Coping with Diabetes

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Dr. Bev has some crucial advice for coping with diabetes. 

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“CONGRATULATIONS on being diagnosed with diabetes!” 

...What? 

That’s what my brother said to me on March 14, 1975, when I was diagnosed with type 1 (then referred to as Juvenile diabetes). When I asked him why he said that, he explained, “I know you will always take good care of yourself.” My brother was right! The same is true for everybody diagnosed with diabetes. Taking good care of yourself includes healthy eating, healthy living, and healthy emotions. 

Common Emotional Responses

Denial

One of the most common initial reactions to receiving the diabetes diagnosis is denial. There is a feeling of disbelief and confusion. It’s understandable when somebody is diagnosed with diabetes to feel overwhelmed and burdened if they fear that they are going to face a scary future living with a chronic condition. 

But, worrying about a future that you can’t predict, and ignoring diabetes self-care, is not a strategy for success. I would recommend taking your diabetes, and its management, one day at a time! Manage what you can, as best you can, daily. When you break down your management into daily self-care in the here-and-now, it’s not so overwhelming.

Obsessive worry 

The exact opposite style of denial is the person who is obsessive in their self-care. Usually, these people are newly diagnosed and want to be "perfect." They worry constantly about their blood glucose and feel frustrated if their reading is out of their target range. They deny themselves foods they enjoy, believing that they must never again eat any high-carb foods. They are stressed worrying about future complications. 

An emotional consequence of such strict diabetes management and obsessive worry is "diabetes burnout." I advise my patients that if they feel like diabetes is a prison, then it's time to break out, before you burnout! Although being perfect in your diabetes management is a noble goal, it is unrealistic. Nobody's blood glucose is perfect all the time! Rather than trying to be perfect, a more realistic goal is to do your best and accept the fluctuations in blood glucose as they occur. People can still enjoy eating their favorite high carb foods while being mindful of portion-controlled sizes. 

Anxiety 

Anxiety is another common feeling among people with diabetes. Stress can disturb blood glucose control because of the body’s release of stress hormones which produce extra glucose. When people with diabetes are stressed, the production of the stress hormones adrenaline and cortisol increases, which raises blood glucose levels. 

Actions you can use to help calm anxiety include exercise, which can manage stress, as well as blood glucose; get enough sleep; and/or try mindfulness and relaxation to keep calm. Changing your thoughts can also help reduce anxiety, such as accepting "it is what it is;" approaching life with a sense of humor to improve your mood; and/or practice having an attitude of gratitude. It is not happy people who are thankful. It is thankful people who are happy!

Diabetes distress 

Depression is also commonly reported to occur in people with diabetes. However, if the depression somebody experiences is related to living life with diabetes, that is known as diabetes distress. Diabetes distress arises from living with the stresses of diabetes, specifically regarding the demands that diabetes self-management requires, such as choosing healthy foods, physical activity, blood sugar monitoring, and taking medications. The rate of diabetes distress is far greater than is often appreciated: 39% of people with type 1 diabetes and 35% of people with type 2 diabetes experience significant levels of diabetes distress at any given time. 

This distress cannot be treated with depression medications because…it is not depression! Depressive-like symptoms (such as appetite, sleep, or concentration disturbances) may more likely be due to the effects of high or low blood sugars. Diabetes distress can be managed by changing your (negative) thoughts which in turn can change your (negative) feelings. You can learn to recognize and challenge unreasonable thoughts and change your thinking to rational thoughts. 

Along with improved thoughts and actions, additional strategies to reduce diabetes distress can include the understanding that diabetes is manageable, and that neither complications nor diabetes distress is inevitable. Find healthy ways to reward yourself for successful self-care so it doesn’t feel like work all the time. Stay connected with your health care provider, as well as with family and friends. You do not have to manage alone!

Congratulations!

You, too, can always take good care of yourself, just like my brother said to me. To successfully live with diabetes, it helps to develop a positive attitude about living with diabetes. As the saying goes, “you cannot live a positive life with a negative mind." A positive outlook leads to a positive outcome.  If you default to a negative mindset, that will limit you. A bad attitude is like a flat tire—you don't get anywhere until you change it. If you feel overwhelmed and out-of-control trying to manage your diabetes, you may benefit from seeing a mental health clinician who provides diabetes-focused therapy. People who are engaged in their own self-care are less frustrated and more upbeat about having diabetes. Empowerment can lead to good diabetes self-management.