Farhan: "what is written will happen"

The case (fictional)

Farhan is 45 and owns a tyre shop in Faisalabad. He was diagnosed with type 2 diabetes three years ago. His HbA1c, a measure of average blood sugar, has risen from 7.5% to 10.2%. He takes his metformin "when I remember", rarely checks his sugar, and stopped going to the clinic after a doctor "lectured" him about his weight in front of other patients.

He says, "What Allah has written will happen," and points out that his father had diabetes and "lost a leg anyway, even with medicines". He eats at the shop, mostly from roadside stalls, and drinks several cups of sweet tea a day. He stopped his evening walk when his knee began to hurt. Last Ramadan he fasted the whole month against medical advice and had two dizzy spells.

His wife worries and now cooks separate meals for him, which he resents. His 19-year-old son has started helping at the shop and looks up health information on his phone. Farhan wants to see his daughter married in two years. He says his mood is fine but he sleeps poorly and feels "tired all the time".

The clinic refers him to its health psychologist.