June 24, 2013

What You Need To Know After Diagnosis

I may be a bit touchy about this topic, but time after time people leave much out of the discussion for people newly diagnosed with type 2 diabetes. I knew that people developed the anger and shock, denial, acceptance, and depression differently. This was a rude awakening when a friend discovered he had diabetes. His first reaction was depression and his wife called me to ask what to do. I called Tim and we went together to talk with them. While Tim talked with him, I talked with his wife which was a good thing as she felt he may be suicidal and was overly concerned for him.

I took the wife outside, made a phone call to a doctor, and explained what had happened. He advised us to bring him to the hospital about 30 miles distant if we could, or if we could not, he, the doctor, would make the call to the ambulance and prescribe a medication to help maintain control. He repeated this to her and she agreed and thanked the doctor. We went back inside and Tim was in the process of getting him dressed when his wife told Tim she wanted him taken to the hospital that the doctor and I had discussed. He was not resisting and his wife said she would drive if Tim would sit with him in the back seat. I could follow so Tim and I would have a way home. No problems were encountered on the way and the doctor was waiting at the emergency entrance with another doctor when we arrived. After he was admitted, his wife said he should be okay now and said she would call me later. She thanked Tim and me for coming so quickly.

Tim and I had a good conversation on the way home. Tim said he was happy that his wife had told me she thought he was suicidal and I had called. He was and Tim said he recognized a couple of things in talking with him that made him realize this as well. This had changed the way Tim talked to him and when we came back, he said what his wife said was reassuring and he knew I had done my part.

I commented that this was uncommon for people just diagnosed with diabetes and pointed out how unique each of us is and our reactions to a diagnosis. Tim agreed that most seem to start out with shock or anger and then may have denial. I said I was thinking about questions to ask his wife and see if we could figure out what may have triggered his depression. Tim asked when he received his diagnosis and I said yesterday afternoon. Tim let out a low whistle and said that was fast and we were fortunate to have found out so quickly. I said he was lucky as his wife has a sister with type 2 diabetes and so was ahead of the game when she recognized the depression in her husband. Her sister had a severe depression early on and several minor episodes later.

Tim said he had asked her if he should call anyone and she said that since the numbers were in her cell phone, she would as soon as she knew he was stable. I said they have two sons and daughter and he has a twin brother. I continued that I am not aware of any other family and that her sister was the only one prior with diabetes. Tim asked if diabetes was present in prior generations and I admitted I did not know.

Tim suggested that we make this a topic for a meeting and I agreed. I sent this to him when we returned home and we have exchanged several emails about what was missing and what should be added. We decided on the following points for a discussion when we come across newly diagnosed people with type 2 diabetes. First, we will print this out and cover it in a meeting. Possibly, we will add to this.

#1. Emphasize that diabetes is not your fault. This is often difficult for people to accept. Yes, you may have done something to trigger it earlier than you wanted, but eventually you would have developed diabetes.

#2. Teach people that the past is the past, and to live for today. Here again some people have a difficult time with this because they want to continue the life they had been living.

#3. Discuss the four general stages that happen after diagnosis. We have covered the depression above, but like we stated, many people often have shock and/or anger before anything else. Denial can happen at any time and even a few years later or even several times. Also, acceptance can happen anytime. For a more detailed discussion read my blog here.

#4. Educate yourself – the doctor does not live with you 24/7. Unless you have an extremely knowledgeable and up-to-date doctor, learn for yourself. Most doctors are unable to stay current and learning about diabetes is research intensive. You know your body better than anyone else. This will assist you in learning.

#5. Learn to be your own lab rat in your scientific experiments. Yes, you can and while the article linked above does say it differently, you need to spend time learning what the blood glucose meter readings mean to you. Eating to what your meter tells you is a good guideline to help you learn about the foods you consume, whether you are eating too large a serving, or if you need to eliminate that food or combination of foods from your meal plan. Other variables such as stress, illness, and for women, the normal monthly cycle can affect the blood glucose levels.

#6. Learn about the new technology, it may be good for you. Do not, I repeat, do not run out and buy a new technology until you have done your homework and determined that the new tool or device will greatly assist in your diabetes management.

#7. Learn to avoid snake oil sales and their tricks. Just because someone says they are cured, do not believe them. Some will be promoting what they term a natural product that has cured them and you are a fool to believe them. The saying that a fool and his money are soon parted is a truth here. Many people are able to manage their diabetes and get off of medications. This is generally what these people have done and they see an opportunity to make money off other people looking for a quick cure. The battle for control of diabetes is not a sometime thing, but is a must for the remainder of your life. Return to old habits and diabetes will return with a vengeance.  As of yet, there is not a cure.

#8. Gain confidence in your abilities. This will take patience and dedication, but it is worth the effort. Like the little engine that could, he kept repeating, “I think I can” until he did it. We are all capable, and need to develop this inner strength for the battle ahead.

#9. Develop good habits. Whether this means eating at regular times and taking your medications when you should, if you develop good habits now, later during hopefully periods of minor depression, these good habits can help you get through them without doing severe damage to your diabetes management. This has been what helped me and was what got me through a diabetes burnout period
#10. Develop a positive attitude. This will also be something that can assist you through minor depression and a period of diabetes burnout. So number 9 and 10 can go hand-in-hand. This is a question I am asked – is it okay to become angry? I say, yes, as long as you do not let it get out of control and cause more problems. We all have experiences when a person that does not understand diabetes makes an absurd comment that can be very hurtful. I have learned to ignore these and walk away from the person. One person would not let it drop and I finally was forced to confront the person. I told this person that when she had diabetes, she would understand how wrong she was. Even then she would not stop and I finally just left the function to get away. I detested this person for forcing me to leave an event celebrating a birthday of a friend. Fortunately, my friend knew why I left.

#11. Time is on your side; please don't rush into new things. Unless you are confident that what you are doing is correct, take time to do your homework and verify that what you desire is indeed correct. Some things are best talked over with your doctor, and at other times reading on the internet can be helpful.

#12. Stay away from the panic panel. I had one person laugh at me when I told him this, but he had just been diagnosed and was in a panic. He could not deny this and we ended up talking for about two hours. I told him that he would forget most of our conversation, but to ask me questions in a few days and I would repeat much of it. He surprised me by remembering most of it and telling me that my panic panel solution was the key for him in remembering.

#13. Stay away from diabetic cookbooks. I made this mistake and learned the hard way, so please don't do this. Most recipes are loaded with carbohydrates and may contain ingredients that can be very difficult to find. In addition, many recipes are not foods we normally eat.

#14. Don't let a doctor set your goals, but accept guidance. If your doctor automatically sets goals for you, be polite and ask the doctor when the education class starts. If he/she says there are no classes, then ask why he is setting your goals. With you best diplomacy, tell the doctor you will do a lot of reading and set your own goals when you understand what reasonable goals are. Most doctors will accept this and then suggest goals on a temporary basis which may be achievable. An elderly sister of a family that I know very well was recently diagnosed and the doctor told her to achieve a goal of 8.0%. She asked what level she had been diagnosed at and was told 7.8%. According to her sister, she reached over and slapped the doctor and told him to wake up. She said that if she could not get under 7.0%, they had better start digging her grave. She did not return to this doctor and her next A1c was 6.7%. And this was without medications, just a strict meal plan and exercise.

#15. Learn to make the needed lifestyle changes. Read my blog here if you need a list of lifestyle changes. You will need to add weight loss, as I left that off at that time. Some may not need to be changed such as stop smoking if you don't smoke. Others may need just some fine tuning, but each person is different.

#16. Discover what works for you, as you are unique. No, I did not say what works for a friend or a relative. What works for them, may not work for you. You may be close to what works for a relative, but generally you will be different in some aspect and then what do you do? No, you can't blame them because I have told you what they have found works for them may not be exactly what you are capable of accomplishing under similar circumstances. This is one thing our group has learned and we each have our own uniqueness and are happy to find out what works for us as individuals.

#17. Diabetes is only progressive if you do not manage your diabetes. Unfortunately, because of the numbers of people that do not manage their diabetes, this is one myth that will not go away. For these people, they develop the complications and say that it is progressive; and it is for them because they are not and have not managed their diabetes. Those that manage their diabetes often live long and normal lives and die of old age before complications become a factor. This means maintaining A1c's near or as close to normal as possible. Some even halt the progression for decades or many years.

#18. Learn the difference between good guidelines and the guidelines of the American Diabetes Association (ADA) and other diabetes groups that adhere to the ADA way of doing things. Yes, there are guidelines that are developed by patients, but they receive no publication or acknowledgment. There is one person that has published reasonable guidelines in some areas, but not all areas and it may be worth your time to read them. Much of it can be read here. Another good way to learn is to read blogs by David Mendosa at his website and here on Health Central. Also read blogs by Gretchen Becker at Health Central. Alan Shanley has some great guides in his blogs before 2012 and even if he is from Australia, they are full of good common sense. Tom Ross is also a great blogger and you need to explore his site.

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