Healthy Coping

Your Emotional Health: The Other Side of Diabetes Self-Management

By Ann S. Williams, Ph.D., RN, CDE

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Depending on how long you%27ve lived and coped with diabetes, you have likely experienced many emotional peaks and valleys—from denial to anxiety to depression to acceptance. News that your illness has taken a turn for the worse—and that perhaps a sharp and irrevocable decline in vision is imminent—will likely restart that emotional cycle, only the peaks and valleys may be either more or less extreme.

Some people believe that advancement through these emotional "stages" is a smooth, orderly process. Hardly! You may seem to move two steps forward and one backward, or be flooded with all of these emotions at once. And even after you%27ve reached the stages of acceptance and adjustment with your condition, this doesn%27t mean that feelings of fear and anger won%27t creep back when you least expect them.

You should know that all these feelings are perfectly normal, even expected. However, if you become so anxious, fearful, or despondent that you find yourself withdrawing from others, or you are unable to keep up your diabetes self-care regimen, then it%27s time to seek outside help.

In the meantime, it will help your outlook to dispel stubborn myths and stereotypes associated with diabetes, its causes, and the impact it has on those who live with it.

Diabetes and Vision Loss: Myths and Reality
Shedding the Stigma of Diabetes
Dealing With Diabetes Burnout, or "Diabetes Overwhelmus"

Diabetes and Vision Loss: Myths and Reality

OK, pop quiz: are the following statements about diabetes care true or false?

  1. People with diabetes can never eat anything sweet again.

  2. Diabetes is caused by eating too much sugar.

  3. Insulin causes diabetes complications.

  4. The advent of serious complications—blindness, kidney failure, amputated limbs—is only a matter of time.

All four statements are popularly accepted conventional wisdom ... and they are 100 percent wrong! Perhaps it%27s more accurate to say that these "facts" have been rendered outmoded by modern medical advances and treatments for the disease. People with diabetes can eat sweet foods safely if they understand how to work them into a balanced diet. Eating sugar does not cause diabetes. Insulin does not cause diabetes complications. Complications can be prevented by keeping your blood glucose, blood pressure, and cholesterol under control.

Common perceptions of vision loss and those who experience it are similarly saddled with obsolete, destructive myths. In an age that has seen visually impaired inventors, explorers, corporate leaders, and politicians (New York recently swore in a legally blind governor), many still believe that individuals with visual impairments are helpless and utterly dependent on others to get through life—the unfortunate person selling pencils on the sidewalk, the bungling "Mr. Magoo." In fact, people with vision loss are far from helpless. Indeed, one careful look around reveals the extent to which visually impaired individuals conduct independent, fulfilling, self-supporting lives, fully integrated into society%27s mainstream.

Unfortunately, the myths about vision loss and diabetes extend beyond our understanding of these health issues to how we respond when facing a diagnosis of one or both conditions. The two most common stereotypes associated with diabetes are of the frail, tragic person with type 1 diabetes who suffers frequent, unpredictable episodes of low blood glucose; and the overweight, depressed, and helpless person with type 2 diabetes. While there are some who may resemble these stereotypes, most people with diabetes do not fit any single personality pattern. Furthermore, new and better treatment options—as well as fuller understanding of the causes and impact of diabetes—have vastly improved the outlook for people diagnosed with the disease, whatever their age and circumstance.

Having accurate information about vision loss, diabetes, and modern diabetes treatment is important to dispel such myths and stereotypes.

For more information dispelling common misconceptions and falsehoods, see the following links:

Shedding the Stigma of Diabetes

Myths and stereotypes often lead to social stigma, especially when they relate to health conditions that people are generally afraid of. Many diabetes care and blindness rehabilitation professionals in the United States consider diabetes and vision loss to be grossly stigmatized conditions in our society.

A stigma is a perceived trait or condition that results in that person being viewed as undesirable and, ultimately, socially marginalized. Stigmas often have moralistic overtones, with individuals seen as largely at fault for whatever illness befalls them. We saw this happen in the early days of the AIDS epidemic, for example.

The social stigma connected to diabetes is not as openly vicious, but it is present and it does affect how people with the disease are treated. Some experts will cite a tendency among health professionals to not treat diabetes as vigorously as other diseases that can result in severe, life-threatening complications—a bias that may be based on the stereotype that people with diabetes cause their own problems by overeating and ignoring signs that they need to lose weight. And sometimes a well-meaning family member or relative might treat a person with diabetes or visual impairment as if he or she is very fragile, or has become like a child who is suddenly no longer able to make decisions.

Only you can tell if someone else%27s stigmatizing attitude has become a problem for you. If you feel you are being patronized or treated dismissively because of your diabetes or visual impairment, it%27s important to speak up. Explain to the person what particular actions make you feel stigmatized, and how you would like to be treated. If the person is a family member, consider family therapy to help you both learn to communicate better with one another. If you%27re experiencing problems with a health care professional who you feel is not taking you seriously or is not treating your diabetes as vigorously as you know is best, take charge of the situation. You can always choose to go to a different professional for your care.

Helpful Coping Methods for Dealing With Diabetes Burnout, or "Diabetes Overwhelmus"

The responsibilities of coping with diabetes are with you 24 hours a day, seven days a week, 365 days a year (366 in a leap year), with no days off for good behavior. Indeed, the only reward for diligent diabetes management is avoiding complications—an important but hardly inspiring incentive. It%27s understandable that the demands of self-management will get to you from time to time, and it may seem that family members and friends don%27t really understand. They mean well with their suggestions and overtures of support, but that may not be the help you want or need. Fortunately, there are things you can do to minimize the stress and emotional strain that comes with the territory. Here are some helpful coping methods:

Arm Yourself with the Facts

The more accurate and updated information you have about diabetes and visual impairment, the better equipped you will be to meet the challenges they present. Knowing the facts will help you discard harmful stigmas and stereotypes and provide you with an avenue to the new and advanced treatments, tools, and coping techniques.

Ease the Stress

Prayer, meditation, yoga, a long, hot bath, a walk in a natural setting—whatever your favorite mode of reducing stress, be sure to take the time to slow down and renew your body and outlook. It%27s not simply a question of your emotional state. Emotions also have physical effects; stress raises blood pressure and blood glucose levels, and that%27s a serious matter if you have diabetes.

If you%27re not sure how to lick stress, you can learn stress management skills from a number of sources, such as diabetes education. An introduction to stress management is often included in diabetes education programs. In addition, many diabetes education programs have ongoing support groups that help people to reduce stress through connection with others who face the same sorts of problems.

More in-depth information and skills can be found in books about stress management techniques specifically for people with diabetes, available at many libraries, most large book retailers, and the American Diabetes Association Bookstore. You might start with these titles:

  • 101 Tips for Coping with Diabetes, by Richard Rubin, Gary Arsham, Catherine Feste, David Marrero, and Stefan Rubin

  • Diabetes Burnout, by William Polonsky

  • Meditations on Diabetes, by Catherine Feste

  • Psyching Out Diabetes, by Richard Rubin, June Biermann, and Barbara Toohey

  • Zen and the Art of Diabetes Maintenance, by Charles Creekmore

You will find a wealth of information about stress management on the Internet. A few helpful links include:

  • Contemplative Outreach. This site provides information, books, and links about centering prayer, including teacher referrals.

  • http://hprc.stanford.edu/pages/classes/006_stress/default.htm
    Four Steps To Manage Your Stress
    . This is a clear, step-by step, Internet-based program designed to help people identify stress causes and symptoms. Here you can also learn techniques to reduce stress make your life stress-resistant.

  • Health Journeys. This site is a source for in-depth information about guided imagery. You will find a wide variety of recordings to use for guided imagery, as well as information on other meditative and alternative healing methods.

  • Mindfulness Meditations. This site is a source for CDs, tapes, and books by Jon Kabat-Zinn, a noted teacher of mindfulness techniques in the U.S.

  • Yoga Journal. Here you can find information, books, and recordings about yoga, and referrals to teachers near you.

Personal instruction in stress management is often available through local community centers, religious and spiritual organizations, alternative health centers, counselors, and psychotherapists. In general, it is helpful to work with someone who has enough experience to be flexible in teaching techniques.

If you feel that you are experiencing severe emotional adjustment problems—chronic depression, apathy, or anxiety, for example—you should consider professional counseling or psychotherapy. There are several types of mental health professionals who could help you through your difficulties, including professional counselors, social workers, psychiatric nurses, psychologists, and psychiatrists. Pastoral counselors or clergy may also be able to help, particularly for people with strong religious or spiritual convictions.

Start by asking for recommendations from someone who knows you well—a trusted friend or family member, or your doctor, diabetes educator, or visual rehabilitation professional. Once you have a few names, call and talk with several people before you make an appointment. (You will want to ask each of them about how they work with your kind of problem.) Before long, you will have a good sense of which professional you feel most comfortable with.

You may also want to try these web sites:

Modern medications for depression and anxiety can be very effective in helping to relieve emotional suffering. They must be prescribed by a physician or other person who is licensed to prescribe them (such as a nurse practitioner). They are almost always more effective when used in conjunction with "talk" therapy, or counseling. This is especially true when the emotional problem has its roots in major life change, such as having diabetes or visual impairment. For more information, see the following sites:

Personal Stories

  • Vivian: Living with Diabetes and Visual Impairment
    Vivian was diagnosed with diabetes twenty years ago, at age 58. Ten years later, she was diagnosed with diabetic retinopathy and spinal stenosis. She talks about how she is living and coping with her diabetes and some of the tools and techniques she uses.

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