The diagnosis of diabetes evokes different responses in different persons.
That a child diabetic cannot understand the gravity of the diagnosis can readily be understood. But many a time, even adults react childishly. Many patients just refuse to accept the situation. This refusal is expressed in different forms. Some patients bluntly state that they can’t have diabetes. Some others, who look at the diagnosis with suspicion, go from one physician to another and request for repeat laboratory investigations, as if in search of a physician who would favour them by saying, ‘You do not have diabetes.’ Even after being presented with irrefutable proofs and made to accept the bitter truth, such patients take medicines irregularly or in lesser doses. To some patients, the diagnosis diabetes gives a great jolt or a shock. Unending worry then overpowers them. Some patients do accept the diagnosis, but they hide it from their near and dear ones.
However, as time passes, most diabetics come out of the shock, assume a more mature behaviour and sincerely start following their physician’s advice.
In fact, there is no need at all for a diabetic to be unduly upset or feel ashamed. Millions of people in this world have diabetes. A patient who has reshaped his mind and is determined, can launch an assault against the disease. Today diabetics can boast of an almost normal and creative long life. Diabetics no longer die of acute complications like diabetic coma or gangrene. Diabetic pregnant women give birth to healthy babies at the right time. Life insurance corporations have started accepting insurance proposals from diabetics. These facts are indications of the progress made in the understanding and the treatment of the disease.
The life-picture of diabetes has undergone a complete change during the past 75 years. The statistical data given below is a testimony to this fact.
Diabetes is not a blow that has been struck by fate in retaliation of sins committed in the previous birth. A person should not think that diabetes is a ‘fruit of karma’ and that one can do nothing but meekly suffer it. The fact is that diabetes is a disease determind by heredity and precipitated by incorrect life-style, especially faulty dietary habits. With intelligent steps, the disease can be controlled and the life-span lengthened.
After the diagnosis of the disease, the diabetic (and his family members too) should strive to gather information regarding each and every aspect of this disease. If knowledge about (1) principles of dieting and exercise, (2) the dosage of insulin and the method of injecting it, (3) symptoms and treatment of low blood-sugar (hypoglycemia), (4) causes, symptoms and treatment of diabetic coma and (5) skin and foot-care is acquired, a diabetic can lead a happy, fruitful and long life.
Equipped with complete knowledge about the disease and with the support of the physician, the diabetic should launch an assault against the disease, first with non-medicinal weapons like diet, exercise, Acupressure and Magnet therapy. After commencing the treatment, he should get his urine and blood examined to assess the degree of control achieved.
It should be clearly understood that mere amelioration of symptoms is not a proof of the control of diabetes. For that, a periodic analysis of urine and blood is inevitable.
Diabetes can be said to be under control only when:
- Symptoms of diabetes are absent,
- Patient’s ideal body-weight is maintained,
- Blood-sugar levels are within the normal range,
- Sugar does not escape in the urine,
- Blood does not show signs of ketosis,
- The blood – cholesterol and blood – triglyceride levels are normal,
- The amount of glycosylated haemoglobin is less than 8.5 percent.
If the above-mentioned goals are not achieved with non-medicinal modes of treatment, the patient should, without delay, start medicines as per his doctor’s advice.
Till the disease comes under total control and till the physical condition has stabilised, the patient has to visit his doctor frequently.
Once the correct amounts of diet, exercise and medicines have been arrived at, the patient should faithfully cling to the treatment programme. A person who has learned to administer an insulin injection himself and can analyse his own urine and blood need not usually visit his doctor before three-monthly intervals. Thus the expenditure for treatment is considerably reduced.
The diabetic should meticulously note down the results of his day to day urine and blood analysis in a diary or a calendar.
Such a record gives a complete information about tht degree of control of the disease and guides the doctor in deciding the future treatment-plan.
Education : Child or young diabetics find no difficulty at all in pursuing education. Their intelligence and memory are in no way inferior to those of other healthy students.
It is desirable that the class-teacher and a few close friends of the diabetic student know that he has the disease and also know about the symptoms of hypoglycemia.
Household chores : A diabetic women can easily do all the household work herself. She should refrain from visiting relatives too frequently, where she may have to give in to her host’s insistence to eat or drink prohibited preparations.
If during an occasion, the diabetic women has to work more, the amount of medicine should be correspondingly decreased or the amount of food increased.
Job / Business : A diabetic can usually follow any kind of job or business to earn his living.
It would be desirable that a few of his colleagues know about his disease and the steps to be taken in an emergency.
Marriages, Parties, Restaurants, etc : A diabetic can take part in any function of his choice. Albeit, he should remain careful about his diet. It is natural that the host may, out of courtesy, insist on his having certain dishes or foods. But the diabetic should politely refuse, without making too much fuss. He should not hesitate to leave behind those sweet foods which have been forcibly placed in his plate.
Sport : Juvenile as well as adult diabetics can participate in sports, regularly or occasionally. However, care should be taken to prevent blood-sugar level from dropping too low. An untoward incident can be prevented by having immediately before the start of the sport, a snack which would provide easily and rapidly digestible carbohydrates.
Other illnesses : Like other people, diabetics, too, may suffer from other routine illnesses. Medicines taken for those illnesses may affect the blood-sugar level or may interfere with anti-diabetic drugs. For example, a drug called cortisone may elevate the blood-sugar level. If this drug is inevitable, the dosage of insulin must be proportionately increased for the time-being. Most tonics and cough syrups have considerable amounts of sugar and should be avoided by diabetics. In fact, a diabetic should take no medicine without his doctor’s consent.
Driving a vehicle: Today, maintaining and driving a vehicle is a part of life. A diabetic should remain careful while driving.
It is desirable that patients whose blood-sugar level fluctuates wildly (unstable or brittle diabetes) refrain from driving. This would prevent an accident on the road.
A diabetic who has to drive for long periods of time, should have a suitable snack before commencing the drive. Besides, he should keep with him foods which would supply easily and rapidly digestible carbohydrates.
Surgery : Many people harbour a false notion that diabetics cannot undergo a surgery without grave risks to their lives. In fact, any operation can be safely and successfully carried out if the diabetes is well controlled.
Sometimes, an acute complication of diabetes may necessitate an emergency surgery. A diabetic who has not taken due care to control his disease may find himself in a tight corner in such a situation. The surgeon has first to bring down the blood-sugar level before performing the surgery. This results in loss of valuable time. This is one more reason, why diabetes should always be kept under strict control.
Pregnancy: At one time, diabetes was a grave risk factor for diabetic pregnant women. The incidence of abortion or death of either the child or the mother was very high. The discovery of insulin has considerably transformed the situation. Even then, it is not easy for a diabetic women to first conceive and then give birth to a healthy baby at the right time. Difficulties can however be kept to the minimum with an expert gynaecologist’s care.
During pregnancy, the blood-sugar level of a diabetic woman fluctuates. In the first trimester of pregnancy, the requirement of insulin is low. During the second trimester of pregnancy, the blood-sugar level and consequently the requirement of insulin rises. If due care is not taken during this period, ketosis may ensue. In the last trimester of pregnancy, diabetes becomes very acute and management of the pregnant women poses great difficulties. Many a doctor opts for an early forced delivery, about two to three weeks before the right time.
During labour, a pregnant diabetic women has to strain a lot. Consequently her blood-sugar level plunges. Even after the delivery the blood-sugar level remains low for a few days, that is to say the disease-seemingly disappears. This, however, proves to be a temporary relief and diabetes soon reappears.
The blood-glucose level of certain women rises only during pregnancy. Such diabetes is termed ‘diabetes of pregnancy’. Prior to conception and after the delivery, the blood-sugar values are normal. About 50 percent of such women develop frank diabetes later in life. All women who present high blood-sugar levels during pregnancy or who give birth to large babies should take all possible steps to prevent frank diabetes in future.
In conclusion it can be said that a clear understanding of the disease and effective medicines available today enable the diabetic to lead an almost normal life. He can, under certain limits, play all sports, perform all activities and enjoy life. In many a country, there are special associations of diabetics, which arrange entertainment programmes and get-togethers for diabetics, hold sports competitions and keep the members appraised of new developments in the understanding and the treatment of the disease.
Great patriot Lokmanya Tilak and great saint Swami Vivekanand had diabetes. Talbert, the famous tennis player was a diabetic. Dr. Minot received the prestigious Nobel prize for medicine, in spite of suffering from diabetes. Prominent persons from all walks of life are living a joyous, active life spite of diabetes.
Come, let us accept the challenge posed by diabetes. If we obtain a correct understanding of the disease, we need not fear it, nor need we allow it to interfere with our normal life.