Saturday, September 6, 2008


Diabetes is the ultimate lifestyle disease. A metabolic avalanche, poisoning the body organs. When I diagnose or meet an early diabetic, I tell them that they can reverse the whole thing with lifestyle changes. They can avoid pillboxes, insulin, blindness, kidney disease, heart attacks, without any help from me, if they can make the lifestyle changes needed.

How many have taken me up on it?

Two. Out of the hundreds of diabetics who's paths I have crossed.

The first was unintentional. A middle aged man, his wife died suddenly. He was lost without her. He stopped eating, lost large amounts of weight. Stopped coming to see me. Stopped taking his pills. After a year, his diabetes, high cholesterol, and high blood pressure were gone. He was so depressed, so distraught, his most fervent desire to be with her again. I couldn't tell him that his lifestyle changes (albeit depression-induced) had greatly extended his predicted lifespan.

The second was beaten into submission. His wife, so quiet I rarely hear her speak, listened carefully at our first visits. They started walking between 5 and 10 miles a day. Every day, for years now. It's clearly her idea. It's clear that he doesn't have an option to not walk. And it's worked great for him, his numbers are fabulous. He feels great too.

The rest don't do it. The vast majority know what it is that they are supposed to do. But they don't. Over and over I ask myself "Why?" Surely there is plenty of negative reinforcement.

What doctors require of diabetics isn't fun. Shots, blood sugar monitoring, daily medications, frequent office visits. I ask, "What is your worst eating habit?" and they know. It's not that they don't know. But they don't change their behavior.

Doctors aren't educated in behavior change. We don't really have time for it. Diabetics can get all of the diabetic education you can shake a stick at, but without behavior change it means little. These are deep-rooted behaviors, formed very early in life, cemented in by kids, work, family, society.

We need to understand better how to teach behavior change. It needs to become an integrated part of the medical field. There is only so much that advice can do.


Anonymous said...

Have you seen this blog?

She's lost over 100 pounds already, and talks about the changes she made to make it happen. She's smart, thoughtful, practical, and funny. Oh, and she's reversed her diabetes. You might find it interesting.

Dr. Smak said...


Without having read the book that the blog author credits, this is *exactly* what I'm talking about. Cognitive behavioral techniques to deal with lifestyle changes. Thanks for the link! I'm going to have to look into it more.


PharmacistMike said...

Making an impact from your educational efforts is a big problem I am dealing with now. I formed the Testicular Cancer Society and have talked with dozens of other survivors. No one remembers being told by their physicians to do self checks. I do remember the conversation with my doctor when I was 16 but I didn't listen. I just found my tumor by chance at age 33.

So if you are going to educate the how do you get it to stick?

Anonymous said...

Thanks for this.

I rarely comment, and really, really enjoy the blog.

But I have to tell you, this post has really been on my mind a lot this week.

I've been going through this thing for the past few of months where I have the best intentions to cut out all the processed sugars, actually do it for a couple days, and then go right back to pie for dinner and cookies for breakfast when I get stressed.

I'm actually slightly underweight, and not or diabetic (yet!), so it's been a little tough to ramp up my commitment level.

I KNOW that my eating habits are making trouble, and that if I change them other parts of my life will improve too. And I'm even pretty confident that it'll clear up some the incredible trouble I've been having with my skin and hormones. Yet still about a week ago I came home and had a bag of Milanos for dinner. With a healthy glass of milk.

They were good, too, dammit. Very good.

I'm aware that if this continues I may soon be on the receiving end of a talk like you described in this post.

But I've really tried to turn it around this week--all veggies, proteins, and tons of fruit.

I keep thinking about how, of hundreds of patients, only 2 were willing to take care of themselves. Why on earth would I *volunteer* myself to feel shitty? I spend so much time taking care of my health---why bother if I'm just going to screw up it all up by ignoring my diet? I might as well just start smoking again....

It's a lot easier to think of this as a choice rather than a penance.

Thank you.