Dr. Beverly S. Adler, aka "Dr. Bev", is a clinical psychologist and certified diabetes educator with a private practice in Baldwin, NY. She specializes in treating the emotional issues of patients with diabetes. She is the author/editor of two diabetes self-help books. Dr. Bev has lived successfully with T1D for 40+ years. She can be reached at her website www.AskDrBev.com. You can also follow her on Twitter @AskDrBev.

Diabetes acceptance is the goal. How long it takes to achieve, and the journey to get there, varies for everyone. In my own case, I did not need long to accept my diabetes and appreciate that it was an illness which I could live with. That was 40 years ago!

Emotional stages of adjustment

Common stages of adjustment, which were originally used to describe stages of grief, have been expanded to other situations including diabetes acceptance. It is important to note that not everybody goes through these stages nor in the same order.

Denial is the first stage many experience. When somebody is in the stage of denial, they don't want to even acknowledge their diagnosis. A person (and/or their loved ones) may feel overwhelmed with feelings of anxiety and worry about what the future may hold and try to cope by ignoring the facts.

Anger is the stage that arises out of feelings of fear and frustration. A person may feel angry at their diagnosis and the unfairness of having diabetes. They may ask the question, "Why me?" Anger expressed outwardly may be aimed at inanimate objects, complete strangers, friends, or family. Anger expressed inwardly can be felt as low self-esteem.

Bargaining is the normal reaction to feelings of helplessness and vulnerability with your diagnosis. It can be evidenced by the vain expression of hope that the diagnosis of diabetes is reversible. Bargaining is a false way to try to feel that you have regained control.

Clinical depression/diabetes distress are not the same. Clinical depression is a feeling of persistent sadness, not related to living with diabetes. It can be treated with psychiatric medications and psychotherapy. Diabetes distress arises from living with the emotional stresses of diabetes.

Diabetes burnout is the extreme end of diabetes distress. Diabetes distress does not require psychiatric medication for relief and can be reduced with the help of a diabetes-focused mental health provider (such as a psychologist).

A spiritual approach

I am a big fan of the "Serenity Prayer." (My use of the Serenity Prayer has nothing to do with any 12 Step Program.) If you're not familiar with it, this is what it is:

God grant me the serenity To accept the things I cannot change; Courage to change the things I can; And wisdom to know the difference.

Troika: the three pronged approach to diabetes care

Elliott Joslin, MD, (1869–1962) was the first doctor in the United States to specialize in diabetes and was the founder of today’s Joslin Diabetes Center in Boston. Joslin's approach to diabetes management was expressed by the "troika," the Russian word meaning threesome. Joslin created a three-horse chariot to reflect this philosophy of living with diabetes—the three-horse motif symbolized insulin, diet, and exercise, which are needed to achieve "victory" over diabetes.

Updated four-pronged approach to diabetes care

In my book My Sweet Life: Successful Men with Diabetes, contributing author Bob Scheidt described his holistic approach to diabetes care. He viewed it as a square, the four points being medication (insulin), diet, exercise, and spirituality.

I endorse this updated approach. Many of the contributing authors (also true for my book My Sweet Life: Successful Women with Diabetes), including me, view diabetes as a blessing in disguise. This attitude develops after you achieve diabetes acceptance.

Combining spirituality with Cognitive Behavior Therapy

Cognitive behavior therapy (CBT) helps a person to accept the things they cannot change (such a diagnosis of diabetes) by challenging their unreasonable thoughts and actions. When a person learns to change their thoughts and actions to be more reasonable, the outcome is improved mood. The underlying cause of feeling helpless, anxious, angry, depressed, or distressed is based upon your thoughts. If your thoughts are negative, irrational, and unreasonable, so too will be your mood. But, it is within your power to change those thoughts, thereby changing your mood!

Learning to recognize what is not within your power to change (your diagnosis) and to recognize what is within your power to change (your thoughts and actions)—and the understanding of both choices—will result in the wisdom to accept your diabetes. And, with a positive attitude toward diabetes, you can choose to feel serenity with your diagnosis and empowerment with your diabetes self-care.