American Diabetes Association Complete Guide to Diabetes: The Ultimate Home Reference from the Diabetes Experts

CHAPTER 19

Coping with Diabetes

• Your Feelings and Concerns

• Take Control

Everyone has stress and anger in their lives. Yet, managing a chronic condition such as diabetes can add extra frustration and unrest.

When you were first diagnosed with diabetes, you probably had many different feelings. Maybe you tried to shrug diabetes off. Maybe you felt imperfect or that your body had failed you. Perhaps you felt angry and wanted to find something or someone to blame. Maybe you felt sad, blue, or out of sorts.

If you’ve been living with diabetes for a while, you may have 

accepted your condition, but you may still feel stress and sadness. Diabetes can cause feelings of depression, isolation, anger, frustration, fear, and guilt.

Finding ways to deal with stress and negative emotions is called coping. It’s not the flashiest concept in the world, but it’s probably one you’ll use on a daily basis as you move forward with your diabetes. It’s a fabulous skill that you can continually hone and modify.

Everyone needs a variety of coping skills to use in different situations. There are three important factors in coping: having enough information, feeling in control, and having the support of others.

This chapter will discuss some common feelings and concerns people with diabetes face, as well as strategies for managing these emotions and situations.

Getting in Touch with Your Diabetes

• What part of living with diabetes is the most difficult or unsatisfactory for you?

• How do you feel about this situation?

• How would this situation have to change for you to feel better about it?

• Are you willing to act to improve this situation for yourself?

• What steps could you take to bring yourself closer to where you want to be?

• Can you pick out one thing that you can do to improve things for yourself?

Your Feelings and Concerns

The emotions you experience as you deal with diabetes are generally negative ones. But these negative feelings may actually be useful. For example, denial can be part of nature’s way of letting the news of diabetes sink in gradually. Even anger can be an ally in dealing with 

diabetes if you are able to channel your anger into energy that helps keep you motivated.

The key to dealing with your emotions is to understand your feelings and not try to suppress or deny them. Learning to understand how you are feeling and how your feelings influence your actions is the first step in dealing with your emotions.

Denial

Denial is not necessarily a bad thing. It can help you adjust to living with diabetes. By putting your emotions on hold, you can better deal with the shock of absorbing all of the new information. By pretending you don’t have diabetes or that diabetes is not that big of a deal, you can avoid feeling overly stressed out, angry, or depressed as you learn about diabetes and begin to care for yourself.

Eventually, however, denial is no longer helpful or protective. In fact, it can be just the opposite. People who continue to deny the seriousness of diabetes are less likely to take positive steps to manage their blood glucose levels and ultimately to prevent diabetes complications.

Signs of Denial

• Your first reaction to the news that you have diabetes was to try not to think about it or wish it away.

• You tell yourself you’ll deal with your diabetes later.

• You convince yourself that the diabetes care providers don’t know what they are talking about.

If you feel overwhelmed, talk to your spouse, your close friends, or your diabetes care provider or educator. It may help to take one step at a time. Don’t try to change everything all at once. Pick one area that is meaningful for you and start there. Remember that every step in the right direction is a big step.

You may want to consider joining a support group, joining a chat room or message board on the Internet, or seeking counseling. It can be reassuring to know that you have many of the same concerns as others, and they may be able to offer you ideas about ways to cope with diabetes.

Anger

You are likely to experience feelings of anger and frustration in managing your diabetes. You may feel very angry when you are first diagnosed or you may feel quite frustrated after living with diabetes for a while. Your emotions are common reactions to dealing with a difficult condition. It is normal to feel angry over something you feel you can’t control. Trying to manage blood glucose levels is often frustrating.

Common Feelings of Anger

• You may feel that life is treating you unfairly.

• You may feel frustrated when all of your hard work doesn’t seem to be paying off.

• You may find that feelings of anger coexist with feelings of denial, depression, or anxiety.

• You may find yourself feeling angry whenever you think of having diabetes or when confronted with some of the problems it brings.

• You may find that you lose your temper more quickly in situations that have nothing to do with diabetes. It’s as if you are using all of your strength and coping skills to deal with diabetes. There’s not much left to deal with life’s other stresses and strains.

A good way to deal with anger and other bad feelings is to recognize the feelings, realize that they are common, and find ways to channel your energy.

Tips for Managing Anger

• Start to keep track of your angry episodes and the events that trigger your anger.

• If possible, keep notes or a journal.

• After a few days or even weeks, sit down and review your observations. Try to figure out if there is any sort of pattern.

• See if there are any particular situations or people that make you angry. Does your anger typically occur after sitting in a traffic jam? Does it occur when people start to ask you about your diabetes?

Sometimes just identifying the triggers may not be enough. You may also need to avoid those situations that make you angry. If you find yourself getting hot under the collar every time your spouse asks you about your blood glucose, don’t wait until things build up to an angry outburst. In a calm moment, explain that it bothers you. Let your spouse know how he or she can be helpful.

You can let anger eat away at you and make you miserable, or you can think of it as unharnessed energy. Use that energy to do something positive. Your anger may be telling you that you are due for a change in your life.

Educate yourself about diabetes. Learn ways to handle anger without taking it out on others or yourself. For example, go for a walk, count to ten, or walk away from the situation. Many people find that seeing a professional counselor can be helpful initially and as they live with diabetes.


Coming to Terms with Diabetes

You may discover that you have angry feelings because you haven’t completely come to terms with your diabetes. If this is the case, think about joining a support group, talking with other people, or seeking the help of a professional counselor.


Stress

Stress is a double-edged sword for people with diabetes, as with many chronic diseases. Stress may contribute to the symptoms of the disease, and living with diabetes can trigger stress.

Stress and Diabetes

Stress doesn’t directly cause diabetes. However, for people already headed in that direction, it can push them along a little faster. You may have heard stories of people whose diabetes began after a stressful experience, such as a severe illness or a car accident.

In type 1 diabetes, the immune system mistakenly destroys the insulin-producing cells of the pancreas. This process usually takes many months, perhaps even years, before enough cells are destroyed to lead to diabetes.

A person on the way to developing type 1 diabetes makes less and less insulin. A stressful experience increases the need for insulin. So, the insulin demands brought on by a stressful experience could overwhelm the body’s ability to produce insulin.

In type 2 diabetes, the body loses its ability to respond to insulin. As this happens, the pancreas makes less and less insulin. Adding stress-produced hormones, which create more resistance to insulin, could bring on the first symptoms of diabetes.

Stress can have an effect on your blood glucose levels, too. Your body prepares for stress by sending out hormones. High or fluctuating blood glucose and ketone levels may result. If stress is short lived and repetitive, levels of blood glucose and ketones may “bounce” considerably. Some people actually experience a low blood glucose level with an acute stressor.

Depression

Everybody—regardless of whether they have diabetes—goes through periods of feeling down, when they have low energy and don’t care to be involved in things going on around them. Depression is serious when these feelings go on for long periods or when they interfere with your quality of life or your ability to care for your diabetes.

The causes, symptoms, prevention, and treatment of depression and other mental health disorders are discussed in detail in chapter 14. If you suspect that you may be experiencing depression, seek help right away. Talk to your health care provider or ask to be referred to a mental health specialist.

Anxiety

Everyone feels nervous or anxious from time to time, especially in a stressful situation. This is normal and, often, even helpful. But if you find that you feel nervous or anxious in situations that are not stressful to most people or if your anxiety is so intense and long lasting that it interferes with day-to-day living, you may have a more serious problem called an anxiety disorder. See more about anxiety disorders in chapter 14.

Alcohol Abuse

If you have diabetes and your blood glucose levels are on target, it is generally safe to drink alcohol occasionally. However, you may have an alcohol abuse problem if you drink too much or have trouble controlling how much alcohol you drink.

Alcohol abuse is even more dangerous for people with diabetes. Many diabetes complications—including nerve damage, eye problems, high blood pressure, kidney disease, and heart disease—can worsen with excessive alcohol use. Long-term alcohol abuse can interfere with how you take care of your diabetes.

Ending alcohol abuse can be very difficult, but it is crucial for many reasons, including your diabetes care. If you have a problem with alcohol, or think you might have a problem, there is help available to you. Talk to your provider, or call your local chapter of Alcoholics Anonymous (AA). Your health care team can help you find the treatment you need to begin the path to recovery.


Alcoholism and the Liver

Alcohol abuse is especially hard on the liver, where your body stores glucose. If your liver is damaged by alcohol, your blood glucose levels may become erratic, and you are more likely to have hypoglycemia.


Take Control

Taking control of your feelings is one of the best—although not always easiest—things that you can do for yourself. This can mean different things for different people. One person may find it helpful to be more assertive with family members. Another person may find relief in practicing yoga or progressive muscle relaxation. In this section, you’ll find tips for taking control of your feelings in positive ways.

Handling Stress

Your level of stress depends on you and your environment. Each of us defines what situations we see as stressful and how we respond to the stress.

Both positive and negative situations can be stressful. Change almost always is. How stressful we perceive it to be depends on how good or harmful we find it to be and what else is going on in our lives. Something can feel stressful one day and not the next.

How Do You Act When Stressed?

• Do you anger easily and take your feelings out on others?

• Do you cry easily or become depressed or withdrawn?

• Do you feel emptiness or apathy?

• Do you reject help from those close to you or want extra attention from them?

• Do you come down too hard on yourself?

Each person deals with stress in his or her own way. We usually behave in ways that are familiar to us. Some of these strategies work; others leave us feeling tense, tired, angry, or sick. Some strategies, such as smoking, drinking too much, and drug abuse, cause other problems. Other techniques and ways of dealing with stress can help us feel more in control, relaxed, and less tense after a stressful event.


Is Your Strategy Working?

To determine whether a strategy is effective, ask yourself: “Did it work? Did I feel better both immediately and later? Is this an effective strategy to use in the future?”


Tips for Managing Stress

• Find someone to talk to and who will listen when something is bothering you.

• Join a support group. Your diabetes educator may be able to recommend a group in your area.

• Form a discussion or networking group on any topic or activity that interests you.

• Take up a new hobby or sport, learn a musical instrument, or join a dance class.

• Get moving—join a health club, sign up for an aerobics class, or just take a walk every day.

• Engage in volunteer work.

• Sign up for a class that interests you.

• Think of something you can do that relaxes you and do it—read a book, take a bubble bath, get a massage, or watch a movie.

• Spend time with friends or alone, whichever will replenish you more.

• Pray or meditate. Some church groups offer support for people with diabetes.

• Do a relaxation exercise.

• Take a vacation or even a night away.

• Get a babysitter to give you some extra time alone or with your spouse.

Recognize that everyone has choices in life and that you make your own choices. Pace yourself. Make it a point to identify and anticipate stresses, and create ways to deal with them ahead of time. You may not be able to control traffic jams, an angry boss, or a crying baby, but you do have some control over the way you react to these situations.

Progressive muscle relaxation is a technique that can help relieve stress. The sequence of inhaling, exhaling, and relaxing specific muscles can “take you away” from your current situation. Try it the next time you feel tense.

Progressive Muscle Relaxation

• Close your eyes and breathe slowly and deeply.

• Start with the muscles in your face, working your way down to your feet and toes.

• Inhale. Raise your eyebrows. Tense them. Hold for a count of 3. Relax your eyebrows. Exhale.

• Inhale. Open your mouth and eyes wide. Then close your mouth and eyes tightly. Squeeze. Hold for a count of 3. Relax your eyes and mouth. Exhale.

• Inhale. Bite down on your teeth. Hold for a count of 3. Relax your jaw. Exhale.

• Inhale. Pull your shoulders up. Hold for a count of 3. Relax your shoulders. Exhale.

• Inhale. Tense all the muscles in your arms. Hold for a count of 3. Relax your arms. Exhale.

• Inhale. Tense all the muscles in your chest and abdomen. Hold for a count of 3. Relax your chest and abdomen. Exhale.

• Inhale. Tense all the muscles in your legs. Hold for a count of 3. Relax your legs. Exhale.

• Inhale. Tense all the muscles in your feet. Curl your toes. Hold for a count of 3. Relax your feet. Exhale.

• Inhale. Exhale any tension that may be lingering in your body. Breathe in energy. Take several more deep, slow breaths. Enjoy feeling relaxed.

• Gradually open your eyes.

Boosting Your Self-Esteem

It is much easier to meet life’s challenges with a healthy dose of self-esteem. You do better in your work, studies, and personal relationships. And you are more likely to go after what you want out of life when you feel good about yourself.

Unfortunately, diabetes can gnaw away at your sense of self-worth. Some people with diabetes blame themselves for having the illness or its complications. Sometimes, people think less of themselves because they feel different. This can happen whether you are a child, a teenager, or an adult. Some people even wonder if they are being punished when they get diabetes.

Many of our feelings of self-worth stem from the messages we were given as children (both positive and negative) and the messages we give ourselves as adults. One way to boost your feelings of self-worth is to give yourself affirming and positive messages. Recognize your good qualities and give yourself a break, even if no one else does.

Tips for Boosting Self-Esteem

• When you are feeling good about yourself, write down a list of all your strengths and positive qualities. Include things you are especially good at doing.

• When someone compliments you, add it to the list.

• If you have trouble coming up with things to put on the list, ask those around you who like and love you. Often your friends and family are quicker to recognize your strengths than you might be.

• On days when you are feeling down, take out the list and remind yourself of what a great person you are.

How you feel about yourself can affect how you care for your diabetes. Do you believe you deserve to spend the time, effort, and money it takes to care for your diabetes? How do you show yourself respect? If you do it by making choices, others will respect your needs, too. If you need to check your blood glucose right now, do it. Don’t be worried about asking others to wait for you while you check.

Be Assertive

One of the ways you can take charge of your diabetes is to learn to be assertive. Most conflicts do not arise out of differences of opinion but out of gaps in communication.

If you are unable to assert yourself, you might find it difficult to talk about your diet or how much time you need to take care of your diabetes. You may be reluctant to have your needs interfere with those of the people around you.

Assertive communication means that both your needs and the needs of the other person are equally important and respected. Assertive statements often begin with “I”. For example, “I find it helpful when you don’t keep chips in the house.” This statement is more effective than blaming or aggressive statements (“You always try to undermine everything I do”) or reacting passively and being inwardly resentful.

Tips for Being Assertive

• Learn to say no. A simple “no, thank you” communicates to yourself and to others that “I respect myself enough to act in my own best self-interest, and I respect you enough to know that you will understand.”

• Maintain courtesy. Courtesy is the cornerstone of effective and assertive communication. It relays the assumption that you will treat your needs and those of others equally and that neither will suffer at the other’s expense.

• Be direct. Direct communication while maintaining courtesy is as important as saying “no” at the appropriate time.

• Meet your own needs. Hypoglycemia is an example of an urgent situation in which you must be assertive. Don’t put off treatment 

because you are afraid of offending someone with whom you are interacting.

• Be firm. It is important to be firm with both yourself and others. Make a plan about how you will handle certain situations. If pressured, explain your decision directly to others.

• Maintain self-respect. If you respect yourself, it will be easier to be assertive.

Making Good Choices

Diabetes is largely a self-managed illness. Unlike more acute illnesses, you provide almost all of your own care.

It is up to you. You are free to decide how much or how little you do to care for your diabetes. Because you benefit from the results of your choices, you have the absolute right to make these decisions.

Many things in our lives are not of our own choosing. Diabetes is not something most people would choose to have. Although you cannot change having diabetes, you do make choices about how you live with it and your attitude toward it. No matter how constrained you may feel, you can often make different choices.

Freedom brings responsibility as well. In fact, freedom and responsibility are two sides of the same coin. Because the choices you make affect your outcomes, you have a great deal of responsibility for your own health and quality of life. It can be overwhelming. There are things that you can do to help you accept this much responsibility.

Tips for Making Good Choices

• Learn all that you can about diabetes. The more you know, the more you are able to weigh the positives and negatives of the choices you have to make.

• Ask your provider for a referral to a diabetes education program in your area.

• Work with your diabetes care provider to develop a plan to manage your diabetes that matches your goals and abilities. Be honest about what you can and cannot do. Remember, you are the one who has diabetes and lives with it each day. You are the expert on yourself and your life.

• Be honest with yourself. It may be tempting to shift the decisions to your health care team or blame the people around you for your outcomes. But when we do not accept responsibility, we become victims of our situation.

Power comes from accepting responsibility for our choices and our lives. Taking responsibility for managing your diabetes gives you power and control over your diabetes and your life.

If you are struggling with this level of responsibility, there are some questions that you can ask yourself to try to understand more about why you feel this way.

Questions of Power and Responsibility

• What stands in the way of accepting responsibility for my diabetes?

• What negative consequences come from feeling forced to behave in certain ways?

• What benefits come from feeling controlled by diabetes?

• What negative consequences come from accepting responsibility for diabetes care?

• What benefits come from accepting responsibility for diabetes care?

• What is one thing can you do this week to take charge of your diabetes care?

Ask for Help When You Need It

Trying to meet the never-ending demands of life with diabetes can make anyone feel frustrated. It’s easy to feel cheated when you’ve met your end of the bargain by doing all that you can, but your blood glucose levels don’t reflect your efforts. Wide swings in blood glucose levels can also cause your emotions to change.

If you suspect that this is happening, consider doing some investigative testing. If your mood swings are related to blood glucose fluctuations, talk to your health care team about other ways to manage your diabetes.

Tell the people close to you who want to support you about how you feel. If you need more help dealing with mood swings, ask for a referral to a psychologist or other mental health counselor. You don’t have to be alone with diabetes. There is help and support available; you only have to ask for it.



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