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April 28, 2013

The emotional side of diabetes

The Canadian Charger

More by this author...

If diabetics were robots, things would be a lot easier. Robots can be programmed, and therefore we could program them to test their blood sugar, adjust meals accordingly, and take insulin by mouth or injection as required. Fortunately or unfortunately, diabetics are human.

Human beings do things for a variety of reasons, and these reasons may or may not help in control of diabetes.  I am a social worker, and from time to time I come in contact with diabetics, though my practice is not focused on treatment.  The literature says and my experience confirms that depression is a common problem among diabetics.

When you are depressed, there is a tendency to fail to carry out all kinds of tasks, from washing the dishes to washing your face to eating appropriately. 

Depression can also affect relationships with family and friends.  If you don’t follow the correct regimen, your blood sugar is affected.  High blood sugar can lead to serious problems with kidneys, the heart and circulatory system, eyes, and feet, among other parts.  Low blood sugar can cause depression and anxiety.

So we get a downward spiral with depression and diabetic self-care.  Poor compliance leads to depression and anxiety.  These in turn lead to poor compliance, and down goes the spiral.  Some kind of intervention is needed to halt the cycle, either a forcible decision by the person to change, or help from the outside. 

In the following cases, I was not a therapist and my intervention was incidental to why I was there.  Yet, at some point we dealt with depression as an issue.

Hank was diagnosed by his family physician with poorly controlled diabetes, due to anxiety and depression.  He developed type 1 diabetes as an adult.  I performed a diagnostic screening for depression and then met with him and his wife.  I explained the downward spiral and suggested that better compliance with the regimen would make him feel better.  He acknowledged that when he did follow it, he felt better.  When I suggested to his wife that she may want to “nag” a bit to get compliance, she replied that she did but that it did not do any good.  I focused on how he felt when he took proper care of himself, and he seemed committed to do better.  He also reported that he had an appointment with a nurse for education about diabetes.

Haile, an African immigrant, developed type 2 diabetes in his 30's.  Because of depression, he was a cocaine user before diabetes, a habit that continued for a time after he developed the condition.  He stopped using cocaine.  This was a good start but the depression continued.  As a result of poor compliance, he lost a toe. 

I visited him in a rest home, where he was staying because he had suffered a head injury in an attack by an assailant.  It was meal time, and he picked at his food.  I stressed the importance of eating properly, as poor nutrition could lead to further amputations.  I also involved the nurse’s aide in the home to help him to eat more appropriately.  A few months later when I had occasion to see him again, he had gained weight.  He seemed in better physical health and his mood was somewhat improved.

In the third case, while working in a social planning agency I received a phone call from a woman who was desperate for advice.  She had recently married a man with diabetes, and since the marriage he had changed.  He was not caring for himself appropriately.  What was she to do?  I ran the problem by a psychiatrist, and his advice was stark.  Lay the cards on the table.  Tell him, “Either you shape up or I ship out.”  While we don’t know the full story, it appears that he was making himself pitiful and helpless, trying to make her feel sorry for him and mother him.  His behavior was not good for either of them.

These are some examples of the emotional element at play with diabetes.  Some people can identify the downward spiral and take the necessary steps to pull out.  For others, it may take a slight nudge.  For still others, there is a need for fuller intervention combining in some fashion psychological counseling, diabetes education, and medical treatment.

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