Coping with Emotional Vulnerability

Life’s already an emotional roller coaster without the added burden of diabetes, so you don’t always need to hold your disease responsible for your ups and downs.

Coping with Emotional Vulnerability

In fact, doing so may make you feel more helpless and out of control (and prevent you from solving problems not related to diabetes). But it’s useful to recognize when diabetes does fan the flames of feeling-and address the emotions head-on.

The first step is to recognize that mood swings are a natural phenomenon with diabetes-even apart from the emotional challenges of managing the disease. Variations in your blood- sugar levels can affect mood directly. Low glucose levels can make you nervous, irritable, and anxious, while high blood sugar can make you feel fatigued and down in the dumps. That means the steps you take to control your blood sugar can have an emotional payoff as well. Still, you can expect to contend with negative feelings that have nothing to do with blood sugar but everything to do with having diabetes.

Defeating Depression

Everybody feels low at least some of the time, and common sense suggests that having a chronic disease is ample reason to be depressed. In fact, people with diabetes may be as much as four times more likely than the rest of the population to bandy with the blues, and they may also suffer from depression longer. All of which suggests that depression is normal if you have diabetes. But you don’t have to-and shouldn’t-accept low moods as inevitable or beyond your control.

Be alert to symptoms

Your problem may have a physiological cause that can be remedied by, say, adjusting your diabetes medication or taking you off drugs that can have depressant side effects (including some blood-pressure medications and antihistamines). Otherwise, your doctor or psychiatrist can prescribe antidepressant medications that fine-tune levels of certain chemicals in the brain. SSRIs-short for selective serotonin reuptake inhibitors-are likely candidates because they’re effective and generally have fewer side effects than other antidepressants, though in some people they can cause such side effects as ner- vousness, insomnia, lack of appetite, and dulled sexual response. Drugs in this class include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).

Talk it out

Sharing your feelings is one of the most effective ways of taking an emotional burden off your shoulders-which is why counseling is a mainstay of treatment for depression. Start by asking a friend or loved one if you can talk about what you’re going through. Assure him that he doesn’t have to try to solve your problems but that an open ear might do you some good.

Socialize more

Just being with other people in a social setting or a group like a community club, volunteer organization, or religious congregation can take your mind off your troubles, brighten your mood, and make you feel less alone.

Stick with the program

Don’t let your low mood derail your self-care program, especially when it comes to regular exercise. In fact, physical activity has been shown to lift mild or moderate depression.

Don’t drink

Because it’s a depressant, alcohol won’t drown your sorrows, it will only aggravate them. Drinking in excess, of course, will also add empty calories to your diet and possibly erode your self-discipline.

Attacking Anger

Most people go through a predictable cycle of emotions after they’re first diagnosed with diabetes, typically starting with a this-can’t-be-true sense of denial that eventually gives way to anger when you realize you’re in it for the long haul. You may feel that your body (or nature or God) has betrayed you, that your life has been turned upside down in ways you can’t control, or that you don’t deserve something like this and it just isn’t fair.

These are normal responses that may make you irritable for weeks and even months at the outset. As you gradually accept your diabetes and settle into a self-care routine, your anger may cool down. But it’s also possible that anger will persist, especially if you find yourself frustrated by your disease. For example, your best efforts at glucose control may not be producing the results you want. You may resent the intrusion diabetes has made on your daily routine or feel irritated by having to change your eating or activity patterns.

Frustration is a part of dealing with diabetes, but unchecked anger isn’t healthy for your relationships, your mental health, or your body. As with depression, anger is linked with higher rates of heart disease. It can seem a difficult emotion to control, but if you’re alert to it and prepared to contend with flare-ups, you can get the upper hand. Here’s how.

Take responsibility

Making progress toward peace means working toward an attitude of acceptance-not only of the diabetes itself but of the emotional toll it takes as well. Diabetes can be frustrating, and it can make you mad. Those are realities, and it’s okay to recognize them as such. This allows you to take a step back and see a bigger picture in which your emotions aren’t overwhelming and out of control but rather predictable responses for which you can begin to take responsibility. Part of this responsibility involves understanding where your anger is coming from, and not unfairly blaming other people or circumstances. If you stay calmer, those around you will as well, and you’ll likely find less fuel to fire your outbursts.

Look for patterns

Try to predict when you’re most likely to experience feelings of annoyance, frustration, or rage. Is it waiting in long checkout lines with slow cashiers? Does a particular person tend to get under your skin? Do certain topics of conversation raise your ire? If you don’t have a handle on when you tend to get angry, try writing down what’s happening every time you get mad to see if patterns start to reveal themselves. In some cases, simply knowing your triggers can give you a greater sense of control. And, of course, it can help you avoid them.

Ignore the bait

One exercise some experts suggest is to think of yourself as a fish being baited by a hook. On the hook is a trigger for your anger. Do you take the bait or recognize it for what it is and simply pass it by? Consciously choosing not to bite lets you take control of your anger by refusing to let another person or situation determine your feelings.

Change your mental channel

Sometimes, even when you approach anger rationally, you still feel peeved. In those cases, try shifting your thoughts. If you’re steaming while stuck in traffic, turn on a radio program or listen to a book on tape. Mentally replay last night’s basketball game or crime drama. Repeat a quiet phrase like “Calm down” or a favorite prayer.

Seeking an Anxiety Antidote

If you’re feeling depressed, it’s likely that you’re experiencing anxiety as well-the two emotions often occur in tandem. But even if you’re not battling the blues, having diabetes can give you plenty of cause for worry. For starters, there’s the fear that progressing complications may impair your quality of life in the future. Even if you’re doing a good job of monitoring and managing your diabetes, the unseen and unfelt nature of the disease can foster a nagging sense of dread.

Worrying about your diabetes is normal and, to some extent, even healthy because it helps motivate you to follow your treatment plan. But anxiety can sometimes acquire a life of its own and can become counterproductive and unhealthy. If your fears are more intense than they need to be, crop up frequently, or persist even when circumstances no longer justify them, they can distract you from the better things in life, undermine your ability to manage your disease and paralyze more positive thinking. To release yourself from the grip of fear:

Check in with your doctor

Remember that nervousness and such symptoms as rapid heartbeat are signs of hypoglycemia as well as anxiety, so your first step is to have your doctor evaluate your recent blood-sugar history. In some cases, a bout of anxiety might simply require an adjustment in your insulin or medication. If that’s not the problem, your primary-care physician can refer you to a mental-health professional who may be able to treat your anxiety with medications.

Talk back to yourself

Anxiety can blind you to positive emotions and cause you to focus only on negatives and potential catastrophes. You might fear that a slight slip from your blood-sugar goals is the first step down the road to vision loss or that if you take time to exercise, you’ll never get all your work done and you’ll be fired. Pay attention to what therapists call automatic thoughts, which set the tone for your mental state. If they tend to be negative (“This will never work” or “I can’t handle it”), try to be as objective as possible and ask yourself if evidence supports your thinking or whether you might be wrong. Look back to challenges you successfully met in the past for proof that things can also work out for the better.

Keep a mattress pad

Worries have a way of intruding on your thoughts in the middle of the night. If anxiety keeps you up, keep a pad and pen by your bed so you can jot down what’s bothering you. Try writing concrete steps you can take to resolve your concerns; this provides a reassuring sense that you’ve tackled the problem. Getting better sleep will make you more refreshed and energetic in the morning, and this can help you keep your anxieties in perspective.

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