Sweet Circle of Doom
Updated: Sep 26, 2019
Another day in the clinic. I am preparing to see my next patient, Mr. David who has diabetes for the last 4 years and still has poor control despite being on multiple medications. Both of us know what the problem is. He has a large extended family and attends parties and functions all the time where he finds it impossible to control his urges to consume sugary treats.
Diabetes is an intriguing disease. As a physician, it is amazing to see that diabetes treatment can be both simple and complicated at the same time. Treatment of diabetes is primarily by lifestyle change which includes diet, exercise, stress, and sleep. Medications are only add-on when lifestyle change is inadequate. So, treatment is simple in a way that I only have to advise lifestyle change to the patient rather than fancy medications or procedures. But, at the same time, it is so complicated and challenging as the patient finds it very difficult to change their lifestyle and I find it difficult to get them the resources they need.
David tells me that he feels great and is at the best health of his life. He was hoping that I would give him a clean chit for his health. He does not check his blood sugars at home and so, does not have any idea about his diabetes control between the visits. When I reviewed his blood work, it showed a different picture and his A1c which is the indicator of blood glucose control in the last 3 months, has significantly worsened. He was disheartened and asked me, “Doc, I take all the 3 medication you prescribe me regularly. Why am I not getting better?”. When I further discussed with him, I found out that he has been having birthday parties frequently and also, went on a cruise for 2 weeks where he enjoyed the buffet food. Moreover, he had sprained his ankle and stopped going to the gym for the last 2 months. Then, I started my usual lecture about how important it is to control his diet and exercise. David listened to me, which he had heard many times in the past. I felt like preaching to the choir and he also listened to me getting frustrated, “why don’t they make a magic pill for diabetes”. Exactly ...that is the same thing I would wish as well. But, I very well know that it does not exist.
Diabetes is called a silent killer. Most patients do not have any symptoms during the early stages until they develop complications which are more often irreversible. It is not like a fever or infection, where patients are sick and miserable and actively seek help. In diabetes, you need a strong motivation to be reminded that you have this terrible disease which does not make you feel sick, but still is harming you every day when it is uncontrolled.
Every day, I get frustrated that my patients are not able to control their diabetes as they do not make the lifestyle change. The patients are frustrated that they visit me every 3 months and take their medications and do not see improvement. They blame me for the poor results and I shift the blame back on them by telling that they have not done the necessary lifestyle change. So, every visit I would increase the dose of their medication or add a new medication as that would be the only option, knowing very well that it would not make any meaningful change.
When I look at this from a different perspective, I can see a situation where both the doctor and patient put their honest effort in the wrong place, despite knowing what to do.
The doctor wants the patient to change their lifestyle, but do not have the necessary resources to help the patient in an effective way. They can only discuss for 5-10 minutes which the patient will forget, the moment they leave the clinic. They do not have the resources to handhold the patient and make them do the necessary change.
The patient wants to improve their diabetes and believes the medication will do the trick. They hear from the doctor about the importance of lifestyle change during the visit. But, their life is so busy and complicated that they fail every time they try by themselves. They do not know what and where to seek help and feel they are in a losing battle. They end up with more and more medications over time. They even change the doctors hoping for a miracle not knowing that the issue is about incorporating lifestyle change rather than new doctors and new medications.
It is this vicious cycle which has to be broken and can be done only by an innovative strategy where the patient gets all the resources to get motivated, educated, reminded and kept engaged to do the necessary changes. I honestly believe our program has all the resources to make you succeed and will fulfil your expectations.