Diabetes Management

Diabetes is a complex health condition where symptoms differ from person to person and so does the diagnosis.

At Dr Rupam Das's Diabetes and Footcare Centre every patient is provided with an individualized treatment plan for every individual taking into consideration their :

• Family history
• Pre-existing health conditions
• Lifestyle factors
• Work status

This helps ensure greater conformity to the treatment plan and helps in effective control of the individuals blood sugar control and other associated problems.

Importance of Counselling in Diabetes Management:

Research evidence confirms the existence of close links between positive psychological adjustment and well being and good management of diabetes. The development of psychosocial support, therefore, is essential and should be built into routine care from the onset.

It is important to note that individuals vary widely in their psychological responses to events. Although they share some commonalities, each person's experience is unique The diagnosis of diabetes can have a tremendous emotional impact on the person diagnosed and their family.

The link between diabetes and depression is well documented. Another area of concern is the growing number of documented cases of eating disorders among individuals with diabetes. Whether these problems are more, less, or equally prevalent in diabetes compared to the general population remains controversial. Regardless, eating disorders are clinically important because of their association with poor glycemic control and an increased risk for retinopathy. Eating disorders can be effectively treated with psychotherapy.

One in four people will experience depression at some time in their adult life. For people who live with diabetes this figure is even higher. Research shows that having diabetes more than doubles the risk of developing depression. Living with this sort of chronic disease and having to cope with biological and hormonal factors and the treatment regime on a daily basis may increase the risk of depression.

Other related emotional issues include:

• Adjustment to the diagnosis and life transition
• Concerns about not being able to stick with your diabetes care plan
• Dealing with complications of diabetes
• Work and family stress
• Marital and relationship issues
• Family adjustment
• Child?s school difficulties or behaviour problems.

Being diagnosed and living with diabetes can affect people in very different ways. While some may find coping with diabetes has very little impact on day-to-day life, others may find that it has turned their lives upside down. They may neglect their diet, stop monitoring glucose levels, or revert to unhealthy habits.

The physical impact of diabetes is well reported but the emotional impact is still not always recognised. When people are diagnosed with diabetes, their confidence, self-esteem and sense of being in control may be challenged. Emotions at diagnosis vary but may include shock, denial, sadness, frustration, guilt, fear, anxiety, anger or even relief.

Role of Counselling:

A diagnosis of diabetes is a life-changing event. It is a time when families can often struggle to adapt to the "new type of normal" they must face. Psychological counselling during this time can be of great benefit to all those involved.

In past decades clinicians have increasingly recognized the importance of psychological support for people with diabetes and their families, and many have recommended integrating psychological counselling into routine diabetes care. It is therefore important to consider whether psychological interventions in diabetes are effective in improving clinical outcomes.

It is widely acknowledged that a person's emotions, beliefs and self-esteem have an impact upon the way that he/she thinks and behaves.

Through counselling, one can help clients to acknowledge and share the emotional challenges raised by diabetes. They are able to create a space in which clients may freely discuss how they feel about themselves and their diabetes.

The counsellor can employ motivational interviewing as a technique for identifying and setting realistic goals, maximizing the client's experience of success as each goal is accomplished. Individuals are supported and encouraged to anticipate potential problems and to identify potential stressors. We know that change can create stress, so anticipating change and discussing potential areas of difficulty and their solutions can reduce the impact of a stressful event. Counselling also offers the opportunity to share techniques in stress reduction such as progressive relaxation and positive visualization.

By using some of the methods of cognitive behavioural therapy (CBT) counsellors facilitate, examine and modify negative thoughts or beliefs, thus improving self-esteem. At the same time, other psychosocial issues outside diabetes which may affect a person?s ability to cope may be identified and managed.
Results indicate that cognitive behaviour therapy (CBT) is effective in the treatment of depression in Type 2 diabetes patients, both in reducing depressive symptoms and HbA1c.
Behaviour family therapy proved beneficial in terms of resolving family conflicts, but did not impact glycaemic control.