The Emotional Side of Diabetes - Part 1: Things You Should Know: A series from the Behavioral Diabetes Institute

Part 1 of our series from the Behavioral Diabetes Institute

By William Polonsky, Ph.D., C.D.E

Living well with diabetes takes emotional strength. Why? Because this is a tough disease. Diabetes is more than just a simple matter of eating right and taking your medications. Staying strong emotionally is key to keeping stress and your blood glucose levels where they belong. Unfortunately, people with diabetes—as well as doctors—often neglect these “real life” aspects of the disease.

How can you manage diabetes while also giving proper attention to your own thoughts and feelings? Here are important things you need to know about the emotional features of diabetes. In this article, we focus on the personal side of diabetes.

1. Harnessing your fears.
   With good care, you can live a long, healthy life with diabetes. Many people think they are doomed to suffer terrible complications, but this is simply not true!

Diabetes is a serious disease and some people do develop severe long-term complications, but many of these problems are preventable if you have good medical care and take good care of yourself.

Feeling a little frightened is not necessarily a bad thing, but when your fears get so big that you feel helpless and hopeless, it’s time to take action. You need to harness fear to help you manage your diabetes.

Solutions:

• Fight fear with knowledge. Learn about the powerful benefits of good diabetes care by talking to your doctor or enrolling in a diabetes education program.
• Ask your doctor about what your real odds for developing complications might be, and what you can do to improve those odds.
• Subscribe to any of the popular diabetes magazines to keep informed about how to avoid or slow complications.
• If you are anxious about hypoglycemia, talk to your doctor about medication changes that can help. Fear of hypoglycemia is about losing confidence in your body, worrying a serious reaction could happen at any moment. It can lead to high blood sugars, eating problems and an overly restrictive lifestyle. With treatment, these problems can be completely resolved.
• Remember that your own self-care actions can make a big difference to your health. You are not helpless! After all, it’s not diabetes itself that typically causes serious problems, it’s poorly-controlled diabetes. With good care, you can live a long and healthy life.

2. Overcoming depression
   Depression is a serious problem, and it can be even more serious when you have diabetes.

People with diabetes are more likely to develop depression than other people. If you are depressed, diabetes can become a lot harder to handle and your blood sugars are likely to rise. And when your diabetes is out of control, this can make it even harder to escape depression. It becomes a vicious circle.

The good news is that there are effective treatments that can help you recover your emotional health. They could also help you improve your blood sugar level and feel more in control of diabetes.

        Solutions:

• Watch for the warning signs of depression. If you are feeling down or hopeless about life, have lost your “get up and go,” or are feeling reduced interest or pleasure from the things you used to enjoy, talk to your doctor as soon as possible.
• Take action to avoid depression. Make sure to get a good night’s sleep as often as possible, stay active and spend time with friends each day. Include activities in your daily life that are personally rewarding and meaningful, like taking an interesting class or volunteering at a local museum. All of these can be powerful anti-depressants.
• If you are depressed, don’t just wait around and hope it will go away. There are several good medications and different forms of counseling that have proven to help people recover from depression. Speak with your doctor about getting the help you need.
3. Defeating denial
   Denial can be a valuable tool. It can be a good way to cope with negative feelings about diabetes, especially when you are first diagnosed or when the disease is feeling out of control.
But denial becomes a problem when it is your only way of coping. Instead of a temporary tool, it becomes a permanent way of life. The response to all diabetes aggravations becomes “I will not think about diabetes anymore.” This means trouble. When you turn your back on diabetes, your long-term health is endangered.
Solutions:
• Learn the facts about diabetes by attending a diabetes education class or support group in your area. You need to know that:
  a) Diabetes is a serious disease that can harm you when it is not adequately controlled, even if you feel fine.
  b) Ignoring diabetes is likely to cause more serious health problems.
  c) Paying attention to diabetes can help you to live a longer, healthier life.
• Stay informed about your own health status. See your doctor regularly and complete all of the recommended medical tests (such as A1C, blood pressure and cholesterol). Know the results of these tests and what they mean. When you are well informed, you feel more able to manage diabetes and keep it under control.
• Don’t do diabetes alone. Share your thoughts and feelings about diabetes with a friend. Confiding in someone you trust can help you to gain the support and perspective necessary for making sense out of your own emotions and attitudes.
4. Giving up the guilt
   You are not a bad person because you developed diabetes. It is not your fault. You are not “bad” because you didn’t exercise today or because you ate the wrong thing last night. Nobody can manage diabetes perfectly. Guilt is common when you are living with diabetes, and it is hardly ever useful.
Because of guilt, people often establish tough, sometimes impossible rules about how to manage diabetes (“I must NEVER eat even a bite of junk food ever again”). Since you can never be perfect, rules like these can make you feel like you are failing and can promote depression. Enough already!
Solutions:
• Remember that you didn’t give yourself diabetes. As Americans grow heavier and heavier, it may seem as though everyone is trying hard to develop Type 2 diabetes. Yet most “fail” to do so. Obesity and a sedentary lifestyle are contributors to Type 2 diabetes, but if you don’t have the genes for it, you can’t develop it. For Type 1 diabetes, your own actions played no role at all. It wasn’t all those sweets you ate as a child, or anything else you did.
• With your doctor’s help, make sure your diabetes expectations are achievable. Stop beating yourself up every time you eat the wrong food, forget to exercise or skip a blood glucose test. Perfection isn’t required, though you do want to reach metabolic goals that can keep you healthy. Develop a reasonable behavioral plan that can help you achieve those goals, then relax!
• Get perspective. Instead of criticizing yourself for the occasional lapse, give yourself credit for all of your positive efforts to manage diabetes. Everyone needs a pat on the back, and you probably deserve one.

A few last words

Diabetes can be tough, but you can live well with it. You can succeed with diabetes through knowledge, good medical care and emotional strength.

This article originally appeared in the pamphlet, "The Emotional Side of Diabetes: 10 Things You Should Know About Behavioral Diabetes,” from the Behavioral Diabetes Institute (BDI), and is reprinted here with permission. BDI is a nonprofit 501(c)3 organization dedicated to helping people with diabetes live long and healthy lives. Find out more at www.behavioraldiabetes.org.