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Psychology works for Diabetes
The key to living well with diabetes is to avoid problems which arise from prolonged hyperglycemia (elevated blood glucose levels) or repeated episodes of hypoglycemia (low blood glucose levels). In order to achieve a balance, individuals with diabetes must regulate their behavior on a daily basis.
How is diabetes treated? Diabetes self-care is difficult for a number of reasons. For example, the demands of diabetes self-management can be overwhelming. Ideally, when people learn new and complicated routines, they try out new behaviours in a gradual way, eventually making them part of the new routine. Yet, with diabetes, the individual must quickly learn a large number of new behaviours and they must begin performing them all immediately and at once (e.g., the newly diagnosed individual is instructed in self-testing, dietary modifications, medication/insulin usage, and exercise at a minimum). Further, diabetes self-care is complex, involving the multiple impacts of several factors that work in opposite directions. For example, activity, insulin and the passage of time lower blood glucose, whereas food and stress elevate blood glucose. In general, research shows behaviour changes occur best when simple changes are made first and change occurs gradually over time. However, the individual with diabetes has to try to manage all of the factors simultaneously and right away. Another principle of successful behaviour management is the opportunity to take breaks or "time out" from difficult tasks. However, there are no weekends off, no vacations and no retirement. The demands of diabetes self-care are constant. Finally, diabetes management can be frustrating because effort does not always produce predictable results. There are times when individuals do all that they are asked and still their control is not what they expect.
How Can Psychology Help? In addition to the behavioural demands of diabetes there are emotional and social problems that can arise. Diabetes is often perceived as a burden. It can be hard to accept the disease, and feelings of depression (feeling overwhelmed), anxiety (fear of complications or hypoglycemia) and frustration (with the demands of self-care, or the medical system) are common. Young people, especially young women with Type 1 diabetes, are at risk for developing eating disorders (weight loss through insulin omission). Social problems can result from diabetes as well. Many individuals who do not have diabetes find it difficult to understand the needs of someone with diabetes. Even if they mean well, often those without diabetes act in ways that are not supportive. For example, friends can encourage a person with diabetes to eat something they shouldn’t because "once can’t hurt". Psychologists work with individuals with diabetes in a number of ways. They can help the newly diagnosed individual to understand the impact of this diagnosis, and their role in managing it. They can problem solve to help them learn the daily behaviours needed for successful maintenance. They are trained to recognize and treat psychological distress, including depression and anxiety that can develop when living with an unpredictable disease. Psychologists can be helpful in assisting the individual to develop and maintain the motivation needed to follow the daily routine of self-care. As well, family therapy and strategies to deal with social pressures are often beneficial to those with diabetes and their loved ones.
Are Psychological interventions effective? A number of research studies have evaluated the role of psychological interventions in diabetes. Behaviour change interventions have been shown to be helpful in improving self-care and diabetes control. A recent study of Type 2 diabetes demonstrated the importance of stress management. Reducing depression and anxiety has also been shown to help improve the quality of life of those with diabetes. Further, recent studies have shown that psychological interventions can also improve motivation to perform the self-care behaviours. Where do I go for more information? The following websites provide useful information on diabetes and self-care: Health Canada Report on Diabetes:
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