Dr. Beverly Adler (aka “Dr. Bev”, right) is an award-winning certified diabetes educator and diabetes psychologist. She has combined her first-hand knowledge of living with Type 1 diabetes with a PhD in clinical psychology to serve the mental health needs of those within the diabetes community. She’s also written two self-help books and many articles, and does speaking engagements. We caught up with her via email to ask her a few questions about mental health care for people with Type 1 diabetes.
What has been your experience, as a mental health professional, working with people with diabetes?
When I see patients who are newly diagnosed, they are generally stressed and feel overwhelmed with all the information which they have to learn. I try to help them reduce their anxiety levels. Many people with diabetes are in denial and dismiss the seriousness of living with this chronic illness. I think they so fear the possibility of serious complications in the future that they hide their heads in the sand like an ostrich. Some people are so angry about their diagnosis that they have a hard time managing a self-care regimen. My goal with everybody is to help them accept their diabetes. I think it helps them to know that I also live with diabetes and can be a role model for them. Our goal is to do the best that we can – which does not mean being “perfect,” since there is no such thing.
How would you recommend a person with Type 1 diabetes cope with stress, specifically pertaining to living with this chronic condition?
This is advice I follow myself: Take one day at a time. Worrying about the future when you live with a chronic illness does not help to make the future better or worse. It just drains your energy and enjoyment of life. It’s been said that “worrying about the future with diabetes doesn’t take away tomorrow’s troubles. It takes away today’s peace.”
Also, be prepared! Carry your meter with you and check your blood glucose, when needed, to determine if you are within your target range. If you are prepared with glucose tablets or another source of fast-acting carbohydrate, you will be prepared to treat a low blood glucose reaction. If your glucose level is too high, then you can take a correction dose of insulin. Being prepared helps me to manage my diabetes.
Are there any stresses you find universally when it comes to people with diabetes? If so, what are they?
No, there are no “universal” stresses with people with diabetes. Each person with diabetes should be treated uniquely in their medical and mental health care. That being said, there are five stages that newly diagnosed people with diabetes may go through after their diagnosis. (Not everybody goes through all these stages, or in this order). These stages are based on the model that Dr. Elisabeth Kübler-Ross developed for dealing with death and dying:
1 – Denial (aka “dia-denial”)
When somebody doesn’t want to acknowledge their diagnosis. A person may feel so overwhelmed with feelings of anxiety about the future that they cope by ignoring the facts.
2 – Anger
Anger is the direct result of a person’s thoughts, not of the event. For example: asking “Why me?” or thinking “This is so unfair!”
3 – Bargaining
Bargaining is when a person makes a desperate plea (usually to God) how they will change their life in exchange for taking away the diabetes.
4 – Depression/Diabetes Distress
Diabetes distress arises from living with the emotional burden of diabetes self-management and blood glucose control.
5 – Acceptance
Acceptance is our goal. We want to help people with diabetes to accept their diagnosis and make lifestyle choices that keep them healthy and happy.
Often times, people with diabetes are unable to find professionals who specifically work with chronic illness, or even more specifically, diabetes. Why are mental health professionals so hard to find?
Treating the emotional issues of people with diabetes is a very specialized niche. I think that there is an effort in progress to identify mental health professionals who treat people with diabetes, especially as the importance of psychosocial issues has been getting more attention lately. Certified diabetes educators (CDEs), after attending rigorous continuing education programs, also can treat some basic emotional issues. When they reach the limit of their expertise, they can refer their clients to diabetes-focused mental health professionals.
If you could give a person with diabetes three pieces of advice to avoid stress pertaining to their condition, what would they be?
1 – Diabetes is a chronic illness we can live with. Be grateful for that!
Before I was diagnosed, I was sick with the common symptoms of uncontrolled diabetes: excessive thirst, excessive urination, lack of energy, weight loss, etc. My parents took me to the doctor and told him that I had “lost the sparkle” in my eyes. At the same time as the doctor had me undergo the five-hour glucose tolerance test, my mother, who was a college professor, had a student in her class who was also sick, but not with the same symptoms as me. My diagnosis was Type 1 diabetes; the student’s diagnosis was a brain tumor. That was when I was grateful that I could live with my condition.
2 – Have a positive attitude!
As certified diabetes educator Gary Scheiner has said: “The 3 things needed to manage diabetes successfully are the right tools, the right skills, and the right attitude.” I’ve heard that a bad attitude is like a flat tire – you don’t get anywhere until you change it.
3 – Have a sense of humor!
Psychologists see humor as a character strength. Your sense of humor is one of the most powerful tools you have to make certain that your daily mood and emotional state support good health. If you live with diabetes, attempt to laugh at situations rather than complain about them. This will help improve your mood and the mood of those around you. So, laughter might just be the best medicine….unless you have Type 1 diabetes, then insulin is probably better. Best of all, this priceless medicine is fun, free, and easy to use.
You can read more about Dr. Bev’s work at her website: www.askdrbev.com.
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