The three words, “You have diabetes”, usually have a profound effect on the individual, young or old, especially the former. People tend to go through myriad emotions, ranging from guilt, confusion, fear, anger, self –pity and confusion, to even, relief, ultimately. Some people tend to blame themselves, for their poor food habits or erratic lifestyle, and stress. Some people even feel that its life’s way of punishing them for some wrong –doing. Of course, one has the right to be on an emotional ‘see-saw’, with the onset of diabetes, since it is a major life change like any other.
Onset of diabetes has many implications due to its chronic and indefinite nature. Although diabetes is a clinical disorder, it has a psychological impact on the individual due to nature of the illness, rigorous dietary restrictions and complex treatment regimen. Diagnosis of diabetes maybe viewed as a three stage process:
- Prior health status – good, generally not on much medication.
- Insidious onset of diabetes and one’s reactions to it have been likened to the four stages of grief, viz.,
- Denial: It is a way of coping with something when a person is not ready to face it. It is the opposite of acceptance. Hence, one tries to underplay it – “I’m on the borderline”, “Diabetes is not a big deal’, “The tests are wrong”, and so on.
- Anger: “Why me” comes to the fore here, along with, “I do not deserve this”, “I have not hurt anybody”, “Why bother, I’m going to get complications anyway”. There is a feeling of injustice, and of life being unfair.
- Depression: The individual feels overwhelmed by the many changes they have to make to their lifestyle. They feel that the joy has gone out of their lives. Fear of taking insulin, even if it is only at sometime in the future, sets in. Depression is usually characterized by insomnia, loss of appetite, mood instability, fatigue, and loss of interest in usual activities. If symptoms persist, social support and therapy may be necessary.
- Acceptance: The final stage is acceptance, when the individual comes to terms with reality, accepts he has diabetes and learns to manage it. It is the opposite of denial, in other words.
- Learning self management and coping skills.
Initially, it often takes time to come to terms with diabetes, from several months to even one or two years, occasionally. It is easier to be aware of one’s physical and emotional limits, and be realistic about one’s inner feelings about diabetes. Take things slowly and do not push yourself or let others push you. When one is in denial, or simply not wanting to acknowledge diabetes, sugars can shoot up due to non –compliance with diet, exercise and medication.
Those who have not been seriously ‘sick’ before, experience a sense of loss of previous good health. There is a sense of permanence and powerlessness. Compounded to that, anxiety of family members, and well meaning friends and relatives, who are willing to give a lot of free advice (Take bitter gourd juice and fenugreek seeds first thing in the morning, Do not take medicines as it will damage the kidney, Try acupuncture, If you start insulin, it’s for a life time, so avoid it….), confuses and stresses the individual even more. Knowledge and understanding about diabetes helps in coping with the daily challenges of managing diabetes and a sense of being in ‘control’.
However, despite ones best efforts, the fight with diabetes can often appear like a losing battle, sometimes, both to the individual and the medical team. Some patients are hard on themselves, which can be self-defeating and frustrating. This is because they are trying everything to keep their sugars under control, but with age, duration, severity, and a host of other clinical factors beyond their control, it becomes a huge challenge.
Stress and non-compliance are the two main culprits that act as barriers to effective treatment of diabetes. While stress is beyond one’s control (sometimes), compliance, to a certain extent, is not. Rigidity of habits and unhealthy lifestyle can be a huge deterrent, too. We often find patients unwilling to change, say, their diet pattern, timing or lifestyle, simply because they do not want to let go, or for some strange reason, feel they are being disloyal to their ingrained values, customs and traditions. E g. fasting.
Many a time, stress is self-imposed, usually due to impractical thinking, high expectations and wanting to be in control. More flexibility in thinking, and adaptation to situations, as and when they come, can help reduce one’s stress. However, sometimes, stress can be genuine and beyond one’s control, as in having financial problems, relationship issues, job pressures, ill health, going through an emotional crisis, and so on. At such times, one uses coping strategies, but unfortunately, the sugars predictably shoot up. Professional help for those who are overwhelmed and unable to cope would be a good idea.
Apart from the pressures of dealing with situational stress of this kind, those with diabetes also have to manage their sugars – by eating on time, the right foods, taking their medication, and doing regular physical activity. Any deviations from the regimen could result in hyperglycemia or even hypos. This results in a rush to the doctor/ lab, to check if everything is in order. Patients run through a gamut of emotions at the hospital, ranging from fear, guilt, sadness, hopelessness. There is a lot of anguish for putting their families through financial constraints and emotional distress when they fall ill, or have to be dependent on others. At such times, social and emotional support can help bolster one’s flagging morale.
Acceptance of diabetes is the first step to controlling it. It is more helpful to accept the things that one cannot change than trying to resist it, or keep complaining to aggravate the problem. Listed below are some coping strategies to help the newly diagnosed to manage diabetes effectively:
- Commitment: Make a commitmentto manage your diabetes. Learning more about diabetes can give one a feeling of empowerment. Learn the basics of diabetes, and follow the rules of healthy eating and physical activity, apart from prescribed medication.
- Stress Management: Stress may lead to lack of compliance and self care, paving the way for high sugars. Simultaneously, stress hormones (in response to prolonged stress), oppose the action of insulin from being released, thereby aggravating the problem. Prioritizing one’s work and schedule, time management, and de- stressing through yoga, some sport or hobby helps in compartmentalizing one’s life.
- Lifestyle changes: Make necessary changes to one’s lifestyle to achieve good results, as far as diabetes is concerned. It may be a gradual process, but pays off in the long run. Adaptation is the key word here.
- Positive acceptance: Try and replace negative, self-defeating thoughts with more positive, proactive ones. Staying positive helps in avoiding resentment and depression, and maintaining good health and mental well-being. Acceptance does not mean ‘surrendering’ to diabetes or feeling resigned. It’s a matter of choice, which will help you take care of it.
At the end of it all, one wonders whether there is some specific formula to manage one’s diabetes perfectly, but on the brighter side, readiness to change, self-motivation, a sense of personal choice, and use of problem solving techniques can make one feel more in control of one’s health, and improve one’s quality of life, in the long run. Presently, there are many mobile applications and technological devices that help in diabetes management.
Peter Asperella, in his fictional work, “Good Like This”, has neatly summed up the protagonist’s feelings about diabetes thus, “It’s not a horrible disease, it’s not something I have to conquer or destroy, it’s not an obstacle that I have to surpass. Maybe it’s just something I learn to live with happily, like a friend”.
Individuals with a healthy lifestyle and good compliance remain ‘rooted’, like the green tree.
Individuals with an unhealthy lifestyle and lack of self care could end up weak and fragile, like the brown tree.
Stay healthy and ‘green’.
Vidyulatha Ashok, Psychologist
Dr Mohans Diabetes Specialities Center