The Diet Police

 One of my good friends – who also happens to be my patient – now has Diabetes.

About this time last year he came to see complaining of feeling more than ordinarily tired, being unusually hungry and excessively thirsty, and having to pass urine all the time –  the classic symptoms of diabetes. After doing a few blood tests it was obvious that he had developed what doctors today refer to as Diabetes Mellitus Type II, which is a disease that is becoming increasingly common in the 21st century.

After giving him the diagnosis, instead of straightaway prescribing some tablets for him (which I felt would give him the wrong impression that all he had to do was take the pills every day and everything would be fine) I decided to tackle his problem in a more effective way. After all, he is the one with diabetes, not me – so it would be counter productive for him to think that I as his doctor was responsible for “curing” his diabetes. In reality diabetes is not a disease that can be cured, but it is a condition that can be effectively managed by the person who has diabetes if he or she understands the disease and undertakes the responsibility of controlling it.

I explained to him that in very simple terms, Diabetes is essentially a matter of Imbalance. It is the result of a discrepancy between the sugar and sugar-producing foods a person consumes – and that person’s ability to utilise and/or store this sugar. If more sugar (which we also refer to as glucose) is taken in than is used up or stored, then the extra glucose spills over into the blood – and gets into all the body’s organs where it starts to cause damage.

So instead of just writing out a prescription, I measured his weight, waistline and blood pressure – and suggested he come and see me the following week with his wife. Before that visit, I asked him to do three things:

• Maintain a food diary – by writing down everything that he ate and drank for the next seven days
• Test his blood sugar every day, using the simple machine, called a glucometer, that can test blood sugar using a finger prick sample of blood
• Try to do a good brisk walk for 45 to 60 minutes every day

When he returned with his wife about ten days later, bringing an accurately maintained record of food consumed and blood sugar readings (after all, he IS a conscientious accountant by profession!) it was easy to show him how his high blood sugars were related to the type food he ate, and (even though he had not been able to walk every day) how the glucose readings were usually lower if he had done his “exercise walk” the day before. After he digested this information, I gave him a few tips about how he could select foods and times of eating that would not put his blood sugar up excessively, encouraged him to continue walking as many days of the week as he could, referred him and his wife to a qualified dietitian for advice – and prescribed him a small dose of a tablet that he could take every evening with his evening meal.

The purpose of asking him to come and see me with his wife, I told them, was because it was HIS responsibility to manage his diabetes, and I was sure that his management would be more effective if he could enlist her help in this task.

It would be in effect a joint effort.

I arranged to see him again (with his updated two record books – one with his blood sugar readings and the other being his food diary) after a month. When he returned, all his readings seemed to be good – and when I checked him again two months later, with a special set of blood tests that could measure what his average blood sugar level had been for the past three months, his measurements were excellent.

I commended him for his efforts, and asked him how he managed to be so disciplined.

“It’s not me, Doctor, who should get the credit, it is my wife. After you involved her in managing my Diabetes, she watches what I eat like a hawk and makes sure we make the time to exercise at least four times a week. When we are invited out for dinner, she always now serves my food for me. Everybody says how lucky I am to have her do this, but I know that it is to make sure I don’t eat what I shouldn’t be eating. Even if I try to occasionally serve myself a large helping of chocolate cake or watalappan , she does not say anything – she just gives me That Look, and I serve myself a small piece or take some fruit instead. I now call her the Diet Police.”

“Actually, it is because of her that I have been able to manage my blood sugars so well.”

Then he smiled. “You know, Doctor – wives are very useful people, even if we don’t always like to admit this!”