Building Competency in Diabetes Education THE ESSENTIALS

4-52 | CHAPTER 4

Practice tip: Denial is a common response to diagnosis, especially among individuals with type 2 diabetes, since, for them, diabetes onset is much less dramatic and the symptoms are often more subtle than those in type 1 diabetes. • Denial can even be healthy; if it protects newly diagnosed individuals from becoming emotionally overwhelmed. • Denial is destructive when it makes effective management impossible. Destructive denial can be difficult to identify. The external appearance of not being concerned about diabetes and its management may result from two quite different emotional foundations. • On the one hand, individuals may be unaware of the seriousness of diabetes. • On the other hand, individuals may be extremely threatened by diabetes and may use denial as a way of coping with their fear. Factors that may contribute to intense fear include perception of a need for unmanageable change in lifestyle or a family history of diabetes-related poor outcomes. Lack of concern may result from a belief that diabetes has few consequences or from misinformation, such as the belief that if one does not have to take insulin, the diabetes is not serious (28). Patients will usually need to acquire new coping strategies to deal with the many demands diabetes makes on their energy, attention, time and emotional strength. Management of the daily diabetes regimen may include: • BG testing. • Planning and preparation for exercise.

• Planning for healthy food choices. • Possible concurrent physical illness. • Fear of complications. • The responsibilities of a job, a social life and family commitments.

The goal of any intervention to promote effective coping is to improve one’s quality of life (QOL) (123). The question that needs to be answered is “What is the best way to intervene”? Assessment of patients’ coping strategies and support resources is the necessary first step to determine appropriate interventions. Developmental age, financial resources, medical state,