Sugar वाली madam

It was a usual day at my urban health center. We junior residents from the community medicine department were treating our patients to the best of our knowledge and according to the medicines available in the dispensary.Every Monday ,Wednesday and Friday we have a special OPD for patients with diabetes and hypertension.We even have a special register for them where they have a specific registration number.In that register their ongoing treatment is noted.When we change anyone's treatment we have to note it in the register.So that day after the OPD got over a patient came back to me again and sat down next to me with an inquisitive face.I asked her what happened.I was already tired answering apparently useless questions of other patients.I was in a hurry to send her off.But the way she asked me her question I felt it was my duty to answer her properly.

"मुझे मेरे पडोसी ने कहाँ की मेथी को पानी मे डालके रखनेका फीर सुबह सुबह वोह पानी पीनेका। तो diabetes पूरी तरह से ठीक हो जाता है। " She asked me if this was true. 

As a mandatory PG activity we have to do something called the "thesis".It is a research project supposed to be done other than our daily activities.So it becomes a kind of a burden for the students.But being interested in research I happily took up the project of doing research work on complications of diabetes.It was interesting and exciting at first - checking for complications of diabetes among urban slum dwellers.But later when I came down to look at the practicalities it was full of complications in itself.Collecting the data for my thesis was going to be a big task.This patient asking about मेथी was a part of my data.I had badgered her with a lot of questions then I had pricked her to collect her blood sample and she had given her urine sample too.So she was expecting that I entertain her more.

Diabetes Mellitus is a clinical syndrome characterised by hyperglycaemia due to absolute or relative deficiency of insulin.So much for 5 and a half years of medical knowledge.I be proud of myself.But the lady be like - What is all this medical jargon?Rubbish! You took my blood now, you better cure my diabetes!! So I had to break it down for her. ( Challenges we face while being a doctor )

She was a 4th standard pass female.How would she understand that diabetes can never be cured?I remembered one of my sessions with Aba ( Dr Vijay Ajgaonkar ) ,a well known diabetologist.He was the one who had taught me that you have to go down to the level of patient's understanding and then talk to them.So that is what I did.

She understood what glucose meant.So I told her that all the body organs need glucose to function properly.But how do they utilize the glucose.Imagine the organ having a door for the entry of glucose.But the door is locked.Somebody needs to open the lock for the glucose to enter.She understood that insulin is a hormone produced in the pancreas.Now this insulin acts as the key to the lock on the door.So insulin goes and opens the lock and ta-da the door is open.Glucose can now easily enter the organ for utilization.She was happy that she could understand all this happening in her body.

But what happens in diabetes? Levels of insulin go down and glucose is not properly utilized.She was like "अच्छा ! तो पर मेरा diabetes कभी जाएगा नही क्या ?" I was like how will it get cured it can only be controlled because we cannot make the body produce insulin on its own again.She was satisfied with the answer but not completely happy with it.Who will be happy when you have to take medicines lifelong ?

Diabetes has a lot of complications! I have collected data for 115 diabetic patients. Almost 70% of patients have at least one complication . Neuropathy being the commonest.It is a big task to prevent these complications from happening.You have to monitor yourself frequently.Eye examination needs to be done every 6 monthly to check for diabetic retinopathy. The vessels in the retina get damaged due to diabetes.Like this vessels of the heart and brain may get blocks due to diabetes.

Diet! Most important factor in diabetes.......NO FAST AND NO FEAST!This means you should eat at regular intervals of 2 hours but in limited quantities. Every diabetic person should remember this.Low sugar low carb low fat diet.Although the diabetic patients who are taking medicines or insulin should be careful and remain alert for signs of hypoglycaemia .The signs are weakness, dizziness and extreme sweating.When such hypoglycaemic episodes happen they should immediately have some sugar directly.

Care of the foot is very important too for diabetic patients.I had a patient once who came with a badly injured foot which was not healing at all since 2 months.Amputation is the only option when it comes to such cases.Due to diabetic neuropathy the sensations of foot are lost hence any injury to the foot is not felt and registered by the patient.Due to diabetes immunity is also hampered so infection takes time to heal.

Still after all this a diabetic patient can lead a normal life.I have seen my father going through all this.He is leading a pretty good life even after a few major complications.

My thesis is going take one and a half year more for completion.I hope to meet more interesting patients and treat them as far as possible.

( Brain saying to insulin : तू  तो हर  ताले  की  आज  चाबी  हो  गयी ! )

( PS : Balam pichkari song references )