Living with Diabetes: Psychological Challenges
WebMD Live Events Transcript
A chronic condition like diabetes can have a profound effect on the mind. Did you know depression is three times more common among people with diabetes than the general population? We'll discuss the emotional side of this physical condition with S. Sethu K. Reddy, MD, director of the Department of Endocrinology, Diabetes, and Metabolism at the Cleveland Clinic.The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Support for this University course was provided by Medical Mutual.
Dr. Reddy, can your emotions raise your blood sugar?
In reality, whenever we eat food, normally our sugar can go up to as high as 199 one hour after eating and come down below 140 two hours after eating. These kind of fluctuations are considered normal. Also, exercise can have different effects on blood sugar. If you have type 2 diabetes, which 85% of people with diabetes have in the U.S., exercise typically improves blood sugar levels.
On the other hand, if someone performs extremely strenuous exercise, one can elevate the adrenalin and other hormones so high that sugars can actually become elevated. This is not a problem for most of our patients.
For individuals who may have type 1 diabetes and are taking insulin injections for therapy, they are much more likely to have wider swings of blood sugar. If they exercise and don't have much insulin on board, then their sugars can go very high, and if they have lots of insulin on board and exercise strenuously without enough food, they can have severe low blood sugar reactions. Typically, exercise does not improve the overall control in individuals with type 1; however, exercise is very important for lowering risk of heart disease, raising your good cholesterol, and psychology of well-being.
In the old days, we used to think of hypertension as a silent killer, but now diabetes should also be considered a silent killer -- most of us have no symptoms when our sugars rise to high levels. Many of us think we don't have diabetes until we're put on insulin therapy. But in reality, despite having no symptoms, high sugar levels continue to damage:
I think the first step is to be more educated about the future ramifications of high blood sugars and to think about the management, like you would in getting a life insurance policy.
Remember that life insurance premiums at age 30 are very low, but at 65 are very high. Very early in the state of diabetes, very minor diet and lifestyle modifications can have tremendous benefits. We are getting safer and more tolerable treatments each year; for example, inhaled insulin is also around the corner. Artificial pancreases will also be the new state of technology in five to 10 years. All these advances allow a person to lead a fairly normal life.
Remember, we don't expect individuals to follow many of the dietary and lifestyle principles 100% of the time. We would be very happy if people followed them 85% to 90% of the time. I often tell my patients that if they're very compliant with their lifestyle changes, perhaps once a month or once every few weeks they can reward themselves with a more pleasing lifestyle experience with respect to diet or exercise.
It is sad, sometimes, when we see individuals that do not seek medical attention until they start losing vision or start losing sensation in their feet. So we see the denial quite often, but it's an ongoing challenge.
Two more sources one can use to catch up:
In fact, what some parents do for children, perhaps every two to three months, they give the child a holiday from the day-to-day monitoring and treatment. The parents could check the blood sugar and do the injections, take over the mental work related to the diabetes. This way the child gets a break.
For our adults, there's a theme in psychology that if one performs a task 17 times, that it can become a habit. I tell my patients that a person with diabetes can do anything someone else can do, but they have to plan ahead.
If a person is planning a ski trip, then they know to check their blood sugar during the middle of their exercise and so can enjoy the skiing without any incident. If someone is going out for an anniversary dinner, they can adjust their insulin prior to the meal so that they can accommodate the extra calories.
This way they are actually enjoying everyday activities the nondiabetics are enjoying, and one does not have to feel restrained. In the future, with an implantable glucose sensor connected to an insulin pump becoming available, one can envision total freedom, and it would be unnecessary to feel the stress of day-to-day and minute-to-minute supervision of activity and medications.
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. That way, one gets into -- like brushing one's teeth in the morning -- it becomes a habit and is not seen as an intrusion. Glucose monitoring, now, can take only 20 to 30 seconds, and insulin administration can be performed with a pen device, allowing patients to check their blood sugar quickly and anywhere and also conveniently take their insulin.
Also, we need to look for other causes for the reduced energy. A few possible causes:
It's very important to look for other causes for the fatigue and potentially bring the energy level back. Too often, people contribute tiredness to middle age or getting older, but often there is a correctable cause.
It's important not to let the diagnosis stigmatize your entire life, but rather it should be a stimulus to maintain your health and also incorporate healthy habits for your family.
It would also be helpful to have your husband or mother accompany you to a doctor's visit; sometimes it's better for them to hear it from the doctor rather than from you. This way, the visit serves as an educational tool and will stress the importance of diabetes control.
Try to involve your family members in your exercise activity and on visits to the drugstore or local health fairs. This has to be done gently, since sometimes the fear of complications affecting their loved one will cause even more stress.
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, and like the prayer says, "lead us not into temptation." It would help if they did not tempt you with the wrong foods or denied you access to exercise.
With respect to chocolate, if it's a once-a-month or an occasional craving, then it should not be a big problem. There are several low-carb, low-sugar chocolates available, or you could improvise and add chocolate to soy milk. That might be a healthier alternative. A word of caution: Chocolate itself may not be bad, and many nutritionists have claimed some benefits to chocolate, but chocolate often comes with a high fat component, and these other elements may be harmful to your long-term health.
In terms of sweets, juices tend to have almost as much sugar as soft drinks, so we tend to advise patients to cut back on the amount of juice intake. Whole fruit might a better alternative.
An important way to reduce the carbohydrate intake is to visualize how you would say no to such a food item. If you're attending a social function and someone offers you cheesecake or a rich tart, you would have already rehearsed a polite "no, thank you," and choose a healthier snack. This technique has been used by many professional athletes and other successful people in other situations and has found to be very effective.
So with Thanksgiving coming up soon, you may want to rehearse some healthy responses to your host!
One strategy would be to change to another antidepressant and to embark on a formal weight loss program. We have been successful with weight loss in these situations, and thus we know this is a not a permanent problem. I cannot say that one particular antidepressant causes weight gain, and I have seen a variable response in different individuals. We often tend to switch patients to a medication like Celexa or Lexapro or Wellbutrin, which may reduce some cravings and are not associated with as much weight gain.
The other important point is how to break the vicious cycle of gaining weight, not being able to exercise and gaining further weight. If a person has a significant weight problem, we would suggest a medically supervised weight loss program to initially reduce the weight by 20 to 30 pounds, and at that point to encourage an exercise program and proper diet to either maintain or continue a more moderate rate of weight loss.
As you're losing weight, if you find your sugars are going too low, you definitely need to reduce your diabetes medication at the same time. If you're not on any medications, your sugar should not go too low.
You can remind your friend that the American Diabetes Association does allow up to 15% of your total daily calories from simple sugars. So remember that your overall diet should be low in fat, high in fiber, and balanced across the day.
©1996-2005 WebMD Inc. All rights reserved.
- Allergic Skin Disorders
- Bacterial Skin Diseases
- Bites and Infestations
- Diseases of Pigment
- Fungal Skin Diseases
- Medical Anatomy and Illustrations
- Noncancerous, Precancerous & Cancerous Tumors
- Oral Health Conditions
- Papules, Scales, Plaques and Eruptions
- Scalp, Hair and Nails
- Sexually Transmitted Diseases (STDs)
- Vascular, Lymphatic and Systemic Conditions
- Viral Skin Diseases
- Additional Skin Conditions