Coping
Understanding and overcoming denial, depression, and anger
You’ve heard it a million times: Diabetes care is up to you. But it’s
easier said than done. Staying motivated 24 hours a day, seven days a
week can tire anyone out.
Of course, the more you stick to your plan of care, the healthier and
more energetic you will feel. But what if you lose your drive? If you
find you’re in a slump, you might want to check to see if your
emotions are getting in the way of good self-care. Three common
culprits are denial, depression, and anger. You can learn to spot
when these feelings are disrupting your self-care.
Denial
Denial is that voice inside repeating: “Not me.” Most people go
through denial when they are first diagnosed with diabetes. “I don’t
believe it. There must be some mistake,” they say.
That first reaction is not the real problem. In fact, it’s so common
that some doctors think it’s part of the process of accepting the
diagnosis.
The trouble comes when you keep on denying your diabetes. Long-term
denial stops you from learning what you need to know to keep yourself
healthy.
Why Deny?
Sometimes denial serves a purpose. It is a way of coping with bad
news. It can keep you from getting overwhelmed and depressed. It lets
you accept news little by little, when you are ready.
But denial can return later on because it seems easier. Denying that
your diabetes is serious lets you avoid self-care. It shields you
from the fact that diabetes is a lifelong, chronic illness, which, if
left untreated, can result in complications. Denial also lets your
family and friends pretend that “nothing is wrong.”
Doctors who do not specialize in diabetes care may fuel your denial.
They may talk about a “mild” case of diabetes or say there is “just a
touch of sugar” in your blood. Though well-meaning, these terms send
the wrong message. What you hear is: “Don’t worry. Your diabetes is
not serious enough to hurt you.”
Spotting Denial
Denial has a few catch phrases. If you hear yourself thinking or
saying them, you are avoiding some part of your diabetes care.
One bite won’t hurt.
This sore will heal by itself.
I’ll go to the doctor later.
I don’t have time to do it.
My diabetes isn’t serious. I only have to take a pill, not shots.
Hidden Danger
Because denial can creep into any aspect of diabetes self-care, it
can be dangerous. Any denial sabotages your health care.
Not testing. It can be a bother to check your blood glucose
regularly. You may decide you “know” what your blood sugar is by how
you feel.
But a meter is a much better measure of blood sugar than feelings
are.
Ignoring your meal plan. Changing eating habits and food choices is
tough. When your doctor told you to see a dietitian, follow a meal
plan, and change your eating habits, maybe you thought to yourself:
It’s too expensive to see a registered dietitian.
I can’t ask my family to change what they eat. I don’t want to eat
alone or fix two meals.
There’s no place to buy healthy food where I work.
It’s too hard to bring my lunch.
Eating right may not be as difficult as you think. A dietician can
help you put together a plan that meets your personal needs.
Forgetting your feet. You know you should check your feet each day,
but it takes too much time. Or you forget. Or you have limited
mobility and it’s too hard.
Washing and checking your feet for signs of trouble every day is
essential to avoid serious injury. This is true no matter what type
of diabetes you have.
Smoking. You might tell yourself, “I only take a few puffs.” You may
say smoking keeps you from eating too much: “If I quit, I’ll gain
weight.”
Smoking and diabetes are a deadly duo. Smoking increases your risk
for complications. Quitting is one of the best things you can do for
your health.
Avoiding Denial
Denial is human. It’s bound to crop up from time to time. When it
does, you can recognize what’s going on and fight back.
Write down your diabetes care plan and your health care goals.
Understand why each item in your plan is important. Accept that it
will take time to reach your goals. If you find you are denying some
parts of your diabetes care, ask your diabetes educator for help. If
you have trouble with your food plan, talk to a registered dietitian.
Together you can come up with solutions.
Tell your friends and family how they can help. Let them know that
encouraging you to go off your plan is not a kindness. Inform them
about how you take care of your diabetes-they might want to adopt
some of your healthy habits.
Depression
Feeling down once in a while is normal. But some people feel a
sadness that just won’t go away. Life seems hopeless. Feeling this
way most of the day for two weeks or more is a sign of serious
depression.
At any given time, most people with diabetes do not have depression.
But studies show that people with diabetes have a greater risk of
depression than people without diabetes. There are no easy answers
about why this is true.
The stress of daily diabetes management can build. You may feel alone
or set apart from your friends and family because of all this extra
work.
If you face diabetes complications such as nerve damage, or if you
are having trouble keeping your blood sugar levels where you’d like,
you may feel like you’re losing control of your diabetes. Even
tension between you and your doctor may make you feel frustrated and
sad.
Just like denial, depression can get you into a vicious cycle. It can
block good diabetes self-care. If you are depressed and have no
energy, chances are you will find such tasks as regular blood sugar
testing too much. If you feel so anxious that you can’t think
straight, it will be hard to keep up with a good diet. You may not
feel like eating at all. Of course, this will affect your blood sugar
levels.
What to Do?
Spotting depression is the first step. Getting help is the second. If
you have been feeling really sad, blue, or down in the dumps, check
for these symptoms:
Loss of pleasure. You no longer take interest in doing things you
used to enjoy.
Change in sleep patterns. You have trouble falling asleep, you wake
often during the night, or you want to sleep more than usual,
including during the day.
Early to rise. You wake up earlier than usual and cannot to get back
to sleep.
Change in appetite. You eat more or less than you used to, resulting
in a quick weight gain or weight loss.
Trouble concentrating. You can’t watch a TV program or read an
article because other thoughts or feelings get in the way.
Loss of energy. You feel tired all the time.
Nervousness. You always feel so anxious you can’t sit still.
Guilt. You feel you “never do anything right” and worry that you are
a burden to others.
Morning sadness. You feel worse in the morning than you do the rest
of the day.
Suicidal thoughts. You feel you want to die or are thinking about
ways to hurt yourself.
If you have three or more of these symptoms, or if you have just one
or two but have been feeling bad for two weeks or more, it’s time to
get help.
Getting Help
If you are feeling symptoms of depression, don’t keep them to
yourself. First, talk them over with your doctor. There may a
physical cause for your depression.
Diabetes that is in poor control can cause symptoms that look like
depression. During the day, high or low blood sugar may make you feel
tired or anxious. Low blood sugar levels can also lead to hunger and
eating too much. If you have low blood sugar at night, it could
disturb your sleep. If you have high blood sugar at night, you may
get up often to urinate and then feel tired during the day.
Other physical causes of depression can include
alcohol or drug abuse
thyroid problems
side effects from some medications
Do not stop taking a medication without telling your doctor. Your
doctor will be able to help you discover if a physical problem is at
the root of your sad feelings.
If you and your doctor rule out physical causes, your doctor will
most likely refer you to a specialist. You might talk with a
psychiatrist, psychologist, psychiatric nurse, licensed clinical
social worker, or professional counselor. In fact, your doctor may
already work with mental health professionals on a diabetes treatment
team.
All of these mental health professionals can guide you through the
rough waters of depression. In general, there are two types of
treatment. One is psychotherapy, or counseling. The other is
antidepressant medication.
Psychotherapy with a well-trained therapist can help you look at the
problems that bring on depression. It can also help you find ways to
relieve the problem. Therapy can be short term or long term. You
should be sure you feel at ease with the therapist you choose.
If medication is advised, you will need to consult with a
psychiatrist (a medical doctor with special training in diagnosing
and treating mental or emotional disorders). Psychiatrists are the
only mental health professionals who can prescribe medication and
treat physical causes of depression.
If you opt for trying an antidepressant drug, talk to the
psychiatrist and your primary care provider about side effects,
including how it might affect your blood glucose levels. Make sure
that the doctors will consult about your care when needed. Many
people do well with a combination of medication and psychotherapy.
If you have symptoms of depression, don’t wait too long to get help.
If your health care provider cannot refer you to a mental health
professional, contact your local psychiatric society or psychiatry
department of a medical school, or the local branch of organizations
for psychiatric social workers, psychologists, or mental health
counselors. Your local American Diabetes Association may also be a
good resource for counselors who have worked with people with
diabetes.
Anger
Diabetes is the perfect breeding ground for anger. Anger can start at
diagnosis with the question, “Why me?” You may dwell on how unfair
diabetes is: “I’m so angry at this disease! I don’t want to treat it.
I don’t want to control it. I hate it!”
One reason diabetes and anger so often go hand in hand is that
diabetes can make you feel threatened. Life with diabetes can seem
full of dangers-insulin reactions or complications. When you fear
these threats, anger often surges to your defense.
While it’s true that out-of-control anger can cause more harm than
good, that’s only part of the story. Anger can also help you assert
and protect yourself. You can learn to use your anger. You can even
put it to work for better diabetes care.
Anger and Self-Care
Anger worked against Mary H., a woman in her mid-fifties who was
diagnosed with diabetes six months ago. She was furious. She saw
diabetes as not just a threat to her health, but to her whole way of
life. A very proud woman, active in community and social affairs, she
found it impossible to be open about her “weakness.” She didn’t want
her friends to prepare special foods for her. She even felt her
husband now saw her as an “invalid” and that she was “less of a
woman” to him. Denial fueled Mary’s anger at diabetes.
The Anger Circle
Mary was stuck in an anger circle. She was angry at diabetes for
changing her life. She refused to face her health care needs because
she refused to change her life. Her diabetes went uncared for and her
blood glucose levels stayed high. As the disease went on poorly
controlled, Mary felt worse. Her anger at diabetes grew.
If you find yourself in an anger circle, like Mary, you don’t have to
stay stuck. One way to break the circle comes from Dr. Weisinger’s
Anger Work Out Book by Hendrie Weisinger, PhD. He suggests you do
three things:
1. Figure out what’s making you angry. How is that anger affecting
your life? Keep track of when you feel angry. Each evening, think
back over the day. When were you angry? What time was it? Who were
you angry at? What did you do about it?
After several weeks, read over your notes. See any patterns? When
Mary read her anger diary, she learned that social situations made
her angry. She did not like talking about her diabetes in public. She
felt angry if friends asked her what she could eat or made special
food. When she and her husband tried to go out with friends, she felt
her diabetes was the center of attention.
2. Change the thoughts, physical responses, and actions that fuel
your anger. Look for warning signs that your anger is building. Do
you feel tense? Are you talking louder and faster? When you feel
anger taking over, calm yourself by:
talking slowly
slowing your breathing
getting a drink of water
sitting down
leaning back
quieting yourself. Silence is golden in these situations.
These steps don’t mean you stop feeling angry. Instead, they mean you
are taking charge of your anger.
3. Find ways to make your anger work for you. Your anger diary can
help. Read your notes again. Look at each situation. Ask yourself:
How was my anger helping me cope? Mary decided her anger was helping
her avoid talking about her diabetes with others. She decided to try
answering questions in a matter-of-fact way. But she found that
talking about diabetes in public still made her furious.
Mary’s anger told her something very important. She still hadn’t
accepted having diabetes. To get more support, she joined her local
American Diabetes Association. Meeting other people with diabetes
helped her feel less alone. She also realized that having diabetes
did not make her less of a person.
Slowly, she was able to enjoy her friends again. She was able to talk
openly about her disease and also tell her friends that she didn’t
want special treatment.
Let Anger Be Your Ally
The goal is not to get anger out of your life. You may go on feeling
angry about the same things. When you feel threatened, afraid, or
frustrated, anger is a normal response. But you can put your anger to
work for you. Your anger may be a signal that you need to take
action. A few sessions with a skilled counselor might help.
Anger can be a force for action, change, and growth. The better you
understand your anger, the better you will be able to use it for good
self-care.