As a 45-year old construction worker abroad, Jehangir loved to drink Mirinda to slake
his thirst working in the scorching sun and enjoy some reprieve from the back-
breaking work. Little did he know that the 10 teaspoons of sugar in each can of the
soft drink would turn him insulin resistant and then diabetic in no time. In the middle
of his work one day, he was rendered motionless by a searing headache. At the ER,
his blood glucose was checked, and he was diagnosed with Type 2 Diabetes (T2D).
He was put on medicines and told that he will have to live with this disease for life.
The medicines brought his blood glucose down, but he would faint often in the
middle of his work due to hypoglycemia. He also gained weight ending at 85 Kgs. At
5’5” tall, his BMI became 31 and, for the first time in his life, he was now obese. He
lost his job and had to go back to India.
Through some connections, he managed to find an office job overseas where he
now works as an office help. He is part of the outsourced facilities team in my office
and his job is mostly cleaning and sorting. He is 50 years old now and has known
about his T2D for 5 years now. One day in September, he told me that he is Diabetic
and that makes him feel sad and depressed because he doesn’t feel fit and healthy
at all. His glucose comes to 400 mg/dl at times despite being on medications. The
glycemic target for him is 140 mg/dl 2 hours after meals. So, despite being on
medications he is way off target. He doesn’t know his Hba1c which is the most
important biomarker of T2D and his GP doctor never asked him to check. He is
currently on Galvus-Met 50/1000mg (Vildagliptin 50mg, Metformin 1000mg) and
Gliclazide 30 mg (Sulphonylurea). He told me that he often gets dizzy and feels like
fainting (presumably going hypoglycemic because of the Sulphonylurea). He knows
that his Gliclazide is making him dizzy which is why he often goes off on that
medication. He also has some tingling in his calves and cramps on his upper legs
(neuropathy).
He said he spends $85 each month on his medicines which is a lot given he only
earns approximately $360 a month. He doesn’t have an insurance anymore because
his company has withdrawn their insurance in the middle of the COVID crisis. He
pays for his medicines out of pocket. He cannot see a specialist because their fees
come to $55 minimum, and he can’t afford that out of pocket. During the lockdown
period, for two months, he did not have any medication because he wasn’t able to
step out of his room and there are no nearby pharmacies.
He told me about his diet – he eats breakfast at 7am, lunch at 1 pm and dinner at
10:30 pm. His dinner is 4-5 rotis (Indian flat bread made of wheat flour) with
vegetable curry, his breakfast is bread and lunch are rotis or white rice. He told me
he always feels hungry (side effect of Sulphonylurea stimulating even more insulin
production in an already hyper insulinemic person).
The story of Jehangir Khan shows everything that’s wrong with the current standard
of care. Most patients have no access to specialists either because they can’t afford
to see specialists or because their insurance doesn’t cover them. They never get root cause reversal advice from their doctors in terms of fixing their diet and nutrition. To make matters worse, they are prescribed medications which are now proven to have severe and deleterious side-effects like hypoglycemia, weight gain, cardiovascular disease, etc. Most GPs also don’t look for related T2D complications, let alone treating them.
I told him to do a pin prick test at home in the morning before eating and then again
2 hours after his dinner and let me know the results. I also suggested a lab to him
where he should get his Hba1c test done. I’ll then start working with him on his diet
and get my specialist doctor friend to prescribe the right medicines for him. I gave
him some early tips about the need to eat early dinners, late breakfasts and reducing
his carbohydrate intake and increasing his vegetables, legumes, yoghurt, etc. I also
told him about mixing other grains with his wheat flour.
Jehangir still pines about returning to his family of 3 kids back in Gaya in Bihar, India.
With his savings nearly gone though, he is not optimistic about doing that soon.
Hopefully, with our start-up helping him out at an affordable cost, he’ll be able to
save again by getting off his expensive medicines, improving his health and avoiding
any expensive interventions for his Type 2 Diabetes complications.