Print Living with Fear :: Diabetes Self-Management

You know how doctors always try to motivate you with fear? They tell you all the terrible things that will happen to you if you don’t take their medicines and follow their diets. You’ll lose your kidneys, your eyes, your legs, maybe your life. So shut up and do what we tell you!

When I talk to doctors, I usually tell them that the fear approach doesn’t work for most people. But I thought I would ask you if it motivates you. I do find that fear can sometimes help us make productive changes. But there has to be hope for avoiding or coping with the threat! Otherwise, fear is paralyzing.

Fear as a Weapon
We’re seeing fear used as a weapon now, in the massive “bailouts” (read: robbery) being taken from taxpayers and given to the richest people in the world. The big bankers and government leaders warn that the whole economy will crumble; the whole world will sink, if we don’t give them all the money in the world right now. We can’t afford to wait! The danger is too great.

This is an example of fear that is paralyzing. We’ve gone through eight years of fear-pushing like this from the Bush Administration about terror. We have to give up all of our rights and start a series of wars now and forever, or the terrorists will get us in our sleep. Now Obama is doing exactly the same thing. (Naomi Klein explained the political use of fear in her book The Shock Doctrine.)

So it’s easy to see the lethal effects of fear. I’ve been learning about it for myself lately, as my multiple sclerosis (MS)-related disability continues to get worse. I find myself spending too much time and stressing far too much about the unknowable future.

A Positive Response to Fear
And yet, ignoring my fears or pretending I don’t have them doesn’t help, either. Fear actually can be a positive thing if we handle it right. Sometimes, it helps me to write down my specific fears. What, exactly, am I worried about? What’s the worst that could happen? If it happened, how would I deal with it? And how can I prepare for those possibilities now? Is there anything I can do to prevent them that I’m not doing already?

Another thing that helps is to ask myself, how realistic are these fears? How likely are they? Do I perhaps have some wrong information that adds to my fears? I had a patient with Type 2 diabetes whose father had died of complications of diabetes, and he was convinced he was going to die young also. He thought self-management was a waste of time, because he was doomed anyway. He just didn’t know that the complications were avoidable.

With diabetes, there are obviously some things you can do to prevent complications. But we also know that there are no guarantees. So what do you do to deal with fears of complications? Do you just try not to think about them, or what? It often depends on your earlier experiences with diabetes. How did you first learn of the dangers of complications? How did you feel about that? Was it motivating or paralyzing?

William Polonsky, PhD, CDE, director of the Behavioral Diabetes Institute, says that if you’re tied to a railroad track and can’t move, it doesn’t help to worry about the train. Diabetes is the track and the train is complications. But the difference is, you can get off the track! You can self-manage your way clear of the train, in most cases.

I guess I’m talking about moving from fear to confidence. Do you know what I mean? Does fear help you or paralyze you? How do you move to confidence, or at least serenity?

Comments:

I think it depends on the source of the fear, and what else it's combined with... When doctors or nurses try to scare me into lowering my A1C, it's usually combined with some implicit (probably unconscious) judgement on their part about my morality. It goes something like this: my blood sugars are out of control because I'm irresponsible, (what other reason could there be; insulin is a cure, right?) and being irresponsible is immoral. The cure for folks like me is to get sobered up with some scary facts. It's an intervention modeled on drug addiction (I'm the "addict"), and my natural response it to ... rebel.

On the other hand, when I run across other Type 1 diabetics on my own that are my age and already have complications, it scares the hell outta me and actually does motivate me, temporarily anyways.

Posted by: Xa | Apr 08, 2009 05:28 PM

Dear David.

A little fear may be of some use as seeing my brother's gangerened feet was a good illustration of what happens with uncontrolled diabetes. He was in a "intensive" care old folks home where they measured BG at least once a month.

However with a bit more fear I tend to get paralysed and end up doing nothing.

I think it would be much more productive to have confidence that you can achieve sufficient control to reduce the risk of complications. Not sure how you keep this up for ever, it is a bit like confidence in winning in Vietnam goes down as the war drags on for decades. Diabetes is a war for the duration unless so miracle cure comes.

Posted by: CalgaryDiabetes | Apr 08, 2009 06:01 PM

I think you need just the right amount of fear to motivate you - which of course will vary from person to person! Fear of retinopathy definitely helped me to start a low-carb diet; now I have my blood glucose under control, I don't need the fear as a motivator any more, my blood glucose meter is a positive reinforcement.

If you don't get motivated - by whatever means - you end up like those increasingly sick diabetics I'm sure we all know one or two of - the ones who walk funny because they don't know where there feet are, who "couldn't possibly" change their diet because they love doughnuts so much, and who haven't a clue what their numbers are because their medical team see no point in trying to motivate them.

Posted by: Nicky | Apr 10, 2009 05:30 AM

Fear - hmmm - when I was first diagnosed with diabetes my initial reaction was fear. My maternal grandmother was diabetec and she lost a leg. I immediately read as much as I could about diabetes, consulted both a nutritionist and an endrocronologist and stepped up my exercise program. I have since moved from fear to confidence. I am sure that I am doing everything that I can to keep myself healthy and with all my limbs. Watch your diet, exercise, and don't fall prey to the hawkers that promise instant cures. There is no such thing.

Hang in there.

Posted by: stooksister | Apr 15, 2009 01:34 PM

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