I saw Mr. R yesterday for our regular diabetes follow up. He was a 69 year old farmer with severe insulin resistance. He came with his daughter and grandson and were making a daytrip out of his visit to the city to see me. His grandson gleefully said they just came from McDonald's.
No surprise that his hemoglobin a1c was 9.7. Also no surprise that his triglycerides were 612 mg/dL. What unnerves me professionally, isn't that he has diabetes. Rather, it is the degree of diabetes we see these days. Admittedly I have not been in practice for long. I've had my MD only 12 years, and I've been in endocrinology only 7. But I seem to remember a time when using over 200 units of insulin a day was extreme.
Mr. R however, was using in excess of 800 units of insulin a day. Almost 150 units of prandial insulin per meal!
And while he probably wins the prize of being the most insulin-resistant patient I have, he isn't alone. These days many endos are seeing this phenomenon of patients being on massive doses.
Why is that? It's both a complex and simple answer. Lifestyle. Or rather, how lifestyles have changed.
The modern conveniences often result in less physical activity. Escalators, elevators, cellphones, cars. And if you're deemed medically disabled from obesity, you get to park nearer to your destination (a socially responsible step, but perhaps not the most logical medically). The most convenient or cheapest foods are often the unhealthies. And our perceptions have changed too. What was obese, is all too common now that we consider it normal.
When I asked him about exercise, he was adamant that he works out 5 times a week, at least an hour each. When I asked him what he did, his response was "Pool".
Not swimming, mind you. As in playing pool. Plays with his retired buddies in his basement. Often while having beer and nachos.
Sadly, he isn't the only one. His daughter's BMI was probably in excess of 40 herself. Her pre-teen son was himself visibly obese, on his iPad when I was talking to the patient.
And this isn't a problem affecting only the USA. It's a worldwide epidemic. And so, the solution's going to be difficult. Not because it's complex. Rather it will require a huge momentum, a major paradigm shift, in how we view our bodies and responsible habits. And I'll be the first to admit I myself will have a lot to change, too.