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The Riot Act: sometimes it’s necessary

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Those of you who know me personally will agree that I am generally an easy-going person, although I admittedly like to argue now and then (I can already hear my family laughing at this). I try to be this way with my patients, even when I disagree with their own approaches. But this week I took a different road with a young patient, and I think some of you need to hear this, too.{{more}} I have learned this phrase, “reading someone the riot act,” while being in the US. Some of you know the meaning, but for those of you who don’t, it basically means spelling out all the bad that will happen if you do a certain something, threats and all. What inspired this volcano in me? Hear this:

I met this young man in my clinic, accompanied by his mother. He is 18 years old, lives at home, and works in a fast-food restaurant. He is not very active aside from going to work. He wakes up at various times, stays up late eating and then goes to bed around 2 AM. Why did I harass this young man, you ask. Sleeping in late and eating badly is not a crime, you say. Right you are, but hear me still: this young man has Type 1 diabetes. He was diagnosed at age 16. His Hemoglobin A1C was over 14%, which all of you know is HORRIBLE. I looked back in his chart-it had been over 14% for some time and he admitted to other doctors that he is not good at taking his medications.

More information: he does not check his blood sugars. Why? I asked. He just doesn’t, is the answer I receive.

Do you forget, are your fingers sensitive, do you just not want to check it? I ask again. He doesn’t know.

Are you taking your insulin everyday? I ask. Most days, he says. He misses his insulin at least two times a week. He does not eat on time. He eats junk food and sweets, and in large amounts.

On his physical exam I find he has numbness on his feet.

Take that in: this young man has had diabetes for only two years and he already lost feeling on his feet.

Are you anything like this young man? If you are, this is what I told him, and this is your riot act:

“I cannot fix this for you. Nothing I recommend will fix this until you start taking care of yourself. You are too old for this; you are not a child anymore. Take some responsibility. Diabetes is a train that will run right over you. It has already taken the feeling from your feet. By the time you are 30 years old you will have the body of someone 40 years older. I will do everything I can to guide and encourage you, but this is your responsibility and until you start working on it, nothing I do will help.”

If you see yourself in this young man, I implore you to GET TO WORK. This is your battle to win or lose. This young man is already losing but luckily he still has some time. So do most of you: Use it wisely.

Anita Ramsetty, MD
[email protected]
Medical Director Endocrine Care Group
Tel: 843-798-4227