Dr. Val Farmer
Rural Mental Health & Family Relationships

What I've Learned About Type II Diabetis

March 18, 2002

About 16 million people suffer diabetes. Up to 95 percent of those have type II diabetes or late onset diabetes, which occurs most often in people over age 40. Diabetes has increased five-fold over the past four decades, largely due to increasing obesity and sedentary lifestyles. It is an insidious chronic disease that sneaks up on people without many outward symptoms. It can go undetected for years.

Diabetes results from the pancreas not making enough insulin, a hormone that helps cells convert glucose (sugar) into energy. A second problem is that the cells ignore insulin. Either way the cells are starved for energy. With too much blood sugar levels in a body over time, there is increased risk for damage to vision, kidneys, nerves, and cardiovascular system. Two thirds of the deaths among diabetics are due to cardiovascular disease.

Managing diabetes requires a major change in many aspects of life, especially in eating and exercise. That is the problem.

Advice from researchers. I spoke with psychologists Lawrence Perlmuter of Chicago Medical School and Carl Tishler, an adjunct professor of psychology at Ohio State University, about key issues in coping with type II diabetes.

Permuter made these key points.

- Perlmuter sees undiagnosed and untreated depression as a major component that interferes with sticking to a plan for dealing with diabetes. Adherence is a proactive term that suggests choice instead of the more commonly used term "compliance." Depressed humans are erratic in their self care, have appetite and sleep problems, push away their support system, and are impaired in their decision-making process.

- By being intentional and mindful about food and exercise and taking personal responsibility, people can take charge of their disease instead of letting the disease consume them. People can gain a sense of control over the disease by losing weight, exercising, managing stress and good meal planning. For those situations that can’t be controlled by rest, diet, exercise and stress management, there are helpful combinations of medications and insulin that help the body process sugar.

- Foods with fiber and roughage (vegetables, fruit, whole grain products) are helpful. There is an early release insulin that is more beneficial to the body than insulin that is released later. Anticipation, smell and good mood before eating triggers the early insulin response. Losing the first 10 to 20 pounds has an immediate effect on lower blood sugar regardless of the beginning weight. Occasionally treating oneself to "forbidden fruit" helps with the overall pattern of self-control.

- A regular pattern of exercise also helps people develop a sense of control over the glucose levels in their blood. It also helps with mood and exerts a calming influence. Exercise should be in the correct amounts and fitted to each person’s needs, limitations and acceptance.

Tishler makes many of the same points and adds the following thoughts.

- Obesity and depression interacts. Obese people get depressed and overeat. Depressed people overeat and become obese. Both problems need to be treated simultaneously.

- Support groups such as TOPS or Weight Watchers, or diabetic support groups give both encouragement and pressure that is helpful. Accurate information, accountability, feedback and reinforcement are key components to changing behavior.

- Dieticians and diabetic educators play a key role in helping people understand key ideas that can sustain lifestyle changes. There are no silver bullets. Weight loss should be gradual - one pound a week. No fad diets. Eating at regular times is another key.

- Exercise has to be individualized to increase motivation. Diabetes is a disease of compliance. Some people exercise better in groups, some like water exercises, some do better by exercising in the morning or after a meal. Whatever works works. Tishler advises turning off the TV and computer and get moving and playing. He recommends against exercises that put pressure on the joints. Moderate exercise five days a week, 30 minutes a day is recommended. With elevated blood sugars above 240, exercise is not recommended and special consultation is advised.

- Getting insight into your family background and dynamics is helpful Counseling should not only focus on concrete steps toward change but also understanding "why" the behavior is so hard to change. Couples need to be educated together so that they can be constructive with each other around the compliance issue. The motivation to change has to come from within and then a spouse can be an active partner in being helpful.

This is personal. Why am I telling you all this? I have Diabetes, Type II. I’ve gradually accepted the idea of "adhering," "complying," or whatever it is called. I am taking charge of my health. It has meant giving up buffets, big juicy hamburgers, second helpings, sugared food and wonderful deserts. It has meant learning to exercise regularly, eat delicious low fat foods, lose weight, join Weight Watchers, taking regular blood sugar readings and having regular medical check ups.

It’s tough. Changing a lifestyle is tough. Giving up my poor food habits is one of the toughest things I’ve ever done. My wife likes what I am doing. It is adding years and enjoyment to my life.

It also works. I lowered my blood sugar levels into a safe range and I am preventing, God willing, future complications to my health. I am healthier than I have been in years. In some ways, diabetes was a wake up call. I needed to take my health seriously.

Don’t wait for the wake up call. Changing lifestyles can prevent diabetes as well as manage it.