Diabetes Denial

It’s is the first reaction when you learn you have type 2 diabetes.
Then comes fear, guilt, anger and depression. But education, treatment and patience
can lead to acceptance—the most important step in leading a healthy, active life.

By Joanne Gallo

July/August 2006

You’ve just been told that you have one of the most insidious and potentially dangerous diseases, something that can lead to blindness, kidney failure, heart disease, stroke, amputations and nerve damage if not treated and controlled properly. Hey wait a minute…you didn’t even feel like there was anything wrong. But here you are, sitting in your doctor’s office, listening to him or her routinely rattle off a prescription of diet and exercise (and possibly medication). Surprise: You have type 2 diabetes. Ugh. The kind brought on by eating habits. Now what?

Your mind starts racing as you consider the dizzying array of life-threatening complications. Then you envision a life devoid of all those “magical” indulgences which symbolize happiness and satisfaction: No chocolate or cream puffs (not even the occasional one?), no soda, no ice cream, no candy, no cake. Feeling like a punished 10-year-old sent to your room without dessert? This is only the beginning. All carb-heavy comfort foods—which everybody else seems to be eating—should be banished. Pizza—no. Pasta—no. Bagels—no. Sandwiches? Only if it’s not on a roll or any kind of white bread. Beware of starchy vegetables like carrots. Don’t eat too much fruit. Don’t eat too much at one time. Eat before you exercise. Eat at or close to the same times each day. Limit caffeine. Be careful when dining out for hidden ingredients in foods. Forget alcohol—your beverage of choice should be water.

The Blood-Sugar Challenge

One of the biggest problems with type 2 diabetes is that many people have the disease or its precursor, pre-diabetes, for years before being diagnosed, so that by the time it is found and treated it is already in a fairly advanced stage—causing an array of physical and psychological complications.

“Statistics tell us that most people have had higher blood sugars for three to seven years prior to ever being diagnosed,” reveals Paula Yutzy, a registered nurse and certified diabetes educator at Mercy Medical Center in Baltimore, Maryland. “It is such a sneaky disease because if you aren’t looking for it then you don’t know it’s there.”

The reason? “Most of the time doctors ask that you get a fasting blood sugar,” notes Yutzy. “And in type 2 diabetes, the first abnormality that you see is not the fasting but the after-meal blood sugar. So if you only test for fasting blood sugars, you could have higher than normal levels for quite a while before you ever get a fasting one that is high. I personally think that if doctors suspect a person has a bunch of risk factors they really ought to be doing after-meal blood sugars.”

That’s why people need to be aware of their family history, as well as how their bodies react to food. Don’t just leave it up to your doc to find it in a standard blood test: If you think you’re having symptoms, ask about a glucose tolerance test that can measure blood sugar levels after consumption of a high-sugar drink; it is often used to diagnose gestational diabetes (in pregnant women) or reactive hypoglycemia, in which blood sugar rises and then falls too low (often considered a precursor to type 2 diabetes). Catching the disease in its early stage could make life much sweeter in the long run.

You haven’t even gotten to the part about “testing” your blood glucose levels, which means pricking your fingers with needles 10 times a day—but you now understand why people wind up losing their eyesight over this. Overwhelmed from the blasé, rapid-fire litany of “don’ts” and warnings, your brain starts to play games with you. Maybe you really don’t have type 2 diabetes, maybe there was an error on your test or it’s not as serious as it seems. Maybe you can just cut back on your 3 pm cookie break and you’ll be fine.

Welcome to the land of denial. It’s one of the most common reactions to being diagnosed with type 2 diabetes. “Many people deny it. The doctor says, ‘You have diabetes’ and they say, ‘Oh no I don’t—and I’m not going to have diabetes,’” explains Paula Yutzy, a registered nurse and certified diabetes educator at Mercy Medical Center in Baltimore, Maryland. Patients often fear being stigmatized because the disease is closely linked to obesity and they try to disassociate themselves, while others are so afraid of all the possible complications that they avoid taking any action.

Take for instance actor Stephen Furst, perhaps best known for playing the aptly named Flounder in the movie Animal House. He was diagnosed with type 2 diabetes at age 17 and proceeded to deny it for about 23 years—even though his own father had died from diabetic complications. As Furst relates in his book, Confessions of a Couch Potato, it was only after his left foot almost required amputation that he got serious about treating his condition and lost nearly 150 pounds. (Other famous people who battle diabetes include actress Halle Berry, novelist Anne Rice and rock musician Neil Young.)

Sugar Blues

At the other end of the spectrum, some patients may feel guilty about their diagnosis and be too hard on themselves, since type 2 diabetes is so often linked to weight gain and lack of exercise. “They’ll say, ‘Well, I ate my way into this,’” says Yutzy. “So they deprive themselves more than they need to be deprived. People will stop eating rather than limit what they eat. Of course, if you bring up the other risk factors, it’s not just the weight. If your mother and grandmother and grandmother’s mother all had diabetes, then you just had all the genes stacked against you.”

Even trained professionals who are educated about diabetes can have a hard time coming to grips with the disease if it strikes close to home—as did Yutzy. While her own diagnosis of type 2 diabetes about two years ago didn’t faze her so much, her son was another story. “My son was diagnosed with type 1 diabetes when he was 11,” she reveals. “I’m a nurse. Intellectually I knew what the disease was, I knew how to treat it and I knew the complications were preventable. But emotionally, all I could think about was blindness and kidney failure. My son has had diabetes for 23 years and he has no complications, so the knowledge piece in my head was correct, but still all I could see was all those people I have taken care of who lost legs, who were blind, who were on dialysis and I think that is the case for most people. It’s like getting hit by a ton of bricks.”

Having diabetes doubles the risk of depression compared with those without the disorder, according to the National Institute of Mental Health. And what a lot of patients may not realize is that negative emotions can actually raise blood sugar. “Stress can raise adrenalin levels hugely, and adrenalin can raise your blood sugar, sometimes as much as 10 to 30 milligrams,” says S. Sethu K. Reddy, MD, director of the Department of Endocrinology, Diabetes and Metabolism at the Cleveland Clinic, in an online chat.

Clearly, treating both body and mind is key to overall wellness for diabetics. While it’s natural for patients to feel a range of difficult emotions, working through them to get to a place of acceptance is critical—and that’s a big part of Yutzy’s efforts. “If you get stuck at one of those intermediate steps then you have trouble; I see it in diabetics all the time,” she says.

Yutzy employs something called a “health belief model” to work with patients on four key areas, otherwise they are likely not to treat themselves: “One is susceptibility. People have to believe they are vulnerable to the negative consequences of diabetes. Then you have severity, the perception that diabetes is a serious disease with complications. Then there’s benefit of care: You have to believe that the things that I ask you to do—test your blood sugar, eat appropriately, go for exercise—are going to make a positive difference in the outcome. Then the belief that the cost of care will be outweighed by the benefits of the care and the prevention of the complications.”

A Plan for Action

Once a diabetic gets past all of the emotional issues, it’s a matter of making the lifestyle changes routine. “A key step to reducing the stress in today’s climate would be to make some of these activities, like sugar monitoring and insulin administration, as routine and scheduled as possible,” says Reddy. “That way, like brushing one’s teeth in the morning, it becomes a habit and is not seen as an intrusion.”

Educating family members is another important coping strategy. While no one would expect a non-diabetic husband or wife to alter their diets too, he or she can be more sensitive about bringing home the wrong foods or offering them to their struggling spouses. “I think you could also encourage your family members that it takes a lot of teamwork to succeed with your diabetes management and any help they can give would be welcome,” says Reddy. “Try to involve your family members in your exercise activity and on visits to the drugstore or local health fairs.”

A resource that many diabetics don’t take advantage of is personalized care from a certified diabetes educator (CDE). While most doctors see each patient for maybe 10 minutes, CDEs generally spend an hour answering all of those tricky questions. “We can talk about things you wouldn’t bring up to the doctor because he’s too busy so you can begin to work out your feelings,” explains Yutzy, who was motivated to become a CDE when her son was diagnosed with the disease. “I see people who have had diabetes for years, and they’ll say, ‘Why didn’t the doctor send me to you a long time ago?’ They have been suffering and trying to work through all these problems by themselves, and once we work through them together it’s just so much easier.” Some diabetes educators, like Yutzy, can even adjust medications or insulin for patients by working in conjunction with endocrinologists (doctors who specialize in hormones and treating diabetics).

The point is that once you get past the finger pricking and food restrictions, and mourn the loss of your formerly carefree ways, you can embark on a new lifestyle that is even more vital and rewarding than before. “Many of our patients with type 2 diabetes are, in fact, healthier than non-diabetics,” asserts Reddy. “They exercise regularly, eat properly, control their blood pressure and cholesterol, and are successful members of their family and society.” Saying goodbye to the ups and downs of blood-sugar swings and the changes in energy levels they can cause is ultimately much more satisfying than any piece of chocolate cake.

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