The journey of managing a chronic illness often follows a bumpy road with unexpected twists and turns. Successfully taking charge of any chronic condition requires good medical care, access to resources, and social support. Often, however, it’s a person’s own ability to cope with the daily, nitty-gritty realities of his condition that is the essential ingredient for overall wellness.
In the case of diabetes, achieving a consistent balance between exercise, medication, and diet so that blood glucose levels stay in the desirable range is a daily, ongoing challenge. Being skillful in each of these areas is tough enough, but the real hurdle is making them all work together to manage the condition. For most people, it can feel like an elusive formula to master.
Unfortunately, the health-care professionals who care for people with diabetes and even the friends and family members of people with diabetes do not always recognize how stressful having and managing diabetes can be. Dr. Deborah Langosh, a psychotherapist who specializes in working with people with chronic illnesses, has counseled many people with diabetes. She says, “For many of the diabetic patients I work with, there is a lack of support and acknowledgment of the feelings of stress and strain they may feel on a daily basis. I find that diabetic patients get a common message from practitioners: ‘You are not in control,’ resulting in blaming the patient rather than recognizing that this is a complicated disease requiring time and practice to develop the skills needed. It is a stressful process. It takes a lot of mental work.”
Jane, 42, has Type 2 diabetes. She describes the type of stress she felt and what she did to address it: “Even though diabetes is an invisible disease, I don’t think that people who struggle with diabetes ever forget they have it. Everything I put in my mouth I have to think: ‘Is this good for me?’ This started to really stress me out, and then I would give up and eat poorly and then get sick. When I reached my breaking point, I finally decided to work with a nutritionist to learn more about food and also a psychotherapist to work with my anxiety.”
Marge, 38, has both high blood pressure and Type 2 diabetes. Like Jane, she struggled with issues related to food choices: “I could not get over the feeling of ‘restriction.’ I am restricted from eating this for the sugar, restricted from eating that because of the fat. I was starting to feel deprived and unhappy. I talked with my counselor. I learned that food was the main stress reliever for me. I found other ways to feel nourished, and whenever I have the deprived feeling with food, I distract myself.”
In my own counseling work with people who have diabetes, I have learned of two central issues with which people struggle. First, diabetes management is not simply about access to good education but also about developing discipline — learning to stick to routines, plan meals, and schedule exercise. This is particularly difficult for people who have not previously practiced much discipline in their lives and do not have the skills of self-discipline. For these people, it can be overwhelming to suddenly have to take control of managing an illness. As one person said to me, “I had to suddenly deal with exercise, diet control, and checking my fingersticks three times a day, overnight, and all at once. It was overwhelming and hard to get used to.”
Second, people are so often inundated with information on the health risks associated with diabetes that they don’t have time to process the feelings that arise when they are diagnosed. Without processing, however, the feelings — which often include fear, a sense of loss, anger, and frustration — tend to linger, and they can get in the way of effective diabetes management. Not taking the time to fully recognize or express one’s feelings about diabetes can make it harder for a person to take full responsibility for his diabetes and to perform all of the tasks necessary to manage it.