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.