Insulin Pump Users

(You know you have diabetes when …)

Your ‘honey’ calls you ’sweetie’ and you get upset.

"Is there anything diabetes doesn’t affect?" you may ask forlornly.
The short answer is:
Even one’s moods, outlook on life and ability to handle day-to-day
challenges are affected by diabetes. Slow service at a restaurant or
the energy spent rushing about on the morning the alarm clock failed to
sound can drop blood sugar, causing the sufferer to slip into incoherence,
turn unexpectedly belligerent, or be immobilized with dread.
On the other hand, an infected tooth or the stress of a job interview
can elevate blood sugar, causing fatigue. A fatigued person can become
lethargic, downcast or ill tempered.
"Diabetes is a complex, demanding, pretty overwhelming situation to

deal with," said Shelley Johns, a clinical health psychologist whose clients
include many with diabetes. "What other disease affects every minute of
the day? Am I getting low? Am I getting high? It’s one of the most
time-consuming diseases. Even cancer patients in chemotherapy get a break.
It’s not like that for diabetics. There’s no vacation from this disease."
Johns, 34, practices clinical psychology in Charleston, W.Va. She has a
master’s and is on the verge of completing her doctorate. Counseling is
her second career. For 3 years, she was a broadcast journalist with
WTWO-TV.
Her move into psychology owes in part to first-hand experience with
the emotional trials and pitfalls of diabetes. She was diagnosed with the
disease at age 12.
"I was diagnosed the day after Christmas," she said, recalling that
she had lost a third of her body weight by then.
After two weeks in the hospital and being treated with insulin
injections, she regained her normal body weight to discover she didn’t fit
the clothes she’d been given as Christmas gifts.
Nonetheless, she said, diabetes was not the ruin of her childhood.
"I didn’t really feel all that deprived," she said. "My mom was very, very
good at trying to make sugar-free desserts."
But diabetes belongs to the person who has it. "From the minute I
was diagnosed," Johns said, "I felt I had to take care of this myself. I
really took fast and quick ownership of this."
Keeping diabetes a secret from schoolmates wasn’t possible, she
said. "After you’ve been carted off a time or two by the paramedics (because
of low blood sugar), you do get a reputation for being different," she said.
"I did always grow up feeling different. I didn’t feel defective but I felt
I
had responsibilities that other kids had no clue about."
Johns echoed the feelings of many people with diabetes: "It is a
lonely disease," she said. "Nobody ever understands it."
In her practice, she often works with patients who are struggling
with emotional problems alongside, or even because of, their diabetes.
"Two of the diagnoses that happen quite a bit with diabetes are
depression and anxiety disorders," Johns said. "One of the main reasons
that anxiety disorders are common is the symptoms of hypoglycemia (low blood
sugar) are similar to a panic attack. Oftentimes, people are diagnosed
with anxiety disorders. A lot of time, people are misdiagnosed."
Likewise, depression is significantly more common in people with
diabetes. "Seven to 8 percent of the general population will
experience a major depression sometime in their life," said Johns.
"Depression is roughly three times more prevalent in people with diabetes.
It doesn’t matter if you’re Type 1 or Type 2. It’s a little more common in
women."
Although life with diabetes can get a person down, depression is a
more serious disorder.
Diagnosable depression is a pervasive blue mood lasting two weeks
or longer, Johns said. A person suffering clinical depression may also
exhibit diminished interest or pleasure in activities, a state called
anhedonia. A depressed person would also have four or more of the following
symptoms: a significant appetite change, fatigue, feelings of hopelessness,
sleep disturbances (either insomnia or oversleeping) poor concentration,
recurrent thoughts of death or suicide, or body movements exhibiting either
restless agitation or ponderous slow-motion.
"It’s important to realize that diabetes doesn’t necessarily cause
depression and depression doesn’t cause diabetes, but it may be a
precipitating factor," Johns said. Either way, it can compound the
sufferer’s health problems. "The reason the emotional side of diabetes is so
vital is because once you develop something like depression, it can have a
negative influence on the way we
handle this disease," Johns said. "You may not be as motivated to follow
your exercise routine, to follow your diet."
And so, a vicious circle is created.
"This is why as health professionals, we address this aspect,"
Johns said. "I would encourage anyone with depression to get help from a
mental health professional. If you have a cavity in your mouth, you get
treated for it so you don’t have to suffer unnecessarily. Likewise with
depression, anxiety or any other emotional problem. There are extremely
effective treatments so people don’t have to suffer with those either."
Cognitive Behavioral Therapy, in which the therapist guides patients
in coping and communications skills, usually provides the quickest and
most effective psychological treatment for anxiety and depression, she said.
Johns uses a motivational interviewing technique, asking the individual a
series of questions that will help him or her decide what kinds of goals to
work on. For some patients, medications may be necessary.
Either way, she said, no one with diabetes should suffer needlessly.
"People are realizing it’s not weak people who seek help, but people
who want to maximize the quality of their lives and people who don’t want to
suffer unnecessarily."
Johns has herself ridden the blues elevator to the bottom floor.
Despite her efforts over most, but not all, of her life thus far to maintain
careful control of her blood sugar, she began developing complications -
including proliferative retinopathy (in 1992, her doctors threw up their
hands and told her to prepare to go blind. For once the diabetes was
unpredictable in her favor and the eye disease stopped its advance), the
early stages of kidney disease and mild neuropathy (in her case, foot
numbness).
The biggest descent came when she developed gastroparesis, a
malfunction of the nerves that control the digestive tract, which can cause
the sufferer to experience frequent vomiting, persistent diarrhea and
constipation.
"That was the time I was more depressed," Johns said. "I lost the
functioning of my body — You do have a lot of loss with diabetes.
"I would go to doctors and they would tell me they couldn’t do
anything," she said. They prescribed drugs. The drugs didn’t work. "For four
months, I could not eat solid foods. I was living on whole milk and Ensure
Plus. I lost a third of my body weight," she said. "They thought I was
dying."
Johns managed to halt the advance of her complications with even
tighter control, made more achievable through the use of an insulin pump.
Johns also stays active. She works out with weights and runs, walks and
practices kick boxing for aerobic exercise. But, she acknowledges, getting
or not getting complications depends a lot on the luck of the draw from the
gene pool. And so, some people whose blood sugars run regularly high
may never suffer complications or suffer them only in mild form, while
others who have managed magnificent control of their blood sugars may
still develop complications.
"I don’t sit around and wait for (complications) to come," she said.
"I’m going to maximize every minute that I’m blessed with. That was one of
the reasons I went into what I went into. I knew I could be a psychologist
whether I could see or not. I can do this in a wheelchair or I can do this
blind."

This entry was posted on Monday, December 22nd, 2003 at 11:52 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.