The overloaded vehicle

The overloaded vehicle

Feeling somewhat tired and stressed from the previous day’s activities I had to drag myself from bed and prepare for work. 

What if I told you an overloaded vehicle is not something with 2, 3 or 4 wheels? We will find out soon enough

I had just dropped my bag and was about to check the appointments I had with patients from our register when the support staff beckoned to me that Mr John had come for his blood glucose check. 

Mr John is a retired 55-year-old man. He has a 7-year history of type 2 diabetes and was referred by his family physician to a tertiary health institution.

Mr John presents with recent weight gain, poor diabetes control, and foot pain. He has been trying to lose weight and increase his exercise for the past 6 months without success. He had been started on some medications but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of mild agitation, in the late afternoon.

It was on a routine check-up and prescription filling that I discovered his blood sugar was poorly controlled as the readings I got for the 4 times I checked in 2 weeks showed high sugar level . I placed him on a diet consisting of more vegetables, moderate fat, carbohydrate and protein. 

Mr John was back 2 weeks later to check his sugar level. His left thumb was sterilized using a swab (cotton wool infused in alcohol), pricked with a lancet and his blood was placed on the tip of the Accu-chek glucometer strip. The result I got was not so bad. His blood glucose level was 126mg/dl (normal range: 70-100), which was significant progress when compared with the 166mg/dl that I got 2weeks ago. I asked him what he had done differently, he said the numbers doesn’t matter anyway and if he wanted the sugar level to get to even 0mg/dl he could do it with ease.  Ahh! I said,that’s ridiculous

 I picked up my phone and made a quick call. An hour later we were interrupted by the amazing information about how Mr John took his medication faithfully and also adhered strictly to the diet plan. The quick call I had made was to Mrs Abigail a lab scientist at Mango diagnostic laboratory. I called her to come to take Mr john’s blood sample for a test known as glycated haemoglobin (this test will say how well controlled his sugar has been in the past 3 months) was collected. When I told him what it meant, I saw how quickly the happiness in his eyes fled.

Mr John, I hope you have not overloaded your vehicle?” I asked.

“Erm, madam,” Mr John fidgeted, his expression confused. “Please what does that even mean?”

I began to explain to him, “The vehicle is your blood carrying oxygen as well as nutrients to where they are needed.  When diabetes sets in, other passengers, in this case, glucose comes on board. Taking your drug as prescribed and also dieting helps remove these passengers so that the vehicle may efficiently deliver oxygen, important electrolytes like potassium, calcium and even sodium, as well as some micro and macronutrients that the body needs for survival and proper functioning).”. 

I continued, “When you do not take your drugs for a long time glucose gets accumulated and overloaded in your vehicle. This could prevent your blood delivery of oxygen to another part where they are needed.  And when these cells are deficient in these nutrients for a long time, they die. Your vision is affected, your kidneys, your heart and even erection too.

His eyes were wide, and he was stunned. He had never had it explained to him like that before.

 

I continued, “When you do not take your drugs for a long time glucose gets accumulated and overloaded in your vehicle. This could prevent your blood delivery of oxygen to another part where they are needed.  And when these cells are deficient in these nutrients for a long time, they die. Your vision is affected, your kidneys, your heart and even erection too.

His eyes were wide, and he was stunned. He had never had it explained to him like that before.

Mr John your vehicle is overloaded, I said to him. you took your drugs just a few days or probably just his morning. You only succeeded in removing someone from the seat..and hence what the glucometer detected, unknowingly to you the back is still very much filled up and that’s what the glycated haemoglobin test will show us.

The Good news is we can unload your vehicle I told him with a smile. But we will do it gradually.

 We scheduled a convenient appointment date as I had to see the next patient that has been waiting for a while now.

I said to myself, “it is going to be a hectic day indeed”.