The Diabetes Problems We Aren’t Talking About
CBT for Medical Conditions
In 2014, the diabetes education and advocacy nonprofit, diaTribe, surveyed over 7,400 people about the psychological toll of living with diabetes. They found that approximately 65% of people living with type 1 diabetes, and 50% of people living with type 2 diabetes believe that this condition negatively affects their self-confidence and their ability to take on life’s challenges. Contributing factors include misconceptions about the causes of diabetes, and what is required to manage the disease.
Many people living with diabetes believe that this condition negatively affects their self-confidence and their ability to take on life’s challenges.
Many people believe that those living with diabetes brought it on themselves by poor diet and lack of exercise. Often, newly diagnosed individuals harbor these beliefs about themselves. This is especially true for type 2 diabetes. With type 1 diabetes, the body suddenly and unexpectedly stops producing insulin. However, with type 2 diabetes, the body produces insulin, but the cells have trouble using it. When patients believe that the development of a disease is their fault, they are likely to experience guilt and shame, which can lead them to avoid the support and regimen they need to manage the disease. This can ultimately lead to sub-optimal medical and self-care.
Our patients with diabetes have a great deal to manage with this complex and difficult condition. They must consider the types and quantities of food they eat, the timing of meals and snacks. They must also manage blood glucose levels which may spike or drop without warning, all amidst an expectation of precision. These are the challenges we know about. There are, however, other problems that require our attention. Often overlooked are the feelings of failure and shame experienced by individuals living with diabetes.
Often overlooked are the feelings of failure and shame experienced by individuals living with diabetes.
Over the past two decades, research focused on the psychosocial aspects of management of the disease has suggested that diabetes-related stigma has negative consequences for psychological well-being and self-care, affecting clinical outcomes (Schabert, Browne, Mosely, & Speight, 2013). It is widely understood that changes in diet and exercise are difficult to achieve.
Diabetes-related stigma has negative consequences for psychological well-being and self-care, affecting clinical outcomes.
We have learned from the obesity research that individuals find it challenging to lose and maintain even modest amounts of weight. For some people with diabetes, the failure to follow suggested lifestyle changes results from their reluctance to be viewed as different in the eyes of their peers. Barriers to treatment for adolescents are often related to social situations and environmental influences, embarrassment, and seeking acceptance or perceived normalcy (Mulvaney, et al., 2008). Individuals with diabetes across the lifespan struggle with making food choices that support their needs.
Consider this patient example: Anna, a first-year college student with type 1 diabetes, managed her blood sugar reasonably well throughout middle school and high school–in large part due to family structure and parental support. However, when she went away to college and was left to make her own decisions, she was unprepared to navigate certain social situations. Particularly difficult were the late-night study breaks in which her friends had pizzas delivered when her blood glucose levels were elevated, or outings where stopping to take her blood sugar and give herself insulin left her feeling different. She found herself eating whatever her friends were eating, or giving herself insulin late, so she wouldn’t feel “different.” Anna became ashamed of her condition.
The key to working with Anna was first to understand the core beliefs that got triggered when she was faced with the difficult choices of taking care of her chronic disease or fitting in to the social milieu. Next, we worked to empower her to take ownership of her disease and treat herself the way she would treat someone she loved with the same chronic illness.
Mulvaney, S. A., Mudasiru, E., Schlundt, D. G., Baughman, C. L., VanderWoude, A., Russell, W.E., Rothman, R. (2008). Self-management in type 2 diabetes: the adolescent perspective. Diabetes Educator, 34 (4): 674-82. doi:10.1177/0145721708320902.
Schabert, J., Browne, J. L., Mosely, K., & Speight, J. (2013). Social stigma in diabetes: A framework to understand a growing problem for an increasing epidemic. Patient, 6:1-10. Doi:10.1007/s40271-012-00001-0