On her fifteenth birthday, Sana Ajmal did what the average fifteen-year-old is wont to do: eat a great deal of cake. Unlike the average fifteen-year-old, however, her sugar levels skyrocketed and she fell into a coma. Fortunately, she recovered, but was diagnosed with Type I diabetes. Since then, Sana has learned to live with her condition, to recognize her symptoms and manage her diet, and to help others in a similar predicament. She has a PhD in computer engineering, is happily married with two healthy children, and is the founder and chairperson of Meethi Zindagi, the first patients’ organization in Pakistan to work for the rights and responsibilities of people with diabetes. Living with diabetes has not kept her from doing anything she wanted and in 2013 Sana was invited to the Heidelberg Laureate Forum as one of the world’s 200 most talented young researchers in mathematics and computer science.
Type I diabetes is not easily diagnosed, she explains, because the most common symptoms – frequent urination, excessive thirst and hunger, continuous weight loss and lethargy – often go unnoticed and are unthinkingly attributed to hot weather. Most patients are intimidated by their diagnosis as a result of inadequate knowledge, which makes self-management more difficult. Sana says she took control of her life post-diagnosis by reading extensively on the subject and continuing to ask her doctor how best to manage the condition.
Her "suitability" as a bride often went down when people discovered she was diabetic
As if society wasn’t bristling with enough prejudices, there is still a deep social stigma attached to diabetes. Young patients often find themselves countering anxiety and depression, especially if they feel they cannot rely on their family and friends for emotional and practical support. Sana says she was lucky to have parents who instilled in her a strong sense of confidence and reassured her constantly that there was no reason for the diabetes to keep her from completing her education, finding a partner, or achieving her professional goals.
“When I was diagnosed,” remembers Sana wryly, “people would pass all kinds of comments,” implying that she would not be able to study or get married. Diabetes has patriarchal undertones in Pakistan and Sana found that her “suitability” as a bride often went down when people discovered she was diabetic. Her family took a strict stand on this: anyone who wanted to marry their daughter would have to accept her situation unconditionally. Luckily, she found a supportive partner who, she says, has always been understanding and encouraging – even to the point of modifying his own lifestyle to suit hers. “He has stopped eating sweet foods and started exercising regularly,” says Sana of her husband, and “without his support, it would have been impossible for me to manage my daily life.”
Sana at the Heidelberg Laureate Forum 2013
Managing diabetes is, she agrees, tricky, but it can be done if one is willing to carefully modify one’s lifestyle. Sana says she checks her sugar levels very frequently – usually one to three times a day and more if she is ill. She avoids very fatty foods and controls her carbohydrate intake, having learned to calculate swiftly how much rice or potatoes, for example, are equivalent to one roti. Fresh raw vegetables and fruits are an important part of her diet plan. “I eat what every person who wants to stay healthy should eat,” she points out. Sana also exercises regularly to control her weight and ward off stress, which can trigger a diabetic episode if one is not careful. Most importantly, she keeps to a strict medicine regimen and follows her doctor’s advice to the letter, especially if she has decided beforehand to treat herself to an occasional dessert. “There can be no hide and seek with medication,” she explains.
Of course, there are times when being careful means being doubly careful. When Sana was expecting, she made sure to check her sugar levels eight or nine times a day all through her pregnancy. “Your blood sugar levels immediately affect your unborn baby’s health,” she says, adding that she was also very careful about her diet. “A fat baby is not a healthy baby, as is commonly believed in our culture,” explains Sana.
It can be difficult dealing with diabetes when one is swayed temporarily from a set schedule and meal plan for any reason: unexpected guests, an urgent deadline, children needing attention when one is due to eat or have one’s medicine. Fasting, says Sana, is possible, but should not be attempted without a doctor’s advice, given that one’s entire routine has to be reassessed and modified. “You need to watch your levels very closely to make sure they do not fall too low while fasting. If they do, you must break the fast,” she points out sensibly.
Sana believes there is a great deal that can and should be done to help other diabetics learn to cope and live normal lives. As Pakistan’s ambassador for the online diabetes community, My Diabetes Story, she is actively involved in raising awareness of healthcare issues from the patient’s perspective. Apart from her ongoing work with Meethi Zindagi, she has also served as the vice president and president elect of Young Leaders in Diabetes, an international program run by the International Diabetes Federation.
My Diabetes Story is an online forum for diabetic people to provide each other with peer support. Eight countries are currently represented on the forum and each country has its own ambassador for the diabetes community, with Sana representing Pakistan. “We talk about the daily issues we face in managing diabetes. We discuss things like discrimination and social stigma… how frequently certain tests should be done, what kind of shoes to wear, where to find them,” she explains. Currently, there are 75 members and the community is growing at an average rate of 20 members per month. One of its members is a dietician who engages with the community and offers the benefit of personal experience. Sana herself is a fully trained and certified diabetes peer educator. Engaging with the forum is obviously not a substitute for seeking regular medical advice, but it does help members support and learn from each other.
“Diabetes is complicated. And it’s not a disease… I call it a lifestyle. It has to be adopted by everyone in the family. You cannot single out one person in the family who has diabetes and expect them to adopt such a lifestyle by themselves. The whole family has to become part of it. And it’s a healthy lifestyle too. Adopting it means cutting down the risk of problems like obesity, heart disease, and Type II diabetes in any case,” says Sana.
Visit the My Diabetes Story website and register at www.mydiabetestory.com
