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Question:

From Walden, New York, USA:

My father was diagnosed with diabetes about six months ago. He is 50 years old and he thinks that this disease has got the best of him and he is really down and depressed. He watches what he eats but he will not take any insulin because he thinks that once his body is dependent on medication it might as well be dead. I can respect that, but because he can not eat things he likes to eat like rice, bread, pasta and other foods he does not eat and than his sugar level gets too low.

He is from Greece and it is very hard to talk to but I told him that there are diets that you can go on to help him and he wants to know what they are. He is very active all day; he owns his own painting business, and he says he can not work like he used too because he is so tired from the diabetes and that the diabetes is killing him. I try to do anything to cheer him up but it is hard because he is set in his ways. What should I do, and how can I get him to eat the things he wants without have to be dependent on any medication?

Answer:

I'm very sorry to hear about the tough time your father is having. Many people have difficulty accepting and adjusting to the diagnosis of a serious disease. The diagnosis of diabetes can be particularly hard because it affects so many parts of life. To be told not only that you are "sick" but that you also need to change something as basic as what you eat every day can be a big shock. Many people go through a period of grief -- they grieve for their healthy self that they are afraid will never come back. They grieve for the old, familiar and comforting foods and behaviors that made up their daily routine. Until that grief is dealt with and the disease is accepted, it is unlikely that your father will be able to make changes that will help him feel better and protect his long term health.

It is particularly helpful for most people adjusting to the diagnosis of a chronic disease to talk about it. Being angry is normal and it might be easier for your dad to talk about his anger than about other possible feelings like fear. It can also be helpful to just talk about the specific details of what's going on: how he feels and what he's doing. The more knowledgeable you are about diabetes treatment, the better able you will be to talk to him about how he's feeling and what is happening. But just being listened to can be very powerful for someone as upset as your father seems to be.

This is also something that could be done by a doctor who specializes in diabetes or by a diabetes educator. The advantage of someone who knows a lot about diabetes having this type of discussion with your father is that they would be able to correct any misinformation he might have about the disease or its treatment that may be contributing to his negative feelings.

For example, he now thinks he cannot eat rice, bread, pasta and so on. It might help defuse some of his negative feelings to learn that any food can be part of a diabetes meal plan. The starchy foods you mentioned can be eaten, although he may need to control the serving size or distribute the servings of both starchy and sugary foods (not only sweets, but also fruits and fruit juices) more evenly during the day. That would probably help cut down on the wide variations of blood sugar he has been experiencing.

By testing blood sugar after eating, he and his health care provider can tell if there is a good balance between his body's insulin supply and the amount of food he's eating at one time. The American Diabetes Association has a series of booklets on "Counting Carbohydrates." The first one in the series, called "Getting Started" may be a good starting point for your father. It explains that although he needs to be aware of and manage what he eats in order to control blood sugar, he does not need to avoid his favorite foods.

Your father is not alone in his desire to avoid medications, including his concerns about becoming "dependent." How successful he will be in controlling his blood sugars well enough to feel better and get his old energy back without medications remains to be seen. Many people with type 2 diabetes are able to manage blood sugars very well in the first months or even years following diagnosis by learning about nutrition and using blood sugar monitoring. Unfortunately, though, type 2 diabetes is a progressive disease, meaning that it changes over time. The time may have come -- or may come at some point in the future -- when pills or injected insulin are needed to get the level of blood sugar control that allows your father to feel his best and stay healthy. If that happens, keep in mind that the medicines are used to replace something that has gone wrong -- much as glasses are used to correct vision that has gone bad. The payoff of feeling well is often enough to help people overcome their initial resistance to using medications. Again, if someone can talk to your father about the reasons behind his very negative reaction to the prospect of taking medicine, it may help him work through those feelings.

BB

Original posting 20 Dec 1998
Posted to Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:09:02
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