A guide on how to speak to a diabetic

diabetes

Diabetes is not about pills and doctors alone. Increased blood sugar causes a lot of heartaches in the family. Dealing with feelings, myths and behaviours are some of the greatest challenges. The medical treatment is very important, but the environment can have beneficial or harmful effects on the person. Thoughts, feelings and sensations in the body can also modify behaviour and the course of illness. Following are some communication and attitudinal ‘fault lines’ seen in the family that can be corrected.

Fault line 1

“I have told you for months to check your sugar and you refused. You have no sense of responsibility and are simply careless. What is the use now that your sugars are high? You wasted so much time!”

Feelings to be dealt with

The carer is angry and has lots of fears about the health of his/her loved one. When these feelings are dealt with the ‘statement’ will change.

Fantastic line 1

“I am actually so angry on you that you did not listen to me for so long. I feel so scared some times.  Nevertheless, it is better late than never. Let us work towards recovery!”

Fault line 2

“Take charge of your diet for god’s sake. Follow the doctor’s advice. Do not touch the sweets in the fridge”!

Feelings to be dealt with

Excessive fear and frustration is seen. Here the therapist has to explore the worries of the carer. Sometimes the fears are exaggerated. The nature of the carer may be anxious and s/he may see an illness as a catastrophe. S/he may view and analyse this event from the bad experiences of others. It is so important to deal with the care giver and explore the beliefs, thoughts and feelings. Such ‘fault lines’ can hinder improvement and increase blood sugar.

Fantastic line 2

“It is difficult to actually control your diet immediately. Let us see what happens to you when you see food that you are forbidden or asked to take in small doses. I feel very tense when you just eat and eat. Let us do an exercise on ‘Exposure & Response Prevention’. I will assist you in this. Keep the sweets, chocolates in front of you without touching it for half an hour. I will sit next to you. Watch all the thoughts, feelings and sensations. Your mouth will water and may get many thoughts such as, ‘I will have it only once’, ‘ Once in a while if one has it is  safe’, ‘I will eat less during dinner’, ‘Let me live my life, my friends with high sugar also have and nothing has happened in spite of high sugar’, among others. You will crave for the taste on the muscles of your tongue. So, a lot of thoughts, feelings and sensations you will go through, observe it. We will do this many times. There are many other methods to help you have a healthy diet as suggested by experts. Small morsels and chewing them properly calms down the palate. For example, if one has to eat only one gulabjamun (an Indian sweet) break it into four pieces and chew slowly.  Just a prescription from a dietician alone does not help. Behavioural change needs an effort and at times simple psychological interventions.”

Fault line 3

“Forget doctors and medicines. Yoga and lifestyle management will cure your diabetes. Take a long break and go to a yoga centre. Yoga cures all illness and can cure all those who have diabetes. My friends have benefited. Medicines have a lot of side effects.”

Feelings to be dealt with

Strong beliefs can help or harm. Here hope associated with yoga is pushed. Yoga, Exercise helps diabetes for sure and has reversed the sugar levels in many but may not help everyone. Every person with increased sugar is not the same. There are differences based on genetics, stress and other factors. There is no one sure shot method for all vyadhi (illnesses). One man’s food can be another man’s poison.  Asking someone to take a break may be due to intense fear that needs to be explored.

Fantastic line 3

“I have lot of faith in yoga. You may also do it with the advice of the Doctor. Sleeping enough and on time and exercise will help you. I will be happy if you try these methods too.”

Fault line 4

“Your sugar is normal and your anger is completely gone. I had told you that your sugar is responsible for all your short temper since marriage. Now I like this peace and am surprised that you don’t feel like working. Any way this state is good.”

Feelings to be dealt with

Sudden change in behaviour associated with sugar disturbances needs to be examined. Here the feeling of ‘joy’ in the carer is dangerous. Sadness, loss of interest, wanting to be aloof, irritability and anger are danger signals. High sugar may be associated with depression that needs to be identified and urgently treated.

Fantastic line 4

“I am happy to see your sugar under control but I am surprised to see your mood swings and change in behaviour. Let us check this out with a mental health professional at the earliest. Depression is common among those with diabetes.”

Fault line 5

“Stop your booze now. I am going to throw all your bottles and destroy your bar. At least, now stop taking alcohol.”

Feelings to be dealt with

Extreme disgust, anger, sadness and fear needs to be dealt with. Alcohol and high blood sugar is a dangerous cocktail in the body. Those who have been drinking for long may not do it for pleasure but just to avoid symptoms like poor sleep, palpitations, tremors, anger etc. Such people drink out of habit rather than as a desire.  The feelings of the carer need to be acknowledged and healed. Many feel that something grave will happen to the person on treatment and the carer may be left alone. Many family members feel extremely worried with the thought of the person on medications passing away and thereby increasing their insecurities, financial and otherwise. Time needs to be spent with the carer. Alcohol abuse is a problem and not a vice nor a sin and needs treatment.

Fantastic line 5

“Let us meet a mental health professional honey and help you move away from alcohol. You know that I feel very worried and scared about your health. Many a time I get very angry at your refusal to heed sensible advice.  I am aware that you are worried about the lack of sleep, anger, trembling of your body and your intense craving. We can treat that. Stoppage of alcohol will help your sugar come back to normal early along with treatment.”

Fault line 6

“Just because you have high sugar, do not stop your fight against your brothers and family who have snatched your property. Take treatment and fight. Teach them a lesson so that they suffer. I hate them as much as you do. Because of them you have diabetes.”

Feelings to be dealt with

Anger and its by-products such as resentment, hostility, revenge and hate are seen in the carer. These states are infectious. It may spread like wild fire across the family and may also infect the person with Diabetes. This disturbs the Hypothalamic-pituitary-adrenal axis, a circuit that manages stress. This circuit and others including the hormonal glands lose their rhythm and goes haywire thereby increasing the blood sugar. Uncontrolled diabetes is the result. Here the family needs to be counselled and destructive feelings need to be resolved.  Pursuit of justice is healthy and needs equanimity in the hearts of those involved. Equanimity makes one effective and not meek and weak.

Fantastic line 6

“It is tough to really fight on many fronts. I am very angry at your relatives and so are we. Let our resentment not consume us completely. I feel it is a good idea if we all go for counselling. Managing intense feelings is so necessary for all of us. It will save your pancreas from weeping and crying excessively.”

The family members around the person suffering from diabetes are always ignored. They need to be counselled. Dangerous destructive emotions in the air can ruin the health of the person under treatment and everyone around.  The blood sugar report is important and equally important are the emotional states of the entire family including the person on medical treatment.

The author is a psychiatrist at Dr LH Hiranandani hospital