DIABETIC REACTIONS

The weakness, excessive thirst, loss of weight, and other symptoms characterizing diabetes mellitus are due to low sugar metabolism resulting from a deficiency of insulin. Although the basic cause is physical, and usually constitutional, the onset and course of the disease are known to be greatly influenced by personality and emotional factors. Psychiatry therefore has much to contribute to the problem of treatment and management of diabetics.Psychophysiologic (psychosomatic) investigations have shown that the blood sugar level of diabetics rises during periods of emotional stress. Many attempts have been made to find a common denominator among these situations, but there is no universal agreement on this question. Nor is there agreement on a basic personality structure of diabetic patients. Some studies, however, indicate that they tend to be passive, somewhat immature individuals who need an unusual amount of attention and affection. When these needs are frustrated, they feel anxious and depressed, and at this point diabetes may set in or become exacerbated. Sometimes the precipitating event is a feeling of abandonment due to loss of a person on whom the patient is dependent, through separation, jilting, or divorce.Although the management of diabetes is the responsibility of the physician, there are many areas where psychiatric assistance can be helpful. Some patients are precipitated into dangerous states of acidosis or insulin coma by acute but transient emotional disturbances. Severely depressed men and women sometimes act out suicidal drives by giving up their diets or neglecting to take insulin. Many adults have sexual difficulties that interfere with their adjustment: diabetic men are often impotent, and diabetic women may be deeply concerned about having children. If a child is bom to a diabetic woman with a dependent personality, her need for attention and care may be accentuated to a point where the child becomes a rival. If an immature diabetic husband is made to feel neglected, he may go off his diet and medication, or he may feel so resentful and anxious that his metabolic balance becomes disturbed and his blood sugar level elevates.Many diabetic children present psychiatric problems. Some have difficulty adapting to the strict diet because their parents have let them eat whatever they wanted in the past. Others feel rejected when deprived of foods they want because of an unconscious connection between food and love, or because their parents have used candy as a reward. The problem of diet sometimes becomes a focus of other tensions between the child and the parent. As a result, the parents may be oversevere and perfectionistic in keeping the child to the diet, and the child may react by either refusing to eat at all or by violating the diet and lying about it. A psychiatrist may be called upon to help the parents understand the child’s problem and mitigate the conflict between them; he may also be needed to interpret the child’s reaction to the internist. In some cases, too, he may suggest modifications of the diet and insulin regimen that will be more acceptable and workable.