Thursday, 23 April 2009

Your Boss and Your Blood Sugar

An overbearing or inquisitive boss and especially one that is perceived as unhelpful to your personal goals is bad for your health has been proven in many clinical studies both from England and the United States. The end results studied have been death from Cardiac diseases. So choose your boss carefully!

This becomes even more important if you already suffer from a chronic disease such as Diabetes. As we all know, Diabetes requires constant attention, to the nutrition and the exercise, which have to be done on a daily basis..Having a meddlesome boss can be dangerous to your diabetes control is illustrated by the following patient.

22 April 2009

As I walked into the room, I see this slight woman, engrossed in her bead work, with a young granddaughter observing her. She looks at up me and I am so reminded of a brave patient many years ago, who battled her diabetes and carried all the burdens of a busy and responsible life but unable to meet all demands succumbed to her disease while still young.

Yes, I am her sister. The same slight build. Looking younger than her 50 years, and for an Indian patient with type 2 Diabetes, she is thin. People who call themselves Indian in this continent, with less racial admixture are most likely to be overweight or obese, whether they have diabetes or not. In fact only 5 per cent of American Indians are of normal weight.

Two visual clues immediately, she is the sister of Ms C who had a brave and grave battle with type 2 DM to which she succumbed. Secondly, she is thin, working.

 She is worried that her work situation has deteriorated to some degree that she is unable to go to the wellness centre for the required exercise. She is wiling to exercise on a daily basis, some thing we would like to hear from all our patients but seldom do so. Recent studies show that exercise advice is only seldom listened to and acted upon, unless the effects of exercise are fully explained to the patient, which requires time in a consulting room.

Her new boss began her duties in march of last year and because of the increased scrutiny, our patient had given up running one and half miles per day at the wellness centre around September. Her Hemoglobin a1c was 5.8 at that time, reflecting an average blood sugar of 101 and now it is 12.4, which means an average blood sugar of 316… three times the average sugar when she was exercising. Once again using the little table of what causes A1C to rise, we can see that in this lady, it is a clear cut case of Lack of Exercise, and the physiology in her metabolism is different, a type 2 DM with thin body habitus, who is already on Insulin therapy, but needs exercise for that insulin to work. So the resistance is at the level of peripheral muscles.

I wrote a prescription for 45 minutes of exercise per day and we will assess her in one month and see the improvement, of which I am certain.