Metabolic Karma in Diabetes Care: Medico-philosophical Reflections.

Sir,

The concept of metabolic karma, as described in the editorial by Dr Kalra and colleagues,[1] is a multilayered one. The definition of karma (action; destiny) overlaps with kriya (action) and dharma (duty; constitution). This is true for diabetes care as well.

Indian philosophy, as propounded by Lord Krishna, clearly states that one should engage in one's occupation, and fulfill his or her dharma. Although there are bound to be imperfections, this should not make us stop working. Thus, the diabetes care professional, whose dharma (duty) is to practice diabetes care, should strive to do his or her best, irrespective of all odds and challenges.

“Better is one's own duty, though devoid of merit than the duty of another well performed; for performing the duty ordained by his own nature, man does not incur sin.”

Bhagavad Gita 18:47

The Bhagavad Gita compares, at length, the relative importance of gyaan yoga (knowledge) and karma yoga (action or practice). While both these types of yoga are important in their own right, it is best if concordance is achieved between knowledge (theory of diabetes care) and practice (clinical diabetes care). This age-old philosophy, in fact, is the bedrock of modern clinical methods.

The need for concordance can also be highlighted by viewing “dharma” and “karma” as two sides of the same coin. As long as our actions are in sync with our constitution or duty, we may be able to achieve harmony in life. This, too, reminds the diabetes care professional to follow optimal conduct while managing persons with diabetes. It also reminds us to ensure concordance between our thoughts (knowledge), words (physician-patient communication) and actions (prescription).

“Free from attachment, unegoistic, endowed with firmness and zeal and unswayed by success and failure – such a doer is said to be Saattvika.”

Bhagavad Gita 18:26

The Bhagavad Gita is a sempiternal example of how cost: benefit, or risk: benefit, analysis is done, and then acted on. Similarly, while choosing strategies for screening, diagnosis, and management, one should assess both anticipated benefit, possible side effects, in an individualized, person centered manner. Mastery of this science, and art is our dharma (righteous duty), our karma (action), and our kriya (work). This will facilitate harmonious achievement of good karma (destiny).

Frustration with the lack of adherence or persistence is a fact of life for many diabetes care professionals. Indian philosophy strongly suggests a person-centred approach through these verses of the Bhagavad Gita.

We would do well to internalize this wisdom. As diabetes care professionals, we should work, to the best of our ability, without expectation of reward.

“Thus, has this wisdom, more profound than all profundities, been imparted to you by Me; deeply pondering over it, now do as you like.”

Lord Krishna to Arjuna; Bhagavad Gita 18:63.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.