The 5Ds …... Diabetes, Denial, Dementia, Depression, and Diabulemia

The 5Ds …... Diabetes, Denial, Dementia, Depression, and Diabulemia

Prof. Dr. Inass Shaltout

Prof. of Internal Medicine & Diabetes Cairo Univesity

…. What is the link between Diabetes and Denial ?

…. What is the causes of denial ?

….How can the patient avoid denial?

... Senility is not normal aging, Senility means Dementia.

... Depression is a common & serious disease often leading to suicide

... Is there a link between Diabetes medications and Depression???

.... Do diabetic patients need more psychological

support???

1. Diabetes Denial

Denial is that voice inside repeating: "Not me." Most people go through denial when they are first diagnosed with diabetes. "I don't believe it. There must be some mistake," they say, it is the psychological state in which one feels exempt from reality.

…What is the link between Diabetes and Denial?

An individual who has diabetes but is in denial about it, ignoring his disease by not controlling it, do not test his blood glucose regularly, eat whatever he wants and is not following a strict diet, Do not see the doctor when he should.

….But what is the causes of denial? Sometimes denial serves a purpose, it is a way of coping with bad news, it can keep the patient from getting overwhelmed and depressed, it lets patients accept news little by little when they are ready

….The doctor should tell the patient that "denying your diabetes is serious lets you avoid self-care, it shields you from the fact that diabetes is a lifelong, chronic illness, which, if left untreated, can result in complications"

….How can the patient avoid denial?

By writing down diabetes care plan and health care goals, understanding why each item in the plan is important, accepting that it will take time to reach the goals, if there is a trouble with food plan, talk to a registered dietitian, telling friends and family how they can help encouraging plan, informing them about how you take care of your diabetes - they might want to adopt some of healthy habits

….We can call Denial "The Hidden Danger" because of its drawbacks

 2. Dementia

Senility is not normal aging, Senility means Dementia.

Dementia is a clinical syndrome characterized by the insidious onset and slow progression of a cognitive impairment which impairs at least two areas of cognitive function, for example: memory loss, impaired verbal fluency, impaired executive function, etc.

….Signs and Symptoms of Dementia

• Memory impairment is often the first symptom to be noticed. Someone with dementia may be unable to remember ordinary information, such as their birth date and address, and may be unable to recognize friends and family members.

• There is progressive decline in these cognitive functions as well Decision making, Judgment, Orientation in time and space, Problem solving, Verbal communication, Behavioral changes may include Eating, dressing, toileting (e.g., unable to dress without help; becomes incontinent), Interests (e.g., abandons hobbies), Routine activities (e.g., unable to perform household tasks), Personality (e.g., inappropriate responses, lack of emotional control)

• The American Psychiatric Association has established two generally accepted criteria for the diagnosis of dementia: (1) erosion of recent and remote memory and (2) impairment of one or more of the following functions: Language, misuse of words or inability to remember and use words correctly (i.e., aphasia), Motor activity, unable to perform motor activities even though physical ability remains intact (i.e., apraxia), Recognition, unable to recognize objects, even though sensory function is intact (i.e., agnosia), Executive function, unable to plan, organize, think abstractly

• Symptoms often develop gradually and show a progressive deterioration in function.

DM is a risk factor for Dementia as it increases the risk 2 folds

3. Diabetes and Depressio

Depression is a common & serious disease often leading to suicide

Depression is a huge and growing problem:

• Percent of population with experience of depression in their lifetime 10% Men and 20% Women

• In 2020, Depression will be the second cause of disability worldwide and the first cause of disability in developing countries

• Depression increases the risk for diabetes (type 2).

• Depression incidence is doubled in diabetics according to many studies

• CHD occurs in 39% of diabetics with depression

….Symptoms of Depression includes:

• Persistent sad, anxious or empty mood

• Feeling of hopelessness

• Feeling of guilt, worthlessness, helplessness

• Loss of interest or pleasure in hobbies and activities that were enjoyed including sex

• Decreased energy, fatigue, being slowed down

• Difficulty concentrating & remembering

• Insomnia, early awakening or oversleeping

• Appetite and/or weight changes

• Restlessness..irritability

• Seek an evaluation for depression

….If 5 or more of these symptoms are present everyday for at least 2 weeks Interfere with routine daily activities such as work, self care, and childcare or social life

Is there a link between Diabetes

medications and Depression???

Study done on 5 groups of diabetics:

• diet &exercise alone

• oral medications only

• OHA + insulin

• 2 injections insulin/ day

• 3 or more insulin injections/ day

Study Results....?

Strong correlation was found between depressive symptoms and glycemic control in patients with complex insulin regimen (3 or more/ day)

….Role of Diabetologist in patient education

• Lift Your Spirits

• Join a support group –

• Share your thoughts and feelings with others who also have the disease.

• Learn new skills to cope better.

• Keep a journal of the good things in life and other thoughts: Write down a poem or prayer that has meaning to you. Write out the many blessing that happen each day. Go back and read these things whenever you’re feeling blue.

• Plan an enjoyable day doing something you love: Go shopping, work in the garden, go for a walk at the park, or have lunch with friends.

• Exercise: Just moving can work wonders for the way you feel.

• Talk to family or friend(s): Sharing your feelings can help release, built up emotions and get their support for needed changes.

• Volunteer/help others: Volunteering helps us feel good about ourselves, that we’re making a difference in someone else’s life.