Teens and Diabetes: A Challenging Combination

One of Dr. Afaque Akhtar’s principal healing modalities will not be found in a little black bag. It is kind and relentless repetition.
“Some of my most challenging patients are still teenagers, and they have diabetes,” he notes. “They need kind, persistent, even relentless repetition of what they need to do to get well, to care for themselves, and to stay well.”
An internal medicine specialist, Dr. Akhtar’s practice is the Premier Health Center in Fuquay Varina.
“I repeat for these young patients, as often as necessary, that their diabetes is not a disease, it’s a syndrome. It can affect many parts of their body, including their eyes—it can lead to blindness. It can cause a heart attack. It can damage their kidneys, and possibly lead them to dialysis. They can have wounds that refuse to heal, and even lose a limb.
“Some of these patients come to me—in surprising numbers—and they will tell me, in kind of an off-hand way, that they are taking their medications right on schedule and they are doing okay. But with a little persistent digging we find out that is not true. Their eating habits are not exactly what they need to be. They are not paying attention to the necessity for the right kind of exercise, and they are not taking their medications right on schedule, without fail. And they’re not regularly checking their blood sugar level as they need to do.”


And there is more, Dr. Akhtar continues. “I’ll want to know if they have followed up with an ophthalmologist as directed, to check their eyes—because diabetes can lead to blindness. Are they regularly—every day, without fail—checking their feet for any type of wounds, which can lead to amputation?
“These are all critical issues, individually and collectively. And even one of these conditions, full blown, will have a great impact on the patient’s quality of life. I’m not a psychiatrist, but there clearly is a critical psychological component to this work. It’s critically important that the patient, regardless of age, understand the nature of the disease state. One of the most important ongoing tasks for me is to motivate the patient—especially these younger patients—to understand the power they have to manage their illness. But they need the will to do that.
“If someone has diabetes and they are still smoking, for example, it’s a deadly combination. They need to have the will power and the desire to move from harm to health. And it’s my job to guide and support them every step of the way on this journey.”


Dr. Akhtar notes that while he is not a family-care physician, he sees his role is “to both educate the patient individually and the community at large. This is my job. Everything I do is related to answering a single question: How can we improve the health of the person who comes to my office, in the process of improving the health of the community as a whole?
“We have to understand what the patient is thinking and feeling in her or his life, what problems and challenges they may be dealing with everyday. Invariably, we need to be equally concerned with both physical and psychological issues. If we do not understand our patients’ mental situations, their financial situations, their social situations, and their cultural background, then it is difficult to treat them only with medication. These are among very significant challenges.
“With challenging patients, my strategy is very simple. Keep talking to them again and again about the same things. Perhaps it may sometimes seem to be boring for the patient, but that repetition can be powerful. Even if they seem disconnected or disinterested, the message is getting through—and it can make a difference in their lives. If they keep hearing affirming messages from me again and again, at some point, it registers.”