Recently I had a patient with a strange preference.
She is 31 year old newly wed, wife of a factory worker. She was diagnosed to have Diabetes 7 months ago. The prescription she got from a Government run hospital was for Insulin, and she pricks herself twice a day for last 7 months. Her blood sugars were still high. Someone might have suggested my name. Thus, she turned up in my clinic.
When I asked her family history, I was surprised to hear that 2 of her sisters and one of her brother were Diabetic. That meant she most probably had Type 2 Diabetes which occurs in family, in contrast to Type 1 where family members are not usually that much affected. Type 2 Diabetes is mostly due to Insulin resistance [Insulin is there but not working efficiently]. Initially it is treated with oral tablets which improves Insulin efficiency, but she was prescribed for Insulin which is clearly not helping to reduce the blood sugars. Why?
Her story was like this. As she had very high blood sugars at the time of detection, she was given both tablets and Insulin injections. After controlling her blood sugar, her doctor asked her to continue on tablets. The tablet that was prescribed was not available in the Govt pharmacy, on the other hand Insulin was available free of cost. She comes from a poor family and is recently married to a lowly payed factory worker. She did not want to burden her new family. So, she opted for Insulin which she thought was the superior treatment.
I explained to her that, for her tablets are better option.I assured her that I can reduce her blood sugars with cheap tablets available in the market. Somehow I was able to make her understand that the 'free Insulin' [which is expensive in open market] is not good for her.
Still there was a problem. She already had 3 vials of Insulin with her and she did not want to waste it. So, we reached a compromise. I asked her to continue Insulin at a reduced dose, but started her on oral medicine for better control of sugars. I am sure when she come for follow up visit her sugars will be much lower.
In India[may be everywhere else also] it is tough to be poor especially, if ill.