’m going to share that I’ve been reflecting on the past and everything like that and that I used to be UK size 22 and I was around 96 kilograms which is about 15 stone.  And just in case anyone wonders, I am six foot.  So that is – that was my sizing and everything when I was younger.

Andrew:       Yeah, so I can do – I – this isn’t my truth or lie but I’m about 96 kilograms now but I’m six foot six, so that’s – that’s allowed.  For an underwriter, I’m still in the club.  Yes, but on the healthy theme, so I live in Chelmsford where Mike Adams, one of our previous guests – we reminisced about the McDonalds that is directly opposite his office and that was –

Kathryn:       You’ve not been, you’ve not been that person in the queue have you?  Like an hour’s worth of queue?

Andrew:       So slightly depressingly, Chelmsford was one of the places to open five of our McDonalds last week.  Five of the 15 McDonalds that got opened last week were in Chelmsford.

Kathryn:       Oh wow.

Andrew:       But my truth or lie is that I, on the first day post-lockdown went to McDonalds with my children, whether it makes it –

Kathryn:       Oh no –

Andrew:       I will reveal –

Kathryn:       So hang on, was that – was this when they’ve reopened or was this when you said post-lockdown?  Was this like two months ago or was this like –

Andrew:       No sorry, now.

Kathryn:       Oh.

Andrew:       No, so yeah – well are we post-lockdown or not?

Kathryn:       Yeah.

Andrew:       The first day –

Kathryn:       Post-lockdown, yeah, I think after yesterday – I think –

Andrew:       Yeah, I was going to say.

Kathryn:       Don’t mention Cummings.

Andrew:       Exactly.

Kathryn:       No.

Andrew:       Yes.  A Freudian slip [both laugh].  We were there, in the queue.

Kathryn:       Oh I saw a Twitter video of like a long like line of cars going into like – it was like an hour’s worth of cars backing up and I was just thinking ‘I cannot believe I know somebody in that –’ [both laugh]  I was like –

Andrew:       Well we made it to nine – we made it to nine episodes right?  We had to –

Kathryn:       Ah –

Andrew:       Creative differences.

Kathryn:       Ah, but not McDonalds.  I’m that terrible parent that my eldest child didn’t have a McDonalds or anything like that until he was five.  I’m terrible.  I’m like – now obviously the third child it’s just like ‘Yeah, you can have it for breakfast.  It’s fine.  Whatever you want.  Eat off the floor, it’s fine.’

Andrew:       Yeah.

Kathryn:       Well thank you everybody for listening.

Andrew:       Yeah, and we’ll be back in a fortnight and if you’d like a reminder of the next episode where we’ll be chatting about HIV with a new special guest, then please do let us know.  We’re on social media in all the usual places or come to our website at www.practical-protection.co.uk.  Thank you for listening, bye.

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