In the absence of preventive strategies, emotional and psychological trauma that results from diagnosis and management of diabetes could eventually lead to depression. Final-year medical student Boitumelo Rakwena, says medical research has shown that sustained pressure on the brain, due to life-threatening medical conditions, is a silent killer that is only second to cardio-vascular disease.
“This influences patients to experience unpredictable mood tantrums most of the time,” says Rakwena.
When addressing a bi-monthly diabetes support group (DSG) meeting on factors that influence emotions and psychology at Princess Marina Hospital last week, Rakwena cautioned that continuous depression and irritation could lead to loss of energy and concentration as well as insomnia or hypersomnia.
“Other after effects would be feelings of worthlessness and diminished interest in the things one used to enjoy. Further, diabetics may potentially be anxious, fearful and worried about the accompanying stigma and stereotyping from peers, friends, family and colleagues,” said Rakwena.
Additionally, anxiety may happen if one was to a have a hypoglycaemic experience, leading to fainting in the absence of interventions. Hypoglycaemia, which sets in due to low blood sugar as a result of ill-nourishment or over-exhaustion, can be reversed through intravenous or oral glucose therapy. Diabetics may also be anxious about the long term implications of their condition.
“Furthermore, individuals with diabetes may experience excessive worry about death, what would happen to them, their loved ones and family members,” Rakwena said.
She added that common treatment for diabetic depression, shame, guilt and anxiety can help patients manage the condition and improve overall health. At present, the most common treatments for depression include cognitive behavioural therapy (CBT), a type of psychotherapy, or talk therapy in combination with antidepressant medication, relaxation techniques, breathing exercises and meditation. Rakwena said shame and guilt are the main forms of negative reaction to the self as both may exacerbate diabetic symptoms and need for assessment.
When a client fails to adhere to treatment, as the first steps towards enhancing compliance, medical practitioners must improve their communication style with patients, who often forget or misunderstand medical recommendations. This can be done by simplifying verbal instructions and using clear and straight forward language.
Social support through friends committed to the regimen also promotes compliance, positive attitudes, encouragement and praise. Likewise, self monitoring of treatment records and meals daily is equally important. Non-compliance and adherence to medication may be due to reliance on symptoms and assessment of glucose levels, which are not always accurate. Life circumstances like stress may also make it difficult to test glucose levels and take insulin on time or follow dietary and exercise advice. According to Dr. Dipesalema Joel, chairperson of Diabetes Association of Botswana, recently released statistics from the International Diabetes Federation show that 80 percent of people with diabetes live in low and middle income countries like Botswana.
He said instances of diabetes are high in these areas because of increased urbanization, unhealthy diets and increased sedentary lifestyle. He urged Batswana to intensify the fight against diabetes and adopt healthy lifestyles. Half of those who die from diabetes under the age of 60 do not know that it is a silent killer. Botswana is amongst the top five countries in Africa affected by diabetes, with a monthly average of 1000 diabetes patients.
Diabetes is an illness that affects the way the body uses digested food for energy. Most of the food we eat is broken down into a type of sugar called glucose. The body also produces a hormone called insulin, which assists body cells to absorb glucose and use it for energy. The problem with diabetes is that it reduces or destroys the body’s capability to make or use insulin properly. Without insulin, glucose builds up in the blood, and the body’s cells are starved of energy.