A bit of diabetes (Part 2)

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Why I resist the mild versus serious dichotomy

The perception that Type 2 diabetes is mild, or that it can be subdivided into mild and serious, usually misleads doctors, patients and the public into thinking that this so-called mild form does not deserve earnest attention. This has been my experience, almost without exception, with people who comment on diabetes (whether or not they themselves are diabetic, or are in the medical profession who ought to know better). The reactions thrown my way are a variation of Why go through all that trouble for a little bit of diabetes?

      • There are those who are flat-out blind to the importance of lifestyle changes.
      • I’ve encountered people who for that reason (i.e.,Type 2 diabetes is mild) do not respect, or have accused me of overreacting with, my lower carb choices (especially when I say no to their signature chocolate chip cookies).
      • Strangers have told me how lucky I am that I only have Type 2 because it is not the dangerous kind and will not maim or kill me, overlooking the fact that most complications arise from uncontrolled diabetes. 
      • I’ve had Type 2 diabetics congratulate me for having the type that allows me to get away with only 1,000 mg of metformin, completely ignoring the fact that I run, ski, walk, practice yoga, do strength training and am generally physically active, watch what I eat, and minimize stress.
      • I’ve had people assure me that I just need pills.

Interestingly and on the contrary, a few diabetics who have a stricter control regimen than me have told me that I will regret my current lifestyle once my diabetes is no longer in its mild phase.

The almost blasé image of Type 2 diabetes also makes it easy to play the blame game against those who have developed complications or who may need to inject insulin. The thinking is that if one has complications or needs insulin injections despite Type 2 diabetes being a mild condition, then one must not have been the ideal patient; in other words, this person did not try hard enough. This erroneous assessment completely, unfairly and irresponsibly disregards someone’s efforts to deal with diabetes as best he could or his predisposition to other health issues. Sadly, you encounter the “blame the patient” spiel even within the diabetes community.

The blame game also absolves medical practitioners, diabetes associations, and diabetes educators, who have appalling records in providing adequate and meaningful education to diabetic patients and the public at large. If these so-called experts do not get it right, how can you expect the media and the public to know any better?

Note to doctors, media and diabetes educators

To all medical practitioners, diabetes associations, and diabetes educators, you have the responsibility of guiding your diabetic patients because you are the first person they see and talk to when they are diagnosed. It’s tough but that’s the role you chose to take. Think carefully when you tell your patient that he has a little bit of diabetes or that he has the mild form or that it is not the serious type. While you may think that coddling your patient is helpful, it is by and large not. Yes, you need to be kind, patient, considerate and optimistic, but you do not help your patient by treating his condition lightly. Even if you decide to tread carefully, as I realize you may need to, make sure that you do not leave the wrong impression.

You also have the responsibility of educating yourself so you don’t end up telling your patients what Mr. Hanks’ doctor told him. Mr. Hanks was advised by his doctor that if he weighed as much as he did in high school, he would “essentially be completely healthy and will not have Type 2 diabetes.” Hogwash! If weight loss were a cure, I would not have developed Type 2 diabetes at all, and Type 2 diabetics who have lost a lot of weight should have been cured. Will weight loss help in dealing with diabetes, fitness and possibly staving off complications? Absolutely. Will it cure diabetes? No. Encourage your patients to have a healthy weight but please don’t mislead them into thinking that weight loss is the cure.

And, do not limit yourselves to books and medical journals. Your most important resource are your patients. How many of you actual inquire about how your patients deal with diabetes, about the real life problems they face and the solutions they have come up with? How many of you encourage your patients to learn by themselves and not rely on your infinite wisdom? How many of you engage your patients when they share their BG readings, new information they have discovered, or experiences and lessons learned as diabetics? How many of you really listen?

In addition, there is the internet. Again, I’m not just talking about sites for doctors, but the diabetes online community. You do not even have to join any specific diabetes board or follow anyone in particular. But with diabetics sharing their experiences, frustrations and successes online, you are sure to find something that can help your patients and certainly deepen your understanding. Instead of just prescribing pills, why don’t you also share some of the diabetes sites and blogs which may not be all that interesting to you but will certainly be of major interest to your diabetic patients, especially the newly diagnosed ones?

You have a major responsibility as the first line of recourse and resource for diabetics. Please discharge that responsibility well.

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