Diabetes. You have heard about it often, know enough about it, but when you have to face it yourselves, it is difficult. You ask why me, what have I done wrong? It is important to remember that it is no fault of yours that you have Diabetes. It is the single most widespread metabolic disease that can affect nearly every organ system in the body. There are 190 million diabetics in the world now. Indians are genetically more susceptible (India has been labelled as the Diabetes capital of the world) and the World Health Organisation predicts the number of diabetics in India would go up to 40 million by 2010 and 74 million by 2025. See — you are not alone! Now, let us face the truth together.

There was a school of thought that ‘ignorance is bliss’, knowledge of illness causes distress and prevents or reduces hope. Now the challenge is to move away from this and to be a mature person who is capable of accepting the responsibility of treating his own illness. The whole idea is to understand that treatment will be beneficial and delaying treatment will lead to undesirable consequences.

Five kinds of patients

There are five kinds of diabetic patients. Here’s how they react:

The Knowledgeable Patient: He knows the impact of the illness and is willing to take the right treatment. He has full family support and is calm and composed.

The Scared Patient: He fears the very word diabetes, resents restrictions on his diet and lifestyle, has low family support and is dependent on others.

The Casual Patient: He is nonchalant about the illness and does not want to take any action (until the time complications set in and he is forced to).

The Myopic Patient: He wants maximum results with minimum effort. Also, he has little awareness about the illness.

The Know-it-all Patient: He fakes knowledge about the disease and refuses to heed advice. But seldom does he have complete knowledge. A little knowledge, as we all know, is a dangerous thing.

Not uncommonly, the first response after one comes to know of any chronic illness is denial and diabetes is no exception. Patients’ reaction vacillates between disbelief, revolt (accusation), depression (sadness for health lost), confronting reality and consenting (coping).

These are integrating processes. The process of integration is also dependent on how the patient views his or her disease. Hence patient education plays a very important role.

A young woman had a blood sugar test which revealed that she was suffering from Diabetes Mellitus. She just could not come to terms with this and went through a myriad of emotions, finally leading to denial. She refused treatment, saying that she just did not have Diabetes. A suitable approach would be to acknowledge the denial and to seek reasons for it. She could be asked the reasons for her denial which would evoke a response, which could be addressed suitably. Should the denial continue with the patient saying that she just does not believe it, one could proceed by gently placing before her the consequences of her denial. On gently persisting, issues that can be handled will come out and the denial broken successfully.

Look at another extreme example. A young man, a juvenile diabetic, decides to tie the knot, but fearing that his young bride would reject him if she knew his medical condition, keeps her in the dark. After the marriage, when the couple are on their honeymoon, the young man faces some complications as he is not under any insulin programme.  He promptly gets himself into the nursing home of the doctor who has been treating him, pleading that the doctor tell his wife that diabetes was just detected! What does the doctor do?

Communicating truth

Art of communication is an important part of therapy; occasionally it is the only constituent. It usually requires greater thought and planning than a drug prescription, and unfortunately it is commonly administered in sub-therapeutic doses! Nothing is better than the truth and acceptance of reality lies in the manner in which it is disclosed. This responsibility lies with the health care provider. Various steps in helping patients cope with Diabetes would help them accept the diagnosis, give information that is required, give them scope for ventilation of feelings, formulate an action plan and be available for the patient.

Researchers are intensively studying the genetic and environmental factors that underlie the susceptibility to obesity, pre-diabetes and diabetes. As they learn more about the molecular events that lead to diabetes, they will develop ways to prevent and cure the different stages of this disease.

Until then, we can hope to prevent further progression of this pandemic by eating healthy and having an exercise-filled healthier lifestyle. Yes, you may be at risk. But you can surely postpone it.

www. DiabetesEndocrinology.in Phone: 25284000. 25250392