Saturday, February 29, 2020

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.


Deepak Misra said...

Good to see you back blogging doctor. Could you please comment or write an article on Keto. As I mentioned to you it sounds dangerous and counter intuitive but have a lot of evidence from known people on the weight loss and reduction in medicines for diabetics. Is the Keto sustainable in the long term or is their risk of damage to organs. And if it is followed as trial, how long will should one try it. If we do Keto and get back to a reduced car diet, will sugar levels get back to elevated levels ?

Unknown said...

the tory of Banwari can be extrapolated to almost all the fields of medicine,particularly mine-ophthalmic surgery-where much panic is caused and patients forced to undergo "emergency "surgery.Dr.Srinivas Rao

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