Rashed, a diabetic patient in his late 50s, is lying in the hospital bed. He is waiting to hear back from the nurse about his OT schedule. He has been suffering from uncontrollable diabetes for more than 10 years now, which eventually led to peripheral neuropathy. His left toe became severely infected from a foot ulcer and needed to be amputated. Rashed’s 22-year-old daughter Rodela is sitting right next to him, looking anxious. She is contemplating that if she knew before that a seemingly regular condition would lead to such a dire health complication for her father, she would have ensured that he altered his lifestyle a long time ago. Still waiting in bed, unsure of what further complications may arise after his surgery, Rashed states, “Sometimes I wonder why I have been afflicted with such a horrible disease.”

Like Rodela, lack of proper knowledge amongst patients and families about chronic diseases is prevalent in Bangladesh. Studies published by the International Diabetes Federation and worlddiabetesday.org state: “Over 425 million people are currently living with diabetes and the number is expected to rise to 522 million by 2030. Amongst these people, statistically 3 out of 4 people with diabetes live in low- and middle-income countries and less than 1 in 4 family members have access to diabetes education programmes.”

Diabetes is a disease that affects the way your body regulates glucose or sugar. Glucose gets fed into the cells with the help of a key called insulin. People who have type-1 diabetes do not produce insulin. People with type-2 diabetes either do not produce enough insulin or their body does not sufficiently respond to insulin. Diabetes has genetic susceptibility, meaning someone with a parent or sibling with type-1 or type-2 diabetes has a higher risk of developing it themselves. Type-1 diabetes can be diagnosed at any age, but it’s most common among children and adolescents. Type-1 diabetes is incurable and can only be controlled. Type-2 diabetes is mostly diagnosed amongst people over 45. In 80 percent of the cases type-2 diabetes can be controlled or reversed with just diet and exercise alone.

According to Dr MA Mobin Talukder, consultant diabetologist of Praava Health, “When diabetes patients start showing aggressive symptoms, family members are likely to be the first to notice. Hence, diabetes education and knowledge of continuous care amongst families are the first step towards diabetes management.”

 “In order to manage diabetes successfully, patients must adhere to treatment regimens that include dietary restrictions, physical activity goals, and self-monitoring of glucose levels,” said Dr Talukder. During his career of over 38 years working with diabetic patients, he has seen that amongst all other lifestyle changes, dietary modification is the toughest challenge for most. Therefore, family members’ significant contribution mainly lies in the patient’s regime enhancement. They can help by preparing nutritious food without compromising taste, accommodating the patient during exercise, regularly monitoring patients’ blood pressure, cholesterol, blood sugar levels and, most importantly, by alleviating the burden of this lifelong journey of patients by showing empathy towards them. Dr Talukder further emphasised on family care by pointing out how multiple empirical studies had also shown family support to serve as a buffer to the serious effect of stress and help limiting complications and disabilities.

Families should take into consideration that worldwide heart disease is the major cause of death amongst people with diabetes. Something like the protein in the urine of a diabetic patient can be an indicator of kidney disease or risk of renal failure. Diabetes can also lead to stroke, blindness and lower limb amputation. According to a family doctor of Praava Health, Dr Musharaf Hossain, in counteracting such complications, family doctors can play a pivotal role in the long-term management of this chronic illness by seeing the patient regularly, checking their sugar levels, adjusting the dose of medication accordingly, looking out for complications and referring the patient to the appropriate specialist when required. Dr Hossain with his over 41 years of work experience at National Health Service (NHS) in the UK thinks in the case of Rashed, if he had seen a neurologist on time and if his neuropathy was diagnosed earlier, things might not have escalated this far. Dr Hossain also stated that diabetes being a partly hereditary condition, the whole family is affected once a member of the family is diagnosed with diabetes. As the family doctor knows the other members of the family, the latter can talk to the family doctor about their own fears and anxieties about getting the disease itself and how it might affect their own lives.

According to nutritionist Noor-e-Jannat Fatema, most diabetic patients are recommended to have controlled portion sizes with small frequent meals. Because diabetic patients are mostly on measured and selective food, families need to be well aware about patients’ nutritional needs depending on their condition. For example, a diabetic patient with peripheral neuropathy like Rashed should have sufficient Vitamin B1, Vitamin B12, Vitamin B6 and folic-acid-enriched food.

A diabetic patient with nephropathy should drink measured quantity of water. A male should not drink more than 3 to 3.5 litres of water and female should not drink more than 2-2.5 litres. Fatema emphasises that food items prepared for a diabetic individual should always be high on fibre and intake should depend on the patient’s age, physique and level of activity. Also, calorie intake level of a sedentary diabetic person confined to one’s home should be different from that of an active diabetic person. Fatema always advises patients not to be too aggressive in bringing their weight down. They need to keep in mind that a diabetic patient cannot do a crash diet to lose weight as that might lead to another emergency condition called hypoglycemia.

Surgical amputation of the affected part is what happened in the case of Rashed. If Rodela had known better and if diabetes education was more accessible to the masses in our society, then many extreme cases, such as that of Rashed, could have been avoided in due time. In the era of medical advancement, systematic planning of public health policies and active participation of the affected are what’s required for chronic disease management.