Much ado
Diabetes is one of the eminently
preventable disorders. This disorder has now become a money spinner for pharma
companies, diet counsellors, endocrinologists and a special breed of doctors
who call themselves as diabetologists. There’s so much hype built up, that
this is considered as a deadly disease and news, social and electronic media
are replete with reports, one way or the other related to this illness to the
extent that India now has the dubious distinction of being known as the
diabetic capital of the world. And our super doctor endocrinologists taking
the cue, repeat this sentence ad nauseam in every CME that is held on this
subject.
One of my patients, let me give him
a name Banwari Lal.
Banwari came to see me some time
back.
I could see him very anxious and
tense.
He said,' doctor Saab, I am going
to die'
Banwari is a second-generation
patient of mine and I have known him almost since he was born. Now this
strapping 40 plus man who has been pretty healthy so far is now here
announcing his imminent death.
I asked him,' how are you going to
die?'
He said with all seriousness, '
Sugar disease'
How do you know you have one? I
asked
Another story emerged. Banwari got
a phone call couple of weeks back, the caller identified himself as an
executive from Estocare, a nationally known diagnostic company and they have a
great offer especially suited for successful business leaders'
Our Banwari was suitably impressed
with him being amongst this chosen elite, asked what these tests and the cost.
The executive proceeded to explain
that the offer was for 40 tests and cost was only Rs 2000 which normally would cost Rs 3500 and what is
more, their technician will come to Banwari's residence to take the blood
sample.
Greatly impressed, Banwari placed
the order and next day a sample of blood was taken.
The results came by mail and
amongst the mostly unnecessary tests there were some marked in bold font
suggesting abnormality. Going by his knowledge of sugar disease (his father too
has it) Banwari knew that sugar levels were high and he like his father has
this dreaded disorder
Things would have been different
had he come to me in the first place soon after he got the report.
An avid TV watcher, he had heard a
discussion on diabetes by a panel of doctors and he thought it best to
consult a clinic solely devoted to this disease.
He fixed a date with this
super specialty diabetes clinic and went there as suggested in an empty
stomach.
There his blood was drawn once
again and he was given a breakfast of the clinic's choice.
This done he was asked to get an
ECG and ultrasound of the abdomen done. When asked why these additional
tests, he was told by the nurse who had a permanently fixed smile that it is to
find out if has any additional disease. Thus, held captive in that clinic, he
was kept busy till noon when his turn came to see the diabetes specialist
doctor.
The conversation went along the
following lines.
Doctor gravely looking at the
opened file in front of him asked, ' You are Banwari Lal'
Banwari confirmed indeed he is.
You have a problem, said the
specialist.
As he already knew this because of
the bold fonted figures, Banwari chose to be quiet.
‘You heard what I said'
This time Banwari was forced to say
yes.
Your blood sugar and lipids are
high and unless these are brought to normal you run the risk of complications
involving your heart, brain and kidneys which may result in serious
complications including death.
Banwari did know about
diabetes but this disconcerting information about causing death was new to
him as his father who is 75 years old, a diabetic and still alive
You need to change your life style,
exercise regularly and take medication which I will prescribe now said the
specialist.
He proceeded to give a prescription
for three types of medications.
Banwari was now asked to go to
another room where sat a lady who specializes in giving advice on diet to
diabetics.
The lady took his weight and found
him overweight by 5 Kgs.
Banwari is a Guajarati and a devout
Jain.The dietary discussion with this lady from Banwari's point of view was
very painful.
When she learnt that being a Jain
his last meal was before sunset, she told him in no uncertain terms that
he will have to eat according to her chart and not starve. Banwari telling her
that he is not starving fell on deaf ears.
Banwari's wife too had gone with
him and both were given an hours talk on what each ingredient of the food
that they eat [ displayed on a large tray] and the calorie value of each of
these.
By then it was nearing 2 pm and
past their lunch time and in addition to hunger Banwari also had a
headache with all this detailed information stuffed into his head. Except
information needed for his business, Banwari’s brain finds it difficult to
understand others and this calorie gilorie stuff that the diet expert was
telling him was beyond his comprehension and therefore the head ache.
His wife Sunitha too is my patient
and it was she who advised him to see me before he does anything like staring
the medication and try the diet.
Before I saw his reports, I checked
his BP and heart. Both were normal and he had good circulation in the limbs.
There was no evidence of any skin fungus. Weight was borderline high. I felt
he was in good health.
Now I opened his now fairly bulky
file.
His fasting sugar was 140 and after
food it was 210 and his LDL was 140 and Triglyceride was 240.
I felt like laughing
He must have seen the
expression
He asked, ‘doctor Saab, why are you
laughing’ in Hindi
I said, it's a smile of pleasure to
see these reports, you can get back to normal within next two months if
you follow my advice
Then what about heart attack kidney attack?
he asked
‘Nothing will happen and you are
not going to die and may even outlive your father’ I said half in jest
But what about my evening meal? He
asked with some anxiety
You can have your night meal before
sunset’ I said.
I gave him a diet and exercise
schedule which would not greatly disturb his life style.
He came back the other day.
His fasting sugar was 130 and after
food it was 160 and both the LDL and triglyceride levels had dropped and he was
on no drugs.
I told him to continue the slightly
altered lifestyle [ bit more of exercise and controlled eating] and assured him
at the next visit, in 3 months’ time, all the values will be normal
A very happy and relieved Banwari
took a grateful leave, leaving behind a box of sweets
Hopefully his gift will not make me
a diabetic.