February 27, 2006

Pyschological Effects of diabetes

by



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: Tonightโ€™s Special Guest is Dr. Wendy Rapaport, LCSW, PsyD

[Jon] 6:01 pm: Tonightโ€™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 Tonightโ€™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. Donโ€™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 ๐Ÿ™

[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 ๐Ÿ™‚ 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 ๐Ÿ™‚ you wear perfection well ๐Ÿ˜‰ 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: ๐Ÿ™

[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 ๐Ÿ™‚ 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 donโ€™t like burdening anyone with my care

[gina] 6:35 pm: I donโ€™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 donโ€™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 thatโ€™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 donโ€™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: itโ€™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 ๐Ÿ˜‰ 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, Iโ€™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 ๐Ÿ˜‰

[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: itโ€™s more like survival

[AllieB2] 6:57 pm: I second that notion, Scott! Well put ๐Ÿ˜‰

[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 ๐Ÿ˜‰

[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: ๐Ÿ˜›

[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” ๐Ÿ˜‰

[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 ๐Ÿ™‚

[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 ๐Ÿ™‚

[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: ๐Ÿ™‚

[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 ๐Ÿ™‚

[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 ๐Ÿ™‚

[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 ๐Ÿ™ 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.