Diabetes is more than just a simple matter of eating right and taking your medications. Unfortunately, people with diabetes as well as doctors often …
The emotional side of
10 things you need to know
diabetes
The Emotional Side of
diabetes
Living well with diabetes takes emotional strength Why? Because this is a tough disease Diabetes is more than just a simple matter of eating right and taking your medications Staying strong emotionally is the key to keeping stress and your blood glucose levels where they belong Unfortunately, people with diabetes as well as doctors often neglect these real life aspects of the disease
How can you manage diabetes while also giving proper attention to your own thoughts and feelings? What follows are the most important things you need to know about the emotional features of diabetes, including:
personal side the social side the behavioral side
the
1
Harnessing Your Fears
tHe peRSonAL SIDe
With good care, you can live a long, healthy life with diabetes Many people think they are doomed to suffer terrible complications, but this is simply not true Diabetes is a serious disease and some people do develop severe long-term complications, but most of these problems are preventable if you have good medical care and take good care of yourself Feeling a little frightened is not necessarily a bad
thing, but when your fears get so big that you feel helpless and hopeless, its time to take action You need to harness fear to help you manage diabetes Fight fear with knowledge Learn about the powerful benefits of good diabetes care by talking to your doctor or enrolling in a diabetes education program Know the real odds Ask your doctor about what your real odds for developing complications might be, and what you can do to improve those odds Stay informed Subscribe to any of the popular diabetes magazines to keep informed about how to avoid or slow complications Dont put up with frequent lows If you are anxious about hypoglycemia, talk to your doctor about medication changes that can help Fear of hypoglycemia is about losing confidence in your body, worrying a serious reaction could happen at any moment It can lead to chronically high blood sugars, eating problems and an overly restrictive lifestyle With treatment, these problems can be resolved Stay in charge Remember that your own self-care actions can make a big difference to your health You are not helpless After all, its not diabetes itself that typically causes serious problems, its poorly-controlled diabetes With good
care, you can live a long and healthy life
2
Overcoming Depression
tHe peRSonAL SIDe
Depression is a serious problem, and it can be even more serious when you have diabetes people with diabetes are almost twice as likely to develop depression as other people If you are depressed, diabetes can become a lot harder to handle and your blood sugars are likely to rise When your diabetes is out of control, this can make it even harder to escape depression It becomes a vicious circle the good news is that there are effective treatments that can help you recover your emotional health these treatments can also help you improve your blood sugars and feel more in control of diabetes Watch for the warning signs If you are feeling down or hopeless about life, have lost your get up and go, or are feeling reduced interest or pleasure from the things you used to enjoy, then talk to your doctor as soon as possible Take action to avoid depression Make sure to get a good nights sleep as often as possible, stay active, and spend time with friends each day Include activities in your daily life that are personally rewarding and meaningful, like taking an interesting class or volunteering at a local
museum All of these can be powerful antidepressants If you are depressed, dont just wait around and hope it will go away there are several good medications and different forms of counseling that have been proven to help people recover from depression Speak with your doctor about getting the help you need
3
Defeating Denial
tHe peRSonAL SIDe
Denial can be a valuable tool It can be a good way to cope with negative feelings about diabetes, especially when you are first diagnosed or when the disease is feeling out of control But denial becomes a problem when it is your only way of coping Instead of a temporary tool, it becomes a permanent way of life the response to all diabetes aggravations becomes I will not think about diabetes anymore this means trouble When you turn your back on diabetes, your long-term health will be endangered Learn the important facts about diabetes Attend a diabetes education class or support group in your area You need to know that: a diabetes is a serious disease that can harm you when it is not adequately controlled, even if you feel fine b ignoring diabetes is likely to cause more serious health problems c paying attention to diabetes can help you to
live a longer, healthier life Stay informed about your own health status See your doctor regularly and complete all of the recommended medical tests such as A1C, blood pressure and cholesterol Know the results of these tests and what the results mean When you are well informed, you feel more able to manage diabetes and keep it under control Dont do diabetes alone Share your thoughts and feelings about diabetes with a friend Confiding in someone you trust can help you to gain the support and perspective necessary for making sense out of your own emotions and attitudes
4
Giving Up the Guilt
tHe peRSonAL SIDe
You are not a bad person because you developed diabetes It is not your fault You are not bad because you didnt exercise today or because you ate more than you intended last night nobody can manage diabetes perfectly Guilt is common when you are living with diabetes, and it is hardly ever useful Because of guilt, people often establish tough, sometimes impossible rules about how to manage diabetes I must neVeR eat even a bite of junk food ever again Since you can never be perfect, rules like these can make you feel like you are failing and can promote depression enough
already Remember that you didnt give yourself diabetes As people around the world grow heavier and heavier, it almost seems like everyone is trying hard to develop type 2 diabetes Yet most fail to do so obesity and a sedentary lifestyle are contributors to type 2 diabetes, but if you dont have the genes for it, you cant develop it For type 1 diabetes, your own actions played no role at all It wasnt all those sweets you ate as a child, or anything else you did With your doctors help, make sure your diabetes expectations are achievable Stop beating yourself up when you eat more than you planned, forget to exercise or skip a blood glucose test You dont have to be perfect to reach the level of control that can keep you healthy Develop a reasonable behavioral plan that can help you achieve those goals, then relax Get perspective Instead of criticizing yourself for the occasional lapse, give yourself credit for all of your positive efforts to manage diabetes everyone needs a pat on the back, and you probably deserve one
5
Appreciating The Power of Pals
tHe SoCIAL SIDe
Diabetes is easier to manage when you have people in your life who are rooting for you When you feel alone with
diabetes, it is harder to handle Imagine the meaningful ways that loved ones could support you or help you feel less alone: for example, when family members join you in having healthier meals each night, when a good friend shares your anger or disappointment with a high blood sugar reading, when your spouse offers to help you with your next insulin injection, or when your neighbor agrees to join you for a brisk walk each morning Just having someone in your life who cares can go a long way Ask for the help you need Many of your loved ones want to support your efforts, especially when you are trying to change your habits, but they may not know how to do so in a manner that fits your needs and respects your independence So think of a small, specific way in which a friend or family member can be helpful, then ask for that help Be a pal to your pals Ask for support in a kind, considerate way If you are too demanding, your loved ones may be unwilling to cooperate thank or acknowledge your loved ones when they offer support everybody appreciates positive feedback Seek out new friends Sometimes, friends and family just arent as supportive as you had hoped So make some new friends who
can understand the hassles of diabetes Join a diabetes support group in your community Your doctor or local hospital can help you find one that is right for you talking to other people with diabetes can help you feel less alone
6
Arresting The Diabetes Police
tHe SoCIAL SIDe
Friends and family may sometimes think it is their right to help you manage your diabetes, whether you like it or not Sometimes too much support, especially if you didnt ask for it, can feel like nagging When friends and family are bugging you about what to eat or what to do, you may tend to do the opposite of what has been suggested Dont think I should eat that piece of cake? oK, then Ill have two pieces though they mean well, they have become the Diabetes police, and youve become a Diabetes Criminal Start a conversation Because they care about you, it may be impossible to stop your loved ones from trying to be helpful So instead of telling them to stop policing you, harness their caring in a way that can work for you thank them for their concern about your health, explain that their actions are not helping you if they are not, and let them know specifically how they can be of real help A heartfelt
conversation can help you all feel like youre on the same team, with no police and no criminals Consider your own role Your loved ones may be nagging because they worry you arent managing your diabetes well enough If they are wrong, let them know how well you are doing by inviting them to your next medical appointment, sharing your A1C results, or having them accompany you to a diabetes education class If they are right, consider how you might improve your diabetes care
7
From Discouraged to Encouraged
tHe BeHAVIoRAL SIDe
Dont let diabetes get you down Diabetes can be a lot of work and sometimes even your best efforts dont seem to pay off–like when you follow your doctors recommendations exactly, but still your blood sugars are elevated that is understandably frustrating But it is not your fault ther 
e are ways to make diabetes care encouraging rather than discouraging Measure your diabetes care success in a realistic manner You can never be perfect, nor do you need to be Blood sugars rise and fall, sometimes for no obvious reason So learn about the A1C test, a blood test that measures your average blood sugar over the previous 10 12 weeks Your A1C result is the best way to
determine how you are really doing and it can help you handle the frustration of those wacky blood sugar readings For most people, if their A1C result is in a healthy range, then they are doing fine overall, even if their blood sugars are sometimes erratic Dont let blood sugar readings determine your self-esteem Blood sugar results are neither bad nor good; they are just information to help you remember, place a small piece of masking tape on your meter and write on it, It is just a number Set clear, specific, short-term goals for action If you just have a vague sense that you should be eating better or checking blood sugars more often, you might believe you are never doing enough With your doctors help, determine what your most critical self-care tasks should be, and get specific For example, exactly how much exercise each week? or what type of dietary changes at dinnertime over the next month? By clarifying your action plan, you can tell when you are successful
8
Keeping Diabetes in its Place
tHe BeHAVIoRAL SIDe
Diabetes is an important part of your life, but it doesnt have to run your life For many people, diabetes seems like a prison cell– no more enjoyable foods, no
spontaneity, no fun, and constant attention to the clock Some get so angry they decide to ignore diabetes altogether If you find yourself thinking this way, it is time for an attitude change Diabetes care in the 21st century means almost everyone can live their lives fully and take care of their diabetes successfully Sure, some compromises will be necessary, but diabetes shouldnt be allowed to box you in Feel like you are only allowed to eat birdseed? eating well with diabetes doesnt mean you must limit yourself to certain foods or only eat at certain times there are no forbidden foods Meet with a diabetes-knowledgeable dietitian to develop a personalized meal plan that fits your needs Is the clock running your life? Because of your medications or frequent problems with low blood sugars, the clock may be determining when you eat, exercise or check your blood sugars In most cases, you dont need to live your life like this talk with your doctor about switching to alternative medications or an alternative medication schedule that can give you back control over your life Build a realistic plan With your health care team, develop an overall plan so that diabetes can fit into your
life, rather than your life having to fit into the constraints imposed by diabetes
9
Taking Control of Your Environment
tHe BeHAVIoRAL SIDe
Your environment, whether you notice it or not, influences your ability to manage diabetes Having willpower isnt enough You need to harness the power of your environment to support, rather than hinder, your diabetes care think about it: how well you eat is affected by the number of tempting foods in your house and the size of the portions on your plate How faithfully you take your medications is influenced by how many you have and whether you keep them in a convenient, easy-toremember spot each day When you take back control of your environment, it no longer controls you Diabetes becomes easier to handle Select a convenient place to exercise pick a gym, park or road that is close to your home or work If it is too far away, you probably wont go Keep it ready If you have home exercise equipment, make sure it is always set up and ready to go the more effort required to set it up when you need it, the less likely you will use it Put it away Make sure that tempting, unhealthy snacks are out of the house or put away in cabinets out of sight
Start small At meals, start with smaller portion sizes Dont worry, you can always go back for more later Keep things close Keep your medications, blood glucose meter and supplies in a good spot, like the dining room table, where you are most likely to see them and use them
10
Taking a Diabetes Vacation
tHe BeHAVIoRAL SIDe
You need a vacation Diabetes can be a lot of work, and it demands your attention every day It is worth the effort, but it is a tough job All that effort can wear you down, especially if you never get a break And you can never take a break from diabetes or can you? In reality, everyone takes vacations from their diabetes thats not necessarily a bad thing A break from diabetes can be a big relief But make sure your diabetes vacations are safe And, like any good vacation, this takes some planning Work with your doctor to arrange for the healthy, regular breaks from diabetes you need A safe vacation doesnt last too long and involves planning ahead so your diabetes control isnt compromised this doesnt mean quitting your diabetes care altogether You might, for example, decide to take a night off each week from your diabetes-friendly meal plan, while learning how
to adjust your medications ahead of time A good vacation can restore your energy for managing diabetes Get help if you are taking unsafe vacations from diabetes An unsafe vacation is rarely planned, can go on for a long time, and may threaten your health perhaps you have been ignoring everything about diabetes for years, or you take your medications faithfully but decided you didnt want to ever check your blood sugars again Develop a more practical diabetes plan with your doctor that can help you get back on track and still provide you with occasional safe vacations from diabetes Everyone needs a diabetes vacation, so dont be afraid to take one But think ahead, and collaborate with your health care providers to build safe and healthy vacations into your life
A Few Last
words
Diabetes can be tough, but you can live well with it You can succeed with diabetes through knowledge, good medical care and emotional strength My colleagues and I at the Behavioral Diabetes Institute hope this booklet, which describes some of the most important tips for mastering the emotional side of diabetes, will serve you as a first step towards gaining the strength and skills you need When you are
ready for the next step, please come and visit us at wwwbehavioraldiabetesorg the BDI offers group workshops as well as personalized programs and services that can help you strengthen the emotional and behavioral skills necessary for living well with diabetes Many of these programs are described on the next pages We wish you a long, happy and healthy life William H polonsky, phD, CDe Founder and Director, Behavioral Diabetes Institute
Dr polonsky is a licensed clinical psychologist, certified diabetes educator and Associate Clinical professor in psychiatry, University of California, San Diego A nationally-renowned expert in the field of behavioral diabetes, he received his phD in clinical psychology from Yale University and has served as Chairman of the national Certification Board for Diabetes educators, Senior psychologist at Joslin Diabetes Center and a faculty member at Harvard Medical School Dr polonsky is a member of the editorial boards of Diabetes Forecast, Diabetes Self-Management and Diabetes Health He has authored several books on diabetes, including Diabetes Burnout:What to Do When You Cant Take it Anymore, published by the American Diabetes Association
Finally there
are
solutions
The Behavioral Diabetes Institute BDI is the worlds first organization to tackle the unmet psychological needs of people with diabetes It is a non-profit corporation founded in 2004 and headquartered in San Diego, CA BDIs evidence-based programs are designed to help people overcome the emotional and behavioral obstacles to living well with diabetes the organization is committed to: helping people master the unique challenges of diabetes conducting behavioral research in diabetes providing health care providers with specialized behavioral training for managing diabetes effectively Clinical programs at BDI, which include structured small group workshops as well as individual counseling services, help participants develop a more hopeful outlook on life and greater confidence and control over diabetes
we help you gain
control
BDIs Group
Getting on Track A one-day workshop to help participants learn about the emotional pitfalls associated with diabetes, determine their own diabetes-specific stresses, and develop personalized strategies for mastering those challenges
programs
Overcoming the Hassles of Hypoglycemia A one-day workshop for people with diabetes having
trouble with low blood sugars Learn new strategies for recognizing and dealing with hypoglycemia, conquering the fear of hypoglycemia, and resolving family tensions linked to hypoglycemia
Depression and Diabetes A six-week group program to address the unique problems of people with diabetes struggling with depression Depression is more common in people with diabetes, can be tougher to treat, and can make diabetes harder to manage This program tackles diabetes and depression together
The Diabetes Police An evening program for spouses, family members and other loved ones Learn how to manage your own worries and aggravations about diabetes, how to be helpful without nagging, and discover effective ways to talk about these undiscussables with your loved ones
The Parent Program An evening program for parents who have teens with diabetes Learn new strategies for helping teens be more successful with diabetes management while maintaining your own peace of mind
Diabetes Personal Training A six-month program focusing on individualized problem solving and developing slow, steady improvements in diabetes care
To register for workshops or to receive more information on BDI, its staff,
future programs and upcoming events in San Diego, visit us at: wwwbehavioraldiabetesorg or call us at 858-336-8693
po Box 501866 San Diego, CA 92150 858-336-8693 760-942-5780 fax wwwbehavioraldiabetesorg 2007 Behavioral Diabetes Institute All Rights Reserved
printing Costs of this Booklet have been underwritten by our friends at Roche Diagnostics
Source:dda.gov.np
