It's time to take back control!
At six, I was diagnosed with Juvenile (Type 1) Diabetes. Suddenly, my universe went from waiting for the ice cream truck to asking hard questions about life, death, and illness. Err, talk about change!
In 1977, the emotional aspects of chronic disease were very much under the rug. My doctors encouraged me to "tough it out." In my teens, I translated that nebulous instruction into a life adrift, between blood sugar levels and corresponding emotional extremes. I found my way. Unfortunately, many people with diabetes suffer with denial and shame.
As of 2012, there are about 29 million people (8.1 million went undiagnosed) in the U.S. with diabetes. The disease triggers a lifestyle transformation — it requires 24/7 vigilance and monitoring. Keep in mind, blood sugar levels impact people's moods ... effecting how they think, learn, and interact with others. Understanding the effect of blood sugar levels is the first step in understanding your own mental state and how to avoid problems in your relations with others.
The Vicious Cycle of Diabetes
When you're stuck in a depressive rut or are just feeling "foggy" ... it's not you ... it's your body's chemistry. Low blood sugar reduces the stability in your brain, leading to poor memory and difficulty learning. High blood sugar is no picnic, either. It causes the blood to thicken and oxygen levels to reduce. This mental fog can create a vicious cycle — sickness leads to depression, which leads to apathy, and denial. Without proper management, these symptoms only grow worse.
I've seen people lift their spirits and gain their energy back, simply by getting a handle on their blood sugar levels. Conversely, I've seen people destroy their lives and relationships by letting things go unchecked. The result? Resentment, denial, and dwindling self-worth.
Bob: A Tale of a Ravaged Marriage
Let's take a look at Bob*. Every morning, the type 2 diabetes patient lies in bed, struggling to open his eyes. He's under the impression that he's an early riser, choosing to fall back asleep. Meanwhile, his wife, who has already showered and dressed, resents his laziness. Neither he nor his wife recognize his lethargy as a consequence of the disease.
An hour passes. Bob forces himself up. He's not feeling it, at all. Soon after, he discovers that his blood sugar is high at 250 mg/dL, so he administers a corrective dose of insulin. Moments later, his wife shouts that breakfast is ready. Not wanting to cause trouble, Bob eats without waiting for his levels to return to normal.
And so, Bob's day begins with the dulled, persistent sickness that comes with improper health management. His physical and emotional symptoms begin to blur. He thinks, "Am I really feeling sick? Maybe I'm just depressed." In this moment, the guilt and shame creeps in setting up mines of doubt.
Bob's wife leaves to run errands. Bob has plans too, but the combined stress and guilt leave him cemented to the couch. Two hours later, listless, he checks his blood sugar, which has spiked to 280 mg/dL.
His wife comes home and asks if he did the grocery shopping. He responds, admitting, that he didn't feel like going today. He’ll get to it tomorrow. His wife is fed up.
"What am I supposed to cook for dinner?" she asks pointedly.
He looks at her, dazed, and says, "I don't know."
She responds, "You don't care about our marriage. Do you think I spent all day running your errands because I felt like it? Maybe we should just end it."
Bob gives her a bewildered look. "End what?"
She fires back at Bob, "Our marriage! All you do is lie around the house all day. What happened to you?" she says, incredulous.
Hurt and confused, Bob shouts, "I do plenty!" and storms into another room.
There are two ways to tell Bob's story. The first is one of mysterious tragedy. Five years ago, after 20 years of blissful marriage, Bob began to change, losing interest in his wife, and his daily routine. His diagnosis was the coup de grace, extinguishing whatever vitality was left.
The second story is the truth, and provides hope for Bob's future. Bob is sick and has been for a long time. His illness could have begun up to fifteen years ago. In those years, it took its toll on him — altering his personality and ravaging his body. At diagnosis, his blood sugar was three times the normal level. Terrifying. Bob's journey is just beginning, but he'll need coping tools and the support of his loved ones.
How to Cope
We have examined how diabetes mismanagement can devastate a person's emotional health, and consequently, their relationships. A diabetes diagnosis can make you and your loved ones feel like your lives have been misplaced. However, proper healthcare, therapy, and clear communication with those close to you can end the cycle of illness and depression.
A diabetes diagnosis can place strain on even the happiest relationship, but it doesn't have to end it. While it's natural to not want to burden your loved ones, you have to let them help and understand you.
- Inform your significant other if you're not feeling well or your blood sugars are off — he or she shouldn't have to ask!
- Express your limitations, so your partner knows to be flexible and patient. Instead of branding you as lazy or uninterested.
- Ask your partner to express concern if he or she sees you're not your usual self. And when he or she does, listen.
- Take blood tests often and share the results with your partner.
- Wait until blood sugars return to normal before eating. Dinner can wait — your significant other will understand.
- Change your internal thoughts to allow for mistakes. No one is perfect!
- Avoid placing blame. Replace the phrase, "should have" with "could have."
- Commit to a handful of simple, low-pressure tasks. Follow through even if you're feeling sad or foggy. Do the chores on Sunday or watch a movie with your partner.
- Seek professional guidance if you're emotions are interfering with your happiness and daily life.
Mental illness and diabetes tend to be a package deal. But the story doesn't have to end there — mine certainly did not. I'm thankful every day for my mother's decision to send me to psychotherapy. If it wasn't for that initial support, I wouldn't be where I am today. I can't stress enough the importance of seeking counseling, cognitive behavioral psychotherapy, or a certified diabetic educator as part of your diabetes care.
No two people are the same. But for many people with diabetes, reducing the emotional impact of high and low blood sugars starts with speaking up about their health.
Do you do these things?
- Inform the people in your life when your blood sugars are high or low. Remind or tell them that is why your behavior might be off or odd.
- Discuss the emotional symptoms of diabetes with people you care about.
- If someone comes up to you regardless of who they are and asks if you are okay, check your blood sugars. Regardless of high, low ,or normal, thank them, inform them if the level is off and that you're taking necessary steps to correct it.
- Always have the proper food available.
- Don't end up in a stressful situation where you, your friends, or family members are angry or frustrated due to lack of communication or not having the need supplies to manage your diabetes with you.
- Bring your fast acting insulin with you everywhere in case your blood sugar is high.
While it may seem like constantly monitoring what you put in your body is more trouble than it's worth, these relatively simple changes make returning to your old life possible. When you're overly careful and over-prepared, you've got the sense of security to handle whatever comes at you. Keep reaction supplies like glucose tablets or gels easily accessible. Be prepared should you experience low blood sugar. Tell your boss and coworkers, create a plan.
A diabetes diagnosis brings a slew of emotional issues, but it's also highly manageable. When your diabetes is managed well, the emotional issues become manageable, too. As a veteran Type I, I've dedicated my life to helping other people with diabetes in the New York Metro area.
For me, the most important piece of my health care puzzle was my emotional health and support that comes from talk therapy.
All the advice in this article is therapeutic in nature and should not be considered medical advice. Prior to making any changes to your diabetes maintenance program, please consult with your endocrinologist.
This article was originally published at Diabetic Talks Eliot LeBow. Reprinted with permission from the author.