Diabetes! In today’s world the thought of it probably invokes a similar adrenalin rush the native inhabitants of England might have had to news of the Vikings sailing up the Thames.
Being a doctor and having lived with this family curse (among others) for the last fifteen years, I would like to offer a few insights from both sides of the fence. Frankly, given the choice of family curses I’d have preferred to be howling at the full moon instead.
The common perception of diabetes as too much sugar is actually quite the opposite. The problem is actually too little sugar where it should be, somewhat akin to a blocked kitchen sink.
A simple explanation
A little contorted science here! Everything about life is energy, the cheetah spends energy chasing the gazelle so it can get energy from the kill to maintain a positive energy balance – so we’ll talk about how energy is used; dumbed down to the level that even someone like me can comprehend.
A lot of the food you eat is absorbed in the intestine, sent to the liver, and converted to glucose. This glucose enters the circulatory system and is then used by cells for their normal functioning. However, it does not waltz into the cells like a dog into heaven but has to pass through a gate in the cell membrane. These gates are opened by a key called insulin. Now, arbitrarily, under normal circumstances one key would open, say, ten gates.
Two common types (there are more) of Diabetes, Type1 and Type2, or the older more descriptive nomenclature – Insulin Dependant and Non-Insulin Dependant. In Type1, usually occurring at 20+/- years, there is inadequate insulin secretion from the pancreas hence not enough keys to open all the gates. In Type2 Diabetes, usually kicking in at 40+/- years one key only opens five gates. The worst part of this disease is that there is no cure, only control. Something a lot of people don’t understand.
I do get the occasional patient who comes back for review six months after I initially saw him with sugar levels competing with the cow who jumped over the moon. “So, have you been taking your medication?” And the proud reply is “Yes Doctor. You gave me medications for one month and I completed the full course.”
Either way, there is now a buildup of glucose outside the cell which is detected in the standard blood glucose test. As a result of this the cells do not receive adequate energy and hence do not function properly and eventually die and are not replaced due to the lack of energy. This affects every cell in the body from the top of your head to the tip of your toes. The effect is most pronounced in places where the blood vessels are smallest due to constant branching. The common organs affected, therefore, are the kidneys, the retina, and the peripheral nerves. Not that it spares other organs.
The cardinal symptoms of diabetes include frequent urination, excessive thirst and an increased appetite, coupled with lethargy and sometimes a tingling sensation in the feet or hands. When the curse hit me on virtually my 40th birthday I was wondering why I was urinating so much and feeling so unbelievably parched, to the point where I had to make a decision on whether to pee first or drink water first. I didn’t consider diabetes at first since that kind of stuff only happens to patients, right? As a doctor you sometimes feel you are only an observer and not a participant in life. After two weeks of emulating a minor waterfall and being partially responsible for the freshwater crisis on the planet, I came to the reluctant conclusion I might be diabetic. It took another one month to pluck up the courage to poke myself (petrified of needles) to check my sugar levels. The results made a bottle of Coca Cola look like a health drink.
With these ridiculously elevated levels I made the decision to go straight on to medications rather than mess around with diet and lifestyle modification (I wasn’t likely to succeed with that anyway). It still took about three months of treatment to get things under a semblance of control. We won’t get into the types of medication used.
Should you be unfortunate enough to land on the same side of the sugary fence as me, your doctor will discuss those with you.
On the look out
But as a general rule of thumb, it would probably be a good idea to check your blood glucose levels once or twice a year if you’re past 40 years, especially if you have a family history of diabetes – sometimes diabetes symptoms don’t show up till later. Awareness is everything and could save your life.
The more erudite will undoubtedly find holes in this garbled monologue, but as initially mentioned, this piece is tailored for my own comprehension. In addition to being diabetic I am also fairly non-conversant with technology, but legend has it that there is an oracle called Google which can tell you a lot more on this subject.
Dr Sanjay Shinde graduated from CMC, Vellore. He runs the Southern Medical Centre in Livingstone, Zambia where he practices what he proudly calls bush medicine – the ability to heal without the advantages of most modern-day medical aids. He is an avid photographer, a wildlife enthusiast, the Commodore of the Zambezi Boat Club and a diagnostician of distinguished ability.