By Marina Basina, M.D., a diabetes expert and Clinical Assistant Professor, Medicine – Endocrinology, Gerontology, Metabolism at Stanford University. Dr. Basina spoke on this topic at a recent Cafe Scientifique at Stanford Blood Center.
Type 1 diabetes is an autoimmune condition in which the body’s immune system inappropriately destroys the insulin-producing cells of the pancreas. Insulin is a key hormone which moves glucose into the cells and allows it to be utilized for energy and growth. Without insulin, glucose rises in the bloodstream, causing an abnormally high level of sugar in the blood.
Individuals with type 1 diabetes are faced daily with the challenge of self-managing this demanding disease while simultaneously facing the challenges of daily life that everyone with or without diabetes shares. Diabetes self-management includes a variety of activities: multiple self-injections, checking blood sugar levels, eating carefully, considering food choices, adjusting insulin doses to cover carbohydrates, watching for the symptoms that may indicate hyperglycemia and hypoglycemia, taking action if necessary to correct blood glucose fluctuations. Diabetes is a 24-hour/day, 7-day/week, 365-day/year condition. There are no days off with type 1 diabetes. Anyone who has type 1 diabetes will likely tell you that it is a difficult, demanding and challenging condition, requiring daily attention, it is upsetting, and it never goes away.
Diabetes care is rightfully considered one of the most psychologically and behaviorally demanding of the chronic medical conditions. Therefore, it is common to have feelings of anger and frustration in relationship to the diagnosis of diabetes. And it is normal to have strong emotions but, at the same time, it is very important to understand diabetes and to be able to adjust to daily challenges, and to manage it effectively.
A person’s emotional needs are an important component of overall health and an integral component of diabetes management. Stress levels can be compounded day after day just by living with diabetes. It is undoubtedly more difficult to adhere to the treatment plan when you feel physically and emotionally distressed.
The following factors have been found to make it hard to adhere and maintain daily blood sugar control:
– The regimen is demanding
– The regimen is unpleasant
– Improved control may result in more frequent hypoglycemic episodes
– “Going by the book” does not guarantee the results
– Feeling different and isolated as a person with diabetes may deplete motivation
– No direct positive rewards, but rather longer term benefits (preventing complications) makes it difficult to stay on track
– Demands of self-management frequently cause psychological problems, such as anxiety and depression.
– Diabetes “burnout” psychological condition characterized by chronic frustration and feelings of failure, which may negatively affect glycemic control via the effects of distress on self-care behaviors.
The ancient Greek philosopher Epictetus stated, “People are not disturbed by the things that happen to them, but the views they take of them”.
The good news is that everyone can learn to manage diabetes, reduce the risk of long-term health complications, and live well with diabetes. As one individual with diabetes said, “So it is a pain! Diabetes is not easy, but when you make diabetes management a part of your daily rituals, over time the tasks become a part of your routine”.
A note to those living with type 1 diabetes
It is important to remember that perfection is not the goal. No person with type 1 diabetes can keep their blood sugars in the normal range all the time. When you have a bad day, blame the diabetes but try to understand what went wrong, give yourself some slack and make an attempt to improve the next day. An example of a good attitude is, “Good that I checked my blood sugar, because I was not aware that I was running high. I can now take action”. One psychologist said that he encourages his patients to use humor to handle the diagnosis as well as deal with tension of everyday life with diabetes the personal and relationship challenges. Management of type 1 diabetes requires the person to view himself as a member of a healthcare team, as the most important person on that team because the individual with diabetes will be doing most of the work with the help and guidance of others, such as healthcare professionals. It is extremely useful to participate in support groups and exchange the experiences with others.
Living a life with diabetes is challenging, but you are not alone. There are approximately 285 million people worldwide who like you, live with diabetes and face similar challenges. There are many therapies that make it possible to manage diabetes effectively, but how you feel about diabetes is an important component, and we hope you, like others, will be able to say, “I have come to accept that it is a part of me, rather than a series of blood sugar numbers and lab results. I know that I am not alone, and I can think about diabetes in a more healthy and effective way”.