Dr. Gary McClain is a therapist, patient advocate and educator who works primarily with individuals facing chronic medical conditions to help them cope with the emotional side of their illness. In this series, Dr. Gary answers questions from the Diabetic Connect community about how to cope with the mental and emotional challenges of diabetes.
Do you have a question for Dr. Gary? Email it to email@example.com.
I have type 2 diabetes and have had it since 2009. My conscious mind knows I have diabetes, but I still don't want to believe it and take ownership of my condition, or at least own it enough to stick to a diabetic diet weight loss plan. Have you come across this problem and what do you suggest I do about it?
A chronic condition like diabetes has a daily impact on your life. So while your conscious mind acknowledges that you have diabetes, you’re still human. And it’s only human nature to want to ignore it and hope that, by doing so, it will slink away on its own. That’s called denial.
While denial is a common reaction when you first learn about your diagnosis, it can persist over time, especially on those days when living with diabetes is especially difficult, like when you don’t feel like staying on your diet. “I’m not dealing with this. Not today.”
Here are a couple of ideas to cope with the urge to deny:
Get support. You might want to consider enlisting a friend or family member as a support buddy to help you to stay compliant with your daily regimen. Make a commitment to check in with them frequently, even daily, to let them know how you’re doing and to give you some encouragement – or tough love – when you need it. If your support buddy is also diabetic, then you can help each other to stay on the path. You might also want to sit down and talk to a diabetes educator about your self-care plan. Identify the aspects that are hardest for you, and ask for suggestions for how to stay on track.
Also, take a look at your self-talk around your daily regimen. Giving yourself messages like, “It’s so awful to live with diabetes. This is really unfair,” or criticizing yourself for not taking ownership of your diabetes, contributes to a negative attitude that, in turn, can perpetuate the cycle of denial. Instead, don’t fight your feelings: “I don’t like being diabetic, but here I am.” And shift your attention toward the benefit of compliance with your self-care plan: “The best way for me to live an active life, and keep diabetes in its place, is to take good care of myself. And I’m worth it!” And you are! Be kind to yourself!
My son, 15, was diagnosed with type 1 diabetes four years ago. His A1C at the time of diagnosis was a 10. Now it's at 14. He refuses to take his blood sugar, and only takes insulin when he eats something. He is always hungry and tired. He has missed so much school because of his refusal to take care of his diabetes. His personality has become very mean. To him, I am a nag. This has put a lot of strain on our family and it is taking its toll. I am at my wits end.
It’s so hard to watch someone you love refusing to take care of themselves, knowing the impact that this may have on their future. It can leave you feeling helpless, frustrated, scared.
Given your son’s age, I suspect that his unwillingness to take care of his diabetes is the result of denial – with some confusion and fear – as well as the oppositional “don’t-tell-me-what-to-do” behavior that goes with the territory during the teenage years. Clearly you don’t want to stand by and watch him not take care of himself. On the other hand, you can’t control what he does every moment of the day.
So here are some ideas for finding the middle road. I would encourage you to stay positive with your son. If your discussions about his diabetes turn into arguments, then you risk turning his self-care into a control issue during a time in his life when he is attempting to establish his independence. If you haven’t already, have a talk with him about how concerned you are, and how you want to work with him to manage his diabetes and stay as healthy as possible.
Talk but also listen. Find out what’s hard for him about being compliant, and where you might make compromises. Work out a plan together, with you in a supportive role. Your plan might include monitoring his food intake, sitting with him while he checks his blood sugar, at least until his numbers improve. But also set clearly-defined limits based on his doctor’s guidelines. Tough love! Come to an agreement on privileges that will be taken away when is not complaint, and how he will be rewarded for being compliant. Again, give him some control here, too.
You may want to sit down with your son and his doctor or a diabetes educator to talk about the importance of compliance – so that this message isn’t just coming from you – as well as to ask for suggestions on any tweaks that can be made in the plan to make it more palatable for your son.
Every day, remind him of your love and concern. Give him lots of encouragement when you see him taking action.
By the way, diabetes and depression can go together. If your son is feeling like an outsider at school, or being bullied or ridiculed because of his diabetes, this can lead to depression. The irritability you mention is a common symptom of high blood sugar, which sounds like it's likely the case here. But anger can also be symptom of depression. So keep an eye on how he seems to be doing emotionally, any changes in his interest in things that he enjoys, and any signs that he is isolating himself. If you see what you think may be signs of depression, reach out to a mental health professional.