Copyright 2006 Sharon Crawford

When Karen Mercer was diagnosed at age 13 with Type I Diabetes, her doctor handed her a death sentence. “I was told that I would live to be 28 and I would never have children,” says the 62-year old mother of two and grandmother of three.
Not all the two million Canadians with diabetes receive such a diagnostic jolt. However, living with diabetes is stressful and can stir up a pot of emotions, including anger, sadness and depression, that feed on more than food. Depression occurs twice as often in diabetics than in the general population with 15 percent of diabetics suffering from major depression. Depression also interferes with handling diet, exercising and checking blood glucose levels. Throw in medical treatment for diabetes – oral and insulin, which both affect losing weight – and the emotional stew turns chaotic.
How do you shift the attitude from negative to positive? 
 “Diabetes is not about the diet,” says psychiatrist Dr. Barry Simon, the psychiatric consultant in the Leadership Centre for Diabetes at Toronto’s Mt. Sinai Hospital. “It’s about transforming you. Diabetes is a wake-up call, an opportunity to change and get your life on track.”  In his private Toronto clinic, Transformations, Dr. Simon, along with a dietician and lifestyle coach, helps diabetics get through their emotional hurdles. His practice addresses these eating issues: bingeing; using food to sooth stress, anxiety, worries, sadness and anger; perfectionist attitudes towards diet; sneaking into the fridge at 2 a.m.; eating to ease daily conflicts, and making food the new best friend or the only meaning in life. 
“In high school,” says Karen, “I was quite withdrawn.” She yo-yoed between an enabling mother and a strict father. If dad caught her with her hand in the cookie jar, he’d tell her she’d lost five years from her life.
Dr. Simon describes the classic male diabetic as “a 40-something-year-old guy who is eating in a very disorganized way.” Typically, breakfast is coffee, maybe a little food; he eats little more until evening when he constantly eats. He’s middle management, with one child in university, no time to work out and has gained over 30 pounds the last ten years. “Add their being stressed out and it’s not just a physical change in their body. There’s a disconnect from their inner behaviour and their outer behaviour.” The key is to slow down their stressful behaviour using biofeedback, employ cognitive therapy to change problem-solving habits, and help them organize their eating habits, including some self-talk relaxation strategies when standing at a buffet table.
With diabetic women (30 to 45 years) it’s body image, not the diabetes that motivates them to lose weight. They see-saw between daytime restrictive dieting and evening binge-eating. The key is teaching them strategies to deal with their emotions and to reorganize their eating habits. Studies show that keeping a daily food diary is the most powerful way to organize eating routines. “When you find yourself going for sweet or savory foods ask yourself, ‘What's really eating me?’ ”says Dr. Simon. “Pick a one-word emotion (stressed, annoyed, lonely, etc.) and decide what you really need instead of food and come up with two suggestions... and fill them out on an index card instead of eating.”

Karen adjusted. “There’s always been reasons why you had to get on with life.” First it was work – in 1966, she was the first nurse diabetes educator at the Toronto Hospital for Sick Children. Now, it’s the grandchildren.
Two years ago, diabetic circumstances forced her to adjust again. Her husband was bringing her orange juice at 3 a.m. because her blood sugar level plunged and her hemoglobin skyrocketed to 8. “It scared me,” she said. Now she’s on the pump, which delivers insulin continuously. Karen calls it her “artificial pancreas.” To keep going, she tells herself, “Go do it, Karen.”
Dr. Simon also suggests self-coaching. “Don’t think of yourself as a loser. Think of yourself as someone you’re excited about.” Ask yourself, “what can I do right now? I can do it.” When you goof, think, “I made a mistake. Next time I will do better. Take an action step right now.”  Dr. Simon compares it to a baby learning to walk. “You’ll spend a lot of time on your butt after a setback. Cheer yourself for each step you take.”
Setting goals in the first person, present tense gives you power. Write them down, post them on the fridge and review them daily, suggests Dr. Simon.
Sometimes you need help. Enter support groups. The Canadian Diabetes Association runs peer support groups of eight to 10 people in nine regional offices across Canada. The purpose is “for like-minded people to get together to talk about their personal experiences living with diabetes,” says Alexis Mantell of the Canadian Diabetes Association. Volunteers run monthly meetings where participants learn diabetes management, dealing with emotions, making healthy lifestyle changes and about the CDA and other diabetic services. Karen founded and ran a Richmond Hill, Ontario group which continued for three years with 12 to 15 people, then dropped down. “People feel they’ve gained all they can and then they move on.” She currently goes to another CDA peer group focusing on pump use and meal plans when travelling.
Dr. Simon runs groups – eight sessions and 13 bi-weekly sessions where members learn psychological skills, problem-solving techniques, give and receive peer support and they realize they’re not the only one struggling. “The synergy of the group gets people to change,” he says.
Part of change is to get moving with exercise. According to an article by John Hunt, MD, in the CDA’s Diabetes Dialogue, exercise lowers blood sugar and blood pressure, improves body flexibility, muscle strength, blood circulation, heart function and stamina. He calls exercise “activity.”
Activity works for Dr. Simon – even housework counts. “We like people to get moving, to go to what they like. Half join a resistance-training group, the other half walk. Next level is machines (e.g., stationary bikes). We work with the family doctor to make sure they’re not doing something they shouldn’t do.”
To relax, diabetics can do deep breathing and meditation. Dr. Simon uses the Five-Minute Heart Math breathing technique, which concentrates on holding your hand over your heart, thinking of someone who makes you feel positive, and deep breathing through your heart area. “If you feel dizzy, then breathe out through your solar plexus, but still breathe in through the heart area,” he says.
Living with diabetes doesn’t have to feel like a death sentence. “Every day is a gift,” says Karen Mercer.