3 - IN - 1. ARE WE FOOLING OURSELVES?

Modern medicine has lots of wonders up its sleeves... So do the pharmaceutical companies that manufacture the wonders required for maintaining health. The classical methodology of treatment was using monotherapy (simply speaking its one drug at a time). In diabetes this policy doesn’t work. As I have discussed in many of my previous posts Diabetes is multi-factorial and so does the modality of treatment. Combination therapy is the norm in treatment of Diabetes. We need to squeeze out the insulin from the pancreas plus make the squeezed out insulin work better by increasing the body’s sensitivity to insulin plus reduce the carbohydrate absorption from the food we take... Generally I prefer to start treatment by giving individual medicines. Once the patient’s blood sugar is under control we can try combination of tablets. The logic behind combining is to simplify the treatment schedule for the patient. Lesser number of tablets means more patient satisfaction.

DEPRESSION IN DIABETES!!

              Our country has the largest number of people affected with Diabetes. In the previous posts I have discussed in detail about the cause of the sudden increase in number of Diabetic population. Few years back Diabetes used to be termed an “Urban Epidemic” and now with incorporation of various cultures and poor eating habits we have successfully made Diabetes an “Indian Epidemic”. In this post I am NOT going to talk about Diabetes, instead I am trying to go into the psychological aspects revolving around Diabetes. The following lines will be purely based on the experience which my dear patients have given me. I am not sure how many of my colleagues try to analyse the patient’s state of mind before revealing the diagnosis of Type 2 Diabetes. I am sure most of them do....

            The people who face the diagnosis can be broadly classified into three categories.

• Patients who have a strong family history of Diabetes with classical 3P’s (Polyuria, Polyphagia, Polydipsia). They generally convince themselves of the diagnosis before they come for confirmation with blood test. In most cases whether they reveal or not they would have seen higher numbers in Glucometer /Lab test. These patients are receptive when the diagnosis is revealed. This acceptance makes it easy to start off the treatment (Life style modifications/ pharmacological therapy) immediately.
• Patients presenting with classical 3P’s without family history of Diabetes. Well.... there is gonna be starting trouble...
• The third group of patients are those in whom the diagnosis presents without any warning symptoms. The patient would have undergone a blood test for some other reason and Diabetes comes like bolt out of the blue... They have no clinical symptoms to suggest Diabetes. These are the set of people who need a great deal of psychological support.

Diabetes for many is a spine chilling diagnosis. Advances in science and improved modalities of treatment have not been able to alleviate the fear. In my personal opinion the fear is because of

• Fear of insulin pricks which any Diabetic would need at some point of time.
• Fear of possible damage to kidneys.
  
• Fear of losing the limb.
• Fear of changing the lifestyle (Daily exercise & Diet restrictions).
• Fear of frequent blood investigations and the cost factor involved.
• Fear of frequent visits to the doctor.

Every patient diagnosed with Diabetes goes through the stages of (i) Denial and isolation (ii) Anger (iii) Bargaining (iv) Depression and (v) Acceptance. The time duration of every stage varies from person to person. In the Indian scenario the stage of denial means

• Change of Doctor
• Change of Lab which issued the high blood sugar value
• Trial and error with alternative medicine
• Trial with fenugreek, ladies finger, insulin plant and many other native ingredients used in cooking....
• Some try to stick on laboratories which give lower values
• Avoidance of sweets.

The time duration from stage I to stage IV has to be considerably reduced so as to facilitate early institution of therapy and to prevent Diabetes related complications.

                 In India the mindset does not allow people to access counselling centers. Although the stature of psychological counselling in India is better that what it was a decade ago, there is still a long way before people reach out for psychological help. I feel the treating physician has to take up the role of psychologist as well as far as Diabetes is concerned. Why? The compliance to therapy whether it is life style modification of medical nutrition therapy or drugs depends on the acceptance levels. Going to a psychologist is not well taken by our patients. If we force them to seek help they are just going to change the doctor leading to more delay in initiation of treatment.

                Successful management of Diabetes needs constant education, clarity on the targets and methods to achieve these targets, clear discussion regarding mode of action, timing of tablets and side effects. Every person affected with Diabetes needs a good amount of support mentally to stick on to the planned regimen. Once the reward of hard work in terms of good blood sugar levels is reached then the patient can motivate himself/herself. Diabetes being a chronic condition requiring lot of dedication from the patient as well as his family it would be better if the doctor would keep in mind the psychological aspects as well. This will help in improving compliance to regimen planned, ease in attaing targets and delay / prevention of Diabetes related complications. In a nut shell we can make THE difference by providing better quality of LIFE!

THANKS ITB!!

It is exciting to be recognised!  www.riyazsheena.blogspot.in has been listed in the directory of Indian top blogs (2014-2015) for the SECOND  consecutive year. Thanks ITB for considering my amateur work worthy of being in the list. I also congratulate my dear fellow bloggers in the ITB list. 

Known is a drop, unknown is an ocean. Lets keep learning and sharing!!

THE LIST OF INDIA'S BEST!!!

DIABETES DOCTORS!!

Doctor - a very honourable profession. This profession a unique as a Doctor is expected to have many different qualities under his belt.

Doctor should be a patient listener.

Doctor should think rationally before suggesting investigations and while interpreting the results of investigations done.

Doctor should be cordial and easily approachable.

Doctor should be soft spoken.

Doctor should be a good counsellor as well.

The above mentioned qualities are most important for a doctor while managing patients. These become more important when treating people with chronic disorders like Diabetes. Most of these qualities are sadly missing in our generation of Doctors.

SENSIBLE NEWS Vs SENSATIONAL NEWS!!!

BAD NEWS SELLS BEST!

It is said that our brains are more receptive to information in the mornings. Like everybody else I was scanning through the news paper today morning and came across a article titled “POPULARDIABETES DRUG CAN CAUSE SIDE EFFECTS: STUDY”. By instinct went through the details and to my horror it was about “Metformin”. The side effects mentioned the article related to Vitamin B12 deficiency. This is a classical case of “OLD WINE IN A NEW BOTTLE” Vitamin B12 deficiency on prolonged use of Metformin has been known since ages and it forms the basis of adding multivitamins in the Diabetes treatment schedule.

When reading this article I felt the leading news papers should be more careful while reporting such sensitive issues of public importance. I do agree that it is a reporter’s duty to present the facts as such for people to decide but in certain places I think it is not justified.

Here is what I feel...