Diabetes: Doctors warn on amputation risk
Scotland is in the grip of an obesity epidemic. The consequence of this is type-2 diabetes, a weight-related and life-threatening condition.
Almost a quarter of a million people in Scotland have it.
Dr Gerald Spence has worked as a GP at Shettleston medical practice in Glasgow for more than 30 years.
He says: "We've had an almost 50% increase in diabetics in the past five or six years in the practice.
"We've gone from about 250 to about 350 in the practice.
"Now we are seeing it in younger and younger people. People in their 20s are coming in with symptoms and you think 'oh goodness me, that sounds like diabetes'."
The potential consequences of a diabetes diagnosis are stark - blindness, organ failure, heart disease and amputation.
Ten years ago Ricky Callan, from Edinburgh, was a successful actor and comedian, often using his large size as material for his jokes.
He was diagnosed with type-2 diabetes and an infected foot led to doctors having to operate.
Ricky says that when the doctors told him they might have to amputate below the knee "it was like they were saying it in slow motion".
"I could not take it in," he says.
"I have lost half a leg. I have got three toes amputated on the other foot and I have had both eyes operated on.
"I have recently had kidney failure and it just eats away at you. You feel like you are dying a slow death and that you are being pulled apart like an Action Man.
"It is tortuous and painful and feels never ending - and it's my fault, my responsibility."
Ricky is 52 and was diagnosed in his 30s.
But doctors are now diagnosing patients as young as 13.
That early diagnosis often means that more serious complications will also hit the patient sooner, with years of progressive vascular injury meaning lower limb amputation in their 40s.
Dr Matthew Young, who works at one of Scotland's largest diabetes clinics at Edinburgh Royal Infirmary, says some studies claim that three-quarters of patients could die within five years of an amputation.
He says: "In 80% or more cases, you will have a heart attack within five years of your amputation."
According to Diabetes UK up to 19,000 people are diagnosed every year but they believe up to 50,000 are walking around not knowing they have it.
Diabetes UK's Scottish director Jane-Claire Judson wants the condition to be made a clinical national priority.
"People sometimes talk about the diabetes time-bomb and the way I see that now is that it is almost like the bomb has gone off and there is that beat or two before you hear the blast.
"So we have got a moment right now where we can tackle diabetes care and if we don't grab that then the consequences for people in Scotland could be severe."