Ms. Fei is 51 years old and has found out that her blood sugar is high for two years. In the past two years, she has been suffering from colds and urinary discomfort, but she is not willing to go to the hospital for treatment, and her weight has increased rather than decreased. During this period, she started to take metformin intermittently, and did not take it regularly every day. This winter, she was admitted to the respiratory department of our hospital because of pneumonia. She was given metformin 0.5g 3/day to control her blood sugar and anti-infection treatment, and her symptoms such as fever and cough improved, but her blood sugar remained high, always at 9-10 mmol/L fasting and 12-13 mmol/L after meal, and her glycated hemoglobin was 8.9%, suggesting that her blood sugar was also high at home in the past 3 months. In this case, Ms. Fei, however, suggested that her pneumonia was under control and requested to be discharged from the hospital. Her supervising physician, Dr. Wang, talked to her several times and advised her to treat her diabetes regularly, but she always ignored it, saying that high blood sugar was no big deal. I had no choice, so Dr. Wang sent me a distress signal, inviting me to consult with this patient immediately, and I rushed over. Over the past few years, I have met all kinds of diabetic patients, some of whom pay no attention to their condition, while others are overly cautious and have knowledge that surpasses that of a specialist, and I have accumulated a lot of experience in treating different patients. “I told him that diabetes can be controlled and it is not a big deal. So I thought to myself, “I’ll take her down! Stepping into the ward, Ms. Fei did not pay much attention to me at first, still acting full of care, determined to be discharged from the hospital unwilling to treat the blood sugar problem, but still polite. So I talked about the consequences of diabetic nephropathy, fundopathy, and various serious complications of diabetic foot caused by poor blood glucose control, and suggested that she be transferred to an endocrine specialist for treatment, so that she could see for herself those patients who had lost their feet and legs and lost their quality of life because of foot gangrene, hoping to make her pay attention and be alerted, and finally she reluctantly agreed to be transferred to endocrinology for treatment. On the way to the office, I thought proudly that such a patient who did not pay attention to diabetes was unaware of the consequences of uncontrolled blood glucose, so I had to inform her properly so that she would pay attention to it.
I had just arrived at the office to talk to the respiratory doctor about her condition and the transfer, when a patient came up to me and said that she was a patient in the same ward as Ms. Fei, who was crying with sadness. I was shocked and rushed over to see her. When I asked her why she was crying, she choked up and said that she was not not paying attention to her condition, but she had always known how serious the consequences of this disease were, and had been unwilling to face them and just wanted to avoid them, and now she was once again pointed out by the doctor and told to pay attention to them, and she had to face them and could no longer avoid them. I hurriedly advised her that her blood sugar was still fully under control and that everything would be fine as long as she paid good attention to it, while secretly sighing for my own error in judgment. Ms. Fei gradually calmed down and went through the transfer procedure in the afternoon, determined to develop an ideal plan for herself this time, and also determined that she would actively cooperate with the doctor’s treatment, control her diet and lose weight properly.
Another patient, Mr. Wang, has been suffering from diabetes for 8 years. He was only in his 40s when he got the disease, and no one in his family had diabetes, so at first he could not accept that he had diabetes, but after the doctor explained that he did have diabetes, he started to control his diet and exercise seriously, and took his medication regularly. However, for some reason, his blood sugar fluctuated greatly and was not well controlled. I found that he was very thin, not very talkative, and had no energy, and during the consultation, I found that he slept extremely poorly and did not eat much. So he was advised to be hospitalized. With the persuasion of his family, he finally agreed. After hospitalization, I found that Mr. Wang was often emotionally unstable, often cried alone, and was very depressed after talking with him and his family and observing him during his hospitalization.
There was another patient, which I had introduced in a previous Diabetes Friends magazine, who was depressed after retirement and eventually triggered the onset of diabetes. …… The above cases are just a drop in the ocean, and I have encountered many, many more in my medical practice, with a wide range of psychological problems, reminding us that Diabetes is a psychosomatic disease, and as a doctor, we must pay enough attention to the psychological problems of diabetes in order not to delay treatment.
Studies have shown that psychological and social factors play an important role in the development of diabetes and in the control of blood glucose levels. Negative social and psychological stimuli such as chronic overstress, incompatible interpersonal relationships, sudden unfortunate events in life, depression, anxiety and other negative emotions can lead to the development of diabetes. Reports show a significant increase in the incidence of diabetes after earthquakes and major fires compared to the pre-disaster period; experiencing major life events such as widowhood and relocation is correlated with the development of potential type 2 diabetes. Conversely, the event itself, the occurrence of diabetes, and the exacerbation of the disease, as well as the tedious process of treatment lead to symptoms such as depression, anxiety and other psychological problems of diabetes. Therefore, what we call diabetes treatment is a five-driver carriage, but clinically doctors and patients pay most attention to control diet, strengthen exercise and how to use medication, but not enough care for patients’ psychological problems, and an important reason for poor blood sugar control is precisely the generation of depression, anxiety and other bad emotions: when people are in a stressful state such as tension, anxiety, fear or fright, sympathetic excitation, inhibit insulin At the same time, the secretion of adrenaline increases, which indirectly inhibits the secretion and release of insulin and leads to an increase in blood sugar. At the same time, negative emotions such as depression and anxiety can aggravate endocrine disorders, insomnia and poor coping behaviors in diabetic patients, thus aggravating the condition of diabetes.
A patient hospitalized in our department, one day because of a quarrel with his family, his blood sugar immediately rose from a dozen to thirty (mmol/L), which shows how great the influence of emotion on blood sugar is. Therefore, in clinical practice, if we find that a patient’s blood glucose control is always bad, in addition to dietary factors, exercise and medication, we must not ignore the psychological problems of diabetic patients, and we must pursue and observe the social environment around the patient and his or her own emotional state. The aforementioned Mr. Wang’s blood glucose fluctuation was caused by emotional instability and insomnia, and his blood glucose was obviously controlled after psychological counseling; and once Ms. Fei got rid of her self-destructive thoughts and put herself into the treatment with a positive attitude, I believe she must also get twice the result with half the effort. Therefore, clinicians should often ask patients how they are resting, how they are sleeping, and what is bothering them, otherwise it will be difficult to control blood sugar well. In the face of a diabetic patient, one cannot rely on drugs alone, but must also pay attention to correcting and eliminating adverse stimuli from the society and environment, so that the abnormal psychological state can be restored to normal. Only by treating diabetic patients with both body and mind can we receive satisfactory results.
The psychological problems of diabetes have some specific psychological characteristics, and the doctor can carry out psychological guidance for these psychological characteristics to promote the recovery of the disease.
1.Denial and doubt psychology
In the early stage of the disease, patients often cannot accept the fact that they have the disease and hold an attitude of denial or skepticism, or they think that having diabetes is just a high blood sugar level, which has no great impact on their body, and they adopt a carefree attitude towards the disease, or even suspect that the doctor’s diagnosis is wrong and refuse to change their eating habits and accept treatment, leading to further development of the disease.
Countermeasures: At this stage, we should help patients build confidence and hope, introduce patiently and carefully the knowledge about diabetes, the danger of high blood sugar and possible complications if not treated in time, help them understand the process of disease development, strengthen their attention to diet, exercise and scientific medicine, so that they can overcome their suspicion, refusal and careless attitude towards the disease.
2. Anger and disappointment
Some patients, once diagnosed, will rely on exogenous insulin treatment for life, otherwise it may lead to life-threatening metabolic disorders. Teenagers are in the great time of school, business and love, and they often have an angry emotion when they learn that there is no possibility of a cure, which is compounded by the necessity of lifelong diet control. They feel deprived of the right and freedom to live, lose confidence in life, are depressed, drown in sadness all day long, are emotionally fragile, and adopt a negative attitude toward treatment. Some adolescents also believe that the disease is the result of their parents’ heredity and direct their anger at them.
Countermeasures: To such patients, we should use kind and sincere language to gain their trust, establish a good doctor-patient relationship, use the cathartic method to make the sorrow, aggression and anger accumulated in the patient’s heart to vent out, use the sublimation method to transfer their ambivalence, and repeatedly tell the prospect of diabetes treatment, so that patients actively cooperate with treatment.
3.Anxiety and fear
Diabetes is a lifelong disease that is difficult to cure and may have many complications. In addition, patients know little about diabetes and have many misunderstandings, so they have anxiety and fear, worrying that it will affect their future and life, fearing death, etc. They may also be overly concerned about the treatment and experience sensory allergies, high nervousness, insomnia, etc.
Countermeasures: Doctors need to patiently listen to patients’ complaints, conduct heart-to-heart communication, understand the causes of anxiety and fear, use language skills to stabilize patients’ emotions as soon as possible, give them support and encouragement, conduct timely diabetes knowledge education, guide how to choose and control food, help patients make a life schedule, and actively engage in physical exercise to divert their negative state of mind. Guide patients to self-regulate and learn to be the master of their emotions, so that they can face their condition and treat life correctly, thus alleviating psychological barriers.
4.Self-blame psychology
Patients can’t take care of their families because of their illness, and they need a lot of money for long years of treatment, so they feel guilty for their families’ financial difficulties and think they have become a burden to their families.
Countermeasures: Patients should be made to understand that although diabetes cannot be cured at present, a reasonably controlled diet, appropriate exercise, scientific medication and good emotions can control the disease well and enable them to work, study and live like healthy people. Under the best possible conditions, coordinate all aspects of society to help patients solve practical difficulties to reduce their psychological burden, while obtaining the cooperation of family members, so that patients can adjust their bad mentality and enhance their sense of self-protection.
5.Anorexia and suicidal psychology
Patients with long illness, many and heavy complications, and poor treatment results, become antagonistic to treatment, believe that there is no cure, sooner or later they will die, give up on themselves, and do not cooperate with treatment. They do not trust medical personnel and show an indifferent and apathetic attitude.
Countermeasures: For such patients, first of all, use gentle language, skilled operation, and rich basic knowledge of medical care to gain their trust, take the initiative to talk with patients, provide reasonable treatment information, take the initiative to make scientific and protective explanations to them about changes in their condition and test results, and help patients re-establish their confidence in treatment. Infect the patient with a correct outlook on life and society, prompt the patient to overcome his anorexia and increase his confidence in overcoming the disease. During the existence of suicidal thoughts, patients should be strictly prevented from committing suicide.
Experts say that diabetes is a chronic disease that requires lifelong treatment. In addition to medication, insulin therapy, islet transplantation and other biological treatments, the active use of behavioral interventions, long-term, continuous and integrated treatment of diabetic patients, education and encouragement of active participation in treatment is extremely important for the treatment effect. Therefore, the majority of “sugar lovers” should not only pay attention to the control of blood glucose and its complications in daily life, but also pay attention to the adjustment of their emotional and psychological state. They should look at diabetes and its complications objectively and comprehensively, enhance their confidence in overcoming the disease, realize that as long as they actively cooperate with medical personnel, adhere to standardized and reasonable treatment, adhere to scientific self-management, participate in more group activities and cultivate more hobbies, they will be able to control their disease better and work and live with quality as normal people do.
Clinical psychologists also remind the majority of “sugar lovers” family members, more care, understanding, support and help for family members suffering from diabetes, once found patients appear obvious symptoms of depression, anxiety, do not take it lightly, should take the patient to the hospital as soon as possible to receive symptomatic treatment.