The patient pulls out his/ her reports, and there are the problems: the blood sugars are high, the blood pressure readings are high, the obesity is worsening, and oh, the cholesterol level is high too. The worry about kidney failure and blindness is topped with the sad, frustrated plea, ‘have stopped eating sugar and sweet things, doctor, and my food is different from other family members, yet everything is uncontrolled.’ Worse is the patient who reads up all that the internet, advertising, and social media have to offer: plenty of facts, half-baked opinions, irrelevant information, advice based on western contexts, and outright myths, and even worse, the one who tries to implement the advice, with resultant utter chaos and confusion.
Two thousand twenty has been especially frightening, because all one hears is Covid… Covid and co-morbidities, Covid and diabetes, Covid and uncontrolled diabetes because of the steroid treatment, Covid and higher death rates because of these factors. The lockdown and the forced staying indoors are giving people ample time to worry themselves sick, literally. Yet this is also the time that the sensible ones have turned it to great advantage: the absence of mindless partying, the reduction in commuting time, the increased home cooking, have helped them build up fitness, lose weight, reduce medicine doses with better sugar and BP control.
Ideally, faced with a sorry mess, the explanations have to start—that for controlling sugars, BP, obesity, we need to pay attention to what we are eating; but that there is no such thing as a ‘diabetic diet’; that the person with diabetes (PwD: we no longer like to use the word ‘diabetic person’) should have a sensible, balanced diet, as should everyone else; that there is no need for separate cooking; but that carbs and protein and fat have to be balanced out; that high sugars are very bad, but low sugars can also be dangerous; and so on. The busy doctor has no time for all this, so the patient is packed off to consult a dietician, who then whips out one or a series of diet charts, instead of explaining the basics and helping make permanent changes. Things improve a little, then boredom sets in or old habits make a comeback, and the cycle repeats itself. ‘I have followed the dietician’s charts, doctor, yet everything is uncontrolled.…’