July 4, 2012

Back to Diabetes Basics – Part 1

What You May Experience After Diagnosis

Where to start is the question. First, if you have just been handed the diagnosis of type 2 diabetes, either you had an idea because others in you family history have it, or this is a complete shock as you can recall no history of diabetes in your family. Granted, there could be other reasons that may have induced type 2 diabetes, but I will discuss them in another blog. You must realize that the symptoms are not what every person feels, but they are the minority. The feelings may be of a different intensity and length for each person.

The First Stage – Shock!

Are you in shock, have anger, or totally befuddled? I can understand this and even acknowledge that you feel this way. This is the first stage in the process you will eventually go through to come to grips with your diabetes diagnosis. My anger was short lived as I had a history of diabetes on my mother's side of the family. My anger was at the time directed at a doctor that kept calling me a liar for not knowing I had diabetes. Yes, he had some reason to be upset at me as I was diagnosed while on the operating table for angina. Stent insertion plus ballooning of several areas in my arteries was in process and they could not stop. On top of that, they had the problem of stopping the bleeding at the point of insertion when finished.

His constant calling me a liar for not knowing I had diabetes resulted in a bedpan being hurled in his direction and quite a scene as nurses came running. I said I wanted some quiet time and the doctor was preventing it. Even my roommate said his actions were disturbing and agreed with having him removed from the room. He asked to have his doctor come to see him. Short story – this doctor was told to stay away from our room as long as either of us was in the hospital.

Shock, anger, or being in a fog is expected when you receive the diabetes diagnosis. How you handle this will be important, as you need to consider what you do next. It is not expected that you will retain the information given to you the day of diagnosis. It is important that you be ready for the next appointment and have your questions ready to ask the doctor.

I hope that your doctor will have testing equipment available to give you, or give you a prescription for a meter, lancing device, lancets, and test strips. Be aware that if you are not offered a meter, lancing device, lancets, and test strips, you need to ask the doctor for a prescription before you leave. If you forgot, go back to the office and insist on a prescription. Some doctors will not as they do not want you to know what your blood glucose levels are or does not want you to become depressed by the readings. If you have one of these doctors, seriously consider finding a doctor that will give you a prescription. Your diabetes health can be better for it.

Some doctors will use certified diabetes educators (CDEs) that can give you answers to many questions and should reinforce anything the doctor has time to tell you. They can cover many areas of teaching you about diabetes and how to handle many aspects of the disease. Many doctors do not have CDEs available or will not use them. Some doctors use registered dietitians (RDs) and some doctors do not. In some of the more rural areas, doctors are using nutritionists and others with a nutrition degree because RDs are not available.

With the rapid increase in people with diabetes and a snails pace growth in the number of CDEs and RDs, other resources are being explored by some doctors. A minority of doctors are using diabetes mentors or peer mentors. A few doctors even use peer-to-peer groups. The last three are interesting as this indicates that these doctors are making use of knowledgeable patients that can use personal experiences to relate to new patients. This is a measure to help new patients feel like they are not alone in their struggle with diabetes, help educate new patients, and be available to answer some questions when needed. You should avail yourself of any education you have available. Your doctor is not available 24/7; therefore, you need to educate yourself to manage diabetes.

Okay, I have gotten ahead of myself and covered a few areas that should come a week to a month after diagnosis. Education about diabetes is important, but the first week will be very difficult for many people. If shock and anger don't take over for a few days, you are definitely in the minority. A few people will take the diagnosis in stride and be ready for the next step of being educated. Even if you are in a state of shock, keep the fog at bay long enough to learn that diabetes “is not your fault.”

Many people falsely feel that if they had done this or done that, they would not have diabetes. Part of this may be true, but people that are genetically disposed to diabetes should not feel this is their fault. Yes, their actions may have helped make the diagnosis happen earlier, but by having the predisposition for diabetes; most people have no control in preventing diabetes, just the timing of the diagnosis. There are possibly some people that are not genetically predisposed to diabetes that are diagnosed, but there is little evidence to-date supporting this happening in large numbers.

There is no advantage in dwelling on the past. This was a hard lesson for me to learn, but I had a good friend tell me that diabetes is the here and now and I needed to learn how to deal with it. Since this person did not have diabetes, it really stopped me and made me realize that unless I did just that, I might not be capable of managing my diabetes.

The Second Stage – Denial!

After the initial shock, anger, or what you want to call it, you may have denial. This is not necessarily the order, but can happen early on or years later. Denial can wreck havoc in diabetes management and make it difficult to recover. Denial is thinking you have mastered diabetes and don't have to do anymore to battle diabetes and just stop, or outright refusal to recognize that you have diabetes. Both are damaging to you and may make future management of your diabetes more difficult. Diabetes burnout is very different and should not be confused with denial.

The Third Stage – Acceptance!

The next stage is acceptance of diabetes and the desire to manage it to the best of your abilities. And yes, denial can happen after what may seem like acceptance, but generally does not. Acceptance means that you recognize diabetes is what you have and have decided to manage it as only you can do. Yes, you will rely on your doctor for guidance and assistance, but you have accepted it as your diabetes and intend to do battle with it.

A Possible Fourth Stage – Depression!

Now that I have covered the main stages that most people encounter, I need to add a possible fourth stage. This stage does not generally happen to about one-third of people diagnosed with diabetes, but may happen to the other two-thirds. This is generally a minor depression and may happen at anytime from diagnosis to years later. Only about 19 percent of people develop severe depression. The risk is there and needs to be considered and dealt with when it happens.

I have had diabetes for eight plus years and have had what I believe was depression only twice, the last about a month age. I was in a down mood or funk and had to force myself to continue to work on blogs and do my research, but there were days I did not want to do anything. I don't know what happens to everyone, but unless you really are seriously depressed, take it in stride and work to overcome it. Seek professional help if you feel the need. Some do have serious depression and need to seek professional help. This is normally the best route to follow and get the help necessary.

The last item for this blog is a statement by William Polonsky, PhD, CDE, and director of The Behavioral Diabetes Institute in San Diego, CA. He states that “diabetes does not cause anything.” That is right; diabetes causes nothing, no complications or related problems. This may surprise a few people, but the cause of the complications and some other problems is the poor or lack of diabetes management. You may think that this is what diabetes does, but no, if you maintain blood glucose levels at or near normal, the complications are unlikely to happen. Old age may happen before diabetes complications and you will likely die from old age before diabetes or its complication take over if you accomplish excellent blood glucose management.

This also puts to rest the first myth. Many believe that diabetes is progressive and continues to get worse. If diabetes is managed properly, progression will not happen and people may live a long, normal healthy life. The factor that adds reality and keeps this myth in front of people is that few people actually do what they are supposed to do to manage diabetes. For them diabetes is progressive and their quality of life is often in jeopardy.

Series 1 of 12.

No comments: