Some are so angry about diabetes that they refuse to take medication and keep on eating the wrong foods.
In this series of articles about diabetes that is inspired by the questions I regularly receive from the public, I have realised that some diabetic patients exhibit most disturbing attitudes. More than one patient has declared that he or she is so angry to have this disease that he/she refuses to take any medication or has decided to eat all the wrong foods. This type of attitude can of course have serious and even fatal consequences, particularly in insulin-dependent or type 1 diabetes.
A typical example
Here is a striking example of what such patients feel and how lost and angry they are:
“I was diagnosed at age 21 with type 1 diabetes. I was a skinny happy person then with no psychological problems at all... suddenly I found myself with a million restrictions of all kinds, and food became an obsession in my mind, always thinking and worrying about the food that could mean my death... I was doing well with keeping my sugar right for about 6 months max... Then I got depression. from all the restrictions I had. 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, coz it is 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!!! and I feel so alone with this. And I'm scared that I will die or lose my legs or something with my diabetes being so out of control - I am 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 otherwise this patient will eventually do herself irreparable harm.
The psychological aspects of diabetes
It is evident that this patient 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 is doing.
On the other hand, she is 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 is not 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 which tempts her to disregard all the measures that will keep her safe and healthy, and which has developed into a type of eating disorder. I am sure that many diabetics share these feelings and battle with similar problems.
Why patients get desperate
It is 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, then it is important to obtain expert support 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 type 1 diabetes (as well as type 2 diabetes, for that matter) is not 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 most importantly from your family and friends, then you can rise above these feelings and leave them behind.
One of the most important factors in conquering diabetes is communication (as mentioned in Part I of this series). 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. Do not isolate yourself, but ask for help. Consult a clinical psychologist or an eating disorder clinic, your doctor and your dietician, they are 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?
Last week I mentioned that the human brain is extremely sensitive to blood sugar levels. To be able to think and function, the brain requires blood sugar levels to be tightly controlled.
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 (Mahan & Escott-Stump, 2000). All these symptoms can engender fear and influence your psychological well-being dramatically.
If you have a hyperglycaemic attack, you need to see your doctor immediately and receive treatment to prevent ketoacidosis and coma.
On the other hand, hypoglycaemia (blood sugar levels that are too low), may cause a lack of concentration, sweating, nausea and vomiting, tiredness, anxiety, irritability, aggressive behaviour, depression, disturbed vision, shakiness, dizziness, rapid heartbeat, angina pain, and high blood pressure (Mahan & Escott-Stump, 2000). If left untreated serious hypoglycaemia can result in brain damage or even trigger a heart attack. It is not surprising that diabetic patients who have experienced such symptoms can become fearful and feel threatened.
Diabetics should always have some high-GI foods (sugar, glucose tablets, sugar-sweetened cold drink) readily available at all times so that they can restore their 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 or 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 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 do not develop psychological problems to complicate your physical condition.
- (Dr IV van Heerden, DietDoc, May 2011)
(Mahan LK, Escott-Stump S (2000). Krause’s Food, Nutrition & Diet Therapy. 10th Ed., WB Saunders Co. Philadelphia; Reuters (2010))