It’s easy to get discouraged when you must deal with your diabetes day in, and day out. With the usual life stressors, the prescription is always “Get away from what is causing you stress for awhile.”
That doesn’t work with diabetes, because if we step away from it and we don’t pay attention to it, or manage it well, we are looking at possible long-term complications.
If you have managed to ignore your diabetes symptoms, the complications that can occur from uncontrolled diabetes are impossible to ignore. What’s more, they can decrease the quality of life that you enjoy, and put you more at risk for an early death related to your diabetes.
They can even cause you to lose your hearing, or have the debilitating gastrointestinal issues that come with nerve damage from diabetes (gastroparesis). The long-term effects of diabetes that is unmanaged can affect every organ and system in the body adversely.
Keith came in after three calls for diabetes education, and two missed appointments. He looked frustrated, and didn’t seem engaged. Keith has had Type 1 Diabetes for the last 12 years. He is now 32 years old, and works the night shift, where his supervisor gives him a difficult time by not allowing him breaks to take care of his diabetes.
Keith has been in and out of the hospital with diabetic ketoacidosis four times in the last six months. Admittedly, Keith has not been taking his insulin as directed by his doctor. His insulin pump failed six months ago, which was what landed him in the hospital the first time.
Now, Keith is afraid of insulin pump therapy, and states he would rather give multiple injections. Still, Keith admits that most of the time lately, he just wishes that he didn’t have diabetes. He’s tired of dealing with it, and he has been letting his guard down on his diabetes management.
At this rate, Keith is indeed headed for a diabetic coma that he wouldn’t come out of if he doesn’t change his attitude towards his diabetes very soon. Digging deeper into Keith’s life, he stated that he didn’t see much reason to keep trying as he felt hopeless, and was feeling down and depressed up to four days out of a week.
When thinking of a prescription that could help Keith, diabetes education is not one. Why? It will not help Keith because he has had diabetes education, and he is able to recall all information related to his diabetes management, so understanding his diabetes is not part of Keith’s problem.
In exploring what might help Keith, he was offered several things that might help. One was a diabetes support group that met in the evenings at a local church. There, Keith would meet other people with Type 1 Diabetes. The group had three Type 1s, and a total of 10 members.
Keith also accepted a mental health referral, so he can talk to someone about his hopeless feelings, and to learn to deal with his depression. We scheduled another visit in a month, to check his progress.
Keith agreed to take his insulin injections as directed in the meantime, and was looking for another job that would better suit him with diabetes that didn’t include the night shift, and an unsupportive supervisor.
One month later, Keith had attended the support group, and been to counselling. He stated that he hadn’t missed his insulin injections, hadn’t been back in the hospital again with DKA, and his blood sugar logs and A1C looked much better.
Sometimes, noncompliance in the patient with diabetes comes from depression. Keith started an anti-depressant treatment, and he went to counselling twice weekly. The counselling, along with the support group, gave him hope to begin taking care of himself again.
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Is it a misconception when people say that managing diabetes is out of their control?
There are many reasons that can make people feel that their diabetes is out of their control. Depression and hopelessness play a big part. People with diabetes tend to have more depression symptoms than people without a chronic illness.
Often, people need education related to their diabetes, and how to better manage it. Once they learn these skills, they can then often become engaged in their healthcare.
In other situations, such as with Keith, they know what to do about their diabetes, but they stop doing it. This can occur after a number of years with diabetes, and can be referred to as “diabetes burn-out.”
Diabetes is a controllable disease
Diabetes is a chronic disease that can be controlled. It’s not easy for people who must take multiple injections or perform other taxing diabetes care to stay on their game all the time. Diabetes burn-out is real, and it affects many people with diabetes, both Type 1 and Type 2.
Sometimes, no matter how much a person tries to manage their diabetes, the situation can take a turn for the worse. This could be due to not understanding what you need to manage your diabetes, deciding that you will not “do diabetes” for awhile, and just ignore it, or when your medications and treatments are not adjusted correctly to your needs.
It can also occur from repeated attempts to get things right, that result in the person with diabetes feeling like they have failed. When incentive to do better is removed, there is no more motivation to try. This can certainly affect the way people with diabetes view their condition, and how much they tend to it.
Lots of planning and caution goes into managing diabetes
Taking care of diabetes is a lifelong process once the person is diagnosed. In some cases, they may be able to reverse their Pre-Diabetes or Type 2 Diabetes, but not with a person with Type 1 Diabetes, that must take insulin to survive.
Similarly, some people with Type 2 Diabetes who take insulin or multiple medications, can have a difficult time getting good control. When this happens over time, and the person feels helpless, they will sometimes give up.
When people get tired of planning their day to day diabetes management, and letting down their caution with relation to high blood sugars, they can put their health at great risk.
Signs that your diabetes is not under your control
The three main signs that your body may give you when your diabetes is out of control are referred to as the “3 Polys,” or the cardinal signs of diabetes.
Polyuria (excessive urination)
When your blood sugar is floating in your blood, and it can’t get into your body cells to be used for energy, it must go somewhere. Your kidneys get rid of it for you through your urine. This results in excessive urination, or polyuria.
Polydipsia (excessive thirst)
When your kidneys send all the blood sugar out through your urine with polyuria, you also get extremely thirsty. You may have one hand on the bathroom door, and one hand holding a jug of water. It can be that severe with excessively high blood sugars.
Polyphagia (excessive hunger)
Your body cells are starving, so even though you have high blood sugar, and you have the sugar that you need in your blood stream to feed your body cells, there isn’t any or enough insulin to get the blood sugar where it needs to be.
This causes excessive hunger, or polyphagia. If you continue to eat with high blood sugar and not enough insulin to deal with it, then you will have an even higher blood sugar.
Other signs that your diabetes is out of control
When blood sugar sits in the blood stream, and it can’t get into the cells of your body to be used for energy, it makes you feel lethargic. Fatigue and low energy can be a sign that your blood sugars are too high, and your diabetes is out of your control.
Blurred vision, or visual changes
If you are having trouble with your vision fading in and out, and sometimes your vision is fuzzy, then your diabetes may be causing the lenses in your eyes to swell, and lose their sharp focusing capabilities. High blood sugars over time can cause blindness, but prior to that, an out of control diabetes can cause a number of visual problems, including glaucoma.
All the hunger that results from high blood sugars causes you to eat more. The fact that your body cells aren’t getting the sugar for energy causes your body to shift to burning fat and muscle for energy.
Even though you are eating more and more, you still lose weight. Loss of muscle mass causes problems with the ability to stand and balance, and the person with diabetes may have muscle aches, and weakened muscles.
Dry skin and skin changes
There are numerous problems that can develop with the skin as a result of diabetes. By far, the most common is dry skin. Dry skin can break down and cause an area of open skin, which then can be difficult to heal. In addition, skin tags can develop.
There is also a condition known as Acanthosis Nigricans, which is the development of darkly pigmented skin on the back of the neck, hands, face, or palms, of a person with diabetes. This is due to high blood sugars, and deposits left in skin.
People with diabetes get skin infections much more often than the general population. If you see problems developing with your skin, no matter how mild and you have diabetes, then make sure to talk with your healthcare provider.
Cuts and sores that won’t heal
Decreased circulation to the arms, and especially the lower legs, along with nerve damage from diabetes, can cause even small cuts and scrapes to cause a problem. High blood sugar is like syrup going through the blood stream, and when it gets in the tiniest veins in the tips of your toes and fingers, it makes the wound bed sweet and sticky.
A sweet and sticky wound bed promotes the growth of bacteria, and infection can progress to gangrene, and amputation quickly. The story of Henrico, in our article, “Diabetes and Hispanic Farmworkers: A Family Affair,” illustrates how quickly a small blister can become gangrenous, and require amputation. Once an amputation is performed, life expectancy is decreased to approximately five years.
Numbness and loss of feeling in the extremities
People with diabetes who develop tingling in their feet and hands, or even the lips are usually experiencing diabetic neuropathy. Nerve damage from diabetes makes it harder to feel if you injure your extremities, so it’s important to check your feet every single day when you have diabetes. Numbness can develop into severe pain, as nerve damage from diabetes becomes worse. 1
Tips to bring it under your control
Since we now know what can happen if we don’t keep our blood sugar under control, let’s look at some tips to get it in control before you develop any of the complications listed below. If you don’t do something now, these complications may creep up on you over time. Once you have the complications, there is no reversing them, but you can do something to prevent them now by being proactive.
Check blood sugars often, and use your results
It’s great to check your blood sugars regularly. If you check them, but don’t use your results to better manage your diabetes, then you are missing the point. It’s not just a number to show your doctor once every three months, so that he or she may adjust your medications.
When you check your blood sugars, you can look at your results, and better figure out how to balance your intake of carbohydrates with your activity. You can decide to take an extra walk if they are high, add in a morning snack for a mid-morning low, or plan to eat less carbohydrates the next time for a high blood sugar.
Check blood sugars for issues at different times of the day
If you check your blood sugar only once or twice a day, and affording blood sugar testing strips is an issue for you, then you can check at different times of the day in order to learn your blood sugar patterns. For example, if you check once daily, on Monday check your fasting blood sugar. On Tuesday, check two hours after breakfast, and on Wednesday, check two hours after lunch. On Thursday, check two hours after supper, and then on Friday, check a fasting blood sugar, and repeat.
This way you will have some readings at all times of the day, which will make it easier to spot your patterns, and make adjustments that better get your diabetes managed.
Get back to the core of your original diabetes education goals
Did you always count carbohydrates faithfully, and now have gotten off your game, and are just eye balling things? If you aren’t truly counting your carbohydrates, then get back to it. Think about the motivation that you once had, how you obtained it, and what you could do to get it back.
Take a diabetes education refresher course, or join a support group
If you know you just need a little extra boost, then getting your two hours of diabetes education that is part of your insurance benefit each year may be all it takes to get your management going again.
Learn your diabetes numbers
If you don’t know what your A1C is, then ask your doctor for your number. Find out how far you need to get it down, so that you will have managed diabetes. In addition, work on getting your blood sugars in your target range. Speak to your Certified diabetes educator, or your healthcare provider to learn what your targets are.
You will also need to know your blood pressure and cholesterol numbers, and work to get those under normal limits, by eating healthy fats, watching your salt intake, and getting enough exercise.
Get a new prescription for exercise
Join a walking group, or ask a family member to participate in physical activity with you. Chances are, there are some people to ask who are just waiting for someone to help them with an extra push to get started. Try new activities, and use exercise for what it really is: the very best prescription for your diabetes.
If you’re not sure that you’ll be safe to move, see your doctor for a physical therapy evaluation to make a plan that will work to get your diabetes in control, without injuring yourself in the process.
Not only will exercise help your diabetes management, but it will also help your outlook on life, as exercise helps the brain to release chemicals that help us to be happier.
Speak to a professional if you feel too depressed to deal with your diabetes
If you know what to do about your diabetes, and you have simply lost your motivation to do it, then seeing a professional about your issues may be the best thing to do. You should speak with your Diabetes Care Team about a counsellor near you, a support group, or both.
Do whatever you need to do to get your motivation back. Your diabetes management is important, and it affects your health and lifespan. Good luck in your efforts to jumping back on the diabetes wagon. If you fall off, get up, brush yourself off, and move on. Taking care of your diabetes can mean that you live healthy with it. 2
What can happen if your diabetes is always out of control?
Diabetes affects the entire body, including all the organs and vessels that feed them. Down to the tips of your toes, your diabetes can affect your circulation. With circulation issues, and nerve damage from diabetes, you may have a non-healing ulcer that progresses to gangrene, and amputation.
You can lose your hearing with diabetes, and this is somewhat of an unknown complication. It rarely gets attention. Loss of hearing with diabetes occurs when nerve endings and circulation to the ears are compromised, resulting in gradual loss of hearing.
When nerves are damaged from diabetes, we asee that there is a decreased muscle control and functioning of the bladder, and also of the gastrointestinal tract. Both can lose ability to function appropriately, resulting in loss of bladder control, or problems with gastroparesis, where the stomach’s ability to empty and move food through the GI tract correctly is impaired, resulting in uncomfortable feelings of fullness, constipation, and other bowel issues.
Dental problems, including infection of gums and underlying structures in the mouth, and periodontal disease are much more common with diabetes. This results in tiny pockets where the gums should hug the teeth. Particles of food and bacteria get in these pockets, causing an inflammation of tissues that can damage bone under the teeth, as well as the teeth themselves.
Your mouth can get dry from prolonged blood sugars, which also contributes to dental problems. Mouth sores, and pain in teeth and gums can develop.
Related to your vision, you may notice that you have more trouble reading the things that you used to read with ease.
Your skin can become dry, and when it cracks, bacteria can get in and cause an infection. People with diabetes are more prone to skin infections, including some particularly aggravating and uncomfortable ones, like folliculitis.
Nerve damage can cause feet and hands to feel numb, and make it more likely for a person with diabetes to step on something sharp and not feel it. There can be a considerable amount of pain that goes along with diabetic neuropathy. Even light covers over your feet and hands may cause pain when you try to sleep.
Sexual intercourse becomes difficult, either due to erectile dysfunction in men, or due to vaginal dryness in women.
Aside from all those things that can happen to you with uncontrolled diabetes over time, there is heart disease, and heart attacks, strokes, and even Alzheimer’s disease. It’s time to get yourself back on track to avoid these complications. Best of luck in your efforts.
Over to you
We hope that this article will help you to decide what you need to do to get back on track to control your diabetes. Let us know how you got back on the wagon after losing your motivation to manage your diabetes. Our readers may gain some insight from your personal experiences.