Diabetes is a group of diseases characterized by high blood glucose (Blood sugar), either because insulin production is inadequate, or because the body’s cells do not respond properly to insulin, or both. Dr. Lubna Mirza, MD, Endocrinologist and Diabetes Specialist started a blog www.diabetesinurdu.com in Urdu for people who are not able to read English. The reading materials in Urdu are not up to date with scientific information and there is a lot of magical thinking so this blog is very informative and helpful. She also wrote a book “Everything you need to know about diabetes” in Urdu. Dr. Lubna Mirza was born in Pakistan and is a US citizen. She works at Norman Regional Hospital, Norman, Oklahoma, United State. She has aim to promote diabetes education to empower diabetic patients, improve health and lives of diabetes patients and to encourage questioning and research in the field of Diabetes. I am thankful to Dr. Lubna Mirza for sparing some time to give me detailed interview. The information she shared is not only for diabetes patient but the information is helpful for everyone.
Q: Tell us about yourself, where did you get your education?
First of all I would like to express my gratitude for the invitation of this interview. I am very happy to see the young people working hard, growing and developing. We have great hopes from the new generation.
Ans: I was born in Sukkur, graduated from Saint Mary’s high school Sukkur in 1989, then went to Govt girls college Sukkur for pre-med. In 1990s there was no medical school in Sukkur so I went to Larkana to do MBBS. In 1993, my family moved to Oklahoma. I travelled back and forth until I completed MBBS and the house job in pyshiartry.
I did a residency in Internal medicine at Mercy hospital of Pittsburgh and then a fellowship in Endocrinology, diabetes and metabolism at the University of Oklahoma. I am board certified both in Internal medicine and Endocrinology. I now work for Norman Regional hospital and live in Norman, Oklahoma with my husband Dr. Nazir Balouch and two children, Naveed and Isha.
Q: How long have you lived in the United States and how is the life of a physician in America?
Ans: I have lived in the United States off and on since 1993. The schedule of a physician depends on their specialty. I am a hospital employed Endocrinologist with Dr. Pham. My clinic hours are Monday through Thursday 8:30am to 5:00pm and 8:30am to 12:00pm on Friday. Dr. Pham and I rotate call. Whoever is on call is responsible for the hospital consults. I am on call every other weekend.
Q: Which hospitals have you worked at? And what are the differences in the healthcare system between Pakistan and the United States? How are patients different?
Ans: As you can tell, my work experience in Pakistan is limited to the student life. During med school, we did rotations in Chandka teaching hospital, Civil hospital, Larkana, Shaikh Zayad women’s hospital and the children’s hospital. My house job in Psychiatry was at the Civil hospital, Larkana.
In the United States, I did my residency at Mercy hospital of Pittsburgh, PA, then Endocrinology fellowship at the University of Oklahoma. In OU there are three hospitals, the Presbyterian hospital, Women’s and children and the Veteran’s affairs hospital.
I now work for Norman Regional system that has three hospitals, the Porter campus, healthplex and Moore medical center.
As I have explained earlier, my work experience in Pakistan is limited to being a student. Based on my observations, the main difference between the healthcare systems between these two countries is the managed care, resources and the technology. US are developed and Pakistan is a developing country. The health insurance is not common in Pakistan. There is not a huge concept of preventive medicine. People don’t go to see doctors unless they are very sick. Again there are certain advantages and disadvantages of this. For example, diabetes is silent and has no signs and symptoms in the beginning. If you are not in a habit of getting annual checkups, you will miss it.
Q: Tell me about a patient or an incident that left an impression!
Ans: Being a physician is a privilege. I see wonderful people every day with their incredible stories. A patient once told me, as we age, life stops giving us things and starts to take things away. I recently saw a lady in the Norman hospital. She is not very old but very sick. I was just amazed listening to her struggle through her health problems. She was told four years ago that there was nothing else that could be done for her. What impressed me so much is, she had a computer in front of her in the hospital bed and she was taking an online class. She said to me, I never made as and never went to college so this is what I want to do now instead of sitting around being depressed. I find courage and inspiration in these patients.
Q: You have made this educational blog www.diabetesinurdu.com and the videos to serve diabetic patients. How do you find time out of your busy schedule?
Ans: The world of information is growing at a fast rate. The number of journals on any given topic has increased tremendously in last few years. Aside from the BBC Urdu section and few others, I noticed the reading material in Urdu lacks up to date scientific information. As you may know Urdu/Hindi is the third largest language in the world. There is a great need to reach out and fill this growing gap. There are thousands of websites, newspapers and magazines about diabetes in English, there should be a place where people who understand Urdu can come to find out what’s going on in the outside world.
I work on the blog mostly on the weekends or on holidays. According to an estimate, People spend approximately 4-5 hours per day watching TV and I don’t watch much TV. It saves me some time to do the things which are more important.
Q: Please provide some basic information about diabetes to the listeners. How many types of diabetes are there? And what are the symptoms?
Ans: Diabetes is not just a disease but a syndrome a group of diseases that occurs due to abnormalities related with insulin.
Diabetes is of two types. In type 1 diabetes, there is absolute insulin deficiency and in type 2 diabetes, insulin is present at least initially but the body develops resistance to it.
Diabetes doesn’t have any symptoms in the beginning. As the disease progresses, diabetic patients may develop excessive hunger, thirst and urination. Some present with diabetic complications which are small vessel complications or large vessel complications. The small vessel complications include eye disease, kidney disease and nerve damage. Large vessel diseases are strokes and heart attacks.
Q: When someone finds out they have diabetes, what should they do?
Ans: When patients are first diagnosed with diabetes they are very scared and rightly so. Diabetes is a serious disease with serious complications. If you or someone you know has diabetes, they should see their family doctor right away and start treatment. Learn as much as you can to help prevent further complications of this serious illness. Knowledge is power.
Q: Some people think Diabetes is incurable! Some believe durood, dam, taweez or visiting tombs of saints can control Diabetes! Some use alternative medicine. What’s your take on this?
Ans: Moneeb, this is a very interesting question and the answer is not simple. I would like for you to read the book, “The 7 laws of magical thinking” by Mathew Hutson. Patients come from various backgrounds. Most people in the world hold one or the other kind of irrational beliefs. Doing these rituals for generations, they don’t have an insight. We can’t prove or disprove these claims. Even very educated and intelligent individuals can have magical thinking. You can use them for psychological advantage. We call it a placebo effect. Our patients may belong to any religion, cult or group. Our job is not to argue with them about wearing or not wearing a taweez, pray to a tomb or a God or not. They may continue to use the alternative means for treatment. We only ask them to stick with the medical advice at the same time.
It is everyone’s personal preference if they want to use their own traditional healing methods. No one likes their beliefs challenged. Everyone holds their own very dear. The last thing you want is to drive the patient away. It’s fine with me if my patients want to use taweez, or ask their personal gods or visit tombs etc. I only ask them to take their medications as prescribed. We also ask all patients to keep a list of any alternative traditional hakimi, or homeopathic meds and bring it to their appointments so we can make sure there are no drug interactions with what we have prescribed.
Q: What are the risk factors? Can Diabetes be treated with preventive measures without taking any medications?
Ans: The risk factors for diabetes include age, family history, weight, other diseases such as high blood pressure, high cholesterol or heart disease and lifestyle factors such as diet and activity. As you can see some factors are modifiable and some are not.
You can reduce your risk for having diabetes by following a healthy lifestyle. Eating less calories and implementing regular physical activity can help reduce the risk or at least delay the onset of diabetes.
Pre-diabetes or very early stage diabetes can be treated with following low calories diet, weight loss and exercise. There was a study published in British medical journal that showed when patients with new-onset diabetes were put on 600 calories/day restriction their diabetes reversed in 8 weeks.
But once the disease is well-established there is no turning back. At this point medications become very important in the control of diabetes.
Q: What foods are good for diabetics and which ones should be avoided?
Ans: Fruits, vegetables, high fiber foods are good, starchy, oily and sugary food intake should be limited. Choose brown rice over white and whole wheat over white.
Q: What kinds of Allopathic medications are available for Diabetics and what are the side effects?
Ans: A hundred years ago, there were no allopathic medicines available but now we have a range of medications in our armamentarium against diabetes. These agents belong to different drug classes which work through various mechanisms. For detailed answer to this question, I will refer you to the chapter on medications in my book. Everything you need to know about diabetes.
Q: Some doctors prescribe expensive medications when cheaper drugs are available! What can a patient do?
Ans: This practice is shrinking as information is increasing. Knowledge is power. I suggest to patients to learn as much as they can about their illness. Patients can also ask the pharmacist to switch to a generic drug if name brand is more expensive.
For example, synthroid is a name brand made by Abbot Pharmaceuticals. The same drug is available as a generic levothyroxine or levoxyl which is considerably cheaper. A pharmacist can help you make the switch.
Q: What is a Glucometer? What are the benefits of using a Glucometer? How should one choose one?
Ans: To check blood sugars is an important part of diabetes management. A glucometer is an instrument that is used to measure blood glucose. There are several different types of glucometers available in the market. We prescribe one to a particular patient depending on which ones are covered by their insurance. There are quite comparable and you can use the one that is cost effective for you.
Most important thing is to check blood sugars regularly and record them to help make treatment decision.
Q: What is special about your book? Where can we find it?
Ans: My book is well-researched and has detailed information about diabetes in simple language. If you will read the book, you will start to understand Diabetes. It will no longer remain a mythical or mystical disease.
Q: Considering your book/blog, in my opinion, you could have been a journalist/writer! What would you have become if you were not a doctor?
Ans: There is no such thing as completing one’s education as education is never complete. If I were not a physician today, I would go back to the University and continue studies and research. I would be a teacher.
Q: What are your unfulfilled goals and wishes?
Ans: My deepest still unfulfilled desire is to add to human knowledge, to discover something new.
Q: Please explain any event of your fellowship is USA?
Ans: Picture from the Pool party for graduating and new fellows at Dr. Baker’s house- July 2010. This is Dr. David Kem, my mentor during the fellowship. He invented the saline infusion test and the captopril suppression test to diagnose the disease of primary hyperaldosteronism. These tests are considered gold standard around the world. He trained under Dr. Conn who first described Conn’s syndrome in 1950s.
This is the email he sent me when I passed the American board of Endocrinology, Diabetes and Metabolism.
“Lubna, I am very pleased (and may I say proud) to hear the good news. This is just one of several important milestones in your career; but of course the last one is always most important! I am not surprised that you passed it as I have watched your work and desire for this to happen. I am pleased for you and your family as they have participated in it as well. Sorry I missed you the other day as the session ran over and I realized you had to work. I look forward to your adding more milestones during your career and look forward to the interactions to continue.”
David C. Kem, MD
George Lynn Cross Research Professor
Regents’ Professor of Medicine
Endocrinology and the Heart Rhythm Institute
Q: What is your message to the people?
Ans: My message to all people especially the young generation is to question everything. You should Research! Find cures! Find answers! Help make world a better place. Keep growing, keep dreaming, and laugh some every day!
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