Coping With Your Diagnosis
June 2002 Diabetes Forecast
By Carol E. Watkins, MD
The diagnosis of diabetes is a major blow. It affects every aspect of your life,
from the way you eat to how you schedule your day to what you carry around in
your pockets or purse. You have to master a complex system of dietary and
medical regimens, and plan ahead for “what-ifs” such as low blood sugars, high
blood sugars, and delays in meals.
Moreover, diabetes is permanent. So while you are figuring out the logistics of
diabetes, you are faced with adjusting to a new view of yourself and your life.
Your unique reactions are related partly to your personality and partly to the
nature of diabetes. If you’ve always thought of yourself as invincible, a
diabetes diagnosis may be particularly difficult for you to deal with. And if
you have other health problems, you may begin to feel overwhelmed.
GRIEF: One of the most common reactions to a diabetes diagnosis is grief,
something each of us handles differently. You may experience several stages of
grieving, and some stages more than once. They may not always occur in the
particular order listed here, but most newly diagnosed people go through at
least some of these stages.
DENIAL: “The test was wrong.” “I don’t feel sick.” Denial is a refusal to face
the diagnosis. It may be a way of delaying or protecting yourself from pain. In
people with type 2, denial can go on for years because the disease often does
not have obvious symptoms. If you feel okay, you might tell yourself that you
are okay. This is dangerous because complications can set in without your
knowing it. If you wait until your doctor tells you that you need pills or
insulin before accepting your diagnosis and doing something about it, by then
the damage to your body may have already occurred. Denial can be accutely
dangerous for people with type 1, who often experience a “honeymoon” phase
shortly after diagnosis. During this phase, diabetes appears to go into
remission, and blood sugar control seems too easy. The honeymoon phase may
reinforce denial, but within six months the truth will be unavoidable, as the
pancreas finally stops producing insulin and treatment becomes necessary for
life.
ANGER: “It’s not fair.” “Why me?” “He’s heavier than I am and he’s fine.” Anger
may have many targets. For example, if you have type 2 and are trying to lose
weight, you may envy people who weigh more than you do who seem to enjoy better
health. You may erupt at someone who offers you a rich dessert. You may be angry
about having to take medication or give yourself insulin shots. You may resent
having to change your schedule around to make room for a disease. Unfortunately,
anger can also adversely affect your blood sugars.
GUILT: “It’s my fault for eating all that junk food.” “I shouldn’t have partied
like that in college.” “I should have exercised.” You may feel guilty if your
doctor has told you that your diabetes is related to your weight or lifestyle.
Some people are able to manage their guilt and convert it into motivation for
dietary and lifestyle changes. Others, however, become depressed or revert to
denial. Parents may blame their child-rearing skills or genetics for their
childs’s diabetes, or a mother, the food she ate while pregnant.
DEPRESSION: “My life is ruined.” “This is so hard.” “I miss my old life.” Mild
depressive feelings are a normal part of grieving and adaptation. As long as
they are not pervasive or prolonged, they are probably not harmful. However, if
depression lasts a long time, becomes severe, or interferes with day-to-day
diabetes care, you should seek treatment promptly.
ACCEPTANCE: “Life goes on.” Ya gotta do what ya gotta do.” “When life gives you
lemons….” Everyone achieves a different degree of acceptance and inner peace.
Some need to experience denial, anger, and depression several times as they move
through different phases of their life and different stages of diabetes. Others
may actually come to see some aspects of the diabetes as a blessing. Through
close attention to diet and exercise and close monitoring of stress levels, they
gain a deeper understanding of themselves and their relationships with others.
They realize that all human beings are vulnerable, and that life is precious.
They also feel empowered and in control of their lives when their efforts at
diabetes control start to pay off and they begin to feel stronger and healthier.
CONTINUED…
December 3rd, 2006 at 2:18 am
I FELT LIKE THIS WHEN I WAS TOLD I HAD DIABETES. DIDNT KNOW IT WAS A
NORMAL THING TO GO THRU. I STILL HAVE PROBLEMS WITH SOME OF THESE
FEELINGS. I WAS DIAGONOSED IN OCT. 2000. DOES IT EVER GO AWAY?
of your life, from the way you eat to how you schedule your day to
what you carry around in your pockets or purse. You have to master a
complex system of dietary and medical regimens, and plan ahead
for “what-ifs” such as low blood sugars, high blood sugars, and
delays in meals.
logistics of diabetes, you are faced with adjusting to a new view of
yourself and your life. Your unique reactions are related partly to
your personality and partly to the nature of diabetes. If you’ve
always thought of yourself as invincible, a diabetes diagnosis may be
particularly difficult for you to deal with. And if you have other
health problems, you may begin to feel overwhelmed.
grief, something each of us handles differently. You may experience
several stages of grieving, and some stages more than once. They may
not always occur in the particular order listed here, but most newly
diagnosed people go through at least some of these stages.
refusal to face the diagnosis. It may be a way of delaying or
protecting yourself from pain. In people with type 2, denial can go
on for years because the disease often does not have obvious
symptoms. If you feel okay, you might tell yourself that you are
okay. This is dangerous because complications can set in without your
knowing it. If you wait until your doctor tells you that you need
pills or insulin before accepting your diagnosis and doing something
about it, by then the damage to your body may have already occurred.
Denial can be accutely dangerous for people with type 1, who often
experience a “honeymoon” phase shortly after diagnosis. During this
phase, diabetes appears to go into remission, and blood sugar control
seems too easy. The honeymoon phase may reinforce denial, but within
six months the truth will be unavoidable, as the pancreas finally
stops producing insulin and treatment becomes necessary for life.
fine.” Anger may have many targets. For example, if you have type 2
and are trying to lose weight, you may envy people who weigh more
than you do who seem to enjoy better health. You may erupt at someone
who offers you a rich dessert. You may be angry about having to take
medication or give yourself insulin shots. You may resent having to
change your schedule around to make room for a disease.
Unfortunately, anger can also adversely affect your blood sugars.
have partied like that in college.” “I should have exercised.” You
may feel guilty if your doctor has told you that your diabetes is
related to your weight or lifestyle. Some people are able to manage
their guilt and convert it into motivation for dietary and lifestyle
changes. Others, however, become depressed or revert to denial.
Parents may blame their child-rearing skills or genetics for their
childs’s diabetes, or a mother, the food she ate while pregnant.
life.” Mild depressive feelings are a normal part of grieving and
adaptation. As long as they are not pervasive or prolonged, they are
probably not harmful. However, if depression lasts a long time,
becomes severe, or interferes with day-to-day diabetes care, you
should seek treatment promptly.
life gives you lemons….” Everyone achieves a different degree of
acceptance and inner peace. Some need to experience denial, anger,
and depression several times as they move through different phases of
their life and different stages of diabetes. Others may actually come
to see some aspects of the diabetes as a blessing. Through close
attention to diet and exercise and close monitoring of stress levels,
they gain a deeper understanding of themselves and their
relationships with others. They realize that all human beings are
vulnerable, and that life is precious. They also feel empowered and
in control of their lives when their efforts at diabetes control
start to pay off and they begin to feel stronger and healthier.
December 10th, 2006 at 1:26 pm
Continuation…
June 2002 issue of Diabetes Forecast, by Carol E. Watkins, MD
YOUR PERSONALITY
Your reactions to your diagnosis are shaped by your personality and by the =
nature of diabetes itself. The stress caused by learning you have diabetes i=
s similar, in many ways, to the stress you experience when dealing with any =
catastrophic event in your life, such as losing a job or getting divorced.
Try to be honest but gentle with yourself. Think back about how you have fa=
ced previous stressful situations. Remember how you coped, what worked well,=
and what didn’t. You’ll probably find yourself using many of the coping sty=
les you have used in the past. You may also learn new coping skills that you=
can use in other situationss.
Some people have a dependent personality style. They rely on others in the =
family for their care or expect that the doctor will know and think of every=
thing. If you deal with life this way, you may hesitate to ask your doctor q=
uestions. At first you might need to bring a friend or relative along to hel=
p you be assertive and ask questions. You may prefer a health care team that=
takes a friendlier, more hands-on approach.
Perhaps you have a meticulous, analytical personality. This can give you an=
edge in diabetes care, particularly if you like gadgetsthere are plenty a=
vailable to help you monitor and control your diabetes. Organization is a la=
rge part of successful diabetes management.
On the other hand, be sure to give yourself some “wiggle room” in controlli=
ng your blood sugars. If you constantly aim for the lowest possible normal n=
umber on your blood sugar meter, you increase the risk of developing low sug=
ars. So aim for a range within the scope of normal instead.
Perhaps you need to see yourself as strong, beautiful, healthy, or financia=
lly successful. A chronic illness may challenge these assumptions; it may se=
em easier to deny that you have diabetes. You may find yourself becoming ang=
ry at your health care team, or retreating into depression. If the diagnosis=
is affecting you this way, it may help you to help others who also have dia=
betes.
Then there are rebelsand not just teenagers. Some adults may react to the=
ir diagnosis through denial and reckless behavior. “As long as I’m going to =
die, I might as well enjoy life,” the thinking goes. They may even embrace d=
estructive behaviors such as drinking or severe dietary indiscretions. If th=
is sounds familiar, contact with peers with diabetes who can acat as role mo=
dels may help. When putting togethera health care team, try to find professi=
onals who can accept your anger about having diabetes without taking it pers=
onally.
THE DIABETES ITSELF
Although being diagnosed wiht diabetes has much in common with other major =
life stresses, some aspects of the disease set it apart and may influence yo=
ur initial reactions. People with type 1 often react differently from those =
with type 2.
With type 1, the onset is sudden. There is no room for denial because denia=
l is incompatible with life. People with type 1 must learn more intensive mo=
nitoring and often endure more invasive treatments than people who have type=
2.
That doesn’t mean a diagnosis of type 2 is any easier to cope with. Many pe=
ople with type 2 are diagnosed with diabetes when complications make themsel=
ves known: They seek treatment for a tingling foot, a wound that won’t heal,=
problems with vision, chest pain. If this is how you found out about your d=
iabetes, you may feel overwhelmed, like you’re being hit from several angles=
all at once.
On the other hand, type 2 often has no symptoms, and many people with type =
2 had no idea they had it until their doctors recommended screening because =
of risk factors like family history, age, or weight. Being diagnosed this wa=
y can come as a shock.
If you are a senior, it can be particularly frustration to be told that you=
must change long-cherished habits. Some seniors embrace the technology asso=
ciated with caring for their diabetes, but others find it daunting.
WHAT TO DO
So, you know how you’re feeling. Now what do you do about it? Talk!
At first, you may not want to discuss it, and that’s okay. A certain amount=
of solitude can be useful for reflection. But prolonged isolation can be a =
breeding ground for depression and despair.
This is a good time to reach out to family and friends. It may be helpful t=
o talk to others who have diabetes, particularly if their circumstances are =
similar to your own. For example, if you are struggling to lose weight and s=
top smoking, you mayh not feel comfortable talking with a thin, athletic ind=
ividual who never smoked and has no complications.
Disclosure is an issue as well. You may be ashamed of diabetes, worried abo=
ut how your family, friends, and co-workers will treat you, and how it will =
affect your career if others know. But secrecy is dangerous. If you are taki=
ng medication or insulin, there should be someone who knows what to do in ca=
se you have a severe low and you are unable to treat yourself. Wear a meical=
alert bracelet as well.
Let your diabetes treatment team know about your feelings. If you have a pa=
st history of depression or other emotional difficulties, make sure that the=
y are aware of this. If intense emotions persist, it may make sense to seek =
help from a mental health professional. Depression and certain other mental =
health conditions are more common in people with diabetes. In fact, some doc=
tors consider depression a complication of diabetes.
Don’t be afraid to seek help if you need it. The same goes for your family.=
Some families find that diabetes exacerbates household stress. In such case=
s, family therapy may be useful. If you are coping with your child’s diagnos=
is, and with your child’s own response to his or her diabetes, counseling ma=
y help.
Diabetes and your emotional state are intimately connected. Just as you mus=
t now be more vigilant about your diet, you must also be more aware of your =
emotions. Knowledge is power. This applies to the emotional as well as the p=
hysical side of diabetes.