The Psychological Effects of Diabetes on Patients

Currently, a disease is ravaging America as it turns into an epidemic. According to the Centers for Disease Control (CDC; 2017), in 2015, there were approximately 23.25 Americans that were diagnosed with diabetes. This number has been climbing steadily for over a century. An epidemic as fast growing as diabetes is studied rather closely.

This disease can affect anyone at any age, though the types of diabetes varies from person to person. While it depends on how the individual is effected by the disease, they are always affected. The way they are raised by their parents, the way they live their daily lives, their self-control, and even their personality all determines how affected the patient is. Psychological effects happens to patients of all type of diabetes and, in the case of type one diabetes, extends to the parents of young diabetics.

As a brief summary, four types of diabetes exists: type one, type two, gestational diabetes, and prediabetes. Type one diabetes is considered to be a genetic disorder and happens at a younger age in most cases. With type one diabetes, no insulin is produced whatsoever and in order to stay alive, a type one diabetic must inject themselves with insulin when they ingest carbohydrates (CDC, 2018). With type two diabetes, the body does not make and use insulin very well.

A type two diabetic injects insulin to compensate for the lack of body produced insulin. Type two diabetes is not genetic. Gestational diabetes occurs in pregnant woman who have never had diabetes (CDC, 2018). Gestational diabetes generally goes away after the baby is born. However, babies can be born with an increased risk of health complications (CDC, 2018). Lastly, prediabetes is simply when a person has higher blood sugars, but not high enough to be diagnosed with diabetes (CDC, 2018). While these different types of diabetes have different circumstances, they all affect an individual psychologically.

Psychological development occurs most significantly during childhood and the adolescent period, especially during adolescence. Diabetes becomes a lifestyle in the way that one has to live their life with diabetes, especially type one, which requires a daily strict regimen. Without this regimen, the person would have severe health problems which could cause death. If the child is diagnosed with diabetes early on in their childhood and is incapable of injecting themselves and care for themselves, then the parents must do it.

This may become a problem for some parents, as they feel they are hurting their young children and the child is most likely incapable of understanding why the parent is hurting them. According to an article written by Whittemore, Jaser, Chao, Jang, & Grey (2012), there are four common themes that parents experience while raising their child with type one diabetes. Explained below is the psychological effects of parents and their experiences.

Difficult diagnosis is the first barrier for parents raising a young child with diabetes. Emotional distress is the best word to describe the parents feeling, they have a mixture of guilt, stress, concern, and denial. The diagnosis comes as a shock and they are not ready for it. Many parents report that they feel guilty because they feel it is their fault that their child received diabetes from their genes (specific to type one) (Whittemore, et al., 2012).

Family disruption is the next barrier to parents, things change on how a parent raises the child. The childs blood sugar must constantly be monitored, in doing so, the child will be unable to be as independent as their peers, and may possibly become socially isolated (Whittemore, et al., 2012). Along with that, parents must cater to the nutritional needs of the child. For example, if a child has low blood sugar, they must eat in order to raise their sugar levels. Meals must be custom made for the child. The child may not always be able to eat high carbs. Insulin compensates, but does not completely replace the loss of insulin production.

The next barrier is adjustment. At this point, some time has passed and the parents have come to an understanding of their situation. They have realized what it is exactly that they have to deal with and the shock of the diagnosis is almost gone. The parents have learned how to manage the childs blood sugar and the care has been incorporated into the daily routine of the family. Now that the parents have gained control of the situation, they begin to try to make the situation for the child better, to make the child feel like they are normal.

Though they are still protective of the child, the parents become more willing to let the child experience more things. As an analogy, the child had been kept on a tight leash, for the fear of high and low blood sugars. Now that they have gained more control of the blood sugar levels, they are allowed a longer leash, while still weary, the parent feels more comfortable that the child can take care of themselves to an extent. This process of feeling more at ease with their diabetic child is slow to start but once it begins and with a connection of support through health professionals and support from friends, parents are able to regain some semblance of balance. According to research, parents also utilize coping strategies that include the use of humor, maintaining a positive attitude, and being hopeful. They also maintained a sense of patience and persistence to help cope as well. (Whittemore, et al., 2012).

The final barrier, and perhaps the barrier that has the longest time line, is called ongoing stress. Maintaining metabolic control is the first experience described in the article. The largest challenge here is keeping blood sugars at safe levels and maintaining them there without constant fluctuations of high and lows. The parents constantly worry about the blood sugar level of the child, even after they become an adolescent or even an adult. Furthermore, the parents found the daily regimen of caring for their diabetic child to be time consuming. They have a constant worry of whether or not they completed every single task out of the many they must complete daily.

This responsibility can stress them out at any part of the day, and even if the parent were to complete every part of the daily regiment, the blood sugar of the child may still have gone high or low. In this case, the parents blame themselves for the fluctuations. What did I do wrong? How could I have prevented this? These were common thoughts from the parents, and cause yet another stress factor on the parents shoulders. Finally, the worry of the childs transitions in life were a stress factor. They worry how the child will cope in school without them and if their peers will accept them or discriminate against them for their disease (Whittemore, et al., 2012). Parents have many worries about their child with diabetes, but the child has even more concerns.

Type one diabetes affects all aspects of life when the patient is diagnosed young, but it really comes to affect the patient in their transition to adulthood. This happens because this is when the patient becomes independent and must learn to manage their disease with little to no help from their parents. Development into young adulthood then consists of experiences in education, work, family, and intimate relationships with their partners (Monaghan, Helgeson, & Wiebe, 2015). These experiences make up their existence as an adult and help to identify the patients self-identity. Naturally, a disease like diabetes that affects all aspects of your life, will affect development of self-identity among other things.

According to the article written by Monaghan et al., (2015), a study found that type one diabetics scored lower on a resilience test, a test that examines self-esteem levels and optimism levels, against a control group that did not have type one diabetes. In a different study, the same groups were tested, but instead were tested on self-worth, and again it was found that type one diabetics scored lower than the non-diabetics. Yet another study from the same article tested type one diabetics and non-diabetics that were aged 18-25. This time the test was taken on responsibility, independence, and social maturity, and it was found there was no difference between the diabetics and non-diabetics.

Being a less resilient naturally affects a person's emotional conditions and makes these people much more succeptiable to being diagnosed with a mood disorder. Depression is no exception. Cited in the article written by Monaghan, Helgeson, & Wiebe (2015) was that a study that interviewed female high school seniors and assessed the subjects for major depressive disorder (note that these subjects were not selected for depression or diabetes). The study found that nearly 50% met the criteria for major depressive disorder across the five year period that the study was performed.

The article also identifies that this data is consistent with other studies. Given this, it is determined that 50% of all high school students may be diagnosed with major depressive disorder, translate this with the low resilience of young type one diabetics and the chances for them being diagnosed with a depressive disorder increase. Not only depression, but they are also more susceptible to anxiety as their emotional distress is rather high. The daily regiment places a heavy burden on a type one diabetic as it is, and the daily life of a high schooler also places psychological burdens on a diabetic student. These two factors combined lead to a increased chance of anxiety and depression disorders being diagnosed (Monaghan, Helgeson, & Wiebe).

Stress is a common emotional distress that every person deals with on a day to day basis. According to a study that was summarized in Monaghan, Helgeson, & Wiebes article (2015), stressors that are specific to type one diabetics in young adulthood were identified. One such stressor included an emotion of self consciousness of their diseases and the management if it were largely present. This means that the young adults worried about the thoughts of how others viewed them and also worried about how people viewed their management of their disease (what they thought of them when they had to check their blood sugar levels or the thoughts of people when they had to bodice insulin due to their blood sugar levels).

Another stress is the simple day to day management issues, specifically, the stress of maintain their disease and blood sugar levels, along with the constant fear of something going wrong that prevents them to manage their disease. This also include their worry of their ability to participate in normal life. Naturally, the struggles that these young adults must endure with the healthcare system is also a common stressor. The battles these young adults must fight with the unwilling to pay insurance companies and disruption of daily life for doctor appointments are common problems that these people must worry about.

Overall, the stressors cause a heavy burden that results in fatigue as the type one diabetics fight the temptation to become loose in their daily regimen and take a break from the constant stress. Coping strategies are a must in order to deal with the stress, and while some might cope in a healthy ways, others might find themselves in bad situations as they engage in risky actions to cope (Monaghan, Helgeson, & Wiebe, 2015).

Young adulthood is a time in the lives of many that curiosity and exploration are at the high point of many people. Curiosity and exploration are not restricted or nurtured with diabeates, as diabetics have the same need for exploration as the general population (Monaghan, Helgeson, & Wiebe, 2015). Along with that, drug abuse has a generality to increase in early young adulthood and start to decrease during mid to late 20s (Monaghan, Helgeson, & Wiebe, 2015). This trend is also concurrent with diabetics, the big difference between the general population abusing drugs and diabetics abusing drugs are the effects on their health.

While drug abuse deals out the same effects on diabetics as it does to the general populations, however, diabetics receive additional impact when partaking in drug abuse. As alcohol has carbohydrates in it, drinking it affects their blood sugar levels. Many type one diabetics that participate in underage drinking do not know how (or cannot due to impairment of motor skills which is a side effect of ingesting alcohol) to bolus insulin for the alcohol which increases the chance for uncontrolled blood sugar. On top of that, alcohol ingestion increases the risk for acute hypoglycemia. The article also reports that tobacco consumption has a direct correlation to poor glycemic control and increase risk for long term complications (Monaghan, Helgeson, & Wiebe, 2015).

Substance abuse is not the only problematic coping method. Unhealthy eating habits is another way to cope and rather common. However, since diet is such an important aspect in the daily regimen of a diabetics life, unhealthy eating habits cause big problems for diabetics. Specifically while a young adult, body image and physical appearance becomes an important aspect. With these two factors combined, type one diabetics are at a higher risk for having unhealthy eating habits than the general population. It was found that the percentage of overweight type one diabetics increased from 21% to 54% for women and 2% to 28% for men (Monaghan, Helgeson, & Wiebe).

References:

1. Centers for Disease Control (CDC). (2018). About diabetes Retrieved on October 7, 2018, from  https://www.cdc.gov/diabetes/basics/diabetes.html
2. Centers for Disease Control (CDC). (2017). Long term trends in diabetes. Retrieved on October 7, 2018 from https://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf
3. Monaghan, M., Helgeson, V., & Wiebe, D. (2015). Type 1 diabetes in young adulthood. Current Diabetes Reviews, 11(4), 239-250.
4. Whittemore, R., Jaser, S., Chao, A., Jang, M., & Grey, M. (2012). Psychological experience of parents of children with type 1 diabetes. The Diabetes Educator, 38(4), 562-579.doi:10.1177/0145721712445216  

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