Diabetes For Dummies. Rubin Alan L.

problems for you that justify being depressed. You may rationalize your depression in the following ways:

      ✔ You can’t make friends as easily because diabetes hinders you.

      ✔ You don’t have the freedom to choose your leisure activities.

      ✔ You’re too tired to overcome difficulties.

      ✔ You dread the future and possible diabetic complications.

      ✔ You don’t have the freedom to eat what you want.

      ✔ You’re constantly annoyed by all of the minor inconveniences of dealing with diabetes.

      All of the preceding concerns are legitimate, but they also are all surmountable. How do you handle your many concerns and fend off depression? Following are a few important methods:

      ✔ Try to achieve excellent blood glucose control (see Part III).

      ✔ Begin a regular exercise program (Chapter 10).

      ✔ Tell a friend or relative how you are feeling; get it off your chest (Chapter 20).

      ✔ Recognize that every abnormal blip in your blood glucose is not your fault (Chapter 7).

      If you can’t overcome the depression brought on by your diabetic concerns, you may need to consider therapy or antidepressant drugs. But you probably won’t reach that point.

Moving on

      You may experience the various stages of reacting to your diabetes in a different order than I describe in the previous sections. Some stages may be more prominent for you, and others may be hardly noticeable.

      

Don’t think that any anger, denial, and depression are wrong. These feelings are natural coping mechanisms that serve a psychological purpose for a brief time. Allow yourself to have these feelings – and then drop them. Move on and discover how to live normally with your diabetes.

      

These phases of coping may not occur in the order given, may not occur at all, and/or may last a long time. If one phase inhibits your ability to cope with your diabetes for more than a few months, you may need outside help.

      Here are some key steps you can take to manage the emotional side of diabetes:

      ✔ Focus on your successes. Some things may go wrong as you find out how to manage diabetes, but most things will go right. As you concentrate on your successes, you will realize that you can cope with diabetes and not let it overwhelm you.

      ✔ Involve the whole family in your diabetes. A diabetic lifestyle is a healthy lifestyle for everyone. For instance, the exercise you do is good for the whole family. By doing it together, you strengthen the family ties while everyone gets the health benefits. Also, should you need your family to help you, for instance, during a particularly severe case of low blood glucose, their early involvement in learning about diabetes will give them the peace of mind to know they are helping you, not hurting you. (See Chapter 20 for ways to enlist help from people around you.)

      ✔ Develop a positive attitude. A positive attitude gives you a can-do mindset, whereas a negative attitude leads to low motivation preventing you from doing all that is necessary to manage your diabetes.

      ✔ Find a great team, pinpoint problems, and set goals. Determine the most difficult problems that you have with your diabetes and then consider how you can solve them by yourself or with a great team of supporting players like a primary care physician, a diabetes specialist, a diabetes educator, a dietitian, an eye doctor, a foot doctor, and so forth. Set realistic goals to get past your problems. (Chapter 12 tells you everything you need to know about getting help from the supporting players.)

      ✔ Don’t expect perfection. Although you may feel that you’re doing everything right, you may experience blood glucose levels that are too high or too low. This uncontrollable situation happens to every person with diabetes, and it’s one of the biggest frustrations of the disease. Don’t beat yourself up over something you can’t control. Keep doing the things I suggest in the treatment section, and you will be very gratified at the end.

      Maintaining a High Quality of Life

      You may assume that a chronic disease like diabetes leads to a diminished quality of life, but you don’t have to settle for anything less than a full and fulfilling life.

      Many studies have evaluated the quality-of-life question, and the following sections not only describe what these studies found but also describe my hope that you can take control and ensure that you maintain a high quality of life.

Exercising regularly

      People who do regular exercise often describe it as addictive. They find it so pleasurable that they look forward to the next session. And the benefits for the person with diabetes are enormous.

      

In one long-term study on quality of life for people with diabetes, a factor that contributed to a lower quality of life rating was a lack of physical activity, which is one negative factor that you can alter immediately. Physical activity is a habit that you must maintain on a lifelong basis. (See Chapter 10 for advice on exercise.) The problem is that making a long-term change to a more physically active lifestyle is difficult; most people become more active for a time but eventually fall back into inactive routines.

      Another study demonstrated the tendency for people with diabetes (and for people in general) to abandon exercise programs after a certain period of time. This information was reported in the New England Journal of Medicine in July 1991. In this study, a group of people with diabetes received professional support for two years to encourage them to increase physical activity. For the first six months, the study participants responded well and exercised regularly, resulting in improved blood glucose, weight management, and overall health. After that, participants began to drop out and not come to training sessions. At the end of the two-year study, most participants had regained their weight and slipped back into poor glucose control. However, the few people who didn’t stop their exercise maintained the benefits and continued to report an improved quality of life.

Factoring in the (minimal) impact of insulin treatments

      If you’re in the small group of diabetics who require intensified insulin treatment, perhaps you’re afraid that intensified insulin treatment, which involves three or four daily shots of insulin and frequent testing of blood glucose, will keep you from doing the things that you want to do and will diminish your daily quality of life. (See Chapter 11 for more information about intensified insulin treatment.) Your fears are not justified by the facts.

      A study published in Diabetes Care in 1998 explored whether the extra effort and time consumed by such diabetes treatments had an adverse effect on people’s quality of life. The study compared people with diabetes to people with other chronic diseases, such as gastrointestinal disease and hepatitis (liver infection). The diabetic group reported a higher quality of life than the other chronic illness groups. Interestingly, the people in the diabetic group were not so much concerned with the physical problems of diabetes, such as intense and time-consuming tests and treatments, as they were concerned with the social and psychological difficulties.

      Another report in Diabetes Care in 1998 stated that insulin injections don’t reduce the quality of life; the person’s sense of physical and emotional well-being remains the same after beginning insulin injections as it was before injections were necessary.

      Teenagers who require insulin injections don’t always accept the treatment as well as adults do, so teenagers more often experience a diminished