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The psychological aspects of diabetes

It's a sad reality: some diabetics are so angry about their condition that they refuse to look after themselves properly.

This type of attitude can, of course, have serious and even fatal consequences, particularly in insulin-dependent, type 1 diabetics.

A case in point
“I was diagnosed at age 21 with type 1 diabetes," writes one diabetic on an online diabetes forum.

"I was a skinny, happy person with no psychological problems at all. Suddenly I found myself with a million restrictions of all kinds. Food became an obsession in my mind. I was always thinking and worrying about the food that could mean my death.

"I was doing well in terms of keeping my sugar right for about 6 months. Then I got depression from all the restrictions. It’s not fair to live like this! I went for therapy and went on antidepressants, 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 and 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. 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 am totally out of control! I can't tell my husband. He'll never understand. I don't really know what to do."

The psychological aspects of diabetes
It's clear that this patient has totally given up hope and that she's suffering from serious psychological problems as a result of 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 an insulin regimen, an individual diet prescription, and an exercise programme. She isn't paying attention to one of these important treatment aspects.

On the other hand, she's battling deep-seated fears related to 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), feelings of being totally deserted by the rest of the non-diabetic world, and, most dangerous of all, a death wish that tempts her to disregard all the measures that will keep her safe and healthy.

As a result, she's developed a type of eating disorder.

Why patients get desperate
Many diabetics share similar problems.

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 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.

Once you realise that diabetes isn't a death sentence, that there are steps you can take to control this condition and live a good life, and that you can ask for help from diabetes support networks and 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 anti-diabetic medications), your diet, the role of exercise and where you can get psychological support.

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 diabetes can have such an effect
The human brain is extremely sensitive to blood-sugar levels. For the brain to be able to think and function properly, blood-sugar levels should 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 well-being 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 diabetic patients who have experienced such symptoms can become fearful and feel threatened.

If you're diabetic, 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, you should 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 plan for hyper- and hypoglycaemic emergencies, and guide you in preventing them. Prevention of blood-sugar fluctuations is still the best way to keep healthy and happy.                                                

Reference:
- Mahan LK, Escott-Stump S (2000). Krause’s Food, Nutrition & Diet Therapy. 10th Ed., WB Saunders Co. Philadelphia; Reuters (2010)

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