How to Banish Diabetes-Related Guilt
Tina Szymczak painted the words “I Matter” across a blank canvas and hung it on a wall in her bedroom. She glances at it every morning before she heads to work and takes time to look at it again before she goes to bed each night.
Reciting the affirmation throughout the day has become as much a part of her daily diabetes regimen as eating healthy foods and checking her blood glucose levels.
Szymczak, who works as a resource consultant for kids with special needs in Windsor, Ontario, was diagnosed with type 2 in 2016. She wasn’t entirely surprised. Twenty years ago, a doctor told her she was insulin resistant, delivering what Szymczak now considers a warning that she was at risk for developing the disease.
“I felt guilty,” says Szymczak, now 44. “Even deeper than that, I felt ashamed.”
The link between guilt and diabetes may derive from the social stigma and common misconception that diabetes is an easily preventable condition. Many Americans still believe type 1 is caused by eating too much sugar and that the sole cause of type 2 is obesity.
“It’s natural for people to feel like they’ve done something to bring it on,” says Susan Guzman, PhD, director of clinical education at the Behavioral Diabetes Institute in San Diego. “It’s common for people to look inward for some sort of causal event because it makes them feel more in control. But when it comes to diabetes, there are a lot of things out of our control.”
Guzman estimates that one-third to two-thirds of her patients experience feelings of guilt surrounding their diabetes diagnosis, particularly when it comes to falling short of their treatment goals.
Her findings echo those of a study published in a 2017 issue of Clinical Diabetes, which suggests that 20 to 38 percent of people with type 1 or type 2 diabetes experience distress, including feelings of guilt. “Oftentimes people with type 1 feel guilty because their A1C is high or their numbers are still wacky even though they’ve done their best with healthy eating and regular exercise,” says Guzman. “People with type 2 experience similar feelings, but they tend to report feeling guilty from daily decisions: ‘I shouldn’t have eaten that piece of candy.’ ‘I should’ve planned my meals better.’ ”
Guzman says guilt becomes problematic when it spirals into feelings of hopelessness. “It’s not just feeling bad for eating a piece of cake or feeling guilty for not planning a meal better,” she says. “It’s feeling like they’re a bad person because of it.”
A Self-Defeating Spiral
There are many reasons people with diabetes grapple with guilt. They feel like a financial burden, worry about the ways their eating plan impacts the family’s meals, or simply feel as though they can’t contribute to their families the way they want to because of their diagnosis.
While a little bit of guilt may drive positive behavior—say, if it leads to more-frequent blood glucose checks—Guzman says it often causes people to detach or withdraw. When people with diabetes feel guilty about overeating, for instance, they may skip blood glucose checks. It’s their way of avoiding a high meter reading, which they view as a visible representation of their failure to achieve diabetes-related goals. That, in turn, can create a domino effect.
When people feel guilty about not achieving their goals, they anticipate their doctor will be disappointed, says Cesar Gonzalez, PhD, a clinical psychologist at the Mayo Clinic in Rochester, Minnesota. Sometimes the feelings of guilt even convince people to cancel routine check-ups. This can lead to a downward spiral of substandard diabetes self-care—such as not taking medications as prescribed or skipping out on regular exercise—and ultimately a higher A1C.
Similarly, feeling guilty about high or low blood glucose readings may make someone less likely to maintain a blood glucose log or be open and honest with a health care provider. “Computer-generated logs and physicians often use the words ‘controlled’ or ‘uncontrolled,’ ” says Guzman. “And when we use these words, it suggests everyone can achieve their goals if they do the right thing, but that’s simply not the case.”
Overabundant and complex information about diabetes can play a role, too. When people are overwhelmed, they may disengage from diabetes management and then feel guilty about it, which is what happened to Szymczak.
At 200 pounds, she knew she needed to lose weight, but after attending a diabetes education workshop that her doctor recommended, she didn’t know how to start making diet and lifestyle changes. “I implemented part of the food guidelines, but truthfully, I had zero knowledge about healthy eating,” she says. She was so overwhelmed, she continued eating fast food and drinking soda, only checking her blood glucose levels sporadically. As a result, she gained 40 pounds in six months and had to increase her daily dose of insulin to meet blood glucose goals.
Using Guilt for Good
With the help of regular counseling, Szymczak has learned how to overcome her feelings of guilt. She now visits her doctor regularly, takes her medications on time, and has been able to kick her fast food habit. “Before every bite, I tell myself ‘I matter,’ ” says Szymczak, who is now down to 224 pounds. Understanding her relationship with food has been key in helping her not only lose weight, but also lower her A1C. “[Eating healthy] is a daily challenge, but I’m making better choices for myself one step at a time.” When she’s tempted to have a second cupcake or swing through the drive-through for dinner, she asks whether those choices are good for her soul.
Another tool for turning guilt on its head? The truth. If you feel you’re to blame for your type 2 diabetes, for instance, remind yourself that there are factors beyond diet and exercise that determine who will develop diabetes. Your family history of the disease plays a role, too. “While genes alone will not determine whether you develop diabetes, it does remind us that diabetes is more than what we eat or how much we exercise,” says Gonzalez. “Viewing this larger picture can help people with diabetes move beyond solely attributing diabetes to themselves.”
When dealing with guilt, the goal is to address the issue (sometimes with the help of a counselor) and then use it as a way to adjust your diabetes management. “Diabetes guilt can either motivate you to make changes or scare you to the point of freezing you,” says Gonzalez. “We can view guilt as that friend who tells us how things really are and keeps our choices in check. Guilt is good when we face it, understand it, learn from it, and use it as a tool for change.”
5 Ways to Become Guilt Free
Find a support group. Whether it’s face-to-face or interacting with others online through social media, connecting with people who have a similar diagnosis can validate your feelings and experiences. Ask your doctor, therapist, or certified diabetes educator for recommendations on how to join a local support group.
- Be kind to yourself.
Remind yourself that you matter and your choices are important. Write affirmations on sticky notes and place them on a bathroom mirror. Download an app—such as ThinkUp: Positive Affirmations—on your smartphone. You can record affirmations in your own voice and set reminders to repeat them throughout the day. Having a positive mindset can go a long way toward increasing your motivation to make healthy lifestyle choices.
- Write it down.
Keep a log to document episodes of diabetes guilt. Use a scale of 1 to 10 to rate intensity, and include context: Does it happen when you’re alone or around others? At home or at work? Share your log with a trusted health care provider so he or she can help you find solutions. “By taking ownership of diabetes, it gives you a sense of control, and feelings of guilt can be greatly reduced,” says Nicole Bereolos, PhD, CDE, a clinical psychologist and certified diabetes educator in Dallas.
- Set realistic goals.
Whether it’s exercising for 30 minutes each day or simply taking blood glucose readings at a particular time, give yourself credit for everything you do every day to manage diabetes. That will help you feel proud of your health management. When you achieve a goal, share it with your support group or treat yourself to something that will keep you motivated toward reaching your goals—a pair of new sneakers or exercise clothing, for instance.
- Seek counseling.
If your guilt begins to feel overwhelming, or if you’re avoiding diabetes management because you’re feeling guilty about your glucose levels, eating habits, or medications, it’s important to seek support. Find a mental health care provider who specializes in treating people with diabetes. You can find one through the American Diabetes Association at professional.diabetes.org/mhp_listing.