Updated: Sep 26, 2019
Every day is an exciting day in the clinic. Good word of mouth is the best marketing for any physician and I am used to patients coming with high expectations. It is usual for me to go above and beyond to help them get better and that satisfaction is compared to none.
Last month, I had a 45-year-old man coming to my office for treatment of his diabetes. Before I started the discussion he asked, “Doc, I have diabetes for the last 15 years and have seen several different doctors. Nobody is ever able to fix my diabetes. My blood sugar is always above 300 despite taking multiple medications including insulin. You have helped some of my friends and they recommended to see you. You are my last hope and please fix my diabetes”. This is not new for me and I have to be extra attentive to find the real problem which is hindering his diabetes care.
On discussion, he described in great detail about the different medications he has tried so far. He has practically taken all different oral medications and is also on insulin for the last few years. He is frustrated and wondering why the medication does not work in him. When I started discussing his lifestyle, he got annoyed and mentioned, “Doc, I work in construction and on my feet all day. I go to the gym 4-5 times a week and do weights for 45 minutes. I rarely eat any cakes or cookies and have even decreased eating rice. What more do you want me to do?”.
He seemed very sensitive and I have to be cautious. He is taking three different oral medications and is also on insulin one time a day. He is on medications which is more than what is needed and I am convinced that there is definitely some problem which is yet to be identified.
I questioned him about his beverage preference. He said, “I drink a lot of water every day as I am always thirsty. I do not drink coke, Pepsi or fruit juice. Being a diabetic, I know that.” When I asked him what else does he drink, he said, “Doc, other than water, only Gatorade. It has the right balance of electrolytes. If it is good for the athletes, it should be good for me. I work under the sun all day and working out in the gym, I need those electrolytes. Nothing beats a cold bottle of Gatorade”. On asking how often, he said “oh..I don’t keep count. It is healthy, you know. May be 5-6 bottles in a day”.
Here you go. I have found the problem and my challenge is to convince him. Explained to him that each bottle of Gatorade has around 34 grams which are roughly nine teaspoons of sugar. His excessive thirst is not just about working in the sun but is primarily due to uncontrolled diabetes with very high blood sugar. When the sugar level in the blood is high, it has to somehow find a way to get out. In a diabetic, the only way to naturally decrease sugar level is through urine. So, you pass a lot of urine multiple times a day, which in turn makes you more dehydrated. Drinking that Gatorade every time only adds to more sugar in the blood and you get caught in the vicious cycle. Unless we break the vicious cycle by stop drinking Gatorade and stop putting more sugar in the body, we cannot control the situation.
The patient was shocked to learn that his problem was consuming Gatorade which he believed was helping him quench the thirst. He was of the strong belief that the medications are not working and was hoping to start on some new medication or technology. I had to explain that medications only play a secondary role in diabetes management. Lifestyle changes including diet, exercise, stress, and sleep are the primary treatment. He found it hard to believe and asked, “Doc, each medication I take is several hundred dollars worth. You are just asking me to change my drink. Are you kidding?”. I had to convince him that this could look simple, but could be the key to his problem. Even, I had to caution him that when he stops all the Gatorade, he will need fewer medications and asked to call me. He left my office in disbelief but promised to follow the advice.
He called me the very next day that his blood glucose has improved and I had to start decreasing his medications. I was able to stop his insulin in 2 weeks. I saw him in my office yesterday. He was ecstatic being only on two medications now and his blood sugar is well controlled.
He thanked me, “Doc, you controlled my diabetes.'' I smiled and said, “No. The only person in the world who can control your diabetes is you. I just showed you the path.”