Diabetes: Unmasking Its Hidden Toll
By Eric Bejarano, BS, CO For many people with diabetes, the effect of
diabetes on the mind and emotions is its most devastating aspect.
Psychological help is seldom the first line of defense, but rather
a last resort, which in turn allows bearers to become so deeply
entrenched in depression and anger that they become completely
unable to control the disease.
There are about 798,000 new cases of diabetes diagnosed each
year. Diabetes can cause or exacerbate other major health problems,
such as cardiovascular disease, stroke, neuropathy, amputations,
peripheral vascular disease, kidney disease, and retinopathy.
However, to treat the "whole person" and enable better successful
clinical management of diabetes, the health professional should be
aware of psycho-social aspects faced by persons with diabetes.
Psycho-Social Complications of Diabetes
Many persons with diabetes are troubled more by the emotional
factors associated with diabetes than by its biomedical aspect.
However, it is in this area that they are least likely to receive
support and guidance. Good diabetes management cannot be achieved
without careful and constant monitoring by patients themselves.
Therefore, it is essential that they be in good emotional health to
provide that self-care.
Persons with diabetes may think that if it weren't for this
rotten disease, their lives would be so much better. Most run
through the entire gamut of diabetes-induced emotions of denial,
fear, anxiety, anger, guilt, hostility, depression, and
frustration.
There are no vacations from diabetes. It is a 24-hour-a-day,
365-days-a-year job.
If you are a person with diabetes, the condition affects every
aspect of your life. It may force you to stick yourself with a
needle multiple times a day and deprive yourself of foods you
crave. If you succeed in keeping your blood glucose levels close to
normal, your risk of going too low goes up, and often, so does your
weight. To top it all off, you must live with the idea that there
are no guarantees when it comes to diabetes. You may do everything
right and still get a blood glucose reading you can't explain.
Diabetes-related psychological problems fall into two broad
categories: 1) coping difficulties and 2) diagnosable psychological
disorders. Coping difficulties are the more common problems, and
diagnosable psychological disorders are the more grave.
Psychological problems to watch out for are depression, anxiety
disorder, denial, anger, fear, and stress. These disorders tend to
last longer, feel worse, and recur more often--and having
psychological disorders makes controlling diabetes much more
difficult.
Depression
Depression is probably the leading psychological disorder among
people with diabetes. Depression causes sadness and a feeling of
being emotionally drained. These feelings may come and go in a
couple of hours or a couple of days. Clinical depression is far
more debilitating. The signs of clinical depression are feeling sad
and empty most of the day nearly every day, trouble sleeping or
sleeping too much, feeling agitated or physically sluggish nearly
every day, fatigue or loss of energy, diminished interest in many
or all activities, feeling worthless, diminished ability to think
or concentrate, and the list goes on.
Depression wreaks havoc with sleep. If you are dealing with
depression, the less sleep you get, the more depressed you become.
The more depressed you become, the worse your blood sugar level
gets. The worse your blood sugar level gets, the more neuropathy
can bother you. The worse the neuropathy gets, the worse the
depression becomes. The deeper the depression, the angrier you
become for not handling the depression better, making you even more
depressed.
Research shows that persons with diabetes are four to eight
times more likely to be clinically depressed than the general
population. Chronic hyperglycemia is more common among persons with
diabetes who are depressed. Depression is a concern not only
because of its mental health implications, but also because of its
negative impact on self-management, glucose control, and
complications in both adults and children. Even with all these
known facts about diabetes and depression, it is still
under-diagnosed by many physicians.
Denial
Immediately after diagnosis, people are often in a state of
shock. They may begin to experience intense feelings of
disorganization, anxiety, fear, and other emotions. Eventually this
crisis phase will end, and they must begin to develop a sense of
how diabetes will affect the rest of their lives.
Researchers have found that people suffering from acute and
chronic illnesses develop theories about how they contracted their
illnesses. Where people place the blame for their illness is highly
significant. Do they blame themselves, another person, the
environment, or a quirk of fate?
Self-blame for diabetes is widespread. In some cases, these
perceptions are, to a certain extent, correct. Poor health habits
such as smoking, improper diet, or lack of exercise can cause
illnesses such as diabetes. But what are the consequences to
self-blame? Some say that it can lead to guilt, self-recrimination,
or depression.
Persons in denial often will not be compliant and will not do
all the things needed to keep themselves healthy. It is also
unlikely they will be able to empower themselves--that is, to take
charge of their diabetes and assume responsibility for their own
care.
Reasons for Denial, Consequences
Some people hesitate to tell others about their diabetes because
they feel ashamed and isolated. Some view diabetes as a weakness,
especially when they're having trouble controlling it. This
weakness also is a feeling of being a burden to others. Others have
been taught to be secretive about it. This tends to be the case for
those who developed diabetes as a child, since many years ago
health issues were not discussed as openly as they are today.
Persons with diabetes also may assign the blame to others. They
say, "I can't follow my diet because my wife cooks too much food,
and I can't resist eating it if it's there," or, "I can't follow my
diet because the family doesn't like the things I'm supposed to
eat, and I don't have the time and energy to cook two different
meals." Bosses are blamed for creating stressful situations that
cause blood sugar to skyrocket. Health professionals are blamed for
not spending enough time explaining how to manage diabetes.
Children complain that if their parents would only get off their
backs, they could handle their diabetes much better.
Denial is especially risky in the case of diabetes. People who
deny that the problem exists will not take steps to treat the
condition. Poorly controlled diabetes can lead to further
short-term and long-term complications. Denial may interfere with
the ability to monitor conditions, to take the initiative in
seeking treatment, or to follow through with specified medical
care.
There can be a huge amount of marital discord and tension when
the person with diabetes is in denial and the other spouse is
frantic over the situation. It's most often the wives who
experience this kind of frustration when their husbands refuse to
take care of their diabetes, ignoring it as if it doesn't exist.
They complain that nothing they do makes any difference and may
feel like giving up completely.
Anger
Diabetes brings on plenty of reasons for anger, which can be
destructive. A surge of anger can spike blood sugar in seconds.
Anger triggers a fight-or-flight response that releases
considerable adrenaline and other stress hormones, which in turn
plays havoc with blood sugar and leaves patients emotionally
drained. Diabetes also can induce a physiological anger when blood
sugar drops too low; then a normally happy person with diabetes can
quickly turn into a frantic, irritated individual.
Persons with diabetes may be angry because they can no longer
eat what they want, or they feel that the diabetes has imposed
certain limitations on their life, or their family is not
understanding enough, or they become frustrated when they cannot
keep their blood sugar under control, no matter how hard they try.
Thoughtless comments from uneducated individuals can produce plenty
of anger.
Often people become angry about things they are really afraid
of. Diabetes can give rise to many fears: "How will I deal with
hypoglycemia?" "Will I be able to have children?" "Will I end up
having an amputation?" And, the biggest question: "Why did this
happen to me?"
Grief
When people are diagnosed with diabetes, many feel a grief
similar to that experienced when a loved one dies. They also
understand the unfortunate idea that they are not invulnerable and
immortal. Grief needs to be understood, accepted, and dealt with,
or later on it can become stronger and harder to cope with.
Food deprivations are probably the single most common source of
grief. Food can become an emotional comfort for persons with
diabetes, just as it can with other individuals; it's a way of
giving and receiving love. It's no wonder that food restrictions
make a person with diabetes feel so deprived.
Grieving over complications such as loss of sight, kidney
dialysis, or loss of a limb creates another new form of grief where
they feel guilt, denial, shock, anger, and depression all over
again.
Fear
Many persons with diabetes have a fear of dying, since death
becomes not just a sobering possibility but a reality that needs to
be faced emotionally. Many persons with diabetes also fear that
they will become disabled because of complications related to the
diabetes.
Frustration
Frustration is a constant companion. Besides other causes, they
can be frustrated by the relatively slow progress of medical
science in developing a preventive or cure. Mostly they are
frustrated by the unpredictable nature of their own bodies and the
inability to always control their blood sugar levels. Unrealistic
expectations from healthcare professionals cause frustration. Even
when a person with diabetes does everything right, blood sugar
levels may not achieve expectations. A simple cold, flu, or
infection can send blood sugar levels sky-high.
Guilt
When persons with diabetes become guilt-ridden, they believe
that they are bad, weak, self-destructive persons incapable of
doing anything right, especially when it comes to their diabetes.
They begin having negative thoughts such as, "I'll never be able to
stop smoking," or, "I have no will power when it comes to food,"
or, "I'm incapable of losing weight." These feelings of guilt
involve negative judgments about themselves which tend to focus on
the past, paralyzing them from making needed changes.
They may feel guilty if they need to impose some of their
regimen requirements on family and friends, so that others have to
adjust to their new lifestyle.
Anxiety
Anxious patients tend to report poor glucose levels and
increased symptoms soon after being diagnosed with diabetes. While
anxiety attributed to the illness may decrease over time, anxiety
about possible complications, the disease's implications for the
future, and its impact on work and social activities may
increase.
Stress
Stress is known to cause or exacerbate almost any medical
problem, and diabetes is no exception. Stress is particularly
dangerous for people with diabetes. The hormones that the body
releases as part of the fight or flight response are meant to
prepare the body for quick action. These hormones break down stored
glycogen into blood glucose, which the body should be able to use
for energy. But people with diabetes cannot effectively use this
extra glucose for energy, so the result is an extremely rapid rise
in blood sugar.
Seeking Help
Just as in physiological symptoms, each person with diabetes may
experience different psychological reactions. They need to be able
to accept the changes in their lives caused by the illness in order
to better manage the physiological symptoms. Persons with diabetes
should seek treatment when faced with depression, anxiety disorder,
frustration, guilt or stress; the physical and emotional burden of
being a person with diabetes can become too great to handle
alone. 
Table Of Contents - March 2006
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