In my previous blog, I wrote of how several people set me on Endocrinology’s path, and I am really grateful to them for setting me on this path. Endocrinology is an advantageous branch.
Patient NB walked into my office slowly, nervous and apprehensive of one more doctor. She had struggled for nine years to control her blood sugar levels, finally landing up in the hospital with a heart attack. She took several different types of medications for diabetes, high blood pressure, heart and cholesterol medications, and insulin. She was experiencing high blood sugars most of the day with sudden dips after lunch.
We worked on her sugars for many long months, trying to customise her diet, motivating her to exercise, juggling medications and insulin shots. We struggled through low sugars and sudden highs. But finally, after 7-8 months, she is off the insulin and down to a single diabetes medication.
People ask her what has changed. She looks healthier and happier. She credits me. But, I credit her for not losing her faith in me and continuing to follow up with me without grumbling about the fees closely. All doctors give good advice, but not all patients listen. I was impressed with her perseverance to correct her blood sugars. She never complained even when she got a mild urine infection as a result of the diabetes medication. She understood that the side effect does not mean that the doctor wants to harm the patient.
Her complete faith in me is what made her well.
KB is an 80-year-old gentleman who came to me with very high blood sugars. The kidney specialist referred to him. Unfortunately, most diabetes tablets cannot be given in patients with kidney disease because of safety reasons. The task before me was difficult. To convince an 80-year-old man to stop all his tablets, and take insulin shots 4 times a day, it’s probably easier to walk to the moon!
It took several consults to convince him how diabetes medications would harm his already delicate kidneys, teach him how to inject insulin by himself, check his blood sugars and how to record them. After almost 2 months, he mastered the art of insulin injection, and today his blood sugars were perfectly normal.
His son actually cried – he told me – “main bhavuk ho gaya aaj”(I am emotional today to see him well). Now I can send him back to the village without any fear.
The purpose of this blog is to say that stopping insulin for my patient does not make me a good doctor, and starting insulin for my patient does not make me a bad doctor. Often, patients come with the specific purpose of stopping their insulin shots. After some years of diabetes, insulin may be necessary for the patient.
My job is to make the best choice for my patient, where blood sugars are controlled without undue side effects. So, it may mean starting insulin, and in some, it may mean stopping insulin.
The ultimate goal is the health and safety of my patient.