Diabetes is a disease with varied interpretations to the masses. Myths and misconceptions being misinterpreted as facts pose a hurdle, a stumbling block in diabetes care and many a time often lead to irreversible diabetes-related complications and stigma.
Diabetes is a disease condition that results in the body’s inability to regulate blood glucose levels. It is also considered a lifestyle disease affecting men and women, the young and the aged from both the urban and rural populations across the world
Globally, 537 million adults were living with diabetes in 2021 and the number is expected to rise to 643 million in 2030 and 783 million in 2045 according to the International Diabetes Federation (IDF) Atlas.
To make things worse, three out of four people with diabetes are living in poor resource countries. India is now the second country with the most number of diabetics with 77 million Indians living with diabetes in 2019. With many cases still remaining undiagnosed, the above numbers are expected to be much much more.
Diabetes is a well-known illness, yet ironically people are still unaware or rather ignorant about certain important aspects of the disease; its impact on physical, social, and psychological health and the economic hardships that bring about failures and non-compliance in diabetes treatment. Even with the advancement in the treatment of diabetes, education and self-management training, many patients still experience devastating complications that affect their activities of daily living, careers and decrease their quality of life. 
Treatment and management of Diabetes should not only end with taking medicines. It involves an in-depth understanding of the disease and its management, and a collaborative approach between patients and healthcare providers.
Gone were the days when the sole responsibility to treat diabetes rested on the Physician. Treatment would then only consists of a list of medications and orders about how one is supposed to eat and exercise to supposedly control his or her diabetes. Education was also designed to only promote compliance with medications and using motivational and behavioural strategies, we try to get patients to change to a textbook-defined lifestyle.
This strategy failed in most patients with diabetes. Complications of diabetes like heart attacks, serious blood stream infections and limb amputations are rising exponentially. 
An important approach designed to effectively manage diabetes is empowerment in diabetes care. Empowerment is equipping patients with knowledge, training, support and  motivation, in a continuous process, with the aim to enable them to understand, “set their goals, make choices and decisions, take control and be responsible for their daily management of diabetes” (Funnel MM, Anderson RM. Empowerment and Self-Management of Diabetes. Clinical Diabetes. 2004).
“Health care professional roles are to assist, guide, support, motivate. But patients’ involvement in their own care is the cornerstone in diabetes care” (Gomez-Velasco DV et al. Empowerment of patients with type 2 diabetes: current perspectives. Diabetes Metabolic Syndrome and Obesity: Targets and Therapy. 2019). For e.g., most episodes of hypoglycaemia can be safely managed at home using rule 15 by American Diabetes Association (ADA). Patients who are taking insulin are less likely to develop skin-related complications if they follow patterns of rotation of injection sites and patients will be able to avoid amputations if they are equipped with knowledge about foot care, footwear and good glycemic control.
Following a diabetic diet will certainly be easier if they have the knowledge of plate method, 3meals 3 snacks patterns, choices of locally available healthy food, knowing the glycemic index of different types of food, instead of cutting off nutritive food items in order to control their blood glucose levels or following the same dictated diabetic diet menu every day. Even now, the four pillars of diabetes management still comprise diet control, exercise, medications and regular follow-up. However for the process to be successful, decision-making at every step has to be a collaboration between two equals – the patient and the healthcare provider. Any mismatch will surely result in another patient living with uncontrolled diabetes. 
One common unhealthy practice among diabetics is to seek treatment only when they feel unwell but discontinue self-care when their symptoms subside. Patients are often brought to the hospital only when serious complications have happened, and many a times, require Intensive care.
Incorrect information have contributed to these behaviours among patients. Many are still of the opinion that “Diabetes can be cured” if they follow strategies that are outside the mainstream medical knowledge. Some are of the opinion that walking barefoot on the grass early in the morning or in soil or pebbles can cure diabetes. Some are also of the understanding that avoiding as much food as possible can cure diabetes. Exotic herbs and leaves have been tried by almost all patients before they can be convinced that the treatment of diabetes is a lifelong affair.
Any temptation offering an easy way out plays with our basic human nature and always gets the better of us all, but in the case of diabetes, many patients had lost their lives. Myths and misconceptions, and unhealthy practices need to be replaced with facts, knowledge, education and training.
Unlike the common cold, diabetes cannot be cured with short-term treatment. At the same time, it is not something that should be feared, nor should it be the reason why we cannot do all the things we want to do in life. The belief that one cannot anymore perform or continue one’s studies, work and activities or that one should only stay at home if diagnosed with diabetes is totally wrong.
Controlling blood sugars well will allow diabetics to continue living their normal lives and work towards achieving all their goals. Many people living with diabetes are athletes, doctors, nurses, engineers, artists, social workers, farmers, students etc. So instead of saying ‘I have diabetes so I’m doomed’, ‘this is the end’, people should be adequately informed so they can instead say ‘Oh! So this can be managed’.
Such understanding will dawn on people only when they become aware of the illness, its treatment and ways of managing it. This should be the goal of all health care teams managing diabetes.
The downside of diabetes care is patients’ negative attitudes towards it.
“The overconfident (claims he/she knows it all, have low awareness), the sceptical (wants good result with low inputs, have low awareness), the resigned (believes in fate and takes it as a curse/punishment) and the casual (also believes in fate and not bothered about self-care). Few are proactive ones. These are motivated, well informed, optimistic and fully involved in the care,” (Thomas N, Kapoor N, Melavan J, Vasan SK. A practical guide to Diabetes Mellitus. 8th edition. 2018). People do face a number of challenges when fighting against diabetes, but with continuous and consistent efforts, a willingness to learn and progressive behavioural change, one can overpower diabetes. Just like brushing one’s teeth, every morning diabetes care should become a regular habitual practice in order to achieve the best outcomes.
Finally, economic hardships especially among people of low socio-economic status is another reason why the management of diabetes and its complications has proven to be of great difficulty in our country.
Affecting all age groups, and the fact that it cannot be cured and requires long-term treatment only adds to the economic burden. Diabetes is a very demanding disease in terms of expenditure for treatment and daily routine care. It demands a regular timing of specific food intake, medicines/insulin, regular exercise, and regular check-up. A large portion of patients finds it difficult to meet these expenses of diabetes treatment. The eagerness of Healthcare workers to prescribe medications before motivating patients to first understand and enforce lifestyle modifications like a change in diet and physical exercise, also add insult to injury.
Further, with an aim to give patients the best and the latest medications available, the cost of medications can sometimes be more than what a particular patient can afford, which will lead to discontinuation of treatment. Here too, an empowered patient can play an important role in the choice of treatment to best fit his/her financial position, because the fact of the matter is that older medications also do work very well for the treatment of diabetes and side effects can be easily prevented with proper education and regular followup.
Consistent efforts by all involved will help to ease the financial burden on patients, especially when serious complications can be prevented(treatment of which will actually result in the most expenditure towards diabetes care). Therefore by gaining control over decision-making, daily self-management care, and problem-solving efforts at every step of treatment, people can change the burden and the challenges they face, to hope and victory. 
This November 14, let us celebrate World Diabetes Day by Educating ourselves to Protect Tomorrow. Let us come forward, be proactive and be empowered in diabetes care. Diabetes should not stop us. Let us take charge of our own diabetes care and improve the future of our health by taking action today.
Miss Aibanrihun Kharlyngdoh is a  Diabetes Educator and Nurse, and Dr Meban Aibor Kharkongor is a Consultant at the Diabetes Clinic of Dr H Gordon Roberts Hospital, Shillong.
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