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Some people with diabetes become so angry about their condition that they refuse to take medication and continue to eat the wrong foods. This attitude can, of course, have serious and even fatal consequences, particularly in people with insulin-dependent or type 1 diabetes.
A typical example
Here's a striking example of what one such patient feels:
"It’s not fair to live like that! I went for therapy and on anti-depressants, which worked well, but you can't stay on those forever. Since then, I stopped testing my sugar, because it's always high and it makes me angry and scared. And I eat anything, all the time, by myself in secret. I have chocolate/cookies/chips hidden EVERYWHERE! I eat all day, at least every half hour. I eat myself nauseous, and I eat myself broke, I've stolen food (a lot). I’ve stolen money to buy food. I just can't stop!
"I feel so alone with this. I'm scared that I'll die or lose my legs or something with my diabetes being so out of control - I'm totally out of control! I can't tell my husband. He will never understand. So I don't really know what to do."
This is a cry from the heart and it needs to be addressed, or else this woman will eventually do herself irreparable harm.
The psychological aspects of diabetes
It's clear that this person has totally given up hope and is suffering from serious psychological problems associated with her diabetes. She is, in fact, being incapacitated by a number of simultaneous, seemingly insurmountable problems.
On the one hand, she has diabetes, which requires careful adherence to her insulin regimen, her individual diet prescription and an exercise programme - none of which she's doing. On the other hand, she's battling with deep-seated fears created by her condition (fear of dying, fear of loss of control), anger at the unfairness of having a serious disease, depression (which can have multiple causes, including the fact that her diabetes isn't being controlled, which will influence the function of her brain and nervous system as outlined below), feelings of being totally deserted by the rest of the non-diabetic world, and most dangerous of all, a kind of death wish that tempts her to disregard all the measures that will keep her safe and healthy, and which has developed into a type of eating disorder.
The reality is that many diabetics share these feelings and battle with similar problems.
Why people with diabetes get desperate
It's perfectly understandable that anyone who is diagnosed with a serious condition such as type 1 diabetes should feel shocked, angry, frustrated, unfairly treated, depressed, fearful and defiant.
If you have similar feelings, it's important to get help as soon as possible. Ask your doctor to refer you to a clinical psychologist to help you work through your feelings and develop a more positive approach. If you can face up to reality and realise that diabetes isn't a death sentence, that there are steps you can take to control this condition and live a good life if you take care of your body, and that you need to ask for help from diabetes support networks and from family and friends, you can rise above these feelings and leave them behind.
One of the most important factors in conquering diabetes is communication. Get as much information as possible about your condition, your treatment (insulin or oral antidiabetic medications), your diet, exercise and where you can get psychological support. Then reach out to the members of your support system when you need them. Don't isolate yourself; ask for help.
Consult a clinical psychologist or an eating-disorder clinic, your doctor and your dietician. They're there to provide you with answers when you experience a problem, but they can’t help you if you don’t communicate with them.
Why can diabetes have such a pronounced psychological effect?
The human brain is extremely sensitive to blood-sugar levels. To be able to think and function properly, the brain requires blood-sugar levels to be tightly controlled.
a) Hyperglycaemia
If your blood sugar increases to dangerously high levels (hyperglycaemia, which can be induced by not using your insulin or oral medications in the right doses or at the right times, or by eating sugary foods or drinking alcohol), you may feel tired and sleepy, develop low blood pressure, a rapid and erratic heartbeat, and ketoacidosis, which can cause you to lose consciousness and slip into a coma.
All these symptoms can engender fear and influence your psychological wellbeing dramatically.
If you have a hyperglycaemic attack, you need to see your doctor immediately and receive treatment to prevent ketoacidosis and coma.
b) Hypoglycaemia
On the other hand, hypoglycaemia (blood sugar levels that are too low), may cause a lack of concentration, sweating, nausea, vomiting, tiredness, anxiety, irritability, aggressive behaviour, depression, disturbed vision, shakiness, dizziness, rapid heartbeat, angina pain, and high blood pressure. If left untreated, serious hypoglycaemia can result in brain damage or even trigger a heart attack. It's not surprising that people with diabetes who have experienced such symptoms can become fearful and feel threatened.
If you have diabetes, you should always have some high-GI foods (sugar, glucose tablets, sugar-sweetened cold drinks) readily available, so that you can restore your blood-sugar levels rapidly at the first sign of any of the above-mentioned symptoms. As soon as you start feeling better, eat a low-GI food (low-GI bread with cheese, a boiled egg or nuts) to stabilise your blood-sugar levels.
Your dietician and your doctor will help you to plan for hyper- and hypoglycaemic emergencies, and teach you how to prevent them. Prevention of blood-sugar fluctuations is still the best remedy to keeping your life on an even keel, so that you don't develop psychological problems to complicate your physical condition.
- (Dr I.V. van Heerden, registered dietician)
Reference:
(Mahan LK, Escott-Stump S (2000). Krause’s Food, Nutrition & Diet Therapy. 10th Ed., WB Saunders Co. Philadelphia; Reuters (2010))
