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The New Diabetes Without Fear
By Joseph Goodman
HarperCollins Publishers, Inc.Copyright ©2006 Joseph Goodman
All right reserved.
Fiction Versus Fact
"The most amazing thing about diabetes is the complete lack of true knowledge that exists about it," says Mary Tyler Moore. "When I first learned I had it, I was very frightened. I wondered, 'Am I going to be an invalid? Will I be bedridden?' I just didn't know."
Unfortunately, the actress's experience is not unusual. Diabetes is probably the most misunderstood of all diseases -- so much so that by the time the majority of my patients come to consult me for advice on the management of their diabetes, they have already developed emotionally crippling inhibitions which prevent them from enjoying the normal existence that should be theirs.
The news that one has an incurable disease -- any incurable disease -- is traumatic in itself, and in the case of diabetes, what the typical patient knows of the disease only serves to magnify the trauma. Thanks to pseudoscientific books, so-called documentaries on television and old wives' tales, the newly diagnosed patient quickly develops a swarm of unrealistic fears about diabetes. The disease is connected with visions of physical deterioration, shock from too much insulin and coma from too little insulin, gangrene, amputation, blindness and otherdangerous complications. The diabetic worries about gainful employment, about the possibility of having children or even entering into marriage. Another type of fear and frustration arises with the thought of dietary restrictions and the inability to have sugar or alcohol ever again. The list of frightening apparations is endless.
In addition to the terrible toll such unnecessary fears take on the patients themselves is the heavy burden they place on members of the diabetic's family. Husbands and wives of diabetics wonder if their marriages can ever be "normal" again. Brothers and sisters of diabetics, often neglected in favor of the overprotected diabetic child, are often forced into a confused, guilt-ridden existence. Children of diabetics develop unhealthy eating habits and doubts about their futures. Parents of diabetics often feel plagued by gnawing guilt, blame themselves for their child's fate and doubt their ability to cope with the future.
"I honestly wasn't too upset when they first told me my son had it," said Keith, a hospital worker. "I'd seen lots of diabetics in my job. But then I remembered this TV story -- a police show -- about a diabetic who went into a coma just because he accidentally took too much insulin without eating. And then I remembered I'd heard the same thing from a neighbor, about how her nephew almost died from it. And right away I got to wondering what it was going to be like worrying every day about being certain we did everything just right for my son and whether something terrible would happen to him. All of a sudden I didn't think I could handle it. I started to fall apart."
All too often, television programs that mention diabetes and/or insulin do so in the most negative context possible. For example, a recent episode of "Emergency 911" opened with a woman slumped over the steering wheel of her car as it rolled downhill. And host-narrator William Shatner informed viewers, "The police first thought the driver was a diabetic who had gone into an insulin coma." Only much later did Shatner explain that the woman had actually been an epileptic! Another recent example occurred in December 1993, on the popular "Unsolved Mysteries" series. Here the episode focused on a nurse who injected insulin into the intravenous bags of two patients in order to murder them.
Consider how such stories affect newly diagnosed diabetics as they first learn that insulin must be selfinjected on a daily basis! They might as well be told that their medication will be a daily dose of arsenic. No wonder so many diabetics and their families suffer tremendous mental anguish -- not because of the reality of their disease, but because of unfounded fears about what they believe the disease and its control will be like, and what they believe the disease will do to them. I have invented a term for this dangerous emotional disturbance: diabetic neurosis. It is a vicious neurosis, often more destructive than the disease itself, and it usually begins the moment patients are told that they have diabetes. Why?
First of all, few people are prepared for the discovery that they have the disease. Although untreated diabetes has very recognizable symptoms -- frequent urination, excessive thirst, insatiable hunger, weight loss, fatigue -- most determinations are made well before such symptoms become severe; usually the diagnosis is made by chance, during a routine medical checkup by the patient's doctor, in a hospital where the patient has been admitted for some other disorder or even during a preemployment or insurance examination. Having had no previous suggestion of the illness, the typical patient is armed with nothing but inflammatory hearsay. Imagine, then, the reaction to the announcement that he or she has diabetes.
"It was like a building fell on me," Brian, a jewelry salesman in his mid-thirties, told me. "I've always been an active guy, and when the insurance doctor told me I had diabetes, it seemed like a dead end for my whole life. Maybe I didn't know too much about it, but what I did know was all bad."
Brian had always prided himself on his sound physical condition. He was an avid jogger. "When they told me about the diabetes, right away I thought about a book I'd read -- this story about a guy who lost his legs -- and that made me think about my own legs. I remember reaching down to touch them and wondering if the next thing would be that they'd have to chop them off."
Fear of complications is one of the primary causes of diabetic neurosis. Although the recently completed Diabetes Control and Complications Trial (DCCT) offers clear evidence that proper care of diabetes can allow the patient to lead a normal life, the strict, somewhat time-consuming regimen used by the controlled diabetics in the study tends to frighten away . . .
Excerpted from The New Diabetes Without Fear by Joseph Goodman Copyright ©2006 by Joseph Goodman. Excerpted by permission.
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