emotional health

The Burden of Type 2 Diabetes

Most people with type 2 diabetes are diagnosed at over 60 years of age. The person often finds out by chance that he/she has the disease, or as a result of other medical problems. This is often a shock for somebody who knows little about diabetes. The immediate reaction might be thoughts like, “now I’m truly sick”, “I have to change my life /all the things that I enjoy”, “now I have to live a disciplined life with no pleasure”, or “there goes my happy-go-lucky life”.

The person often knows somebody or other people with the disease who complain about the limitations in their life or who know what would be healthy for them but nevertheless ignore it. That’s why the person initially and automatically feels that it will be a heavy burden. Yet in reality, it is not that much of a burden. The truth is that people with diabetes do need to think a bit more before doing something, and life loses a bit more of its spontaneity, yet most of that burden stems from the demands that doctors place on their diabetic patients regarding the changes to be made:

•  Lose weight and monitor weight regularly: since the majority of those affected are overweight, the main recommendation makes reference to the patient’s weight. The person must eat less, particularly less fat, consume less alcohol, and eat lots of fruit and vegetables.

•  On food: This implies eating totally differently and no longer spontaneously, eating “healthy”, quitting smoking, giving up alcohol, and giving up everything that contains sugar.

•  On exercise: Patients are asked to start getting regular exercise, i.e. a half hour three times a week, taking the stairs rather than the lift, and walking or running more, as opposed to using the car for everything.

•  On social life: Patients are asked to make these changes while all their friends stand by watching, and either feeling sorry for the new limitations of diabetes, or quite the contrary, telling them that they need not take it so seriously. Whatever the case, the newly diagnosed diabetic must make his/her diabetes known, so that friends and family are aware of it and have special food in the house for him/her.

The fact is that very little of this is really necessary. Yet when the person does not know much about diabetes he/she takes to heart all advice, sometimes going so far as to give up other things that he/she enjoys, out of pure worry. The result can be a sad life that is full of fear and anxiety.

Doctors who know little about the feelings of their patients limit themselves to insisting on these changes without discussing the reason for the changes in the person’s life or the person’s potential for change. If, for example, a person regularly experiences lots of aches and pains that make it difficult for him/her to move about much, telling the person to practice more sport is not very good advice. The practitioner ought to at least find out the individual’s potential for change, before asserting that the person’s only other option would be to swim more often than before. And sometimes people do not have a place to go, or the money or equipment necessary to practice certain types of sports.

Let’s look at the person from an unbiased perspective. He/she has lived a long life with burdens, desires, fears, pains and joys. He/she raised children who are now independent and who have their own lives. He/she went to school for years, had some triumphs at work, and maybe a few unfinished projects due to bad luck. He/she has a great deal of experience in many things and was there to help many people when they needed him/her. He/she normally knows what to do in the face of problems, given his/her life experience, which is precisely how he/she has achieved so much. Now that person is about to retire or has already retired and is anticipating a less stressful life with more free time, along with the joy of grandchildren. There were a few other minor health problems, which is why he/she went to the doctor. And now this, “You have diabetes” just can’t be. “Since I still feel healthy, it can’t be.” Sometimes doctors don’t respect everything that a patient has achieved throughout a long and possibly exhausting life, or they don’t acknowledge the life problems that he/she lives with today. At times a younger person does not really appreciate what is truly important for an older person.

Logically the person has his/her doubts about the certainty of the diagnosis: a disease with no cure! He/she needs time to get used to this truth and understand what it means, which does not necessarily happen fast. The person recalls that not absolutely all of the doctors’ advice has been good for him/her, so initially it is natural to not trust everything straight away. Hence, the patient may well feel that a second medical opinion might be in order.

The person affected recalls other people who were diagnosed with diabetes but who do not look after themselves very well, and they seem to be just as healthy as before. This is perfectly possible, as diabetes does not harm everyone in the same way. Some people are more fortunate, and others less. And at that time he/she remembers more of the people who have been lucky. Like grandpa, who smoked until he was ninety years old with no health problems at all. This mistrust is not illogical. Rather, it is normal and very often it may even help the person. Besides, he/she has other physical conditions to think about – backaches, rheumatism, allergies –, which can sometimes hinder his/her well-being more than diabetes. Then he/she would need to gauge the significance of everything and figure out just how much he/she would benefit from diabetes therapy and the recommended lifestyle changes.

What the doctors don’t say is why the patient has weight-induced diabetes if most of his/her friends also weigh more than before, yet don’t have the disease.

The truth is that being overweight does not affect everyone in the same way. Extra weight generally and naturally comes with age, whether due to genetic makeup, failure to adapt diet to reduced physical activity, or changes in metabolism caused by diabetes itself. The type of extra weight that is most often blamed for the risk of chronic diseases (weight gain in the abdomen and hips) is also genetic. Therefore it is unfair to directly blame the overweight person for his/her shape right off the top. Some people never gain weight, even though their eating habits are the same as always!

Nor do the doctors teach people how to lose weight and maintain their weight over time. The vast majority never achieve this, whether through hard effort or medication (which moreover has secondary effects). Losing weight is not the result of strong determination or thought. Instead, it is the product of a great change in how people eat for the rest of their lives. Eating is not an isolated element, but rather part of a psychological and social complex that is not easy to change (and often not desired). There are many things that cause people to be overweight, the first of them being genetic makeup. When a person slackens off a bit with his/her diet, the weight always tends to come back to a point that the person was able to maintain for a relatively long period of time in the past. Making huge efforts to lose weight always entails the inherent risk of mood swings or even feeling depressed for not having reached the goal. And rarely does the diet (which some refer to as “eating healthy” to convince the patient) increase a person’s desire to eat with the family. Self-control and eating with pleasure become enemies forevermore: eating goes with relaxing, whereas self-control causes tension, though it can also increase self-esteem. Ideally the patient would try not to gain more weight, which is quite hard to do anyway with new medications. Whatever the case, the best one can do is avoid major faults when eating (such as eating large and unnecessary amounts of fats) and eating with no thought whatsoever.

It is similarly difficult to convert a person who doesn’t want to exercise into a sports enthusiast (with the exception of watching football on TV). Some people like moving their bodies; others don’t. You can see it in children. Indeed, a person can change his/her habits through training and by practicing sports with his/her loved ones. Yet there are also causes such as a person’s disposition or life experiences that pit them against sports. One of these is the mere habit, which can be easily lost when one is not convinced of the benefit. Not everyone feels like going up the stairs on foot if they are not used to it. It is difficult for them and does not give them any sense of pride anyway. Moreover, each person needs to acknowledge his/her own physical limitations.

So what is left to be done?

This is a matter to taking small steps in these vast battlefields. Anything a person learns and feels that is good can be upheld and practiced more and more enthusiastically. There is nothing positive in fighting against oneself. Instead, the person should try to learn things that he/she has forgotten and which do not imply large obstacles. Sometimes people rediscover fun activities from their childhood.

Eating is a particularly vulnerable issue that generally only allows for a few small changes. Today’s diabetic science and nutrition don’t forbid any food, yet not everything should be eaten in abundance. Sometimes a person discovers something in a food that he/she has never eaten before and is surprised by such a new flavour. There are people who learn to make a bread pudding and cheerfully give all their friends the recipes. However this must not be something that goes against the person’s will. Instead it needs to be a step forward that one takes freely.

It is healthy to lower the blood sugar levels and get one’s blood pressure closer to normal, yet at the same time, it is not good to go overboard with anything. The patient needs to see how life goes with new medicines and a small degree of change in habits. If there are secondary effects or negative feelings, we need to discuss those changes with a specialist who knows how to listen. Changes can always be made to help the patient feel better.

It is the patient who has the responsibility of preventing health hazards for him/herself, and nobody can assume such risks for him/her. We all take risks, regardless of whether we have diabetes. If the secondary effects of a given treatment are worse than the positive effects, a person might consider stopping the treatment and contemplate the high risk. A sensitive doctor will always understand this. Life itself is full of risks, and nobody knows for certain what the future holds.

Take a good decision that will improve your health and quality of life at the same time!
  Axel Hirsch
Traslated by Susan Feuer
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