Sunday, April 11, 2010

Diabetes

This is the third in an ongoing series on medical conditions treated by health psychologists.

Diabetes runs in my family.  My mother died of cardiac complications of the disease.  My brother is insulin dependent.  My aunt has type II diabetes but also uses insulin to control her blood sugar.  I have impaired glucose tolerance but do not have diabetes. 

There are a couple of types of diabetes.  Type 1 diabetes is insulin dependent diabetes.  It's likely a genetic condition in which either the pancreas stops manufacturing insulin or doesn't make enough insulin.  Type 1 diabetes happens most often in children and young adults but can appear at any age. Symptoms may include:
  • Being very thirsty
  • Urinating often
  • Feeling very hungry or tired
  • Losing weight without trying
  • Having sores that heal slowly
  • Having dry, itchy skin
  • Losing the feeling in your feet or having tingling in your feet
  • Having blurry eyesight 
Type 1 diabetes is treated with insulin.  It requires monitoring levels of blood sugar and managing their levels with diet, exercise, and insulin.

Type 2 diabetes is acquired over time as the body fails to manage blood sugar adequately. 
Type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age—even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. Being overweight and inactive increases the chances of developing type 2 diabetes. Treatment includes using diabetes medicines, making wise food choices, being physically active, taking aspirin daily—for some—and controlling blood pressure and cholesterol.  The physical symptoms for type 1 and type 2 diabetes are the same.  There are medical tests that can differentiate the two types.

Health psychologists work with physicians, dietitians, physical therapists, and others to help people manage the complexities of the changes in diet, medication use, and exercise.

After my brother had a heart attack, he got overwhelmed with his health and I got an email from my sister-in-law talking about her frustration with him.  I drove up to Sonoma, CA where he lives, and he and I went food shopping.  I helped him with making food choices to understand the impact of the foods he eats on his heart, blood sugar and cholesterol.  We brought the food back to his house and I helped him to prepare a meal.  We talked about how his blood sugar works.  We had a discussion about glycemic index and how carbohydrates get broken down in a rapid or slow manner.  We talked about his usual diet and what kinds of foods he likes to eat.  We spent a long time talking about taste.  He was depressed because he felt like he had to have a diet that was restrictive.  I showed him how his current diet was extremely restrictive (he was eating the same foods on a daily basis) and the diet I was talking about would be to introduce him to new foods that were both sweet tasting and healthy.  I helped him fix a meal of carbohydrates that will be slowly broken down and lean protein.  He likes vegetables.  He gardens.  He has access to some of the freshest produce right from his backyard.  He has access to the farmer's markets in Sonoma, an area of California known for farms.  We talked about how he could walk to the store from his house.  It's less than a mile.  He had become afraid to exercise following his heart attack.  We talked about his symptoms during the heart attack.  We talked about the fact that he'd had symptoms for hours prior to realizing he was having a heart attack.  It wasn't sudden and it wasn't triggered by exercise.  We walked to the store and walked back.  I helped him manage his anxiety so he could return to a simple exercise program of walking which would help his diabetes and reduce his risk of another heart attack or a stroke.  Within a month his requirements for insulin reduced and he was placed on a "rainbow scale" of insulin rather than a fixed insulin dose.  He could regulate his insulin level more finely based on his blood sugar at testing.  He bought a juicer on his own and started walking to work a distance of 3 miles.  He lost about 35 pounds over the course of a year.  Although I only worked with him for a couple of days at that visit, the gains he made lasted for years afterwards.

Health psychologists routinely work to help people understand how to manage the medical complexities and psychological difficulties of chronic health conditions.  If you think you might have diabetes check with your doctor for an evaluation.

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