HealthCentral colleague, Gretchen Becker, recently posted a blog on The Stages of Diabetes. Through Dr. Kubler-Ross’ analysis of the grief process: denial, anger, bargaining, depression, and finally acceptance, Gretchen has defined her path with type 2 diabetes. Her blog certainly captured my attention since I must go through this process in an ongoing, continual daily basis.
I care for approximately 600 (out of nearly 1,800) patients in our Childhood and Adolescent Diabetes Program at Children’s National Medical Center. Each child/adolescent and family has their own unique way of processing how this new diagnosis has changed their lives. As I reflect upon my upcoming week “on service,” where I am responsible for all newly diagnosed patients at Children’s National, I am acutely aware of this process, especially the initial stages, denial and anger, and how I interact with the newest members of our Diabetes family. I also would like to add another initial stage to the process, shock, which generally precedes the denial stage.
In parallel with Gretchen’s progress in living with type 2 diabetes, I would like to present how I have faced (and hopefully helped families work through) the stages of adaption to the diabetes diagnosis and perceived loss of normalcy.
Diagnosis of a child/adolescent (or nearly anyone) with an (as yet) incurable illness is shocking. People immediately revert into a “haze” where they have difficulty attending and receiving information. In many situations, after discussing the new diagnosis of diabetes, no new information is retained. Imagine the necessity of teaching “survival” skills in the next 24 hours to safely send the child/adolescent home. Therefore, the initial goal of the diabetes team is to empathetically work through the initial shock to begin the actual diabetes education. As the physician, I am often questioned multiple times how I can be so sure of the diagnosis in such a short period of time. This makes sense. How can one diagnose a potentially incurable illness based on one blood test and a brief history?
The diagnosis of diabetes is relatively straightforward, especially in children and adolescents who present with the classic symptoms of weight loss, increased drinking, increased urination, and increased appetite. Confirmation with a blood sugar greater than 200 mg/dl confirms the diagnosis. I then do my very best to “stamp out guilt” in the caregivers as in nearly every situation there is an enormous degree of guilt. The following are often comments that I hear.
-How could we have missed these symptoms? He lost 25 pounds in 2 weeks?
-It must have been the birthday cake or _________ that was the cause.
-My family has a history of type 2 diabetes, so I am to blame.
There is no blame. No family member is responsible for the diagnosis. Yes, it is a combination of genetics along with environment in type 1 diabetes. Familial factors do play a role in the development of type 2 diabetes along with the environment. However, to focus on blame will be a barrier to education. Therefore, the first step is to make attempts to alleviate emotional distress and eliminate the blame factor. Emotional concerns must be addressed before conducting any educational sessions.