Psychological Issues in Diabetes in afya

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At new diagnosis
confusion over diagnosis
threatens role as fit, breadwinner - alters self image and changes to finances
heightened sense of mortality
anxiety - glycaemic control, long term meds, finances
guilt about smoking and diet and frustrations at need to change
worry about complications - eye>heart>kidney>leg>amputation>feet>sex probs
 
Depression
being ill, testing and treatment
feels life is harder at times - annoyed about having disease and having to live with it
work hard at not letting self go to a bad place (psychologically)
2-3 times more likely to be depressed if have diabetes than if don't - therefore screen
 
Often folk find it difficult to accept restrictions on life style - encourage to learn more
Diabetes UK, Expert pt programmes, DESMOND (community based education programme - Diabetes education and self management for ongoing and newly diagnosed), community diabetes nurse

Employment issues - esp if start insulin
Financial - insurance premiums, ability to get a mortgage etc etc
Cultural - Ramadan, care when travel overseas
Sexual - erectile difficulties 3x more likely in diabetic (50% of male diabetics)

Driving (approx)
diet alone - no need to notify DVLA unless eye complications
drugs not causing hypo - no need to notify DVLA if below are met
drugs (sulphonylurea and glinides) -  only need to notify DVLA if concerns
drugs insulin - need to notify and meet below (unless less than 3/12 use -post MI or gestational ....)

awareness of hypoglycaemia
only at most 1 severe hypo in last 12/12
glc monitouring every 2 hours (up to 2 hours before)
vision ok
not be regarded as a danger

Moving onto insulin ... Pt reluctance due to
loss of control
worsening of disease ... needles
lack of percieved benefit - better in fact does feel better and improve coping

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