The Diabetes Grieving Process

Among newly diagnosed diabetics, it’s fairly common to use denial as a coping mechanism. Diabetes denial can take the form of a defeatist attitude, where we feel our fate is sealed so we shouldn’t bother trying. Or, we can underplay the diagnosis, telling ourselves that we’ll be just fine going about life as we always have.

Avoidant coping styles, such as denial, are particularly common in teens diagnosed with type 1 diabetes. A higher level of this kind of denial in type 1 diabetic teens is associated with greater diabetes distress, fewer blood glucose checks, less frequent self-care behaviours, and poorer glycemic control. It’s theorized that disordered eating arises among type 1 diabetic teens and adults as a maladaptive coping mechanism related to their diagnosis.

Diabetes distress

Diabetes distress encompasses the emotional toll associated with diabetes and its management over time. Daily finger pricks, monitoring blood sugar, and taking insulin are just the practical stressors involved in diabetes management.

Then there are the emotional stressors:

• having partners and family fail to understand the complexity of diabetes management
• dodging the fears of declining health
• feeling shame and guilt about not managing the disease well enough
• expecting admonishment from health care practitioners

Perhaps the saddest part of diabetes distress is avoiding travel or favourite activities for fear of having a diabetic attack.

While these are all understandable stressors, having greater diabetes distress increases risk of poor disease management, reduced quality of life, and diabetes-related complications.

Perception is reality

The extent to which we perceive that disease management must interfere with our daily activities bears weight on how successful we’ll be. Higher diabetes distress, a higher perceived severity of disease, and lower sense of self-efficacy are all associated with poorer glycemic control.

By contrast, the psychological well-being traits of optimism and positivity are associated with better medical outcomes, including glucose control and lower mortality rates.

In children and adolescents with type 1 diabetes, body awareness and an open-minded attitude toward the disease are also associated with improved metabolic control.

Support system

When a child or teen is diagnosed with type 1 diabetes, the entire family can experience shock, distress, and sometimes anger. If your loved one has been diagnosed, the key is shifting into a supportive and health-promoting role once you’ve navigated these complex emotions (sometimes after seeking help from your own support system!).

For those with diabetes, having supportive family and friends is associated with significantly better diabetes-related attitudes, self-care, and glycemic control. Goals and interventions implemented as a couple or family are helpful for maintaining healthy behaviours.

The delicate nuance to honour is supporting your loved one by encouraging healthy behaviours—without using fear, shame, and guilt as motivators. Work together to set attainable goals according to their timeline, to promote a greater sense of accomplishment and self-efficacy.

Reaching acceptance

Acceptance-based mindfulness therapy for those newly diagnosed with diabetes is helpful for shifting out of an avoidant coping style. Among adult type 1 diabetics, acceptance-based therapy is shown to improve emotional flexibility, reduce diabetes distress, reduce symptoms of disordered eating, and improve diabetes self-management.

Children and teens also benefit from mindfulness-based approaches. Teens with type 1 diabetes and disordered eating who participated in an eight-week self-compassion program reported a reduced sense of loneliness, enhanced mindfulness, and improved disease-related coping resources.

Moving forward

Since type 1 diabetes is an autoimmune disease that impairs pancreatic production of insulin, treatment with exogenous insulin is required. Managing blood sugar requires keen attention to daily fluctuations in food intake, exercise, and insulin administration. It is challenging, but with good self-management, it’s possible to prevent acute complications (diabetic attacks) and reduce long-term complications (such as kidney failure and blindness).

Type 2 diabetes arises from either the underproduction of insulin or the body’s resistance to insulin. Unlike type 1 diabetes, type 2 diabetes can be reversed with lifestyle modifications if it’s addressed in the early years of diagnosis.

Research also shows that lifestyle modifications can prevent or delay diabetes in those at risk. Inducing modest weight loss with dietary modifications and physical activity is key for preventing type 2 diabetes.

Research consistently shows that the Mediterranean diet reduces diabetes risk and is beneficial for managing diabetes. This approach to eating is rich in fruits, vegetables, and olive oil, incorporates whole grains, prefers fish as the main animal protein, and generally avoids processed foods in favour of whole foods.

Make sure you enjoy what you’re eating, though! Incorporating your personal dietary preferences is better for long-term adherence.

Second chance

Considering the myriad health-promoting behaviours we can adopt to stall or reverse type 2 diabetes, we can transform a seemingly lifelong diagnosis into a snapshot in time in the rearview. Acting now to transform how we eat, move, and reduce our diabetes risk can pave the road to a bright and healthy horizon.