Even before any tests were done I knew he had diabetes because he complained of its four cardinal signs: thirsty all the time, urinating frequently in large amounts, always hungry, and losing weight.
And so the 35ish year old was surprised and skeptical of the diagnosis even after he was shown the hard copy A1C lab report. The A1C is the blood test that measures the amount of glucose in a red blood cell and provides a 90-day snapshot of what one's glucose system has been doing for the past three months. Normal is less than 6.5%. His came back at 12%, very high.
I recommended medication, a diabetic diet, and increased aerobic activity. He deferred on the medication, admitting he wasn't eating right and would improve. But he denied he had a problem taking prescription medication.
A month later, the A1C was unchanged and his urine was 4+ on a range of 1 to 4 with 4 being the highest amount of sugar present. I told him it was like he had Karo syrup coursing through his veins and that eventually it would affect his vision, his kidneys, and arteries, subjecting him to possible amputations. It wasn't a matter of "if" the complications were forthcoming -- it was a matter of "when."
His hard-headedness maybe stemmed form the fact that he was young, self-employed and an achiever. He failed to return for his monthly follow-up and resurfaced one year later when he came in exasperated, complaining of blurred vision for several months.
He brought me up to date on his medical history. He had consulted a 'health professional' who owned a vitamin shop, and had bought almost $200 of herbs and supplements designed to "improve his body's immune system and increase his body's insulin." He said the supplements, he was told, was supposed to "detoxify his system" and rid him of diabetes.
But he continued feeling badly and saw a doctor in a nearby town. He'd failed to significantly change the way he ate, dining out 7 - 10 times a week. He'd failed to change his lifestyle, working 65 hour weeks and snacking morning and afternoon on processed nabs. He failed to engage in aerobic activity or regular distance walking. And he failed getting educated about the condition after being referred to the ADA website. But, he had not failed as a lawyer, though blurred vision was now impairing his reading legal documents.
He's a denier. He's a horse led to water but refusing to drink. He's been doubting the diagnosis, admitting to having only "a touch of it". Many doctors rail into such patients; I used to myself until I realized that people as well-informed as a lawyer have entrenched self-directed reasons to deny their condition that supersede any amount of scolding a doctor could muster.
But with so much information at everyone's disposal these days, there's really no excuse for someone to be uninformed about any health condition. Primary care doctors nowadays seem more like shepherds of medical information rather than repositories of information. But regardless, deniers continue to trickle in.
The psychologists tell us that deniers are people who deny reality in order to defend their ego. When reality conflicts with one's beliefs one will undergo extreme lengths to ignore or distort evidence so that they can maintain the beliefs. As in a belief that one's work, perhaps lawyerly or doctorly work, is paramount above all else and embracing something like diabetes means spending time and energy on a medical condition that can potentially shorten one's life, change one's lifestyle, or impinge upon one's sense of independence and individuality. Or, perhaps change one's perception of what others expect of them. Ignoring reality is necessary in order to maintain one's belief system, whatever that belief system is.
Other reasons for denying diabetes or anything else include maintaining one's self-image, not wanting to be reminded he is not eternal.
The best antidote to helping a denier is to educate them about what it is they are in denial about. The more facts that they are exposed to the more likely they are to be shaken from the grip their own ego has on them in preserving a belief system that has become for them obtrusive.
Stephen Furst, the actor who played "Flounder" in the movie "Animal House" admits to denying his diabetes for 25 years. And only "woke up" from his denial when he nearly lost his foot by amputation. He since has lost 140 pounds and has written a book and produced a video to help men who are where he was, in denial, when he was much younger.
If you have a denier in your life, someone close to you, someone you want to have around awhile, then help them get educated about the issue they are in denial about. And if they still insist in denying the reality of the matter, then you're only left to pray for their deliverance -- even if they happen to practice law.
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