How do people react to being told they have Diabetes?
Here are some examples, by Dr. A.G. Unnikrishnan with inputs from Sunila Kelkar.
A doctor's dilemma
A very frequent dilemma faced by doctors involves conveying to patients that their ill health is the result of a disease. Informing patients that they have Diabetes is a tough task. But informing a person that s/he has Diabetes is far less difficult than informing a patient that they have a very potentially life threatening and serious disease like cancer. Usually, when told that they have an illness, people's responses pass through a range of emotions from a simple denial onto absolute acceptance. The same trend is observed in patients with Diabetes.
This is important to understand as studies are increasingly showing that understanding our brains and minds better increases our awareness of our thoughts and actions. This means these stories will offer the reader an insight into how crucial any doctor-patient relationships are and how we can harness our thoughts and actions to improve our health. Secondly, if you know somebody (a friend or a relative) who has been diagnosed with an illness, understanding their mindset can help you assist them accept their disease. This helps put them on the road to health and recovery.
The following are two undesirable responses observed when patients are told they have Diabetes. The patient names have been changed to preserve confidentiality.
Simple Denial: Case of the Confused Lawyer.
I had, before me, the entire blood work report of Mr. Thomas RJ (42 years old). His blood glucose level was 156 mg/dL in the fasting state and 298 mg/dL (taken 2 hours after a meal). This clearly meant that the patient had Diabetes. A fasting glucose level of >126 mg/dL or a post-glucose-load value of > 200 mg/dL indicates Diabetes. Mr Thomas was worried as he had a strong family history of Diabetes. He asked, "Doctor, tell me are my reports normal?". I explained to him over the next 15 minutes that he had Diabetes and that there was nothing to worry about. I also explained that with diet, exercise and medications, he would be fine. Mr. Thomas was a lawyer by profession and lived a stressful life. I informed him that stress could worsen his blood glucose levels.
Mr Thomas replied with utter disbelief, "I don't think I have diabetes. I will retest after 3 months and decide". "Sure," I said. "It is your decision after all. I have merely confirmed the diagnosis and explained the details to you. I feel that it is best that you follow my treatment advice. However, I have no problem with you seeking a second opinion. But it would be beneficial for you to check in, in a week or so, rather than after 3 months". Fortunately a week later, Mr. Thomas came back for a retest. This time, his fasting glucose value was 199 mg/dL and his post-meal value was 314 mg/dL.
Seeing the report, he accepted the need to immediately start medications, which was promptly initiated. Today, his glucose levels are under good control.
This raises questions regarding the shock and horror linked with the deniability that people experience when they are first told that they have Diabetes. The very fact that the prevalence of Diabetes exists in an individual's family history should ring a warning bell. Mr Thomas was an educated lawyer but his refusal to accept that he had Diabetes was astonishing. Mr Thomas sought out the help of a Diabetes specialist but refused to accept the prognosis. When one's feeling of well-being is threatened, people have a hard time accepting that they suffer an illness and require medical intervention. In fact, many patients undergo tests only to prove that they are well and don't require any treatment. This was the crux underlying Mr. Thomas lack of acceptance. Though re-testing convinced him this does not hold true for all patients. In spite of repeated testing, many patients do not accept the fact that they have Diabetes. This denial can last from months to even years, till they really fall ill. The solution, in my view, lies in distancing yourself from your emotions and taking a pragmatic stance. Only in this state of "wakefulness", when patients are able to look at themselves from a distance, are they able to understand and accept the fact that they have Diabetes.
Deep Seated Denial: Case of a disbelieving teacher
The door opened, and Mrs. Sharma (name changed) walked into my room. A teacher in the nearby school, she had been referred to by a practicing physician, Dr. Bose. Her fasting glucose level was 148mg/dL, and that the post-meal glucose level was 223 mg/dL. This clearly meant that Mrs. Sharma had diabetes. When informed of her diagnosis, Mrs. Sharma was of the opinion that reports could be wrong, and wanted to see a specialist. Dr Bose, sensing that it might be difficult for him to convince her about the illness and the treatment plan, immediately agreed.
At our hospital, Mrs. Sharma's fasting glucose level was 151 mg/dL and the post-glucose-load value was 211 mg/dL. The results continued to confirm Diabetes. Another test, the HbA1c was done. This was 8.2 %, suggesting that the average blood glucose levels across 3 months were very high. There was now ample proof that Mrs. Sharma had Diabetes. I informed her that she had Diabetes and also reassured her that she would be fine with good control of blood glucose, blood pressure and lipid levels. I also emphasized the need for an annual screening for Diabetes-related complications in future. Mrs. Sharma took her time to understand all this. She had plenty of questions to ask. I answered all these doubts. She then asked me to prescribe medications, which I did. After thanking me, she promised to come "later" for a follow up.
I did meet Mrs. Sharma later, but it was 3 years later! While visiting patients admitted to the Intensive Care Unit (ICU), I was informed by the ICU doctor that a patient had been admitted with very high glucose levels and a very severely infected foot. The patient's kidneys and lungs were failing because of the infection. The patient was not taking any allopathic medicines for Diabetes but was on a mixture of alternative medications pills. I recognised the patient as Mrs. Sharma when I had a look at her hospital records.
Mrs. Sharma's condition gradually improved with blood sugar control and the required antibiotics. Her kidney functions also normalized. Today, she continues to take insulin and is a regular patient who comes for consultation every month. Her blood sugar levels are perfectly controlled. She often tells me that she regrets her decision to avoid allopathic medications and try alternative medicines instead. She felt she lost valuable time and her health, exposing her body to very high levels of glucose. She described it as "escapism" and as she could not come to terms with her illness.
Diagnosing Diabetes: An Ideal Scenario
Scientific evidence suggests that for young persons with Diabetes, achieving glucose control early can help prevent complications of the eyes, kidneys, heart and feet. An immediate start to treatments on diagnosis proves beneficial as early glucose control reduces the complications affecting people afflicted with Diabetes in the short and long term. Your doctor would not be prescribing medications or issuing a diagnostic label unless it was necessary. By all means, seek a second opinion if you desire (indeed this is the right of every patient).
Patient deniability with regards to Diabetes is tied up with the level of Diabetes awareness in the community. Knowledge Diabetes as well as its co-morbidities is necessary for patients, their care-givers and the general. This will help initiate early and accurate glucose for the millions of patients with this illness. Refusing to believe there is an illness/disease will not make it go away. That is merely wishful thinking! It is completely illogical to delay diagnosis and treatment, as the disease only worsens and reaches dangerous levels.
The responsibility to make the public aware of Diabetes (its treatments as well as its complications) rests on the shoulders of medical professionals, media, teachers and the people with Diabetes (their relatives). Read about health and illnesses. There are many resources, both in the digital and print media to choose from, not to mention television and radio shows on health. When there is universal awareness about Diabetes, the care and control of those with Diabetes will improve, enabling them to lead a healthy life.
It is essential to "KNOW" Diabetes is to say "NO" to Diabetes!
Not to ignore any warning signs with regards to our health when they present themselves.
That every patient prepares themselves to face reality whenever they meet a doctor. Take a step back, relax and look at the situation objectively.
To not delay your diagnosis or treatment for an excessively long period.