DIABETES AND DENIAL

by Peter J. Nebergall, PhD

Diabetes is a serious disease. Its consequences can be major, even life-threatening, and it can kill you quickly if ignored. We know this. But there are still many people, folks with diabetes and folks around them, who do not take the condition seriously.

Denial is the psychological state in which one feels exempt from reality. "The rules do not apply in MY case; I'M different!" Folks deny lots of things: Old age, obesity, business failure, ignorance, military defeat, even the end of a relationship. But if you have diabetes, denial, used as an excuse to NOT practice good self-management, is about as subtle as drinking slow poison.

Why do folks go into denial? There are many reasons, most having more to do with a person's self-image and psychological state than with the nature of the disease. Folks want to think of themselves as "well." Like the onset of grey hair and arthritis, the demands of diabetes remind the sufferer that he is not eternal. Some folks don't want to hear it, and tune it out.

Some people get mad. In our culture, there is still the strong belief that afflictions are visited upon those who deserve them; that disease comes from moral defect, or is punishment for sin. For one who believes this, to admit diabetes is to admit character defect. WE KNOW diabetes is not a character defect, but for many, this ancient belief system is still quite real. Someone knows he or she has lived a decent life, and yet winds up having to lose weight, exercise, watch their diet, test their blood, and inject insulin—"Why ME!" is not hard to understand.

Some folks have been misinformed about their diabetes. Ignorance is not a pretty word, but there are a lot of folks out there giving "advice" to the diabetic, and some of them haven't cracked a diabetes journal, or a current textbook, in years. Twenty-five years ago, the outlook for a life with diabetes was not what it is today! There have been great changes in what we know about this condition, and in how it is best treated. Research has given us new medications, better glucose monitors, less painful syringes, new ways to schedule testing and medication, more convenient meal-planning techniques, safer and more widely available transplantation, and the real hope of a cure. Make sure your diabetes advisor is up to date!

Burnout is a possibility. The demands of diabetes self-management are mercilessly unsubtle. Today, tomorrow, and everyday after, you must perform the tasks that will keep your blood sugars as close to non-diabetic normal as possible. There is no vacation; and there is little forgiveness for departure from that almighty schedule. Some folks do well for a time, and then lose patience with the necessary discipline. Then they depart from good self-management, and their health suffers.

Some folks have a real psychological need to be "in control." All their lives, these individualists have resisted authority, public opinion, and social pressures to conform. They may be devilishly effective salesmen and negotiators, but diabetes cannot be cozened at the bargaining table. Lacking the emotional skills to deal with a disease they cannot overawe, unable to confront it in their traditional fashion, these folks are lost at sea.

There are many other reasons why folks depart from good self-management, or fail to ever adopt it. What matters is what we need to do about it. The best response to denial is education. Fact cures fiction. Education shows us the consequences of departure from good self-management, but it also shows us the rewards of tight control. It shows us the constraints diabetes places on diet, but it also shows us how those constraints have eased substantially in the past few years. It shows us what we need to do to keep ourselves going, but it also shows us how that task has become easier. It shows us the ways diabetes can be life-threatening, but it also shows us how it is becoming ever easier, even to someone facing complications, the ramifications of diabetes, to live a long, full, and in-the-mainstream life. Education shows us the undeniable truth about diabetes.