When I give advice on type 2 diabetes

Last week I was walking across Germantown Avenue in Philadelphia when I noticed a fat man carrying a bag of burgers and fries limping beside me. On his right foot he wore a huge surgical boot. As we reached the opposite curb, I nodded at the boot, telling him I understood his situation: I had worn a similar boot for a broken foot in a hot summer a few years ago.

“Not fun,” I told him.

“Mine isn’t broken,” he said. “Let’s go.”

“I’m so sorry,” I said. “An accident?”

“Type 2 diabetes,” he said. “First my toes, then the foot.”

Even though it was a sunny day in June, I shivered. Limb loss to type 2 diabetes is far less common than it once was thanks to advances in both disease management and improved surgical techniques. Teams of neurologists and surgeons work together to save rather than amputate.

Yet, in cases where diabetes is not controlled, amputation is still possible. People who live in denial about their disease, inequities in health care, lack of access to healthy food, unsafe neighborhoods where exercise is difficult or impossible, expensive medications, and a host of other social issues can make treatment for type 2 diabetes prevent complications like amputations, heart disease or loss of vision a difficult proposition.

Everything I didn’t say.

Instead, the man and I exchanged small talk. We discussed unusually warm temperatures for the season, the results of a recent local election: odds and ends between neighbours. But the more we talked, the more I debated: Need I mention that the bag of greasy burgers and fries might not be the best type 2 meal for someone with serious blood sugar issues? Need I share how I switched to a pescatarian diet a few years ago and lost 20 pounds, improving my sugar levels along the way?

Or should I keep chatting until we part?

It was not the first time that I faced such a dilemma. Although I am not a medical expert, I have spent years studying, thinking, and writing about type 2. Yet I have learned not to offer unsolicited advice because it often doesn’t happen. good.

There was, for example, my type 2 brother who gained 50 pounds or more. When I told her that I had read that even 10% weight reduction could lower her blood sugar, she told me she didn’t need a class. Then there’s a dear friend who refuses diabetes medication because she doesn’t feel sick. “The pills are for the sick,” she says.

I tried to explain how diabetes doesn’t always come with symptoms even though it creates serious complications, but she just smiles.

“I’m fine,” she said.

Around the corner, the man – Charlie – and I ended our conversation. He offered his hand.

“Really nice to meet you,” he said. “Thank you for stopping talking.”

I smiled.

“You know,” I started. I also have type 2 diabetes, I wanted to say. But the words stuck in my throat.

“Take care of yourself,” I told him. “And have a wonderful day.”

Photo credit: Compassionate Eye Foundation / David Oxberry / DigitalVision via Getty Images