Living with Diabetes

Living with diabetes is a challenge, and one that requires attention to specific aspects of health on a daily basis. Self-care is important in order to reduce complications that can arise from diabetes when blood sugar levels are not managed well. Most every person with diabetes will feel, at one time or another, that the challenge of self-care is a burden. Many people can, and do cope with this challenge. But there are also some others who may feel overwhelmed and even become depressed when confronted with life as a person with diabetes.

HealthandAge Editor for Emotional Health, Dr. Shachi Shantinath, recently spoke with Dr. Richard Rubin, a psychologist who specializes in helping people live successfully with diabetes. In addition to his private practice, Dr. Rubin is on the faculty of the Johns Hopkins University School of Medicine in Baltimore, MD (USA), where he teaches and conducts research on the emotional aspects of diabetes.

The Importance of Good Mental Health

HealthandAge: Please give us an overview of why good mental health is important when a person has diabetes.

Dr. Rubin: Mental health is critically important. It involves the ability to cope with diabetes, and is the foundation on which other areas such as medicines, exercise and food rest. Emotional stability rests under all of these things, which are essential for good outcomes in diabetes.

Emotional Reactions to Diabetes

HealthandAge: What are some of the most common emotional reactions older persons may have in response to diabetes?

Dr. Rubin: People have a variety of reactions. Some people feel that this is not serious, while others feel devastated. Some people have relatives who had diabetes and have seen them suffer all sorts of consequences, so they may become scared.

No matter what a person's reaction is, the most important thing is to recognize that diabetes is a serious disease. And if you take good care of yourself, you are likely to avoid the problems that make the consequences serious.

Some people may be diagnosed only after having had the disease for many years. In fact, about one-third of the cases of diabetes are picked up on the basis of these complications, which have taken years to develop. In such instances, people may be angry that their condition was not detected earlier.

Some people feel that it is incredibly difficult to do all the things that are related to self-care. They develop what I call "Diabetes Overwhelmus" - where they lose their motivation for making changes in their lives.

Diabetes and Depression

HealthandAge: What is the connection between depression and diabetes?

Dr. Rubin: We need to recognize that depression is the most common psychological problem among persons with diabetes.

Depression is about three times more common among persons with diabetes than those without. If you are clinically depressed, it is difficult to take good care of yourself and do all the things you are supposed to do, like exercise, eat properly and attend to your medications.

Researchers are beginning to think that there might be a common pathway for the origin of both diabetes and depression. There is a strong school of thought that says that persons with depression might be two to three times as likely to develop diabetes, than those without depression.

In depression, there is an increase in the stress hormones, which then reduce sensitivity to insulin. So, it is likely that there is a neuro-chemical connection between the two.

A Common Emotional Scenario

HealthandAge: What is a typical scenario that you come across, with regard to feelings of sadness and hopelessness?

Dr. Rubin: In my work with patients, I have observed that there is a pattern of binge eating that occurs between dinner and bedtime. It is what can also be called a "grazing pattern". As a result, the person does not feel well, is up at night, and has sleep problems. This then triggers a negative cycle, where the person might finally say "to hell with it" and start saying to themselves things like "exercise does not help me". Then they feel guilty because of bad outcomes such as too much sugar when they check their blood.

Coping with Negative Emotions

HealthandAge: How can a person cope effectively with this and other negative emotions associated with diabetes?

Dr. Rubin: The main thing is to recognize that such reactions are natural and normal. People do get thrown for a loop. It is completely understandable that people may feel upset and resentful.

They may begin to think that they are the only person with such problems. It is important to keep in mind that everyone with diabetes struggles.

But there are ways to make the process easier. Think about your own goals. Be specific. What particular aspect of living with diabetes causes you trouble? Work with your health care provider and have them engage with you in finding solutions. Even with diabetes, it is possible to have a fairly normal life.

If you are depressed, keep in mind that effective treatment for depression is available. Cognitive-Behavior therapy [a kind of talk therapy that looks at thoughts, feelings and behavior] and anti-depressant medications work well among persons with diabetes.

Support Groups

HealthandAge: What is your opinion of support groups?

Dr. Rubin: It is important not to feel alone. Diabetes is a demanding disease and people need help and support from their family and health care provider. There are also times when no one else can relate to you but another person with diabetes. At such times, a support group is very useful. It can also be a place where persons get practical tips from one another on how to live with diabetes.

People can attend support groups in local hospitals. They can also join support groups via the web, for instance in chat rooms.

What to do When Having Difficulty with Self-Care

HealthandAge: What do you suggest to someone who is having difficulty with self-care?

Dr. Rubin: The key is to identify what specifically is the hardest thing that makes it difficult to live with diabetes. Everyone has "sticking points" where they experience problems. The key is to identify it, and then work to resolve it. So, first ask yourself, what exactly is the problem? For example, is it snacking at bedtime?

Then, recognize that there was a time when you did not always do this. Every behavior has exceptions, and finding those exceptions is the key to gaining stability and coping well.

Maybe you are not even conscious of what you are doing right in those moments when you have those exceptions. Bring this to consciousness and do it more often. Remind yourself of reasons to stay healthy. For example, for one person, church might offer them spiritual fulfillment. For someone else, it might be wanting to be around to see the grandchildren graduate from school.

Remember, you are the expert in your situation. Once you solve one problem, it will also raise your confidence in your ability to solve other problems.

Diabetes and the Family

HealthandAge: What kinds of situations do you see that involve persons with diabetes and their families?

Dr. Rubin:There are a variety of situations. One kind is where the family is not supportive of the person with diabetes. Family members may give up or simply deny that diabetes is there, and ignore how serious it is.

Another kind of reaction is what I call the "Diabetes Police", where people try to control their loved one's diabetes. It creates tension among family members. Health then takes a back seat to control.

It is a good idea to ask the family member with diabetes what he or she needs. Then do that. Doing anything more will feel like you are pushing them, and will only have the opposite effect.

There are three questions that a family member of a person with diabetes can ask. Or for that matter, a health care provider can ask the same questions too:

• What is it I am doing right now that makes it easier for you to live with diabetes?
• What am I doing that makes it harder for you to live with diabetes?
• What more can I do?

Then listen and follow through on the answers and adjust yourself accordingly. Think of it as a series of day to day experiments and adjust accordingly.

HealthandAge: Thank you for your time today, Dr. Rubin.

For more information on diabetes, and related books including Psyching out Diabetes by Dr. Rubin, please see links below.