If in the early weeks or months the onset of diabetes is stressful in the absence of psychological support and advice, over the years one can live in a very relaxed way with the disease
In the wake of Diabetes Day, I have chosen to provide a personal experience as a diabetic patient. It is a factual account of how I coped with the disease in my own context with all the mistakes and shortcomings in my individual approach. It may or may not provide some insights to anyone interested in the disease or even to medical practitioners and health workers to understand their patients better. Yet in our Mauritian context, there is a need to understand patients’ weaknesses, prejudices, mistakes to better help them to combat the disease in more effective ways.
In my twenties I knew that one day I would become diabetic. One parent had been diabetic and I don’t remember that he took any tablet; in those days he contented himself with herbal infusions. With hindsight, becoming diabetic does not automatically follow if one parent is diabetic: of the six children, three are diabetic and three are not. As for me I had a sweet tooth and, despite the well-balanced meals given in the hall of residence during my student days, a desert at lunch and dinner had become an ingrained food habit.
In the 1970s when I joined the government service, I suspected that my sugar was high after a urine test but following a blood test at the hospital, I was never informed of the results. It was only in the late 70s, when I found some ants clustering around a few drops of urine in the toilet, that it dawned upon me that it was time to see the family doctor. A urine test did not reveal anything because of a high renal threshold but a blood test confirmed that I was diabetic and was advised to cut down on sugar and fat and was prescribed Daonil tablets.
I was worried and nervous for the first few months and decided, perhaps unnecessarily, to adopt a drastic food regime. It was not difficult, having been used to boiled vegetables in my student days, and slowly the diet regime became the standard dishes in the family. Apart from food I had to pay special attention to my feet: I made regular inspections and watched carefully for any blisters or any itch. The shoes had to be broader in front and my use of slippers and flip-flops was reduced to the minimum. I have learnt that with the loss of sensation in the feet of a diabetic, any injury could be painless.
Unfortunately in our popular culture we consider painlessness to be harmless with the result that many diabetics have had to undergo amputation. When I missed my daily walk for some reasons, I had burning sensations in my feet, my doctor would recommend some vitamins or some tablets to assuage the nerves, but usually after resuming my walk all the burning would disappear. Keeping informed about the disease led me to grab any book or article which dealt with the subject and in most foreign magazines health issues occupy an important place. I would take any NHS leaflet whenever I visited a surgery.
Herbal complement – monitoring blood sugar
While taking the diabetic tablets, like many people I have also considered herbal remedies. I tried very cautiously a few, mostly as supplements but stuck to allopathic medicine. An Aryuvedic specialist writing in an Indian newspaper had advised using Aryuvedic medicine in the early years of the disease but not as a substitute for allopathic medication for a number of reasons.
Even on my recent visit to India there was a new Aryuvedic medication approved by the government authorities but the reviews are divided on its effectiveness and its side effects. I have bought 100 tablets and am yet to use them. When I was diagnosed with diabetes, the generalist and the diabetologist were very helpful, always checking my blood sugar, my blood pressure and blood circulation and often prescribing some vitamin supplements depending on the type of complaints. I tested my blood sugar whenever I felt the need.
I always visit a generalist for other ailments and also because I find it necessary to have a second opinion whenever I feel the need not only for diabetes but for any ailment which crops up now and then. In Mauritius I am always in contact with relatives and friends who are diabetic and we also exchange information about our experience and treatment. There is also an element of self-medication. As I grew older, although my blood pressure is considered normal I have on my own taken a very small dose of blood pressure medicine as a preventive measure.
To monitor my blood sugar, I used a glucometer when I felt the need to do so and to keep to the range of 70-120, although at times a little higher was still acceptable occasionally but not to exceed140. It is extremely difficult to remain within the range for so many factors come into play. Sometimes the food may be richer than expected or I may miss my exercise for a day or two for a number of reasons. In the early years I never monitored the blood sugar on a daily basis and even today I do it occasionally. Increasingly I realize I have to do it more than once daily to stabilize the blood sugar during the day.
While in the beginning it was possible to do so with an increase in the number of tablets, in later years when I had reached the limit in terms of tablets I could only adjust the regimen by adding a slow-acting insulin. Sometimes I have also to intensify the daily exercises instead of increasing the medication. Even now with Metformin, Diamicron and10 units of slow acting insulin I can get a HbA1c of 7.5 but hardly 7.To reach this target it would require a strict diet plan as well as more physical exercise. This means outdoor walk must at times be complemented or supplemented by indoor exercises whenever the need is felt.
There are also new medications on the market which are more effective and also costly but one has to make a cost benefit assessment before adopting new medication. Monitoring one’s diabetes successfully requires an all time and unrelenting effort and one has to exercise one own’s judgment continuously. Sometimes we may be right or wrong. In the early years, a friend of mine, a medical doctor in the UK, suggested to go directly for insulin injection. I did not want injection at this early stage though this might have been current practice for people in UK, may be for people who cannot go without their daily pints of beer. I also thought that one or several injections might be inconvenient for me. With hindsight I think I may have been wrong in not taking his advice.
The Mauritian context
In Mauritius we prefer diet, some tablets and exercise. But dieting is not that easy. We do not know the glycemic index of every portion of the local food or the everyday meals that we consume. In other countries we have tables for the different kinds of food or food exchange but which are not easily applicable to our context. I still do not know the glycemic index of a pair of dholl puri or a few gateaux piments or even the amount of protein in these foods. I do not know the amount of calories in a dish of rice, lentils with one or two vegetables. All that I know from the many leaflets I collected abroad is to eat any food moderately.
Recently in the Harvard Medical School Newsletter, we are told to pay attention not only to the glycemic index of food but also to the glycemic load for ‘it gives a more accurate picture of a food’s real-life impact on blood sugar.’ The glycemic load is determined by multiplying the grams of a carbohydrate in a serving by the glycemic index, then dividing by 100. And the load of hundreds of foods is available on-line.
Food, food preparation and a food plan are important for the diabetics but it is also a daunting task for the diabetics and his family. The pesticide infected vegetables as well as the chicken and other animals routinely fed with antibiotics make it difficult for anybody to get proper food. We are all exhorted to have a balanced diet. Even the term balanced diet remains an abstraction for many of our compatriots and even those who seek to prepare a balanced diet face an uphill struggle.
Foods are expensive and are of poor quality. People do not have time at work to have proper meals and in a recent magazine, doctors in India who, all the time, preach to patients to have a balanced diet, find it hard to put it into practice themselves. More often they had to grab a sandwich between two operations and have no time for meals. In our homes how often do we measure the portion of food we cook or eat or consider the calories content except may be for pastry or deserts.
While there is a lot to be done to improve the diabetic’s meals, especially outside an institutional set-up, exercise remains an integral part of the lifestyle of any diabetic. Luckily I live near a park and had been taking the children every afternoon since they were 4 or 5 years old to play football with other kids and we adults joined in the children’s teams. Today when I go for a walk I can see these kids, now grown into adults still playing football. Over all these years, exercise had become an integral part of my daily life and this has contributed largely to improve my diabetic control and inevitably delay the onset of other diseases.
The age factor
As I grow older there are more challenges on the horizon, more threatening diseases which can appear at any time and which will get complicated by diabetes. One can expect to have cataract, problems with blood circulation, kidney problems and many more. Luckily I have had only one minor heart problem so far after volunteering for a stress exercise. More preventive measures are needed. I have drastically cut down on any animal protein and it suits me well because I have lost the taste for any animal food but still have to make sure that I have enough vegetable protein in my food.
The influenza vaccine which I have had since the 1990s has been very helpful. Recently I was advised at Apollo Hospitals, Chennai, to have pneumonia vaccine which lasts for five years. Diet, exercise and medication remain the main defenses against any complication of diabetes. It is a very expensive disease and on my next visit to a diabetologist I shall discuss with him about fresh adjustments to my medication so as to keep it within the normal range as far as possible.
If in the early weeks or months the onset of diabetes is stressful in the absence of psychological support and advice, over the years one can live in a very relaxed way with the disease, remaining vigilant as ever, always keeping in mind that stress has an impact on the blood sugar level. Today we should not make food, eating and drinking our only pastime; we should also develop as many other pastimes as possible and right from childhood. These should include exercise, sports and many more relaxing leisure activities to occupy our time than just eating and drinking.