A person walks into the doctor’s office with diabetes. He is newly diagnosed by coincidence and he doesn’t like to be diagnosed diabetes. It doesn’t feel right, it doesn’t make him feel right. The doctor has a more clinical approach: he gives him a set of what he should and should not eat, he gives him medicines to bring down his sugar and asks him to come back with glucose rechecked after a month. This is even scarier because it feels as if now he is going through some exams and the glucose report will be his report card.

People respond differently when “challenged” with the diagnosis of diabetes. They may take the challenge head on. They watch videos of people who have managed diabetes through lifestyle changes, some who have reversed it as well. He wants to take control of his disease like they had done. It is like in a war. If he is able to take control, the subsequent steps become easier. He feels great about himself and speaks of his victories. If he is not able to take control of the disease, it is a shameful defeat for him. He feels ashamed each time he has to visit his doctor. His high glucose levels are held against him. He is looked down upon by his family who don’t stop worrying about him, his doctor who doesn’t stop advising him about what he “should” be doing. But this shame brings him down. He finds it unable to exercise his will power. All his energy is consumed in fighting the shame and guilt, anger for having the disease. The number of people who now start advising him increases. His friends think they can advise him, his spouse and kids would remind him of how careless he is with his exercise and food. Because that must be the reason his glucose levels are uncontrolled.

His vocabulary changes gradually and now speaks out loud of the shame he feels. When he visits the doctor he says it’s all my fault. I am not doing the right things, therefore the sugars values are going high. It has now become more a game of shame and blame and real story of diabetes management is lost.

He feels defeated and the worst feeling a person can feel is that: shame and failure. When people advise him, they look down upon him. They do not understand what he is going through. Their advices makes him feel worse. He wants to now eat his favourite dessert to get over this dreadful feeling. His body and soul asks to be cared for. He wants to sleep till late.

What he needs now is someone to understand him, feel compassionate. Someone who can tell him that it’s ok to feel all this and this is natural and normal. It’s ok to indulge sometimes. Listen to your body, listen to yourself. Take it slow because diabetes is no war.

The communication from the doctor goes a long way, the understanding about what diabetes is and how to deal with it because this is a new way of living now. There is no “shoulds”. No one else can tell you what you should or should not do. It’s your decision. The first step in a shared decision making is just this- how to build up good communication bridge between the doctor and patient so that the patient is able to convey his or her feelings. Sometimes they do not understand the complex thought processes inside them, so a good communication helps them to understand their feelings and accept them without someone stupidly advising them to “feel positive”.

Shared decision making can only happen when both the doctor and patient are ‘on the same page.’ The Doctor understanding the feelings, strengths and limitations of the patient, which needs active listening.

It is then important for the doctor to be able to convey the knowledge about the disease to the patient in a way he or she can understand. This can be through use of metaphors or stories. It is a difficult part of the communication because the concept of diseases like diabetes can only be explained when the patient understands the concept of risk and probability and predictions. Hence the role of metaphors.

A patient asked me tell me what should be my HbA1c. He had early chronic kidney disease due to diabetes. I answered well that depends on how many years you want to live. He laughed and said I just want to live for 5 years because my son will be settled by then. I said why not target 20 years. It was all in a light vein, it helped better and open communication. We both realised that we are discussing about life prolongation and a healthy disability free life. All the medications and diet changes ultimately were for that purpose. Of course life is unpredictable, but not completely. We do have the power of predictions, thanks to data analysis and science. This science of analysing past data and using that to predict our futures has what lead to definitions of diseases like diabetes.

Diabetes is not an enemy or war, it’s an ally. It’s a crystal ball, which shows us our future and also gives us the power to improve it. So if you know you have diabetes, you have your future in your hands. That is a burden and a responsibility, and we hope we can deal with this together through shared decision making.