Joe Nelson

During the last session of the TCOYD (Taking Control of Your Diabetes) conference I attended yesterday, the moderator, Steve Edelman, M.D., asked those of us on a panel what messages we thought were most important to give people who live with diabetes. To summarize all five responses from the panel would be difficult, since each came from a different medical bias, but the essence of all the responses had to do with encouragement to “keep on keeping on.”

May is apparently Mental Health Month. I learned this from a presentation last week called “How Harley Davidson Saved Me From the Asylum.” It was presented by a man named Pete Feigel, who did a wonderful job of telling the story about his own depression and his struggles with multiple sclerosis (MS).

I was really impressed and touched by the responses from readers related to last week’s blog entry on anger (“Anger! What Do You Think It’s Good For?”). I consider it courageous to risk sharing the feelings you have about this condition.

In an ideal world, we would all have friends and family members who would provide the support we needed whenever we needed it. In an ideal world, we would have no need for self-help groups or support groups. The reality, however, is that at times most of us need a type of support that requires acceptance from others who are struggling with a similar issue.

Minnesota finally got some snow this past weekend. It is beautiful and fairly deep, about 10–12 inches. Our usual bragging rights are simply about the cold, but now we have something we can play in. I like the snow today, but the other night I didn’t feel so kind.

Diabetes is a condition that can make people feel like they have done something wrong even when they haven’t. The unpredictable fluctuations and frustrations that come with diabetes, even when you behave the way health-care professionals have suggested, can make you think that you messed up. For instance, when someone like me suggests that if you go to therapy you will feel better, and you follow my advice, you expect that you will feel better. However, sometimes that isn’t the outcome. So what might interfere with effective therapy, and who is at fault?

A few weeks ago, I wrote a blog entry called “When Therapy Makes Sense.” Since then, some discussion has taken place regarding barriers to seeking therapy. In the weekly Diabetes Self-Management e-mail newsletter, our editor, Tara Dairman, asked for responses to a survey question about obstacles to seeking therapy. I’d like to address some of these responses.

Those of us who chose to make our livings as mental health professionals probably didn’t do so because we had so much good mental health that we wanted to share it. Most of us likely started the process as seekers of mental health services and, somewhere along the way, discovered that we had something to offer as well.

This past week, I have been at a conference called the “Psychology of Health, Immunity and Disease Conference.” This conference is held in South Carolina, on Hilton Head Island. Not a bad spot for a conference—40° warmer than Minnesota, beaches to walk, golf courses, and a connection to individuals who see the world of health care with somewhat different eyes.

First, I want to address a question that Envoy posted on my blog entry from two weeks ago. Envoy asked if I thought that depression was more common in people who have diabetes. The first answer is that I have always believed it is more common, and research has also indicated that it’s twice as likely to occur in people who have diabetes. That is part of the reason I suggest a yearly mental health checkup in conjunction with your annual physical.

Yesterday, I spoke at a conference called TCOYD: Taking Control of Your Diabetes. It’s a great conference devoted to helping people who live with diabetes do it better. I gave two talks: one about “Emotions: The Wild Cards in Diabetes” and another on “Dealing with Diabetes Related Stress, Burnout, and Other Emotional Issues.”

To Cathy W, who commented about her friend with diabetes on last week’s blog,

It certainly sounds like you’re feeling frustrated about your friend’s lack of self-care and a bit powerless to help her. The interactions you have reported with your friend make it sound like her health is more important to you than it is to her. This type of relationship keeps you on edge about something you cannot control and lets her off the hook about something she needs to address.

On October 4, I wrote a blog entry proposing a “day off” from diabetes. This suggestion evoked some strong feelings—mostly anger at my lack of sensitivity about life with diabetes. I accept responsibility for irritating those of you who responded. Your responses have helped me clarify my ideas about the psychic weight of living with diabetes.

Medical problems are often treated as brief events that need immediate, short-term treatment. A problem is diagnosed, a treatment is chosen, then the person with the problem follows through with the health-care professional’s recommendation, gets better, and all is well and good.

Many people who live with diabetes struggle with the effort it takes to keep up with all of the related tasks. They get frustrated with the “forever-present” nature of diabetes care and often settle into a type of self-care that is “just enough to get by.” This goes on until about two weeks before their next doctor visit, at which point they become far more serious about following their meal plan and checking and recording their blood glucose levels.

Last week, I wrote about the courage I witnessed in some of the people I’ve worked with over the years. Someone asked me if I would follow that entry up with a note about how courage can be developed. I really think that courage is a combination of several factors converging at the same time.

Dear S.,

For the last two weeks, I have responded to your letter by addressing issues related to mental health and emotional eating. This week, I’d like to discuss the final area of concern you identified: motivation.

Dear S.,

Last week, I began to respond to your e-mail and wrote about mental health issues and diabetes. This week, I’d like to talk about the eating patterns you are struggling with and why they are so challenging to change.

Last week, the DiabetesSelfManagement.com editors received the following letter via e-mail and asked me if I could answer it on this blog. The letter touches on many issues related to mental health and diabetes, and I’ll address them in my next few blog entries.

I was playing golf the other day and found myself getting really mad at one of my opponents. On one hole, he reported a six when he actually had an eight. I confronted him about his error and we had a small argument. For rest of the round I ruminated about this interaction, and I didn’t play well, either. I blamed him for my bad round of golf, but my partner reminded me that I was the one hitting my ball and I am responsible for my own reaction and feelings.

I don’t have diabetes, but it has played a major role throughout my life. My dad had Type 1 diabetes and had it before I was born. Some of my earliest memories are of him playfully spraying alcohol across the room before he would fill his glass syringe with insulin. That was 20 plus years before disposable syringes, blood glucose meters, and insulin pumps. Those days were also long before anyone was focused on their feelings about diabetes, so like everyone else in my family, I stayed silent.