Psycho-social issues in diabetes (3)
Another problem area in diabetes is the feeling of deprivation and that of being an unfortunate person as regards food s and meals that a lot of individuals with diabetes experience. This unfortunate state of affairs has been perpetuated by old wives fables about diabetes and more unfortunately so by healthcare workers who are not on the cutting edge about the food individuals with diabetes should and should not consume.
Global restriction of intake of carbohydrate foods is no longer the norm. What is advised is these days is reduction in the quantity of carbohydrate taken and increase in the quantity of vegetable consumed, which may necessitate the individual with diabetes to eat multiple times a day; this is referred to as small frequent meals which would help to prevent both. Hence, with proper and up to date dietary education, this problem area in diabetes can be satisfactorily addressed. Depression that follows thoughts about living the rest of one’s life with diabetes is another problem area in diabetes.
However, with proper counseling and good family support system this can be overcome. The social/family environment is important in helping the person with diabetes to manage the disease well. Social support is believed to have a mediating effect on the stress associated with diabetes. The family provides support for the day to day management of the diabetic state in relation to medications and blood glucose monitoring while friends provide support during times of exercise and periods when meals have to be eaten outside the home. Feelings of depression would only worsen the blood sugar control and the person with diabetes is best advised not to go down that pathway.
The individual with diabetes who treads the part of depression is likely to have an untimely death as depression negatively impacts on self care which is the core of good diabetes management. Exercise is known to improve one’s outlook on life and is thus highly recommended for people with depression. Worries about the lethal effect of low blood sugar levels are another important problem area in diabetes. This state of affairs could be so paralyzing for those that have experienced such low blood sugar levels before that it actually prevents some individuals from taking their medications.
This need not be so if the person with diabetes and their relatives are aware of the warning symptoms that precede low blood sugar levels in majority of cases. These early warning symptoms include palpitations (increased awareness of one’s heartbeat), hunger pangs, tremors of the hands, sweating, anxiety and numbness of different parts of the body.
The late symptoms of hypoglycaemia include behavioural changes like anger, confusion, fatigue or weakness, transient weakness of one side of the body, restlessness, incoherence, warmth, headaches, visual changes like blurring of vision, convulsions, loss of consciousness and in prolonged cases, death. When the warning symptoms occur, such a person should quickly take a sugary drink or put some sugar inside the mouth, or take glucose tablets or some orange juice.
This should be followed immediately by a more solid meal. One fact that all individuals with diabetes should be aware of is the need to always have sugar containing substances on their person whether on a long journey or on a short walk that they can quickly put in their mouth when they begin to experience the symptoms of hypoglycaemia. Another problem area in diabetes is the constant worrying about the development of the devastating long-term complications of diabetes in the eyes, kidneys and the legs.
Individuals with diabetes need to realize that if they endeavour to keep their blood sugar under control today, then the risk of the development of the chronic complications of diabetes tomorrow, though not totally removed, will be greatly reduced. Screening for these long-term complications is imperative as it leads to early detection which then enables the managing Physicians to quickly take steps that will prevent further deterioration. Hence, once yearly eye, kidney, teeth and feet screening should be carried out, among others.
By Dr Olubiyi Adesina