DEPRESSION IN DIABETES!!

              Our country has the largest number of people affected with Diabetes. In the previous posts I have discussed in detail about the cause of the sudden increase in number of Diabetic population. Few years back Diabetes used to be termed an “Urban Epidemic” and now with incorporation of various cultures and poor eating habits we have successfully made Diabetes an “Indian Epidemic”. In this post I am NOT going to talk about Diabetes, instead I am trying to go into the psychological aspects revolving around Diabetes. The following lines will be purely based on the experience which my dear patients have given me. I am not sure how many of my colleagues try to analyse the patient’s state of mind before revealing the diagnosis of Type 2 Diabetes. I am sure most of them do....

            The people who face the diagnosis can be broadly classified into three categories.

• Patients who have a strong family history of Diabetes with classical 3P’s (Polyuria, Polyphagia, Polydipsia). They generally convince themselves of the diagnosis before they come for confirmation with blood test. In most cases whether they reveal or not they would have seen higher numbers in Glucometer /Lab test. These patients are receptive when the diagnosis is revealed. This acceptance makes it easy to start off the treatment (Life style modifications/ pharmacological therapy) immediately.
• Patients presenting with classical 3P’s without family history of Diabetes. Well.... there is gonna be starting trouble...
• The third group of patients are those in whom the diagnosis presents without any warning symptoms. The patient would have undergone a blood test for some other reason and Diabetes comes like bolt out of the blue... They have no clinical symptoms to suggest Diabetes. These are the set of people who need a great deal of psychological support.

Diabetes for many is a spine chilling diagnosis. Advances in science and improved modalities of treatment have not been able to alleviate the fear. In my personal opinion the fear is because of

• Fear of insulin pricks which any Diabetic would need at some point of time.
• Fear of possible damage to kidneys.
  
• Fear of losing the limb.
• Fear of changing the lifestyle (Daily exercise & Diet restrictions).
• Fear of frequent blood investigations and the cost factor involved.
• Fear of frequent visits to the doctor.

Every patient diagnosed with Diabetes goes through the stages of (i) Denial and isolation (ii) Anger (iii) Bargaining (iv) Depression and (v) Acceptance. The time duration of every stage varies from person to person. In the Indian scenario the stage of denial means

• Change of Doctor
• Change of Lab which issued the high blood sugar value
• Trial and error with alternative medicine
• Trial with fenugreek, ladies finger, insulin plant and many other native ingredients used in cooking....
• Some try to stick on laboratories which give lower values
• Avoidance of sweets.

The time duration from stage I to stage IV has to be considerably reduced so as to facilitate early institution of therapy and to prevent Diabetes related complications.

                 In India the mindset does not allow people to access counselling centers. Although the stature of psychological counselling in India is better that what it was a decade ago, there is still a long way before people reach out for psychological help. I feel the treating physician has to take up the role of psychologist as well as far as Diabetes is concerned. Why? The compliance to therapy whether it is life style modification of medical nutrition therapy or drugs depends on the acceptance levels. Going to a psychologist is not well taken by our patients. If we force them to seek help they are just going to change the doctor leading to more delay in initiation of treatment.

                Successful management of Diabetes needs constant education, clarity on the targets and methods to achieve these targets, clear discussion regarding mode of action, timing of tablets and side effects. Every person affected with Diabetes needs a good amount of support mentally to stick on to the planned regimen. Once the reward of hard work in terms of good blood sugar levels is reached then the patient can motivate himself/herself. Diabetes being a chronic condition requiring lot of dedication from the patient as well as his family it would be better if the doctor would keep in mind the psychological aspects as well. This will help in improving compliance to regimen planned, ease in attaing targets and delay / prevention of Diabetes related complications. In a nut shell we can make THE difference by providing better quality of LIFE!