Archive for the ‘Diabetes and Depression’ Category

Diabetes and Depression Chat with Dr. Wendy Rapaport 12/09/09

Thursday, December 10th, 2009

wendy*** (09:41):Welcome to Diabetes and Depression!

dr wendy rapaport says to  (09:59):
good evening..80 degrees in Florida..care to brag about your weather

dr wendy rapaport says to  (09:59):
that was not meant to sound hostile!

gina says to  (09:59):
cold and raining here in NY

landileigh says (09:59):
i’m 45 mins north of san francisco

pinkdolphin says to  (10:00):
hot here in sydney australia

landileigh says (10:00):
and it will be below 20 for record freezing weather again tonight

landileigh says (10:00):
with snow

akoster says to  (10:00):
warm in new orleans

dr wendy rapaport says to  (10:00):
well I love how international we all are

dr wendy rapaport says to  (10:00):
and so the subject is how to stay warm in our hearts and minds, regardless of the weather

Ellen2110 says to  (10:01):
Especially this time of year

landileigh says (10:01):
awesome

dr wendy rapaport says to  (10:02):
yes, this time of year has high expectations on our behaviors and what we expect from others..sometimes that’s a set up

gina says to  (10:02):
Hi everyone welcome to diabetes and depression

bjphilly says to  (10:02):
evening everyone

dr wendy rapaport says to  (10:03):
that does sound funny..”welcome to depression”..au contraire..we need to recognize and fight it

dr wendy rapaport says to  (10:04):
heard you did a terriffic Job at Diabetes 2.0 Gina..

gina says to  (10:04):
I guess that sounded weird lol

gina says to  (10:04):
The floor is open to questions for Dr. W

gina says to  (10:04):
ask away

dr wendy rapaport says to  (10:04):
I want to start and end with this thought: Depression is treatable!

gina says to  (10:05):
Wendy agreed.

jchesen says to  (10:05):
Good evening everyone

gina says to  (10:05):
I have been battling depression since diagnosis

gina says to  (10:05):
9 yrs

dr wendy rapaport says to  (10:05):
It’s treatable with exercise, changing food habits, improved diabetes control (of course!) changing your thoughts, and occasionally medication

dr wendy rapaport says to  (10:06):
she didn’t pay her dues?

gina says to  (10:06):
lol

dr wendy rapaport says to  (10:06):
it is important not to compromise yoursself and expect to “live” with depression..rather than use the tools

gina says to  (10:07):
i used to just live with it

gina says to  (10:07):
until some friends told me i didnt have to

Stephanie9571 says to  (10:07):
Sometimes it’s almost as if depression because comfortable..

dr wendy rapaport says to  (10:07):
yes, important not to think of it as your destiny

dr wendy rapaport says to  (10:07):
what do you mean comfortable? did it get you out of obligations, keep you close to home

jchesen says to  (10:07):
I used to think it was inevitable

jchesen says to  (10:08):
expected

Stephanie9571 says to  (10:09):
As in.. A comfortable state of being, when you don’t really know or remember what it’s like to be “happy” I feel like folding into oneself and surrounding yourself with that sadness becomes a normal state of being for you, and you’re almost scared to be

Stephanie9571 says to  (10:09):
any other way..

dr wendy rapaport says to  (10:09):
It certainly isn’t inevitable..depressed feelings are dark thoughts..and everyone has them..especially if you have the full time job of taking care of diabetes..but it is different than the “state of depression”

pinkdolphin says to  (10:09):
I have been battling with depression since i found out i have diabetes 3 years ago i am now 29 . I was on the pill and at first thought it was the pill making me depressed but since stopping the pill  i feel the same.

akoster says to  (10:10):
im a perfectionist and when my levels are out of range It feels like I can never pull myself out of depressive thoughts. Like I can never relax and just live

jchesen says to  (10:10):
I used to think it was hormonal too……now I really don’t know. And my Diabetes control is better too….but still

gina says to  (10:10):
akoster, i feel the same exact way

dr wendy rapaport says to  (10:10):
remember that fluctuating or out of control blood sugars contributes to depression..look around at your family history to see if there is depression running in your family
Stephanie9571 says to  (10:10):
Those feelings are what lead me to define myself as “being in a state of depression.” I am in a much better place now than I was even just a few months ago, with diet change and exercise, but there are still some bad days when it almost feels tempting to
Stephanie9571 says to  (10:10):
“give up” and go back to that thought process which I’ve come to know so well.
gina says to  (10:10):
depression doesnt run in my family
jchesen says to  (10:11):
My standard comment to fluctuating (daily) BS is “I just can’t win”
dr wendy rapaport says to  (10:11):
when you say hormonal..do you mean when you are getting period
Stephanie9571 says to  (10:11):
I find that when I’m eating a lot of high and refined carb foods my moods fluctuate a looot more
gina says to  (10:11):
the worst is when you try and try but, it feels like you are failing
jchesen says to  (10:11):
Wendy: yes at times
akoster says to  (10:12):
I put a lot of care into my diabetes care . . . my endo says that mine is one of the difficult ones to manage than others. Its putting in all that effort and getting nothing out. I agree with gina
gina says to  (10:12):
or the numbers flucuate so much that it drives you mad and then you dont want to check
jchesen says to  (10:12):
EXACTLY gina…..I go to the gym 4-5 times a week and my BS always plummets no matter how low I put the pump
dr wendy rapaport says to  (10:12):
cognitive therapy is about changing those thoughts…your first reaction can be “I just cant win” but you must challenge that thought with..it’s just a number..I need to change the pattern and change my thoughts..I am a good person who is having a lousy da
Stephanie9571 says to  (10:12):
During the worst of my depression I would experience what I’d refer to as “false alarms” feeling wonderfully emotionally one day, and crummy the next with no real explanation
landileigh says (10:12):
I had an a1c that was 2 points higher than I’d ever had and the fear of failure and that I unable to deal with this like i should depresses me
jchesen says to  (10:13):
Hard to have a good day when it starts with a 49
Stephanie9571 says to  (10:13):
I feel like there’s a lot to deal with diabetes, it’s almost like facing your mortality on a daily basis
akoster says to  (10:13):
I know, bad morning levels are hard to recover from emotionally
dr wendy rapaport says to  (10:13):
well gina if the blood sugar plummets while exercising.. that is great..it is doing the job…but add abit of food or some people suspend the pump
Stephanie9571 says to  (10:13):
What is your take on medication? I have always been against medication for depression, fearing dependency..
jchesen says to  (10:14):
I think the golf term is wanting a mulligan
dr wendy rapaport says to  (10:14):
I can hear a lot of thought changing needed…you listened to people who scared you and shamed you (they didn’t know better)
jchesen says to  (10:14):
Wendy: I put the pump to 1/2 basal when I exercise…..Is it safe to suspend for an hour?
dr wendy rapaport says to  (10:15):
I think medication is a great help and just sometimes biochemically necessary
Ellen2110 says to  (10:15):
Hi Beth
gina says to  (10:15):
Wendy that was Chesen not me.
sisterbeth says to  (10:15):
Hi everyone
bjphilly says to  (10:15):
hi
jchesen says to  (10:15):
Call me Jody :)
Stephanie9571 says to  (10:16):
hi!
gina says to  (10:16):
stephanie, my doctors wanted to put me on anti-depressants but I fought my way to not take it although i probably should have
dr wendy rapaport says to  (10:16):
you don’t get dependent on antidepressants (prozac, welbutrin, effexor, cymbalta)…they work or they don’t…you have to be more careful with xanax..which can still be helpful
gina says to  (10:16):
is lexapro addicting?
jchesen says to  (10:16):
I have an extremely addictive personality….Rx would NEVER wor\k for me
bjphilly says to  (10:16):
hey Scott!
dr wendy rapaport says to  (10:17):
gina..what is the fight against antidepressants? (I get it..many people feel that way)..but you don’t resist insulin or do you
Stephanie9571 says to  (10:17):
It has always been recommended to me as well but I’m constantly searching for alternative routes,
akoster says to  (10:17):
I think that it has been hard for me to hear for all these years that if I dont have tight control I am going to get horrible compliactions and die. – for me medication was necessary . . . Im on zoloft
sstrumello says to  (10:17):
Hey Betty, everyone … sorry I’m late
gina says to  (10:17):
At the time of my depression I didn’t want to take meds
Fran3040 says to  (10:17):
It’s Fran! Sorry I’m late too!
gina says to  (10:17):
Fran jump right in!
jchesen says to  (10:17):
I feel my best right after I exercise but the endorphins don’t last…..anyway to help that?
dr wendy rapaport says to  (10:18):
addictive personality means you are vulnerable..and maybe even more so need the type of medication that you take everyday..not the kind you want to take when you feel badly
Fran3040 says to  (10:18):
AAHHH!!! I don’t remember how to do this. that is, how to HEAR and be heard! (It’s probably an age thing—mine!)
Stephanie9571 says to  (10:19):
As far as types of depression go.. manic depression/bipolar how could one go about alleviating the symptoms of that- is it any different than the course of treatment for other types?
dr wendy rapaport says to  (10:19):
chesen..learn to change your thoughts about diabetes, life…and your mood will change
gina says to  (10:19):
Wendy, that is what i did
jchesen says to  (10:19):
Hard with the stress of the job….and the disease.
dr wendy rapaport says to  (10:19):
I do think anyone who has diabetes should start a dialogue with a trusted therapist
bjphilly says to  (10:19):
I agree Wendy
jchesen says to  (10:20):
Got me through childhood!
akoster says to  (10:20):
stephanie- bipolar shouldnt be treated with antidepressants- it can trigger a manic episode
bjphilly says to  (10:20):
me too ichesen
dr wendy rapaport says to  (10:20):

therapy to “grieve”..how  to manage the chronicity of everyday

jchesen says to  (10:21):

Group was SUCH a relief as a kid…..looking for something “regular” like that now

pumpergirl says to  (10:21):

this doesn’t necessarily have to do specifically with diabetes and depression but depression in general. is there any thing that says you are more likely to have it if it’s in the family (like a sibling). . .

Stephanie9571 says to  (10:21):

I know this is a chat regarding diabetes and depression, but would you all say that diabetes is the CAUSE of depression, or simply compounds the difficulty of it?

havana16 says to  (10:21):

i have been type 1 diabetic for 35 years   and i learned that there are far worst diseases in this world than diabetes

bjphilly says to  (10:21):

it compounds life

gina says to  (10:21):

i think having diabetes in general and the day to day would make anyone depressed at one time or another

dr wendy rapaport says to  (10:21):

koster…great point..that is why therapy BEFORE meds..so you get the right diagnosis..there are good drugs for bipolar

havana16 says to  (10:22):

so i learnd to be content and deal with what i have

jchesen says to  (10:22):

definitely compounds things…..not the only cause

bjphilly says to  (10:22):

I know there are worse

havana16 says to  (10:22):

the happier one is

havana16 says to  (10:22):

the easier it is to control diabetes

akoster says to  (10:22):

the idea that there are worse doesnt really make diabetes any better

havana16 says to  (10:23):

no

jchesen says to  (10:23):

I like that havana

gina says to  (10:23):

diabetes is chronic

havana16 says to  (10:23):

i know that

Stephanie9571 says to  (10:23):

I’ve thought a lot about this ideal of “there are worse things” and I think that creates for people with disease a sense of guilt when feeling bad about it

gina says to  (10:23):

other disease can go into remission

Jane5198 says to  (10:23):

For someone who is having a difficult day with diabetes to think of someone who is worse off may not be the answer.

gina says to  (10:23):

not saying its better or worse

havana16 says to  (10:23):

but when u think   that diabete  does not have to kill you

havana16 says to  (10:23):

unless u do not control it

dr wendy rapaport says to  (10:23):

false beliefs contribute to depression..as do exaggerated beliefs ( a few days of high blood sugars do notcause complications

gina says to  (10:23):

doctors scare us into all of this

landileigh says (10:24):

I try to be optimistic, but feel that sometimes i just can’t handle all that diabetes and chronic kidney disease throw at me. it’s the never ending “every minute” of diabetes

gina says to  (10:24):

i think that if we were given a pyschologist at time of diagonisis we would all be much better off

jchesen says to  (10:24):

my father was recently diagnosed with T2 and it threw him for a loop even though I’ve had it close to 30 years now…..He has his good and bad days too

Stephanie9571 says to  (10:24):

I think the comparison is a futile one. Every disease is difficult in its own right, to call one “better” or “worse” or less serious than the other is unfair

gina says to  (10:24):

they should be a part of our diabetes care from day 1

bjphilly says to  (10:24):

I don’t know if anyone knows this saying but I heard it as a child “I cried because I had no shoes and then I saw a man who had no feet”

Jane5198 says to  (10:24):

I agree Stephanie.

jchesen says to  (10:24):

I agree Gina

jchesen says to  (10:24):

bj: I’ve heard that one,…..and agree

landileigh says (10:25):

gina, kind of like… you have diabetes – here is your endo, your cde, your nutritionist, and your psychologist

gina says to  (10:25):

exactly

gina says to  (10:25):

i wrote about this on my blog once

dr wendy rapaport says to  (10:25):

here are negative toughts to get rid of //I amdoomed to be unhappy..I will never control my diabetes

gina says to  (10:25):

the missing team member

jchesen says to  (10:25):

It is definitely a team disease

havana16 says to  (10:25):

staying positive is of most importance

dr wendy rapaport says to  (10:25):

they are feelings not truths..not facts

jchesen says to  (10:26):

your heart sometimes rules your mind

bjphilly says to  (10:26):

50 years ago we didn’t have such a health care team as those

Jane5198 says to  (10:26):

this is important havana, but feelings are neither right nor wrong. They just are.

havana16 says to  (10:26):

yes that is true

havana16 says to  (10:26):

i was dx in 1975

bjphilly says to  (10:26):

I was dxed in 1959

havana16 says to  (10:26):

and had the old fashioned needles

dr wendy rapaport says to  (10:26):

staying positive and not freaking out when you don’t feel it…have a session or 2 with your therapist…learn to use your mind to overrule the emotions

havana16 says to  (10:26):

and no glucose monitorring

bjphilly says to  (10:27):

and I was told to not mention it

jchesen says to  (10:27):

1980….and I just saw an article about the original Glucometers

havana16 says to  (10:27):

me too bjphilly

bjphilly says to  (10:27):

we had to bite the bullet

havana16 says to  (10:27):

yep

Jane5198 says to  (10:27):

There  isn’t just this “be happy” it’s a process.

bjphilly says to  (10:27):

those were the dark ages

dr wendy rapaport says to  (10:28):

well  u r using perspective now..which is helpful..getting you to gratitude after feeling reasonable rage that it isn’t fair

gina says to  (10:28):

betty, you are a diabetes all star!

jchesen says to  (10:28):

bj: technology helps now

bjphilly says to  (10:28):

lol

bjphilly says to  (10:28):

I love technology

gina says to  (10:28):

i mean if you are going to get diabetes this is the age to do it. there are a lot of technologies out there now. Although i would rather be cured. This is good till then i guess.

dr wendy rapaport says to  (10:29):

well chesen you are looking at  technology in a positive way..some people are overwhelmed

gina says to  (10:29):

technology can be very overwhelming. especially for the people that have had it for a really long time

akoster says to  (10:29):

im overwhelmed!

gina says to  (10:29):

like my aunt who has had it for like 40 years, she doesn’t want a pump or anything

jchesen says to  (10:29):

If I had only gone on the pump 27 years ago….I’d have been better off…..these past two years have been a comparative breeze

Ellen2110 says to  (10:30):

Maybe for some Gina, but I know a woman who has had type 1 for over 50 years and she has a pump and a cgm

bjphilly says to  (10:30):

I’m 67 and appreciate tech, not just for managing D.

gina says to  (10:30):

im just using an example

dr wendy rapaport says to  (10:30):

you  need to give yourself permission for any difficult or negative feelings..a place to share them..without someone reacting to it (that’s the power of having a  therapist or being in a support group

jchesen says to  (10:30):

In a perfect world there’d be a cure!

gina says to  (10:30):

in a perfect world we wouldnt have disease

jchesen says to  (10:31):

good point gina

sstrumello says to  (10:31):

Our healthcare “system” does little to coordinate care among all the individuals involved with a patient; and there is also the tendency to “blame” diabetes for things that have nothing to do with glycemic control.

dr wendy rapaport says to  (10:31):

well  we are people…differing from each other and then d gets put on you

Ellen2110 says to  (10:31):

How many of you ask for support from your loved ones and friends?  Are you able to ask them for what you need – especially when feeling overwhelmed?

bjphilly says to  (10:31):

so true Scott

gina says to  (10:31):

ellen, i never used to till i hit rock bottom

dr wendy rapaport says to  (10:31):

say more about blame scott

akoster says to  (10:31):

I feel like they just dont quite get it

Jane5198 says to  (10:31):

No Ellen. I find support online.

gina says to  (10:31):

and once i started asking, it felt better

Stephanie9571 says to  (10:32):

i am often unable to reach out for help

Stephanie9571 says to  (10:32):

There’s an issue of feeling “misunderstood” or unable to communicate why I feel the way I do

akoster says to  (10:32):

I feel a lot of blame too

dr wendy rapaport says to  (10:32):

it is up to each of you to ask for the support you need..each of you is different for what you want

bjphilly says to  (10:32):

fraid not

landileigh says (10:32):

ellen, i find they don’t really understand it all and feel more overwhelmed than i do

Stephanie9571 says to  (10:32):

and also guilt for feeling the way I do when objectively there is not much in my life that should make me feel the hopelessness that I have felt in depression

jchesen says to  (10:32):

D is the great equalizer, like death and taxes

jchesen says to  (10:32):

Ellen: I try to talk to my husband, he tries to understand but he is healthy so he can’t really

dr wendy rapaport says to  (10:33):

some peoople want someone to make special foods for you (how thoughtful) and somee are horrified by anyone remembering that you have diabetes

bjphilly says to  (10:33):

too many years I’ve felt isolated, so it’s difficult to express since I was told not to tell…although I did

Stephanie9571 says to  (10:33):

I think that’s the problem.. identifying with someone who does not share the similar feelings, it’s hard to convey that feeling to others

jchesen says to  (10:33):

I have heard from a doctor friend (ex-boyfriend) that I am the healthiest sick person he knows….ironic isn’t it!

Stephanie9571 says to  (10:33):

I do have one friend who has experienced depression who has been invaluable in my support system because I feel as if I can talk to her without trying so hard to explain

gina says to  (10:33):

jchesen, my husband is so supportive and healthy. He checks my blood sugar for me sometimes or helps me prep. its little things that for a second makes me feel better because I didnt have to do it

MelissaBL says to  (10:34):

I isolated myself for many years, thinking that support groups were lame and whiny.  Didn’t realize I needed to talk, too.

akoster says to  (10:34):

I refused to talk abotu diabetes for years

Stephanie9571 says to  (10:34):

it’s the same way as it is with diabetes, talking to other diabetics, there’s this unspoken aspect of the relationship where you just understand the other person since you’ve gone through the same things..

dr wendy rapaport says to  (10:34):

but it is worthwhile totry to explain..it makes it clearer to you

jchesen says to  (10:34):

gina: my husband tries so hard, I don’t blame him, I appreciate his effort….

gina says to  (10:34):

my husband doesnt completely understand everything i go through but he is willing to help me wtih anything

gina says to  (10:35):

even if its just checking so i dont have to especially at times when i dont want to do it

Stephanie9571 says to  (10:35):

I often ahve trouble talking about diabetes to others, too, though.. I hate exposing my flaws and whether it’s valid or not diabetes FEELS like a flaw, a broken piece of me

sstrumello says to  (10:35):

I’ve seen doctors for things unrelated to diabetes (for example, I saw a dematologist for cracked fingertips) and they wanted to talk about glcemic control … my last HbA1c was 5.9

gina says to  (10:35):

stephanie its so true

jchesen says to  (10:35):

I kinda like when people forget I’m diabetic (human first, sick second)

gina says to  (10:35):

scott, what do you tell them

MelissaBL says to  (10:35):

gina:  mine too.  when he hears my cgms beeping and he knows I’m stressed about a high, he’ll silence it so I won’t growl.

dr wendy rapaport says to  (10:35):

yes..being in a room with others  is powerful

gina says to  (10:35):

i would be like dude. I am here for cracked fingers not my diabetes care i have an enod

gina says to  (10:35):

endo

gina says to  (10:36):

melissa me too

gina says to  (10:36):

we have keepers !

akoster says to  (10:36):

I hate that doctors always want to talk about diabtete even if i am there for something unrelated- even the dentist has to give me a lecture

Stephanie9571 says to  (10:36):

It’s definitely difficult to stop the doubts I have when telling people about my diabetes, fears that they’ll somehow think less of me

dr wendy rapaport says to  (10:37):

gina another way to look  at a derm asking you about your diabetes is to say hey I am glad you keep up and r informed about diabetes (that is changing your thought

jchesen says to  (10:37):

My endo referred me to my GP, they are friends so it’s almost always AIC first…..even when I was dxed with Vertigo

sstrumello says to  (10:37):

When I tell them my HbA1c, they usually respond in embarrassment with something about “keep up the good work”

Stephanie9571 says to  (10:37):

recently,  I was unintentionally “outed” when my insulin pump fell out of my pocket in front of my friend.. I think he sensed my fears in response

gina says to  (10:37):

the only doctor i listen to about diabetes besides my endo is my eye doctor

Ellen2110 says to  (10:37):

Do you think others take their cue from you – if you are confident, they will feel more comfortable?

dr wendy rapaport says to  (10:38):

try not to get “lectures”..tell the dentist you love that he is reading his professional journals to educated self about diabetes…”thanks for your interest”..I take good care of myself

Ellen2110 says to  (10:38):

Not to say anyone should pretend to be confident

gina says to  (10:38):

everyone is the diabetes police!

jchesen says to  (10:38):

My eye doctor couldn’t find any sign of D in my eyes on the last visit…..kinda nice

Stephanie9571 says to  (10:38):

I definitely think so. His response to what I told him was to tell me that “this doesn’t define you, you know, is that what you think??  you’re no less of a person because of it”

Stephanie9571 says to  (10:39):

I think sometimes I avoid telling people also because I’m afraid they won’t understand, and that I don’t have the means or the time to explain everything it MEANS to live with diabetes

gina says to  (10:39):

Wendy, we can all use the W.T.F method lol

jchesen says to  (10:39):

sounds good to me gina

dr wendy rapaport says to  (10:39):

aactually Ellen..you can pretend to be confident..it is almost an “affirmation”..I am not perfect..I am capable and I am impressed with all that I do to take caree of myself..not overinvolved with what I don’t do

bjphilly says to  (10:39):

gotta go. nice chatting

jchesen says to  (10:40):

I am outwardly confident and inside full of doubt…..

jchesen says to  (10:41):

I wish the inside and outside matched

dr wendy rapaport says to  (10:41):

if your favorite psychologist uses WTF..it is purposefull..finding humor in the tough (that is cognitive therapy

jchesen says to  (10:41):

sounds like something to try

dr wendy rapaport says to  (10:41):

just keep working on being mentally fit..it needs a workout..new skills..and social support..a ellen says

30ccsteven says to  (10:43):

Question

dr wendy rapaport says to  (10:43):

actually you can try singing to improve your mood (I saw that on GLEE…tv) but it actually works…so do watching funny movies, or trying to think funny

jchesen says to  (10:43):

my singing would clear the room! :)

Ellen2110 says to  (10:44):

As a parent of a person with diabetes, I hope my son can praise his efforts and not solely focus on the numbers.  Checking bg, taking action – is something to feel good about.

Stephanie9571 says to  (10:44):

Well all I’ve gotta go, nice chatting

jchesen says to  (10:44):

same here…..this was VERY helpful……Thanks all!

MelissaBL says to  (10:45):

I spent many many years discouraged when actions didn’t seem to have the desired results.

dr wendy rapaport says to  (10:45):

yes, it’s effort not outcome that alwys needs to be applauded..it starts with parent s helping their kids to thinking  that way..hard to be enlightened,…but it can be LEARNED

cindy elias de koster says to  (10:45):

I’m with Ellen!

akoster says to  (10:45):

I think im in your shoes now melicca

akoster says to  (10:46):

*melissa

dr wendy rapaport says to  (10:46):

when you don’t get the outcome you want..if you are too harsh..you wont retry with new tools and perhaps better outcome

MelissaBL says to  (10:46):

It was hard to be positive and proactive.  I had A1c’s over 10 for the first decade with T1.  Now, after another decade of tech and education, I have a 5.6.

gina says to  (10:46):

melissa that is amazing

cindy elias de koster says to  (10:46):

brava, Melissa!!!

MelissaBL says to  (10:46):

I had to find out what I didn’t know, which was HARD.  Because I am a stubborn, know-it-all.

Ellen2110 says to  (10:47):

5.6 without many lows is quite an accomplishment

gina says to  (10:47):

arent we all? LOL

dr wendy rapaport says to  (10:47):

someone prob “taught” you how to be discouraged..(not out of malice but fear)…Melissa nice turn around

MelissaBL says to  (10:47):

thanks, folks.  gina: lol

dr wendy rapaport says to  (10:47):

stubborn seems to be a complication of diabetes

MelissaBL says to  (10:47):

dr wendy: lol

MelissaBL says to  (10:47):

indeed

akoster says to  (10:48):

i agree. i am so used to assuming people dont actually know what they are talking about with the disease

landileigh says (10:48):

that’s my problem! stubborn

dr wendy rapaport says to  (10:48):

sereiously there are so many asking, rpobing, criticizing looking upset..that people defend themselves with being stubborn not interested..want ing to be the expert..we are the expert of ourselves but friendship and support are crucial (and more fun)

dr wendy rapaport says to  (10:50):

you are not putting people down when YOU  help them…s

MelissaBL says to  (10:50):

good points.  I had an attitude of “well, I’m still alive and I’ve been doing it such-and-such way for this long, so back off”

akoster says to  (10:51):

I feel like I often live in fear of complications

dr wendy rapaport says to  (10:51):

Melissa I do hear that alot.. a normal response…but then LET IT GO.

MelissaBL says to  (10:51):

right.  I didn’t know how much I didn’t know until I stumbled into the online diabetes community.

landileigh says (10:52):

i had chronic kidney disease before ever having diabetes, but now it is progressing faster thanks to the diabetes. i have to wake up positive every day, and sometimes, like today, when it was so cold, it’s easier to not want to deal with it all

MelissaBL says to  (10:52):

akoster: I wish docs didn’t use complications as scare tactics.  We need to be able to face those threats honestly, but with a feeling like we’re empowered to do something about it.

landileigh says (10:52):

but then the online community is there for me

dr wendy rapaport says to  (10:52):

mY HUSBAND  has diabetes..I feel embarassed sometimes that I don’t know something after working with people for 25 years..oops 35 years..lying about my age..but we ALL MISS SOMETHINGS..HAVE BLOCKS

landileigh says (10:52):

and my BFF who knows how i feel

landileigh says (10:53):

does he use the internet and communities?

dr wendy rapaport says to  (10:53):

I agree..it is how complications are presented to you..fear tactics..they just make you afraid not adherent…

akoster says to  (10:54):

i agree

dr wendy rapaport says to  (10:54):

cplications are not inevitable..fear is..and you can control it..voice it..and be empowered by going to a new doctor..getting a consultation, tightening your bs..changing a habit

dr wendy rapaport says to  (10:55):

you will lalways need refresher courses on your attitude..your actions..that is the point about the “chronicity” of diabetes..do it to stay empowered

MelissaBL says to  (10:55):

I agree.  Changing my endo and my ophthalmologist made a huge improvement – both because I found docs who were positive AND because I felt I needed to start off fresh with someone

Ellen2110 says to  (10:56):

Thank you Gina for hosting this chat and thank you Dr. WSR for your time :-) .

sstrumello says to  (10:56):

Thank you Wendy.  Thank you Gina!  Great chat, as always!

dr wendy rapaport says to  (10:56):

being motivated is like being “in recovery”..you need support, new ideas, a team

MelissaBL says to  (10:57):

great thought, dr

dr wendy rapaport says to  (10:57):

It ivery touching to know that you are all there for each other..Iloved seeing you together at the Diabetes research Institute..we will do it again next year..maybe something for the online bloggers that  I would love to joino

dr wendy rapaport says to  (10:58):

thank you all for your openness and good ideas

cindy elias de koster says to  (10:58):

Thank yu for this forum!!

dr wendy rapaport says to  (10:59):

so be proactive..about the emotional and social side of diabetes..

gina says to  (11:00):

thank you so much wendy

dr wendy rapaport says to  (11:00):

I wish you all well..it’s a job and one you can do well

gina says to  (11:00):

it is always a pleasure to have you come chat with us!

landileigh says (11:01):

wendy, i’ve loved hearing what you have to say!

dr wendy rapaport says to  (11:01):

I am happy to..thanks for asking

gina says to  (11:01):

hope you will come back

dr wendy rapaport says to  (11:03):

good night!

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Pyschological Effects of diabetes

Monday, February 27th, 2006

Monday, February 27, 2006 – 9PM EST.
Wendy Satin Rapaport, LCSW, PsyD
Topic: Pyschological Effects

Dr. Rapaport has been on the staff of the University of Miami School of Medicine for 22 years as a social worker and psychologist, specializing in patients with diabetes and their families. Her book WHEN DIABETES HITS HOME, published by the American Diabetes Association, along with many articles for lay and professional audiences on the subject of addressing the emotional aspects of living with chronic illness, targets health professionals and families in improving adherence and quality of life for those living with diabetes.During the summer, she teaches a course in Group Psychotherapy in Health and Mental Health Settings.

[Scheduled Chat Room]: wendy rapaport has entered at 5:55 pm [Jon] 6:00 pm: Welcome everybody to the Diabetes Talkfest Chat Room!

[Jon] 6:00 pm: Tonight’s Special Guest is Dr. Wendy Rapaport, LCSW, PsyD

[Jon] 6:01 pm: Tonight’s Topic: Psychological Effects of Diabetes

[Jon] 6:01 pm: Dr. Wendy Rapaport has been on the staff of the University of Miami School of Medicine for 22 years as a social worker and psychologist, specializing in patients with diabetes and their families.

[ms] 6:01 pm: thinking about the fact that I was lured here by a fan and for that I am thankful! Procrastination is great!

[wendy rapaport] 6:01 pm: procrastination is a good topic

[Jon] 6:02 pm: Lets get started then

[ms] 6:02 pm: ha… ellen could tell you all about my procrastination – especially when it comes to purchasing a new pump LOL ellen

[Ellen] 6:02 pm: A topic we were discussing before you came in tonight Wendy, is why are so few endocrinologists interested in the psychological well being of their patients and how they’re managing psychologically with the diabetes, and rather they are just in the bg, and A1C numbers? How can we ask for help

[gina] 6:02 pm: here we go

[Jon] 6:02 pm: Are you ready for questions Wendy?

[wendy rapaport] 6:02 pm: yes

[sstrumello] 6:03 pm: Hey everyone … technical trouble, but I have returned

[gina] 6:03 pm: hey Scott Tonight’s Topic: Psychological Effects of Diabetes with Wendy Rapaport

[wendy rapaport] 6:03 pm: I think endos don’t always have the skills. Perhaps they are overwhelmed and feel guilty about not being able to help others

[wendy rapaport] 6:05 pm: docs are also afraid to take the time. Don’t have the time or skill. So sometimes it is a good idea for people to deal with the psychology with support groups and professionals

[ms] 6:05 pm: Do you work primarily with adults, children, or both?

[gina] 6:05 pm: do you think that endos realize that if a person is depressed it affects their blood sugars

[wendy rapaport] 6:05 pm: well I started out working with children and thank goodness. They became adults. And I have been around long enough to work with their children

[wendy rapaport] 6:06 pm: depr4ession can effect b.s. and b.s. can effect depression

[wendy rapaport] 6:07 pm: It is important to identify and treat depression..it is treatable..very treatable

[wendy rapaport] 6:08 pm: patients cannot assume they are depressed and that is now their “new normal”..

[gina] 6:08 pm: do you think that once you are treated that your numbers will go down drastically or its subtle

[Ellen] 6:08 pm: What are some of the less than obvious signs of depression?

[ms] 6:08 pm: do you know if individuals with diabetes who take anti-depressants typically seen changes in blood sugar (due to the medication) or other health problems?

[ms] 6:08 pm: I know your are not a psychiatrist, just wondering if you have made any observations

[wendy rapaport] 6:09 pm: In some cases..it can be dramatic changes..

[sstrumello] 6:09 pm: Given the correlation between diabetes, and the fact that patients with diabetes have a statistically higher incidence of depression than does the general population, why is it that so few endos seem willing to refer patients to psychiatric doctors who may be able to help?

[wendy rapaport] 6:10 pm: I think docs are afraid they will “insult” their patients..or perhaps expect people to be depressed

[gina] 6:10 pm: I know from experience that once I was told I needed to seek a therapist it made me feel worse

[wendy rapaport] 6:10 pm: depression is nor normal..tho it is a consequence of high blood sugars..

[AllieB2] 6:11 pm: absolutely…..

[wendy rapaport] 6:11 pm: to me the therapist should be a part of the team..prevention

[AllieB2] 6:11 pm: if I might interject with experience…

[wendy rapaport] 6:11 pm: look at the skills needed to take care of yourself..one is not born with that

[AllieB2] 6:11 pm: poor blood sugar control leads to emotional numbness

[wendy rapaport] 6:11 pm: say more about numbness

[AllieB2] 6:11 pm: which can easily become depression

[AllieB2] 6:12 pm: <~ self professed insulin manipulator….

[wendy rapaport] 6:12 pm: If you have a lot of feelings and use food to relax yourself or avoid feeling badly…blood sugar rises

[AllieB2] 6:12 pm: I knew exactly how to keep myself “alive and well” to the public eye, but emotionally stoic and numb inside by sustaining INCREDIBLY high numbers

[wendy rapaport] 6:13 pm: and if you use insulin “incorrectly” on purpose or by accident or avoidance?

[gina] 6:13 pm: Wendy, have you faced a lot of cases of women that have become diabulemic ?

[wendy rapaport] 6:13 pm: allie why else did you keep the numbers high?

[AllieB2] 6:13 pm: exactly…manipulation….in the WORST sense :(

[sstrumello] 6:13 pm: what are signs that someone should look for to ask for professional assistance? Anything come to mind?

[gina] 6:13 pm: for self image problems

[ms] 6:13 pm: one of the biggest issues for me is having the day in and day out drive to maintain optimal care – it would be easy if everything ran the way we hope, but unfortunately things are thrown into the mix of our best efforts! That leads to frustration. It would be nice if doctors looked at the whole picture more often!

[wendy rapaport] 6:13 pm: is it out of anger..at yourself, others..to lose weight?

[AllieB2] 6:14 pm: in order to avoid the weight-gain and insatiable hunger that went along with injections and larger doses of insulin

[gina] 6:14 pm: to lose weight

[gina] 6:14 pm: I find myself doing it more often than I would like to

[wendy rapaport] 6:14 pm: perhaps we have to use tolerance of ourselves and the blood sugars

[j.b.] 6:14 pm: what’s that gina?

[wendy rapaport] 6:15 pm: not to “weigh” your self-esteem thru the outcome of blood sugars

[j.b.] 6:15 pm: oh

[AllieB2] 6:15 pm: diabetes is inherently a *difficult* disease to control perfectly. It really is just a matter of “best efforts”. And the incorrectly manipulation of insulin gave me a sense of controlling something that felt, convincingly, uncontrollable

[ms] 6:15 pm: high blood sugars are easier to walk around with

[j.b.] 6:15 pm: yeah…not to look at it as a “report card”? What would you suggest a better view would be, Wendy?

[wendy rapaport] 6:16 pm: It may seem like a “lucky” way to lose weight..different..an advantage to others who don’t have diabetes..but it has the ability to cause depression from the high blood sugars as well as complications

[Jon] 6:16 pm: my son is afraid to go to sleep at night after taking a shot

[wendy rapaport] 6:16 pm: “Just a number”…that tells you what to do next

[Heidyn] 6:17 pm: afraid of lows, Jon?

[j.b.] 6:17 pm: yeah…just a clue to a series of actions and adjustments…input

[Jon] 6:17 pm: yes he is very afraid of lows

[wendy rapaport] 6:17 pm: numbers are not to evaluate you..just feedback..recognition..and improvement for the next number

[AllieB2] 6:17 pm: that’s a good way of looking at it :) a number– nothing more than a thermostat YOU control

[gina] 6:18 pm: wendy the strive for perfection is what gets me

[j.b.] 6:18 pm: one number at a time? sounds 12-steppish :p

[gina] 6:18 pm: the numbers drive me crazy

[wendy rapaport] 6:18 pm: do you know for sure why he is afraid to go to sleep? we all think we know? But it is good to have a conversation

[gina] 6:18 pm: I would rather not look at them

[AllieB2] 6:18 pm: LOL 12-steppish

[Jon] 6:18 pm: he is worried that he will drop too low and not wake up

[j.b.] 6:18 pm: wow

[AllieB2] 6:18 pm: yeah, a lot of people don’t “log” them…they just take them and use it for the 3 seconds it takes to look at it

[sstrumello] 6:18 pm: so why is so much weight placed on the Hemoglobin A1C … which is just a number, an average of averages for the last 3 months??

[Jon] 6:19 pm: I think he is lying about taking his shot at night

[wendy rapaport] 6:19 pm: the issue of perfection problem gets you in other areas..and is worth working on

[gina] 6:19 pm: ha, you should ask the people in here about my perfection problems in other areas lol

[Heidyn] 6:19 pm: Jon, if you say you’ll check his bs during the night, might that help?(allay the fears a bit)

[wendy rapaport] 6:19 pm: If he is lying Jon…then he needs compassion..and “amnesty” about his need for dishonesty..that “we” are not doing our job in “hearing him”

[Jon] 6:20 pm: I am not going to comment on your perfection problems, Gina

[ms] 6:20 pm: that is a good question… do people with diabetes tend to seek perfection or control in many areas?

[wendy rapaport] 6:20 pm: Heidyn’s idea is good

[Ellen] 6:20 pm: I think kids need to be supported and directed – do you think parents give up too early with teens and just let the teens manage the diabetes (or not manage the diabetes) when kids are too young?

[Jon] 6:20 pm: he is lying because he doesn’t want to have insulin in his system at night

[AllieB2] 6:20 pm: awwwwwww, gina :) you wear perfection well ;) a testament to your site!

[wendy rapaport] 6:20 pm: “help” him out…you are never too old

[wendy rapaport] 6:21 pm: yes perfection has some good outcomes..it makes you focused..task oriented and then must be quieted to not become negative

[szabel] 6:21 pm: Wendy, I find kids, usually between ages 3-8, do better at accepting the rigors of managing diabetes than older kids or teens. Do you also find that?

[wendy rapaport] 6:22 pm: Jon some education..to help him challenge his irrational fears..unless of course he is drinking..then he should be afraid that his body won’t compensate

[j.b.] 6:22 pm: nobody is perfect

[j.b.] 6:22 pm: though we can do the best we can

[wendy rapaport] 6:22 pm: Yes..when you are used to following “instructions” as a little kid..easier

[j.b.] 6:22 pm: it’s all about the effort to me

[j.b.] 6:23 pm: strive for consistency…when u screw up…restart

[wendy rapaport] 6:23 pm: but then it is also a process of finally rebelling..being in touch with anger and trying to fit in “why me” at a different age

[ms] 6:24 pm: there is no screwing up – just taking steps backward

[AllieB2] 6:24 pm: Jon– has he tried a fat/carb snack before bed (like PB crackers)? to delay the immediate release of carbs over time…

[Jon] 6:24 pm: I think my son is more nervous since his dog died, because the dog used to wake him up if he dropped low at night

[wendy rapaport] 6:24 pm: strive for consistency..do habits rather than emotional decisions..like “do I feel like exercising” what has feel got to do with it! Just do it..same time everyday

[Ellen] 6:24 pm: If a person is on a long acting insulin like Lantus and they take it at night at bedtime but are afraid to take it at night, why not ask the doctor about taking it 1x daily in the morning instead?

[AllieB2] 6:24 pm: :(

[j.b.] 6:25 pm: wendy, you are so sensible!

[wendy rapaport] 6:25 pm: maybe he also is nervous about his dog dying?..why it happened..when it happened

[Jon] 6:25 pm: it’s not the Lantus he is afraid of, it is the Humalog at dinner time

[Jon] 6:25 pm: and the correction at bedtime

[Jon] 6:25 pm: the dog was run over by a car

[AllieB2] 6:25 pm: Humalog is only in the system 3-6 hrs, top– isn’t it?

[wendy rapaport] 6:26 pm: Yes..the doc needs to know our “individual hang-ups)..what our fears are

[Ellen] 6:26 pm: Would you as the dad be willing to check his blood sugar 2-3 hours later to make sure he’s ok so he can sleep?

[Jon] 6:26 pm: I have been doing that every night

[Jon] 6:26 pm: and it is always 500 or higher at 3 am

[AllieB2] 6:26 pm: #$%^&* phenomenon

[AllieB2] 6:26 pm: dawn

[Jon] 6:26 pm: he swears he took a correction shot, but I am having a hard time believing him

[AllieB2] 6:26 pm: it’s a spike in the blood sugar early morning…

[wendy rapaport] 6:27 pm: and as ellen says..check it for a while for him…write it down..let him see..or wake him so he has control over it

[Jon] 6:27 pm: he was on a cgms, and his bg was not going down at all after dinner

[wendy rapaport] 6:27 pm: so it sounds like he is not taking it…and when we know those things…confrontation with warmth and interest..save the anger for us

[Jon] 6:27 pm: I don’t get angry with him, just concerned

[wendy rapaport] 6:28 pm: and do not be afraid to get professional help..as a family…then there is no “identified” patient..just a team that works together

[sstrumello] 6:28 pm: Maybe not the dawn phenomenon … protein takes about 6-8 hours to be metabolized into blood glucose, so if he has any protein for dinner, say around 7:00 pm, that may be behind the numbers as well. The only way to know is to avoid eating any protein for dinner some night and see what it does.

[AllieB2] 6:28 pm: how long has he been a diabetic, Jon?

[szabel] 6:28 pm: Wendy, over 20 million people in US now have diabetes, about 1.5 million are type 1. But more kids are getting type 2 due to lack of exercise, high carb diets, and are not aware of risks as are their parents often times. In 1977, we had 6 million diabetics. This is a huge increase. Are you worried?

[ms] 6:28 pm: if he is not taking it because of concern of going low , perhaps you could work on lowering the dose a bit – better he get most than none until he become more comfortable?

[Jon] 6:29 pm: today is his 7th anniversary with diabetes

[wendy rapaport] 6:29 pm: yes I am worried..

[Jon] 6:29 pm: he will be 15 on Wednesday

[wendy rapaport] 6:30 pm: I like ms idea…gradually make changes..we can not be in “crisis” mode about diabetes..even tho it is anxiety producing

[AllieB2] 6:30 pm: wow- he’s coming right along with it :) nothing about it is easy– but good for him for dealing with it and not ignoring it!

[wendy rapaport] 6:30 pm: and I think skipping shots is making a statement..kids know you will know..and are relieved and trapped to be found out

[wendy rapaport] 6:31 pm: sometimes parents want to protect their kids from directness..think they are hurting enough already..but the talking about it is important

[Ellen] 6:31 pm: Is it ok to give the 15 year old the shots if the 15 year old isn’t taking them him/herself?

[Jon] 6:32 pm: that would not go over well

[crazidiagal] 6:32 pm: I had to get a replacement pump and my basal doesn’t go as high as it did enough up to my basal..

[wendy rapaport] 6:32 pm: Yes..I think you can say..”this seems to hard for you at this time..I will be there for you..and I will give it for you for now

[ms] 6:32 pm: jon, I missed it, how long has he had diabetes?

[Jon] 6:32 pm: 7 years, today

[AllieB2] 6:33 pm: 7th anniversary coming up

[wendy rapaport] 6:33 pm: It is like partnering with your kids..giving them a vacation..

[Beth (IA)] 6:33 pm: Jon, do you do a correction at 3am if he is 500

[Jon] 6:33 pm: yes, and then his bg will be fine when he wakes up

[Jon] 6:33 pm: he won’t let anybody else give his shots or even stick his finger

[Jon] 6:34 pm: not even nurses

[wendy rapaport] 6:34 pm: so in some ways you are already “partnering”

[Jon] 6:34 pm: I tell him how much he needs to take

[ms] 6:34 pm: do you think he is overwhelmed by the whole thing in general Jon?

[Jon] 6:34 pm: although lately he has been doing good at calculating his own

[wendy rapaport] 6:34 pm: sometimes parents are afraid to let others help..it is a source of pride too..that you are special..but it is a drain not to share it

[Jon] 6:35 pm: I would love to share it

[Jon] 6:35 pm: nobody else wants the job

[gina] 6:35 pm: I don’t like burdening anyone with my care

[gina] 6:35 pm: I don’t let anyone help

[AllieB2] 6:35 pm: me neither

[gina] 6:35 pm: either

[j.b.] 6:35 pm: I hardly talk about it at all

[AllieB2] 6:36 pm: I always kept it to myself….to try and hide my frustrations with it. I knew my parents would assume *total* control if I let them

[wendy rapaport] 6:36 pm: I tell docs not to tell their patients how much to take..it makes patients feel dependent..same way..I tell parents to ask their children what they think first..so competency begins

[gina] 6:36 pm: this way if I screw up, its my problem and no one else is to blame but me

[Jon] 6:36 pm: I have been doing that lately, and it seems to work

[Jon] 6:36 pm: sometimes he doesn’t want to think about it though

[Beth (IA)] 6:36 pm: Do you watch him give his shots?

[Ellen] 6:37 pm: Maybe that’s why some parents hand the care over to the kids too young, so the parent won’t feel responsible for the A1C etc.

[ms] 6:37 pm: I think that for adults, the help is of a different kind – it is more emotional – less needing/wanting others to do things for them (i.e., fill syringes, prepare things) – there are many different layers for an adult

[wendy rapaport] 6:37 pm: why the blame Gina?

[ms] 6:37 pm: in my opinion

[gina] 6:37 pm: Wendy, I am 30 yrs old and my mother still tries to control what I eat, how much I need for carbs

[Jon] 6:37 pm: I try to, but lately he has been going into the bathroom to do it in private

[River] 6:37 pm: Anybody struggle with OCD? Any greater occurrence in diabetics?

[gina] 6:37 pm: ha river

[gina] 6:37 pm: I have OCD

[wendy rapaport] 6:37 pm: love is about sharing…as adults..helping each other..not feeling less than if you are imperfect

[gina] 6:37 pm: I don’t want to share this

[trish] 6:38 pm: Shouldn’t he be the director of the final decision as to how to solve the problem? But, as a parent, our job is to demand that the problem be solved?

[wendy rapaport] 6:38 pm: OCD is a medical illness..that effects the mind…and must be treated..

[Jon] 6:39 pm: how do you treat OCD?

[ms] 6:39 pm: I share diabetes with a few people, but the day to day ins and outs are reserved for my “chat friends” – poor ellen!!

[AllieB2] 6:39 pm: if you start lobbying demands on your kids, trying to deal with a disease they didn’t “apply” for….it might build resentment and they’ll utilize it too, in a sense, flex their independence

[wendy rapaport] 6:39 pm: Gina what does it mean to share? lose control? burden others? you have to be perfect

[River] 6:39 pm: He works on it. Hand washing is a problem. Skin breaks down. Went to therapy, but therapist was not good. HE DOES NOT WANT MEDICATION.

[ms] 6:39 pm: I do not have ocd, but when my care is “top notch” I have to be hyper focused on it

[gina] 6:39 pm: all of the above

[AllieB2] 6:40 pm: it really has to be THEIR decision and you have to give them the ownership to make the decisions: the best and most responsible ones possible

[wendy rapaport] 6:40 pm: diabetes adherence must be treated as behavior..like how do you insist your kids clean their rooms or do their homework

[wendy rapaport] 6:40 pm: I think kids..and even adults need “empowering” supervision of their diabetes..interest..firmness..not leaving the “doing it up to them

[Jon] 6:40 pm: lol he is not good at cleaning his room either

[gina] 6:41 pm: who is jon lol

[trish] 6:41 pm: so what are the consequences?

[Jon] 6:41 pm: my kid

[Ellen] 6:41 pm: Parents sometimes need help to learn to parent – it’s not intuitive

[River] 6:41 pm: Dr.s have pointed out that the focus sam give’s his disease will have shades of OCD and may not be all bad. Balance is key.

[ms] 6:41 pm: truth be told, people for the most part do not understand diabetes ins and outs and it feels like complaints to foreign people who can not really lend adequate understanding or support – and give empty “sympathy”

[wendy rapaport] 6:41 pm: good point trish..what consequences do you give for not doing the things you require

[gina] 6:42 pm: my mother takes all of the “bad food” out of the house no matter how many times I tell her MOM I CAN EAT THAT UGHHH

[gina] 6:43 pm: she makes me feel like a little kid

[River] 6:43 pm: Like people who tell their kids not to touch your because they might catch it!

[gina] 6:43 pm: I mean what do I do when I am still getting yelled at for a high blood sugar

[wendy rapaport] 6:43 pm: testing and care requires conscientiousness. but not self punishment in the talk..like you are not bad for overeating and not taking
insulin..but what stopped you..were you self conscious? what skills do you need to handle it better next time..KINDNESS in your conversations with yourself or to your kids

[Jon] 6:44 pm: I can’t buy Oreos because my kid will devour them

[Heidyn] 6:44 pm: sounds like my coworkers, Gina(but coworkers can be ignored..Mom’s can’t!):-(
[wendy rapaport] 6:44 pm: If parents mean well..then you have to talk to yourself..since you are the only one listening Gina..and decide not to be insulted

[gina] 6:45 pm: its every day

[wendy rapaport] 6:45 pm: some people would appreciate there not being oreos around the house..and some will resent not being free to make the choice not to eat so much…let’s face it..it is hard not to want things we see

[Heidyn] 6:45 pm: geez that’s rough

[gina] 6:46 pm: I like knowing that the food is there

[gina] 6:46 pm: and having a choice

[ms] 6:46 pm: not sure which is better … too much support, or none at all – of course a happy medium is ideal, but… I suppose we all have to make the best of our situations.

[gina] 6:46 pm: I don’t like the choice being made for me

[wendy rapaport] 6:46 pm: Gina take your mom to a nutritionist with you..let her hear it from a professional..she probably learned that foods were “forbidden”..that is what they used to tell you

[Jon] 6:46 pm: it’s bad though. He had that Oreo problem when he would go to his Moms house for the weekend

[Jon] 6:46 pm: and his bg would not drop below 500 all weekend

[gina] 6:46 pm: Wendy she has been there with me

[gina] 6:46 pm: every single time

[AllieB2] 6:47 pm: it’s difficult ;) that “happy medium”– diabetes is so hormonally driven! LoL

[wendy rapaport] 6:47 pm: I think at different times we want different things… from people and it requires talking up..not just diabetes

[ms] 6:47 pm: gina, is there a way to assert your independence /without her?

[gina] 6:47 pm: my aunt is also a type 1 and has lived with it for 35 yrs and has every complication and two kidney transplants and I think that is why she is like that with me its me only guess

[gina] 6:48 pm: its my only*

[wendy rapaport] 6:48 pm: then bring your own Oreos Gina..and “show” her that you can do it

[gina] 6:48 pm: I hate Oreos, I will have a snickers please lol

[wendy rapaport] 6:49 pm: I like how you are thinking Gina..you are beginning to empathize with her…and that can make you less anger

[gina] 6:49 pm: its just so frustrating from all different aspects

[ms] 6:49 pm: allie, talk about it! My last bg was through the roof – hormones? set? goodness only knows – NO HAPPY MEDIUM right now

[gina] 6:49 pm: I get the mother thing from her and everyone

[wendy rapaport] 6:49 pm: Allie..everyone eats more when they are premenstrual..so of course women with diabetes do..and so it requires a different regimen??

[wendy rapaport] 6:50 pm: but you have to be happy..regardless of your numbers..because then diabetes gets you twice

[ms] 6:50 pm: I also eat more when I am running higher – have crazy food cravings – frustrating at times

[AllieB2] 6:51 pm: well, interesting enough: the hormone that is naturally released in the body when insulin is released (amylin) controls the appetite and cravings…

[ms] 6:51 pm: feeling cruddy takes its toll at times!

[wendy rapaport] 6:51 pm: when you are running higher..you probably feel more hungry and tired and of course food makes you feel more energetic..psychologically

[j.b.] 6:51 pm: I have been feeling a lot of work stress lately

[AllieB2] 6:51 pm: in the past 2 weeks, I’ve almost felt NONDIABETIC on the symlin (synthetic amylin) injections

[wendy rapaport] 6:51 pm: allie what do you mean

[AllieB2] 6:52 pm: taking insulin didn’t drive my appetite either way

[wendy rapaport] 6:52 pm: when you feel cruddy ms…get support..whether you were negligent o

[sstrumello] 6:52 pm: wendy, when is it “time” for someone to see a psychiatrist? are there any telltale signs that should indicate that someone is having trouble psychological trouble?

[AllieB2] 6:52 pm: it almost makes the affect of my hunger non-existent as I took more insulin to control the numbers

[wendy rapaport] 6:53 pm: I use negligent in allowing for your humanness and imperfection

[ms] 6:53 pm: support is hard to come by – no real positive outcome in “complaining” for me

[ms] 6:53 pm: I guess having a support network to express concerns to would make a difference too

[Jon] 6:54 pm: unless Wendy can stay late

[wendy rapaport] 6:54 pm: Personally I think everyone with diabetes should “check in” with a therapist..to be diagnosed and have all that to do..get the skills and the ventilation..

[j.b.] 6:54 pm: thankfully, I have been working out…but have been finding myself hitting the “snack box” when I can’t get out for lunch…it’s my fault for not planning ahead

[ms] 6:54 pm: that’s why there is a cyber world i suppose

[Heidyn] 6:54 pm: ventilation?

[wendy rapaport] 6:54 pm: J.b. don’t say “fault” say awareness that you want to plan ahead

[vixen] 6:55 pm: the adage don’t let the diabetes control you, you control it – is rather contradictory to me

[wendy rapaport] 6:55 pm: I think exercise is crucial for mental health and good diab control..it relaxes, makes you like your body

[Ellen] 6:55 pm: And don’t let the diabetes police control you, you control the diabetes police :yeah:

[j.b.] 6:55 pm: well, I am always trying to get my stuff ready for the gym ahead of time and I have been very good about going…I don’t think I am consciously avoiding packing a lunch

[vixen] 6:55 pm: as a matter of fact, it does control everything we do…when to eat, what to eat, types of food, etc.

[vixen] 6:56 pm: I agree with you ellen

[wendy rapaport] 6:56 pm: vixen it requires a lot..but you make the decision to do it or not..you control it..

[gina] 6:56 pm: well said ellen

[sstrumello] 6:56 pm: I HATE the word “control”, we only control 3-4 factors out of dozens which actually influence blood glucose levels. The best we can do is “manage” all of these factors.

[AllieB2] 6:56 pm: TRUE!

[vixen] 6:56 pm: exactly

[ms] 6:57 pm: ellen, usually, but sometimes delinquency gets in they way ;)

[vixen] 6:57 pm: manage

[Ellen] 6:57 pm: Although as parents we sometimes feel like the diabetes police when what we want to be is a team player in the game

[Heidyn] 6:57 pm: it’s more like survival

[AllieB2] 6:57 pm: I second that notion, Scott! Well put ;)

[vixen] 6:57 pm: because I can’t control that I have diabetes

[j.b.] 6:57 pm: but the 2nd or 3rd day of microwave popcorn and Oreos definitely leaves me feeling betrayed…by me

[vixen] 6:58 pm: I don’t think food should be considered an enemy.

[j.b.] 6:58 pm: but then I get up the next day and start over

[j.b.] 6:58 pm: it’s a clean start each day

[vixen] 6:58 pm: I think simple moderation whether it’s popcorn here or there is OK, especially if on the pump.

[j.b.] 6:58 pm: MDI for me, but I manage ok

[wendy rapaport] 6:58 pm: attitude can be a choice..I think it is hard to be positive..but it can be learned..but first it is good to “ventilate” talk out the anger and resentment..then move forward..easy to be bitter and hurt yourself by overeating..harder to have to turn it around to gratitude

[j.b.] 6:59 pm: hm

[j.b.] 6:59 pm: I don’t really want to hurt myself…sometimes I just “give in”

[j.b.] 6:59 pm: I don’t

[j.b.] 6:59 pm: think I do

[reese] 6:59 pm: I just hate when I eat healthy like today turkey sand and an apple and I bolused the same as last time I ate that same healthy sandwich and I have a LOW

[wendy rapaport] 6:59 pm: and don’t wait to make a clean start the next day..make it the moment you take the b.s. and find it is higher than you want

[ms] 7:00 pm: easier to not think about it J.b.

[wendy rapaport] 7:00 pm: but give in in ways that are nice to yourself

[j.b.] 7:00 pm: what do you mean, ms?

[j.b.] 7:00 pm: like how, wendy?

[gina] 7:00 pm: sometimes I will have a huge eating binge

[gina] 7:00 pm: i say i dont give a you know what

[ms] 7:00 pm: gina, as will I -

[Ellen] 7:00 pm: wb me LOL…aol. kicked me offline

[j.b.] 7:01 pm: lol

[sstrumello] 7:01 pm: wendy, thank you so much for joining us this evening … I hope you can join us again someday!!

[wendy rapaport] 7:01 pm: like say I am hungry and lonely..and go find someone
(not a stranger??) and say I need some loving

[AllieB2] 7:01 pm: thank you wendy!

[j.b.] 7:01 pm: thanks wendy, this has been great!

[AllieB2] 7:01 pm: LOL

[vixen] 7:01 pm: I don’t think food has ever been the prob for me. It’s the uncontrollable factors, such as the affects the disease has on one’s body, and I find it utterly frustrating when docs want to blame it on poor control – especially when the prob was present well before my diagnosis.

[AllieB2] 7:01 pm: good idea, wendy ;)

[j.b.] 7:01 pm: whoa

[gina] 7:02 pm: lol wendy

[j.b.] 7:02 pm: i wasn’t going there

[j.b.] 7:02 pm: :P

[sstrumello] 7:02 pm: goodnight everyone!

[gina] 7:02 pm: gimme some lovin!

[Ellen] 7:02 pm: I think it’s important to be very clear with doctors and others who are disempowering, that you won’t tolerate it.

[gina] 7:02 pm: nite scott

[wendy rapaport] 7:02 pm: you are giving each other nice things..and don’t take blame..take control..and don’t let anyone put you down for outcomes..

[AllieB2] 7:02 pm: or just “hug it out” ;)

[j.b.] 7:02 pm: wendy has a sense of humor, for sure

[gina] 7:02 pm: ellen come here gimme some lovin! lol

[vixen] 7:02 pm: reese – I understand your frustration.

[gina] 7:02 pm: :kiss:

[Ellen] 7:02 pm: :kiss:

[gina] 7:02 pm: lol

[wendy rapaport] 7:03 pm: doctors feel guilty they can’t “cure” it in the first place

[ms] 7:03 pm: we’d have to pay her fare!

[reese] 7:03 pm: ty vixen :)

[j.b.] 7:03 pm: gina and ellen…get a priv chat!

[ms] 7:03 pm: man… this kissing stuff is getting personal!

[gina] 7:03 pm: lol

[AllieB2] 7:03 pm: lol

[gina] 7:03 pm: :heart:

[vixen] 7:03 pm: Do you find you are inconsistent dependent on your moods or the day’s events, reese?

[Ellen] 7:03 pm: I’m Gina’s cyber Jewish mother…this is not “lovin’” in that sense. It’s a kiss on the keppie

[j.b.] 7:03 pm: oh well

[gina] 7:03 pm: thats for you ms lol

[gina] 7:04 pm: loool

[j.b.] 7:04 pm: ah

[gina] 7:04 pm: ellen is my mommie

[gina] 7:04 pm: wendy, thank you so much for your information tonight

[j.b.] 7:04 pm: ellen, as a mommie of an 18-yr old…you are experienced, no doubt

[ms] 7:04 pm: LEAVE ME OUT OF THE KISSING LOL

[Ellen] 7:04 pm: Wendy, we will be using that quote “give me some lovin’”

[wendy rapaport] 7:04 pm: and if you are hard on yourslf..or feel blue or can’t sleep ..get some support professionally..you “deserve” the privacy of a professional and a place to complain..anti depressants if necessary can help the blood sugars

[gina] 7:04 pm: thats the quote of the week

[reese] 7:05 pm: my bgs effect my moods, but I don’t think my moods cause me to go high or low

[j.b.] 7:05 pm: hm…never considered that

[wendy rapaport] 7:05 pm: Have I started a sexual revolution?

[Ellen] 7:05 pm: Do you want to start one?

[vixen] 7:05 pm: gotcha – sometimes I think it can go both ways

[gina] 7:05 pm: ha, wendy that can be for another chat lol

[ms] 7:05 pm: gina, is there a list of resources somewhere of qualified professionals (out of curiosity_

[AllieB2] 7:05 pm: righteously and proudly! LOL

[ms] 7:05 pm: OMG – eek – get me out of here LOL

[wendy rapaport] 7:05 pm: reese, depending on what you do with your moods..like drink or eat..will effect the b.s.

[j.b.] 7:05 pm: I guess anything can happen after 10pm

[gina] 7:05 pm: lol

[AllieB2] 7:05 pm: thanks again, Wendy :)

[ms] 7:06 pm: oops, meant that for wendy

[gina] 7:06 pm: the kids are in bed

[gina] 7:06 pm: lol

[gina] 7:06 pm: sex in the city chat starts now lol

[j.b.] 7:06 pm: o.O

[gina] 7:06 pm: jk

[j.b.] 7:06 pm: we know

[j.b.] 7:06 pm: :)

[vixen] 7:06 pm: I’ve gone the professional route and all that want to do is drug ya up. Honestly, it would be nice to visit someone that especially deals with chronic conditions, such as diabetes.

[wendy rapaport] 7:06 pm: well seriously..sexual energy does not begin with high blood sugars

[ms] 7:06 pm: wendy, s there a list of resources somewhere of qualified professionals (out of
curiosity_

[Ellen] 7:07 pm: Cant’ sleep is a big one for me as a parent of a child with diabetes. Over the years I’ve trained myself not to sleep well…need to fix that

[vixen] 7:07 pm: To just go on antidepressants doesn’t do a thing, unless the therapist can offer the appropriate guidance and understanding.

[j.b.] 7:07 pm: I have tried to do everything on my own…with help from you guys

[gina] 7:07 pm: not sleeping is a huge problem for me also

[j.b.] 7:07 pm: me too

[wendy rapaport] 7:07 pm: vixxen it is good to talk to therapists before the meds

[j.b.] 7:07 pm: I take benadryl at night regularly

[gina] 7:07 pm: wendy I was prescribed lexapro

[gina] 7:08 pm: and I sat them on my dresser

[reese] 7:08 pm: I believe wendy that I have had diabetes for so long that I just don’t react the same or consistent to insulin each time, plus today I walked up six flight of stairs that perhaps I did not the last time, exercise makes me drop big time

[wendy rapaport] 7:08 pm: any therapists that you see..you can have them talk to me to consult on the diabetes parts..sometimes therapists are “afraid” of diabetes

[gina] 7:08 pm: and talked myself out of needing them

[j.b.] 7:08 pm: reese, depending on what your body is used to, it can happen

[gina] 7:08 pm: Vixen

[gina] 7:09 pm: I have the number of a therapist that specializes in diabetes

[gina] 7:09 pm: in our area

[vixen] 7:09 pm: cool – will you email it to me, plz?

[j.b.] 7:09 pm: hey, g…k.m. is moving into your area maybe

[j.b.] 7:09 pm: so I read

[ms] 7:09 pm: wendy, do you find in general that individuals with diabetes are more independent, seek control, and perfectionistic?

[j.b.] 7:10 pm: some of us are absolutely obsessed to be honest

[wendy rapaport] 7:10 pm: the ada has a list of professionals…but good professionals..if they “listen” to you and tell them not to be afraid of diabetes..can help out too..sometimes I think because I understand it..I may not ask the same questions I would have in the beginning

[j.b.] 7:10 pm: I am not usually OCD, but I am about this disease

[j.b.] 7:11 pm: but I hear that has been covered previously

[reese] 7:11 pm: I was put on Effexor and it was the best thing that I have done to help me cope besides starting an insulin pump

[j.b.] 7:12 pm: so I won’t belabor it

[wendy rapaport] 7:12 pm: I think people with diabetes are people..who have many different attitudes..but we give you the goal of “controlling your diabetes”..so that is a set up…and docs don’t realize that hemoglobin is not a grade but info about where you have been and where you want to go

[ms] 7:12 pm: what does effexor target?

[reese] 7:12 pm: anxiety

[wendy rapaport] 7:13 pm: OCD IS different than meticulous..which helps if you are not judgmental about the outcome..but conscientious about doing

[ms] 7:13 pm: as I stated earlier, it would be nice to have doctors who see the whole picture

[vixen] 7:13 pm: see, I am still having difficulty with the word “controlling”

[vixen] 7:13 pm: It seriously turns me off.

[ms] 7:13 pm: and treat outcomes without blame, but with understanding and an open mind

[reese] 7:14 pm: I think the tighter control we want to obtain the harder it is to cope

[wendy rapaport] 7:14 pm: effexor and lexapro can both target anxiety and depression and luvox is also used to OCD..combinations of drugs for different symptoms can work

[ms] 7:14 pm: in ways – I think there are different emotions that go along with tight control and lack of tight control – I have been in both places

[wendy rapaport] 7:14 pm: how about “taking care of” attending to..managing vs. controlling

[vixen] 7:15 pm: Manage really is more appropriate because it goes back to, “I didn’t ask to have the disease in the first place.” Maybe that’s why most diabetics have a hard time “controlling” it because the adage sounds so simple, when in fact it is not.

[ms] 7:15 pm: is lexapro more common? out of curiosity

[wendy rapaport] 7:15 pm: go for tight control and go for acceptance of imperfection

[reese] 7:15 pm: Most of my high bgs are due to overeating bottom line, and therefore I blame myself and have guilt

[vixen] 7:15 pm: Even “taking care of” is easier to accept.

[wendy rapaport] 7:15 pm: words and advice are annoying

[reese] 7:16 pm: so why don’t I try harder to eliminate the guilt

[gina] 7:16 pm: I think for me, I was dxd at 25

[carly] 7:16 pm: hi all, I just joined in. I agree controlling is a tough word…. I hate when random people ask me how well I’m controlling it….

[gina] 7:16 pm: and it was much harder to deal with in general

[wendy rapaport] 7:16 pm: doctors get attached to the drug they have been using..some don’t go to the new ones…(not good or bad)..they target different symptoms..don’t “rate” yourself by using drugs that others do

[vixen] 7:17 pm: It can be subjective, but at the same time why are millions of diabetics having a hard time “controlling their blood sugars?” I truly feel that the ADA and many diabetic orgs try to make it sound so simple to handle/control.

[wendy rapaport] 7:17 pm: use the guilt as a motivator..not punishment

[vixen] 7:17 pm: When in fact, it is not.

[reese] 7:17 pm: it is so not simple

[wendy rapaport] 7:18 pm: “Just do it” is not a statement of simple..just a direction

[reese] 7:18 pm: I am trying wendy:)

[wendy rapaport] 7:19 pm: listen the world without diabetes has trouble exercising, eating well and not drinking..not to mention smoking…why would it be any easier for you when you have to add taking medication and testing and answering questions!

[vixen] 7:19 pm: Maybe the ADA, the medical industry and orgs, etc. shouldn’t be trying to focus on guilt. In addition, the ADA hasn’t done a very good job of differentiating between Type 1 and Type 2. I find it extremely insulting when a majority of society thinks I caused the disease myself and that “controlling it” will make it all better.

[j.b.] 7:19 pm: that is true, wendy, my habits are very much improved since dx

[wendy rapaport] 7:19 pm: When people ask you how well you are controlling it..Just say” I think you mean well..You are expressing interest in me. Thanks for that

[reese] 7:19 pm: so true wendy

[reese] 7:20 pm: everyone has issues with exercise and eating

[reese] 7:20 pm: that statement just helped me :)

[carly] 7:20 pm: I agree

[wendy rapaport] 7:20 pm: type 2’s don’t actually cause their diabetes either..tho their behaviors may not help

[Ellen] 7:21 pm: I’m exercise resistant even though I know I feel great when I get out there and do it.

[carly] 7:21 pm: does anyone get annoyed though when random friends ask how they’re handling it? I feel like they’re being judgmental sometimes.

[j.b.] 7:21 pm: lol ellen

[wendy rapaport] 7:21 pm: oh..then I can say good night..because finally!!! haha..someone feels better

[j.b.] 7:21 pm: you will give in eventually

[reese] 7:21 pm: me to ellen, but then I have a low, and I get upset, and feel that it is so unfair

[ms] 7:22 pm: Good night Wendy, and thank you for you time and insight.

[wendy rapaport] 7:22 pm: exercise is not a decision..just a habit and it takes 28 days to make a habit

[j.b.] 7:22 pm: yes, johnboy thanks you from the bottom of his heart…this has been great!

[Ellen] 7:22 pm: Thank you Wendy. You’re the best.

[wendy rapaport] 7:23 pm: Thanks for having me..I think you all are smart and kind..good luck..oh yeah and good behaviors!

[Jon] 7:23 pm: Thank you for chatting with us Wendy

[reese] 7:23 pm: carly I hate when I bring up possible complications to friends and they say well you could be hit by a car tomorrow, grrrrrr

[Jon] 7:23 pm: And thanks for spending the extra time

[reese] 7:23 pm: Yes ty wendy :)

[j.b.] 7:23 pm: yes, indeed

[Ellen] 7:23 pm: :clap::clap: WENDY :clap::clap:

[Jon] 7:23 pm: Come back and chat with us again

[wendy rapaport] 7:24 pm: :kiss::kiss::roll:

[Ellen] 7:24 pm: Reese, is there some acceptance that those without diabetes will never “get it”?

[Jon] 7:25 pm: Wendy Rapaport’s book ‘When Diabetes Hits Home: The Whole Family’s Guide to Emotional Health’, published by the American Diabetes Association, along with many articles for lay and professional audiences on the subject of addressing the emotional aspects of living with chronic illness, targets health professionals and families in improving adherence and quality of life for those living with diabetes.

[gina] 7:25 pm: thanks wendy!!!!!!!!

[reese] 7:25 pm: I supposed Ellen

[carly] 7:25 pm: thanks!

[carly] 7:25 pm: I hear ya reese

[Jon] 7:25 pm: We will post up a chat transcript in case anybody missed any part of this chat

[Ellen] 7:26 pm: I don’t give up trying to educate them…but I also, after 17 years, don’t think they care enough to really understand…even the family :-( so I try to accept that

[Scheduled Chat Room]: wendy rapaport has left at 7:26 pm

[carly] 7:27 pm: I hear ya Ellen

[Jon] 7:27 pm: Chat is closed! You are all welcome to stay as long as you like.

Posted in Diabetes and Depression, Past Chat Transcripts | No Comments »

Diabetes Burnout

Thursday, December 8th, 2005

Thursday, December 8 9PM est.
Dr. William H. Polonsky, PhD, CDE
Topic: Diabetes Burnout
Author of “Diabetes Burnout: What to Do When You Can’t Take it Anymore”

Dr. William H. Polonsky, Ph.D., CDE is a licensed clinical psychologist, and the Behavioral Diabetes Institute’s Founder and Director. He is also an Assistant Clinical Professor in Psychiatry at the University of California San Diego. Dr. Polonsky has and served as a behavioral consultant in diabetes to several multi-site clinical research trials, and is an active researcher in behavioral medicine and a licensed clinical psychologist specializing in psychosocial issues related to diabetes.

William H. Polonsky, PhD, CDE
PO Box 2148
Del Mar, CA 92014
e-mail: whp@behavioraldiabetes.org
<a href=”http://www.behavioraldiabetes.org/”>http://www.behavioraldiabetes.org/</a>

Welcome! You have entered [The DTF Lounge] at 7:31 pm
[Scheduled Chat Room]: Dr. Polonsky has entered at 9:02 pm
[
Dr. Polonsky] 9:02 pm: Hello all. I believe I am in the right place, aren’t I? [Gina - Type 1 dxd Nov 2000] 9:03 pm: Welcome to our very first Guest Chat

[Gina - Type 1 dxd Nov 2000] 9:03 pm: and thank you all for coming!!

[Scott] 9:04 pm: It is with great pleasure that I introduce Dr. William Polonsky. Dr. Polonsky is President and Founder of the Behavioral Diabetes Institute, the world’s first organization dedicated to tackling the unmet psychological needs of people with diabetes. A licensed clinical psychologist, certified diabetes educator and Assistant Clinical Professor in Psychiatry at the University of California San Diego, he has been studying the psychological and behavioral aspects of diabetes for over 20 years.

[karen] 9:04 pm: Dr. Polonsky do you have any relatives that are diabetic?

[Dr. Polonsky] 9:05 pm: Yes, Karen, I do have relatives with diabetes! You?
[karen] 9:05 pm: no dr. P I do not

[rjommp] 9:07 pm: Dr I’ve had Type One 40 years and sometimes it seems like there has not been enough with treating complications and also a true cure

[rjommp] 9:08 pm: This is frustrating

[Dr. Polonsky] 9:08 pm: The Guardian is sure to be very, very cool. And possibly a good remedy for burnout (though maybe not sarabean’s)…. but anyway…

[bjkiah] 9:08 pm: 46 years T1

[Dr. Polonsky] 9:08 pm: rj, what do you mean? not enough research?

[karen] 9:09 pm: sara i had to split my dosage when i was on lantus to get good bgs or i was sky high after dinner on one shot

[Scott] 9:09 pm: Dr. Polonsky, what prompted you to start the Behavioral Diabetes Institute? Can you tell us a little bit about it?

[Dr. Polonsky] 9:09 pm: oh good, i’ll start with scott’s questions

[rjommp] 9:10 pm: there is research just not enough concrete happenings with cures and treatment of complications technology is awesome now

[jim] 9:10 pm: i work in a busy hospital and wanted to know if it is possible to have a dubble burn out from healthcare and diabetes

[Dr. Polonsky] 9:10 pm: the BDI is, as you know, the first of its kind. we do a whole variety of workshops for folks with diabetes, focusing on burnout, depression, etc.

[Dr. Polonsky] 9:10 pm: unfortunately, so far, all of them are in San Diego!

[Scott] 9:11 pm: Dr. Polonsky, your latest BDI newsletter indicates you are planning to take them elsewhere soon!
[sarabear63] 9:11 pm: whose next ?

[karen] 9:11 pm: what kind of things do you use mostly to treat burnout/depression, etc, any one thing that works the best

[Dr. Polonsky] 9:11 pm: what prompted me? so much burnout and stress, and very few who can be of any help. finding a way to do this in groups, and as cheaply as possible (we are a nonprofit) seems an important solution….

[Dr. Polonsky] 9:12 pm: yes, we do have hopes to take our programs on the road. hopefully, sometime later in 2006.

[Dr. Polonsky] 9:13 pm: to answer karen, there isn’t a single thing that helps with burnout, so we have a menu.

[Dr. Polonsky] 9:13 pm: for example, the most import answer seems to be “controllability”. you get burned out when you feel that diabetes is out of control…

[Dr. Polonsky] 9:14 pm: so by looking at every thing bout your diabetes, we try to tackle one things at a time– the diabetes police in your life, the fact that your best efforts don’t seem to lead to better BG’s, etc.

[sarabear63 QUESTION] I have been T1 for 29 years no major complications is memory loss a possible complication and I have had depression for years and cant shake it no matter what kind of anti depressant i have tried.

[Dr. Polonsky] 9:16 pm: sara has 2 good questions. let me answer both, one at a time

[Dr. Polonsky] 9:17 pm: first, memory loss. even if you have had many severe low blood sugars, the evidence suggest that most people do not suffer any serious cognitive problems. good news. and not memory problems.

[Dr. Polonsky] 9:18 pm: memory problems ARE associated with depression. people with diabetes are at double the risk of depression

[Dr. Polonsky] 9:18 pm: antidepressants help a lot of people, but not everyone. if you’ve tried a bunch and nothing works….consider the following…

[Dr. Polonsky] 9:19 pm: first, we know that cognitive-behavioral therapy (brief, structure, focusing on the present and helping to problem solve issues in your current life, and talking about how you think about thins) help depression as well as medications! the combination works best.

[printcrafter QUESTION] IS burn out more a problem with t1 or t2

[Dr. Polonsky] 9:20 pm: other things that help– regular exercise, a decent sleep pattern, feeling successful with your diabetes, etc. I’d recommend find a good skilled psychologist!

[Dr. Polonsky] 9:20 pm: G the second question is about burnout, type 1 vs. type 2
[Gina - Type 1 dxd Nov 2000] 9:21 pm: YES

[Dr. Polonsky] 9:21 pm: no one knows for sure, but I’d wager that it is much more common in type 1., where it is much harder to ignore diabetes completely!

[Heidyn QUESTION ] 9:14 pm: Dr. P- at what blood glucose level is there a significant rise in depression? Does it vary by the individual?

[Dr. Polonsky] 9:22 pm: but again the common issue is– feeling out of control with diabetes. so it can affect anybody living with this tough disease

[Dr. Polonsky] 9:22 pm: good question, heidyn.

[Dr. Polonsky] 9:23 pm: there is NO BG level where you see a rise in depression. I’m not sure exactly what you mean.

[Heidyn] 9:24 pm: when I’m in the 200’s-I get depressed easier

[Dr. Polonsky] 9:24 pm: you can certainly feel lethargic and crummy when your BG’s get high and stay high, but depression is a more chronic, serious problem.

[Dr. Polonsky] 9:25 pm: I see what you mean, H. elevated BG’s, because they can make you feel more tired and out of sorts, can EXACERBATE depression, but they don’t really cause it. know what i mean?

[AllisonBlass] 9:25 pm: Heidyn, I think you’re talking more simply about moods… Depression is chronic problem that doesn’t go away.

[karen] 9:25 pm: I understand Heidyn question, our emotions change with bgs changes and we do feel differently at low and highs

[Gina - Type 1 dxd Nov 2000] 9:25 pm: yes i think i am more depressed when my sugars are high also

[Dr. Polonsky] 9:25 pm: yep, karen. and that is probably much more noticeable for someone with type 1 than type 2

[Scott] 9:26 pm: Dr. Polonsky, what the signs are for depression that require seeking counseling and/or medication?

[Heidyn] 9:26 pm: yeah, I guess its a mood thing-but it is depression, because depression you don’t want to do anything about it anyway..

[Dr. Polonsky] 9:27 pm: scott, signs for depression include: depressed mood (DUH!), loss of pleasure in daily activities (nothing is fun any more), sleep problems, change in appetite, problems concentrating, etc.

[Gina - Type 1 dxd Nov 2000] 9:28 pm: [The LIVabetes Glucose Goddess] 9:16
pm: How can we work through the guilt/shame part

[Dr. Polonsky] 9:28 pm: Hi LGG. Depends which kind of guilt you mean. For example…

[Dr. Polonsky] 9:29 pm: some people guilty whenever their BG gets out of whack or they eat one wrong morsel. often the solution here is to think about expectations. is it reasonable to think i will always eat perfectly, or that i will never have a bg above 150? thank goodness for a1c testing. know what i mean?

[Dr. Polonsky] 9:30 pm: some people feel guilty (more likely to be type 2) that they gave themselves diabetes.

[The LIVabetes Glucose Goddess] 9:30 pm: I am okay it is the wrath from the diabetes police

[Dr. Polonsky] 9:31 pm: OH, so its dealing with the comments/nods from others!

[The LIVabetes Glucose Goddess] 9:31 pm: Yes! What would be some good way to handle

[Dr. Polonsky] 9:31 pm: i just wrote something for Diabetes Forecast about the need for “diabetes etiquette” wallet cards, which should be available so you could hand them out to threes…. for example

[Scott] 9:31 pm: or is it the wrath of The Blood Sugar Fairy??

[The LIVabetes Glucose Goddess] 9:32 pm: It is the standard you cant’s or you shouldn’t

[Dr. Polonsky] 9:32 pm: i always suggest finding a nice calm moment to talk with your loved ones who are acting like Police, and….

[Dr. Polonsky] 9:33 pm: first remember, because they care, they will never, ever stop…

[Dr. Polonsky] 9:33 pm: so you must DISTRACT them…

[Heidyn] 9:33 pm: smack them upside the head?(just kidding…)

[AllisonBlass] 9:33 pm: I try to use the opportunity to educate them. To tell them why I can do it even though I have diabetes. Most people are just confused….

[Gina - Type 1 dxd Nov 2000] 9:34 pm: I sat my friends down when they were trying to be the police and explained everything to them in a calm manner and they appreciated it in the end

[Dr. Polonsky] 9:34 pm: tell them exactly how they COULD be of help. give them something to do. AND let them that their comments, even when they are right, just aren’t helpful. also, like allison said, educating them can work..

[The LIVabetes Glucose Goddess] 9:34 pm: I find that I constantly try to educate my family and friends and sometimes just choos to withdraw instead.

[Dr. Polonsky] 9:34 pm: thanks for that comment, gina. perfect.

[Gina - Type 1 dxd Nov 2000] 9:35 pm: i think that a lot of people just don’t understand
[AllisonBlass] 9:35 pm: Well, here’s another little secret: Ignore them!

[Gina - Type 1 dxd Nov 2000] 9:35 pm: back in the day people were told not to have things but these days you can have everything in moderation

[Dr. Polonsky] 9:35 pm: not to toot my own horn, but let them read the chapter in my book (Diabetes Burnout) about the diabetes police. sometimes that can help to start a nice conversation… and change!

[AllisonBlass] 9:35 pm: Sometimes when they say “Can you eat that?” I just say “Yes” and then take a big bite of whatever it is.

[Scott] 9:35 pm: It seems like the media doesn’t really help … I see mis-information in news articles re: diabetes every week!

[The LIVabetes Glucose Goddess] 9:36 pm: yes it is true… Thanks Doc…I love the work you do and your book

[Dr. Polonsky] 9:36 pm: scott, the media clearly doesn’t help!

[onepfalzer] 9:16 pm: what of i do if i think 1 of my meds is making high BS – Zetia, I’m type 1.5 for 8yrs on insulin, + metformin

[Dr. Polonsky] 9:37 pm: well gosh, onepfalzer, you may be right! why not talk to your doc or pharmacist ASAP! there certainly are meds that can do that.

[onepfalzer] 9:38 pm: my docs said ………..not supposed to!!

[Dr. Polonsky] 9:38 pm: however, I’m certain that neither insulin or metformin is not raising your bg’s. which med?

[onepfalzer] 9:39 pm: Zetia……..its has changed the absorption I think

[onepfalzer] 9:40 pm: my doc it trying to raise my HDL’s

[Dr. Polonsky] 9:41 pm: you can always try, with your doc’s collaboration, an experiment. stop zetia for x period of time and see if bg’s change. but do it with your doc please!

[onepfalzer] 9:41 pm: thanks

[rjommp] 9:18 pm: Have some major life effecting complications that can’t all see
m to be documented with tests but they appear to be neurological and am frustrated by not knowing exactly what is causing the problem

[Dr. Polonsky] 9:42 pm: rj, well that sucks. have you seen specialists? another thought….

[rjommp] 9:43 pm: Yes i have been to a Neurologist

[Dr. Polonsky] 9:43 pm: I am a big fan of Joslin’s DOIT program (diabetes outpatient and intensive treatment), a 3 1/2 day intensive program, very personalized, that can help you to get to the bottom of probs like this…. know about it?

[rjommp] 9:44 pm: No haven’t but thanks for the suggestion.

[rjommp] 9:44 pm: just getting there with limited finances

[Dr. Polonsky] 9:44 pm: what i like about very specialized programs like this is that they can hook you up with diabetes-knowledgeable neurologists, who’ve seen it all.

[rjommp] 9:45 pm: Are there any in Michigan

[Dr. Polonsky] 9:45 pm: the $$$ issue isn’t an easy one. sometime insurance covers. check it out at the website, <a href=”http://www.joslin.org”>www.joslin.org</a>.

[rjommp] 9:45 pm: thanks again Dr

[Dr. Polonsky] 9:46 pm: in Michigan? i don’t know. i know that they have an awesome diabetes program at the U of Michigan. contact Martha Funnell there for guidance and advice re availability of the right stuff at U of M….

[trish] 9:38 pm: Does clinical intervention/counseling at an early age help at all?
With coping skills? Any research on this?

[Dr. Polonsky] 9:47 pm: not sure i understand the question, but i won’t let that stop me….

[Dr. Polonsky] 9:48 pm: it seems likely that when you grow up with diabetes in the “right way”, its easier to deal with as an adult. for example…

[trish] 9:48 pm: Me neither…can seeing a counselor to deal with small issues help to prevent bigger ones later?

[Dr. Polonsky] 9:48 pm: Yes, trish. absolutely. what are you thinking of?

[trish] 9:49 pm: I’m thinking that, while I cannot “prevent” burnout in my 8 yr old, can seeing a counselor significantly help?

[trish] 9:49 pm: Before the issues fester? Have there been any studies on this?

[Dr. Polonsky] 9:50 pm: good question. perhaps it would help, depends on the counselor of course. but there may be other things to do. things we do know about. for example, is everyone eating the same way as your daughter?

[trish] 9:50 pm: Yes. One for all…

[Dr. Polonsky] 9:50 pm: your daughter shouldn’t be restricted to “special meals”, while everyone else eats “real food”

[Dr. Polonsky] 9:50 pm: great!

[Dr. Polonsky] 9:51 pm: a second issue is making sure you share all diabetes tasks..

[Dr. Polonsky] 9:51 pm: she shouldn’t have to do it all, or nothing.

[trish] 9:51 pm: OK…

[Dr. Polonsky] 9:51 pm: your daughter needs to know she doesn’t have to be alone with this crumby disease. and that it doesn’t have to be horrible

[trish] 9:52 pm: Gotcha. I hope I am doing that.

[Dr. Polonsky] 9:52 pm: its tough being a parent with a kid with diabetes. talk about stress and guilt
[Dr. Polonsky] 9:52 pm: 1 hang in there

[trish] 9:52 pm: Thank you for your advice tonight.

[Scott] 9:18 pm: How about asking Dr.
Polonsky what the signs are for depression
that require seeking counseling and/or
medication.
[Scott] 9:20 pm: How are you doing?
[Scott] 9:24 pm: Dr. Polonsky, how much
is the BDI doing as far as working to help
diabetes educators, endocrinologists, etc.
recognize and properly address issues
related to depression

[Dr. Polonsky] 9:53 pm: scott, we do have a depression program, and we do travel around the country lecturing and training providers about depression and burnout in diabetes. our very formal programs should start in the Fall for providers.

[Dr. Polonsky] 9:54 pm: I’m still amazed that providers are surprised by the strong link between depression and diabetes. they love to hear about this!

[AllisonBlass] 9:47 pm: “I do a lot of mentoring with teens with diabetes, and I’ve found that even those most of these kids haven’t had diabetes for that long, they burnout so fast (mostly because of being “different” from their peers. Even though I’m 20 and have had diabetes since I was 8, I don’t always know how to address their issues of denial and depression. Any pearls of wisdom you could offer?”

[Dr. Polonsky] 9:55 pm: oh goodness, I’m no expert when it comes to teens, but…..

[Dr. Polonsky] 9:56 pm: i know that teens get a lot of pressure to be more motivated by parents and to take this diabetes more seriously, but….

[Dr. Polonsky] 9:56 pm: that’s tough when you’re a teen and feel immortal. AND

[Dr. Polonsky] 9:56 pm: as you mentioned, the not wanting to be different is REALLY tough.

[Dr. Polonsky] 9:57 pm: when i work with teens, i like to work with whole families. making sure we know who is responsible for exactly what. trying to get kids to be at least a little more responsible, while helping parents to back off (at least a little)…

[Dr. Polonsky] 9:58 pm: so what do i recommend? probably what you’re doing with those teens, just being a good listener. Diabetes IS tough, especially for them..

[Gina - Type 1 dxd Nov 2000] 10:00 pm: Doc, i was diagnosed with type 1 when i turned 25 yrs old and i have noticed i get down a lot because i feel as though my life is always turned upside down and always have a feeling of diabetes, i also have the feeling of I HATE DIABETES ALL THE TIME. is there a way to calm down without going to a therapist and do you feel a lot of older adults diagnosed with type 1 have this problem

[Dr. Polonsky] 10:01 pm: Shocking? You don’t love your diabetes?

[Gina - Type 1 dxd Nov 2000] 10:01 pm: haha

[Dr. Polonsky] 10:02 pm: In truth, few people are thrilled about it. what I’d recommend is take it part. what are the top 3 things you hate about it? yes, i know there are a million, but…
[Gina - Type 1 dxd Nov 2000] 10:02 pm: that’s easy

[Scott] 10:01 pm: Everyone, I’d like to share with you something from Dr. Polonsky’s BDI website you may find useful. The following pages describe 10 important tips for mastering the emotional side of diabetes. You may also click here ( <a href=”http://www.behavioraldiabetes.org/downloads/Diabetes-10-things-brochure.pdf”>http://www.behavioraldiabetes.org/downloads/Diabetes-10-things-brochure.pdf</a>) to download the PDF brochure version of this booklet.
[Scott] 10:02 pm: Sorry, once again 10 important tips for mastering the emotional side of diabetes. You may also click here <a href=”http://www.behavioraldiabetes.org/downloads/Diabetes-10-things-brochure.pdf”>http://www.behavioraldiabetes.org/downloads/Diabetes-10-things-brochure.pdf</a> to download the PDF brochure version of this booklet

[Dr. Polonsky] 10:02 pm: once we know those top 3, we can begin to problem solve. is there something even small we can do to address even one of those issues?

[Gina - Type 1 dxd Nov 2000] 10:02 pm: checking my sugars, counting carbs and giving myself a shot

[Dr. Polonsky] 10:03 pm: so we might start with checking sugars. what’s tough? doing it, seeing the results, not sure what to do next, etc. we take it apart, and figure out what to do! for example…

[Gina - Type 1 dxd Nov 2000] 10:03 pm: seeing the results mostly
[Dr. Polonsky] 10:04 pm: i don’t know your situation exactly, but many people get terribly upset about the numbers they see and forget– ITS JUST A NUMBER! not a statement of self-esteem..

[Gina - Type 1 dxd Nov 2000] 10:04 pm: doing everything i am supposed to and still seeing a high sugar

[Gina - Type 1 dxd Nov 2000] 10:04 pm: it makes me crazy

[Gina - Type 1 dxd Nov 2000] 10:04 pm: you feel like giving up

[Dr. Polonsky] 10:05 pm: so we cant solve it all right now, but that’s right– it feels like too many straws on the camel’s back. the solution. one straw at a time. as scott mentioned, you might want to read my chapter about the “blood sugar fairy”. you’ll see.

[Gina - Type 1 dxd Nov 2000] 10:06 pm: ok i will

[Dr. Polonsky] 10:06 pm: also, we have been suggesting that you take a piece of making tape, put it under the window on your meter, and write– its just a number!

[Gina - Type 1 dxd Nov 2000] 10:06 pm: ha

[Dr. Polonsky] 10:06 pm: another step would be to make sure you have VERY clear goals. At what number should you decide that this is just terrible and must do something.

[The LIVabetes Glucose Goddess] 10:07 pm: Hey Gina…Have to share a thought. I I try to think of your BG meter as a compass to a mountain climber…just give you information on your current status so you can determine what action you need to take in order to reach your goal…it helps me to think of it this way.

[Scott] 10:07 pm: Dr. Polonsky, I hate the term “control” for blood sugar management. We do not control everything, only a handful of elements in the grand scheme of everything, yet the medical profession loves using the term “control” instead of manage.

[Gina - Type 1 dxd Nov 2000] 10:07 pm: ha that’s a good way to think of it

[Dr. Polonsky] 10:07 pm: right, scott. i hate the term control as well. its just good BG management, not control.

[AllisonBlass] 10:07 pm: Dr. Polonsky, you sound like my dad… He’s been telling me for years that “It’s just a number!” and that he thinks the greatest fault of people with diabetes or caring for the disease is getting emotionally bent because of a BG reading… which really is just counterproductive…

[Dr. Polonsky] 10:08 pm: uh oh, sounding like your dad. that worries me!

[AllisonBlass] 10:08 pm: no no, my dad’s cool!

[Gina - Type 1 dxd Nov 2000] 10:08 pm: DR. DAD lol

[Dr. Polonsky] 10:08 pm: thx allison!

[AllisonBlass] 10:08 pm: lol.

[Dr. Polonsky] 10:10 pm: Heyy LLG, like the compass idea!!

[Dr. Polonsky] 10:10 pm: I mean LGG

[Dr. Polonsky-&gt;Gina - Type 1 dxd Nov 2000] 10:10 pm: how bout one more…

[The LIVabetes Glucose Goddess] 10:11 pm: Thanks it works for me…I found i needed to re-establish my relationship with my meter

[Dr. Polonsky] 10:11 pm: I’ve got time for one more. gina?

[printcrafter] 9:19 pm: D people 2x at risk of depression. ‘Cause it is hard or bio-medical reason?

[Dr. Polonsky] 10:12 pm: Ah, why is depression elevated in people with diabetes, especially type 2?

[Dr. Polonsky] 10:12 pm: one reason is— all the other stuff. it turns out that depression is elevated especially high in people with diabetes who have OTHER disease problems (hypertension, arthritis, etc).

[Dr. Polonsky] 10:13 pm: if you have diabetes and no other disease problems, depression rates don’t seem to be that high

[printcrafter-&gt;Gina - Type 1 dxd Nov 2000] 10:13 pm: I’ll scroll back and get it….multi tasking!
[Dr. Polonsky] 10:14 pm: also, there is new evidence that depression may contribute to the development of type 2 diabetes, not type 1!

[Dr. Polonsky] 10:14 pm: this may be behavioral, depression leads to poor self-care, making diabetes more likely in those genetically predisposed. OR depression may contribute to insulin resistance directly, the core problem in type 2 , not type 1

[Dr. Polonsky] 10:15 pm: wild, huh?

[Gina - Type 1 dxd Nov 2000] 10:15 pm: that is

[Dr. Polonsky] 10:15 pm: of course, i also think that just the hassles of diabetes can also make depression more likely. the core feature of depression is a feeling of powerless ness…

[Gina - Type 1 dxd Nov 2000] 10:16 pm: wow you just summed me up

[Gina - Type 1 dxd Nov 2000] 10:16 pm: powerless

[Dr. Polonsky] 10:17 pm: I’m really enjoying this, but I need to sign off shortly and go grab some dinner. I hope you’ll invite me back sometime!

[Scott] 10:17 pm: we’d love to have you join us again in the future, Dr. Polonsky!

[Gina - Type 1 dxd Nov 2000] 10:17 pm: and thank you so much for doing this guest chat it was a great success

[rjommp] 10:17 pm: Good night Dr

[The LIVabetes Glucose Goddess] 10:17 pm: Thanks for sharing your wisdom Dr.P

[Gina - Type 1 dxd Nov 2000] 10:17 pm: nite doc and thanks again we will be contacting you

[Dr. Polonsky] 10:18 pm: I didn’t know I could type this fast (faster than my brain)…… Thanks again, and see you all again soon!

[Jon] 10:19 pm: Thanks Dr. Polonsky!

[Scott] 10:19 pm: Please visit the Dr. Polonsky’s Behavioral Diabetes Institute’s website at <a href=”http://www.behavioraldiabetes.org/”>http://www.behavioraldiabetes.org/</a> for newsletters and updates on scheduled events in the future

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