Monday, 14 November 2016

So you’ve just been diagnosed with diabetes…

By Prof.S.V.Madhu,  MD, DM(Endocrinology),Professor & Head , Dept. of Medicine & Head, Centre for Diabetes, Endocrinology & Metabolism,UCMS-GTB Hospital, Delhi, India.

When she turned 40, Anjali Wadhwan decided to do her first general preventive health check-up, especially because she was obese (her body mass index was over 30).The examining doctor found that her sugar levels were high. He referred her to me, but asked her to try and lose weight and to exercise. When in a month this didn’t happen, we put her on medication. Unfortunately, these did not have much of an impact either, and in a few months’ time she had to be put on insulin.

Anjali was distraught for more reasons that one. “I suddenly felt old—my grandmother had been on insulin, and had been diagnosed in her 50s, and here was I, at 40, with a condition I would live with for the rest of my life,” she said. She was also petrified of injections, recalling her childhood trauma for them. We reassured her that injections had undergone huge changes in the past 30 years, and that they no longer pained. We also reassured her that it didn’t have to be a permanent feature. If she reduced weight, changed her diet, and began to exercise, we could look at oral medication again.

Anjali isn’t the only one who is worried at having to live the next 30 or 40 years with diabetes.She’s also not the sole person petrified of injections. Here are a few of the biggest fears that I encounter as an endocrinologist/diabetologist, and what advice I give those who come to me, so they can life their best life possible. Use this article as a guide, not as a prescription—that is something your doctor needs to write out for you.

Anxiety #1: “My doctor doesn’t listen to me.”

India has a paucity of doctors, so it’s possible that your doctor is conscious of the mile-long queue outside, to give all patients their due. Having said that, your doctor must be able to clear all your doubts and provide confidence and reassurance. People who are newly diagnosed with diabetes may be acting on several myths. Ask your doctor for a time that is convenient to him when you can clear all your doubts, note them down on a paper, and convey the message to him. A diabetologist must talk to you about your daily routine, exercise, diet, stress levels and of course medication, and guide you with each aspect.

Common complaint #2: “Injections hurt, and I fear them.”

Injections don’t hurt anymore. Most people remember the injections of their childhood which were indeed very painful.Today, there is an array of needles that can be used, which have shorter needle sizes than before, are thinner, and sharper. Insulin pens, for instance, are very easy to operate when you need to inject yourself. Ideally, your doctor should guide your first dose, and also share some literature with you so you know you are injecting correctly. The idea is to inject into the fat, not the muscle.

Common complaint #3: “My stomach will soon look unsightly!”

The stomach is not the only site you should inject into.The back of the upper arm, the hips, the outer side of the thighs, are all possible sites. Try and use the same area at the same time of the day. For instance, if you inject in the stomach close to breakfast, then use the thigh at bedtime. Insulin is absorbed fastest from the stomach, followed by the arm, the leg, and slowest from the buttocks. So if you are going to eat a meal, you will need to have it covered with insulin in the abdomen. Again, you don’t need to keep injecting in the same spot—change it around. If you do keep injecting at the same spot, little fat globules will form under the skin that appear rubbery outside. These will likely disappear in time, but it’s better to prevent this in the first place.

Common complaint #4: “I am doomed—my whole life will change.”

Think of a diabetes diagnosis as a driving lesson. When you are learning to drive, and even in the first year or so of driving, you need to be conscious of the gear, the clutch, the accelerator. But over time, it becomes second nature, and you don’t even notice when you change gears. Your experience with diabetes will be the same. Initially, you will find it a nuisance to check your body insulin levels, to take the injections, to go for the check-ups. With time, all this will just become a part of your routine. If you don’t want it to be routine, change your lifestyle to reverse the disease to some extent.

Common complaint #5: “I can never eat another sweet in my life without feeling guilty.”

Factor in the odd sweet when you want to eat one. Ask your doctor how you can do this. When mango season comes up, again consult with him on how to eat a slice and balance it with medication. However, platefuls of sweets are not okay for anyone, no matter how healthy they may be, so if you’re feeling bad that you can’t binge, then reassure yourself that you’re on the road to getting out of a bad habit.    

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