Looking After Diabetes
Diabetes Mellitus is not simply “high blood sugar”. Unfortunately, that is how members of the medical profession have come to represent this condition, and not surprisingly, their patients have followed suit.
Diabetes is usually diagnosed when a person is found to have a high Fasting Blood Sugar or a very high Random Blood Sugar. Blood sugar then becomes the measure of the patient’s health for the rest of his or her life, with most responses to the condition centred on “treatment” and dietary “control”. Small wonder that so many “diabetics” rebel. People who are feeling well are understandably reluctant to be labeled and directed to “comply with the doctor’s instructions or else”.
There are several metabolic disorders that can lead to elevated blood sugar, but by and large, people with diabetes can be divided into two groups: those in whom there is an absolute shortage of insulin due to a defect in the islet cells in the pancreas (an organ in the back of the abdomen) which produce insulin, and those in whom the metabolic processes that “burn up” glucose are inefficient. Since about ninety per cent of the people with diabetes in this country fall into the latter group, that is the “diabetes” we will be referring to in this article.
To identify “high blood sugar” as the central problem in these people is to come pretty close to missing the point entirely. The level of sugar in the blood is a result, not a cause of the problems that people with diabetes have, and checking the blood sugar, or worse, checking to see if any has spilled out in the urine, is only a partial – albeit crucial - assessment of the extent to which the condition is being properly managed.
To use an analogy, the pressure in the tyres on a car is a very important factor for the safety of the driver, but if the driver only keeps a check on his tyre pressure with no regard for the condition of the tyres, he is still very likely to find himself in trouble.
People with diabetes are not “sick” - at least, not until complications set in. They do not “need” a doctor any more than extra-short or extra-tall people need a tailor. The right doctor can be immensely helpful, especially in maintaining the self-confidence and the autonomy of the individual, but too often the opposite ensues.
The worst thing that can happen to a person presented with this condition is a loss of independence; a feeling that something has developed that is beyond their control. Unfortunately, that is the commonest outcome of the interaction with the doctor at the time of “diagnosis”. To understand why this is so, we would have to examine the whole frame of reference in which the doctor operates.
The first; the most important thing that an individual needs to attend to when presented with high blood sugar is his or her fitness - in every sense of the word.
In a very real sense, high blood sugar means that the cells that make up the flesh are unfit. It is inside the cells that the problems arise; it is there that the prevention of complications must be effected; it is there that the treatment must be applied, and by all indications, the most effective “treatment” (in type II diabetes) is exercise.
Researchers have not yet figured out precisely how exercise affects cell metabolism, but the outcome has been established beyond any doubt. Recent studies have even indicated that diabetes can actually be prevented by a high level of fitness, while at the other end of the spectrum, the complications of diabetes are more frequent and more severe in people who are in poor physical condition.
Good physical condition is almost impossible to achieve in people who are in poor emotional, social and spiritual health. Fat people are almost invariably low in self-esteem. Sedentary people are consequentially lacking in energy; unhappy people do not have the will; bored people will not have the purpose, and lonely people will not have the support that is needed to bring about profound changes in lifestyle.
And so it is that most people do what is easiest: visit a doctor and take some tablets. And of course the busy doctor also does what is easiest: he prescribes some tablets and admonishes the patient to “test your blood regularly, be careful with what you eat, and try to get some exercise. Next patient please.”There is nothing in a doctor’s training that equips him or her to improve a patient’s fitness. No counselling skills are taught in medical school; behaviour change is not in the curriculum. The better general practitioners acquire some insight into human nature with experience, but even the best of them operate in a reactive rather than a proactive mode, so that they have very little to offer a fat and sedentary patient who presents at age thirty with “impaired glucose tolerance”. Thirty years later that patient will still be fat and sedentary and will lose his leg as a direct consequence of this, but it will not occur to either doctor or patient that things could have been any different.
Medicine is a reactive profession. In an age that requires proactive measures, there are those who argue that doctors are part of the problem rather than a resource with solutions. Consider that ninety per cent of medical problems today is lifestyle-related. Consider that one in every six adults has diabetes, and that as much as forty per cent of the national health care budget is spent on diabetes and its complications, and it is possible to understand why.
The government is justifiably proud of the C-DAP programme which has ensured a ready supply of tablets for diabetics. The real problem, however, is that fifty percent of the diabetics in this country ought not to be on tablets in the first place. All we have to do is find a way for them to lose weight and get more exercise.