Little Known Facts About Diabetes.

Little Known Facts About Diabetes.
1. Diabetes is not a disease, it is a disorder. Difference is that unlike a disease, it is symptom free. Therefore, doctors call it a “Silent Killer”.
2. Because it is a “Silent Killer”, doctor community is also mostly silent about it.
3. All doctors know that Diabetes is more deadly than cancer but find it very difficult to tell this bitter truth to patients / public as it sounds very impolite.
4. There are some events in life which cannot be quantified. Examples are : marriage, pregnancy, death and few more. Diabetes is one of them. As no one ever is ‘slightly or almost married / pregnant / dead’, similarly there is no such thing as ‘mild diabetes’. Though this word is commonly used amongst lay public, you may find it interesting to know that if a medical student makes the mistake of uttering this word while appearing for an examination, he is sure to fail. No examiner can ever pass him even if he wants to be helpful!
5. Similarly, once diagnosed; diabetes is either treated or untreated. Use of following words regarding the quality of treatment of diabetes is forbidden:
a. Almost treated.
b. By & large under control.
c. Sugar / diabetes is not a problem. (Remember it is “sssss-silent” like a “ssssss-snake”).
6. Parameter / measure of judging whether diabetes is ‘treated’ or ‘untreated’ is NOT Blood Sugar / Glucose reading on glucometer or in a laboratory test report. Neither fasting, nor after-meal. It is always based upon a special laboratory test called HbA1c (pronounced H B A ONE C). The cut off value is 6.5. A reading of 6.6 means that diabetes is not treated and 6.5 or less means that diabetes stands treated. Make no mistake about it: it is NEVER undertreated.
7. If untreated, regardless of the blood sugar / glucose levels and regardless of the HbA1c levels above 6.5, diabetes relentlessly but silently continues to cause damage to vital organs. It is much like termite (white ants or deemak) working silently on wood. Most of the brunt is borne by the following four vital organs:
a. Kidneys.
b. Heart.
c. Brain.
d. Eyes.
8. This silent damage to vital organs is irreversible.
9. By the time the patient begins to feel symptoms due to vital organ damage, more than half the precious tissues are permanently damaged. There is no known medical treatment world over, which can reverse this damage. Not only that, at this stage the down-hill progression is out of control. Improving the quality of treatment of diabetes at this stage does not cause the pathological processes to be arrested. At this stage, it is understood that kidney failure ending up in dialysis or kidney transplant is inevitable, it is just a matter of time. In addition, even if brain stroke has not taken place, brain damage is so much that early dementia sets in. Even if heart attack /s has / have not taken place, heart is too much enfeebled to work efficiently and chronic heart failure sets in leading to early death after a few years of miserable existence with a low quality of life.
10. There is a lot of controversy on the different modalities of treatment. Life-style journals & Sunday articles in news papers are recommending various ‘Do It Yourself’ remedies. Some people are bowled over by herbal medicines. Others are raving about Homeopathy and this pathy & that pathy etc. etc. My suggestion is that your focus must remain on HbA1c. If it is less than 6.5, your diabetes stands treated and the risk of complications involving vital organs is no more than that to the non-diabetic population. If it is more than 6.5, regardless of the treatment used, the patient is doomed to face target organ failure. Period.
11. Correct approach when you seek consultation with a doctor: Almost all the patients begin to whine about myriad symptoms they are suffering from. Pleeeeease……..remember, diabetes is a ‘Silent Killer”. Therefore, at the outset, you tell your doctor something like this “Doctor, I am a patient of Diabetes Mellitus. I have no problems or symptoms now. But I want you to treat my diabetes in such a way that my HbA1c remains less than 6.5 throughout the year, year after year. And yes, please make sure that I do not get any episode of hypoglycemia, not even once and also that I do not gain weight”. Make it clear that you are committed to this cause and are willing to make whatever sacrifices need to be made and whichever medications have to be taken. If your doctor accepts the challenge, well & good. Otherwise, move on to the next and so on & so forth. Dig deep and ye shall find……….. Jin khojaan tin payee-aan, gehre paani paith……….
12. To treat diabetes successfully, your treating physician needs to have the following: Tremendous amount of will, and a certain amount of skill.
13. Be prepared that you are not likely to find such a service provider willing to accept your request. Who is to be blamed? Let’s see:
a. Hospital (in which the doctor is working)? No. Government hospitals follow Policies & Procedures laid down by the government. And private, corporate and charitable hospitals provide only those services which their Board of Directors / Board of Trustees approve. No Board is ever going to approve a double loss making proposition like HbA1c target achievement. Double loss making because firstly, as such it will need lot more resources than it’s earning potential and secondly most of the revenues of hospitals come from treating diabetes related complications. Preventing those complications amounts to killing their own business! Can you imagine a poultry farm owner spending money on promoting vegetarianism?
b. Government ? No. Governments are made up of politicians who need your votes. Therefore, they will give you what you ask for. If you do not even know what HBA ONE C is, they are not going to thrust it upon you.
c. Doctors : No. Doctors have to work through an establishment which has been set up by some investor / investors / government. The nature & scope of services to be provided in the given establishment is NOT decided by the doctors but by the owners who have invested hard cash and they have to keep to a single-minded focus on achieving ROI (Returns On Investment). Those few doctors who are working through their singly owned or joint private practice also have obey the advice of their Chartered Accountant based upon their Balance Sheet and Business Advisors / Business Consultants. A loss making proposition like treating diabetes to achieve treatment targets with the aim of preventing complications is never ever going to be approved by these professionals. And without their help, no private practice can survive in modern world.
d. You, the end user : That is where the buck stops. Yes, call it blame or call it responsibility, but the ball is in your court, Dear Sir / Ma’am. As is mentioned in Hindu scriptures (so I’ve been told) that we all are sitting under the Kalpavraksh tree and our every wish is coming true. Still the world we are living in is like hell, whereas it ought to be a paradise right here. Where is the disconnect? The missing link is that we are making wrong wishes.
14. For clarifications, all are welcome to contact me through email. After serving in the Indian Army Medical Corps for nearly two decades as a Medical Officer, I sought a premature retirement and then grappled with harsh realities of private sector in Delhi and now am working as a Senior Consultant Physician in the Ministry of Health, Kingdom of Saudi Arabia. more