Everyone is a Diabetic..!

Though I had to read extensively on Diabetes Mellitus as a part of my undergraduate curriculum, it wasn’t until my internship days that I understood it better. You may find diabetics in almost every ward in a hospital but surgical ward is where you find them perceptible. As I began the surgical dressing of a Diabetic Foot Ulcer, that had awfully occupied the entire heel, I wondered why the patient came to the hospital so late. I mean, such a humungous ulcer doesn’t develop overnight. Why could she not seek a medical attention when it was embryonic? She replied, “I was not aware of that!”

Diabetes, a disorder of the carbohydrate metabolism, is described by some authors as “poverty in excess!” because though the glucose levels are high in the blood, glucose cannot be taken up by the cells and used. Spare the insulin-independent organs like Brain and Red Blood Cells, all other organs are starved! So, you see the muscles getting atrophied, the person becoming too weak to fight a trivial injury and succumb to horrendous infections thereafter. Also the unused glucose undergoes an alternative metabolic pathway (non-enzymatic glycosylation) which yields toxic metabolites. Hence the retina gets damaged, the kidneys are affected and the nerves can no longer do their job (Diabetic Neuropathy).

There are sensory nerves collecting the information from every millimetre of your skin. So, you feel the touch, pressure, vibration, temperature and pain from every square mm area of your body even if you can’t see it with your eyes. The moment something hurts you, you are aware of that and you give your attention to that. That’s not the case with Diabetics. They aren’t aware of an ulcer developing in their foot (unseen area of the body) until it goes on to smell badly.

Awareness! That’s the word that churned my thoughts on this appalling disease process. Take a look at the emblem of Karnatak University. It says – "Arive Guru" - which means “Awareness is teacher.” Such is the importance of Awareness. Well, I pity these Diabetics who are not aware of the parts of their body. But they are far better than people who are not aware of themselves! Just like the sensory nerves that pain you but ultimately protect you from developing dreadful complications, awareness or conscience pricks you time and again, and guards you from getting vice.

“A mind which wanders following the objects of desire deludes the intellect of the person just as a strong wind that rips off a ship in the ocean” (Bhagavad Gita 2.67). They are people who are at the verge of their extermination. If at all one could take a photograph of the mental status of such people, I am sure it would be more outrageous than this Diabetic Foot Ulcer.

But why in the first place one loses his awareness? Well, just as diabetics develop neuropathy as a result of uncontrolled blood glucose levels, one loses his intellect as a result of uncontrolled debts of Karma. The disciplines of action as described in the Karma Yoga are very much similar to the mechanisms of Glucose Homeostasis of our body. And that is why the pathology of Diabetes closely resembles the moral instability as per the Karma Yoga.

The Glucose Homeostasis means maintaining the blood levels of glucose within the normal range. There are many mechanisms by which the body senses the decrease or increases in the levels of glucose in blood and tries to bring it back to the normal range. In other words, the body maintains a perfect balance between the “gain” and “expenditure” of glucose. Similarly, Karma Yoga mentions “accepting” and “giving”. It is our duty to sense the “gain” and try to bring the balance back to normal by “giving.”

This is what the Karma Yoga means by mentioning the "Debts" or "Runas." The five debts according to the Karma Yoga are -

1. Debts towards Inanimate Nature (Deva Runa)

2. Debts towards Other Animals and Plants (Bhoota Runa)

3. Debts towards Parents and Ancestors (Pitru Runa)

4. Debts towards Society (Manushya Runa)

5. Debts towards Teachers (Rishi Runa)


So, the “work” or “Karma” we do should be directed in these directions. The Karma Yoga stresses upon clearing these debts so that one becomes free and attains salvation. That goes on to say that we are already in “debts.” Only Yajna (fulfilling the five debts); Daana (contributing more than consuming) and Tapas (stretching the limits and self-improvisation) purify the men of wisdom. (Bhagavad Gita 18.5)

Just as a physically healthy man maintains his blood glucose levels within normal range irrespective of the type and quantity of food he eats or the stressful situations (infections, starvation etc…) he undergoes, the “Sthita Prajna” or the “Yogi” maintains his mental calmness irrespective of the situation he is into.

“Sufferings don’t perturb his mind, He does not cling on to pleasures, He is free from attachment, fear and anger, and He is called a Sage of Stable Wisdom.” (Bhagavad Gita 2.56)

I don’t think we are the “Sages of Stable Wisdom” but we can always strive to be so. That is why I said in the beginning “Everyone is a Diabetic!” Now, the choice is ours – we can either struggle to get our glucose back to normal or go on to lose the sensation sooner or later and develop Diabetic Foot Ulcers!