Psychological - The science dealing with the mind and with mental and emotional processes.
Setting: Grandma's living room
Dustin: Grandma, I am worried about mom. She's having a hard time dealing with her diabetes.
Grandma: I understand how your mother feels; at first my diabetes was difficult to deal with. The first month was the hardest to get through. The reason it is so hard is because you can't learn everything about diabetes in just one month. It is an ongoing process that you deal with for the rest of your life, seven days a week, 24 hours a day.
Dustin: That sounds like a lot of work.
Grandma: They say that stress plays a key role in developing Type II diabetes. My cousin Ruth is a good example of stress-related diabetes. She experienced a deep sense of loss when her husband died after being in a diabetic coma for two weeks. This all happened right before the big flood. You remember I told you about that?
Dustin: Yeah, some people died and a lot of others lost a great deal of valuable possessions because of the flood.
Grandma: Yes, and after this added stress, she experienced an even deeper depression. I've always known her to live an unhealthy lifestyle.
Dustin: What do you mean?
Grandma: She was overweight, never exercised, and spent a great deal of her check at the bar on drinks. She never thought she was at high risk for diabetes and had never been tested. But I noticed she was developing diabetic symptoms, so I told her to go see a doctor.
Dustin: What did the doctor say?
Grandma: She was diagnosed with Type II diabetes, which took her mind away from her depression and allowed her to focus on maintaining her health and keeping her diabetes under control. She was doing well until a few years ago when two of our cousins passed away. You remember your grandmas, Agnes and Mildred?
Dustin: Yeah, I remember playing with my cousins over at their houses. They died a couple of years ago, didn't they?
Grandma: Mildred died of cancer, and six months later Agnes died of a heart attack. These two women attended boarding school with Ruth and were very close, just like sisters. Ruth's blood sugar went out of control; she had her same symptoms appearing again.
Dustin: So she developed diabetes because of stress.
Grandma: Uhmm...well, not exactly, she calls her diabetes a "wolf in a cage" that mounts in a full attack in times of acute or chronic stress or if she goes off her diet or exercise program.*
Dustin: Tell me how you keep your wolf in its cage.
Grandma: The support of family and friends is very important. We have to be there for your mom. Some people join a support group for people with diabetes, to talk to other people with the same kinds of problems. I found counseling to be helpful because I had someone to talk to about my concerns. It is also important to do something fun, like some of my favorite activities which include attending powwows, taking a sweat, telling stories, going to church, going to bingo, or my favorite hobby, beading.
Dustin: I want to support my mom, but she is in denial. What I mean by being in denial is that she has not accepted her diagnosis and is not following her care plan. Why is she going through denial?
Grandma: When I was first diagnosed, I was the same way. Along with my denial, I was angry at this chronic disease for changing my life. It just wasn't fair. I wondered if I had done something wrong or if it was punishment for my mistakes. Denial, anger, and guilt are common when someone is first diagnosed. People don't understand how this can be happening to them. Your mother is using denial to cope with the changes she will have to make in her lifestyle necessary for her to stay healthy. This means giving up some of her favorite foods, like fry bread.
Dustin: I heard that those feelings can lead to depression.
Grandma: Yes, I felt the symptoms of depression. I no longer enjoyed life, I could not sleep, yet I felt tired all the time. I was lonely and helpless. My close friend Margaret noticed I was not my usual self and referred me to the diabetes counselor since she knew I was diabetic. I found out from the doctor that there was a physical cause for my symptoms--depression.
Dustin: What kinds of motivation skills do you use to take care of your diabetes?
Grandma: Adjusting will come slowly as your mother learns how to take care of herself. The key is that her health will be up to her. She is in control of herself and diabetes. I found it very helpful to work with the diabetes coordinator at the I.H.S. hospital. The diabetes coordinator helps, out with care and if needed, counsels the patient and the patient's family for coping with diabetes. I feel strongly that living in harmony and balance with the body and mind is the ideal thing for me. Tell your mom to remember that knowing her values and beliefs as an Indian woman with diabetes will be beneficial to her everyday life.
Dustin: If my mom wants to see the diabetes coordinator, how will she pay for it?
Grandma: It doesn't cost anything for your mother to see the diabetes coordinator or to receive any treatment from I.H.S.
Dustin: I think my mom is worried about how she is going to get health insurance to cover her diabetes treatment expenses since she heard that insurance companies consider people with diabetes to have what they call a pre-existing condition. What is that anyway?
Grandma: From my understanding, a pre-existing condition means that she is more expensive to insure than a healthy person because she was already diagnosed with diabetes before she applied for insurance.
Dustin: So what happens if my mom doesn't get any insurance?
Grandma: Well, when Mildred had to get treatment for her cancer, she couldn't get the treatment she needed at the I.H.S. hospital, so she was referred to the city to get her treatment. Since she has private insurance, I.H.S. covered the difference that her insurance did not pay. It will be more complicated for your mom since she does not have private insurance.
Dustin: What do you mean by that?
Grandma: I mean that whatever your mom needs is offered at the I.H.S. hospital, except for complex surgery because of some diabetes complications. If she had complications and needed treatment that was not offered at I.H.S., then she would be referred by her doctor to another hospital that had the ability to help her. The top officials at the I.H.S. hospital would have to meet at a medical round table and discuss her needs without mentioning her name. The officials decide each case based on life-threatening urgency rather than on personalities or relationships.
Dustin: Do you think my mom will be treated fairly at the job she has now that she has been diagnosed with diabetes?
Grandma: Back when I was working at the factory off the reservation, I was often discriminated against because I have diabetes. Today many diabetics are protected under the law American with Disability Act of 1990. I find it is often very valuable to know your rights as a diabetic person in order to get the treatment you deserve.
Dustin: At Dr. Ponds office, I got some information to help my mom. When I was reading through the material, I came across some material on sexual complications. But since you are my Grandma, I won't ask you these questions because that would be disrespectful.
Grandma: You should ask the diabetes coordinator, Mr. Eagle Tail, those questions and I am sure he will explain it well.
Later at the hospital...
Dustin: Hi, Mr. Eagle Tail, I'm doing research for my mother on the psychological effects of diabetes. I have been talking with my grandma, but I didn't ask about the sexual complications. You know it is not appropriate for me to talk with my grandmother about that stuff. Can you tell me anything?
Mr. Eagle Tail: Well, son, I am pleased that you are seeking out the information. It will be helpful. You are right; your grandma might consider it disrespectful for you to ask such questions.
Dustin: Yeah, I kinda felt embarrassed when I asked her about it.
Mr. Eagle Tail: Many diabetics have a hard time talking about this subject.
Dustin: No wonder I haven't heard anyone mention these problems before.
Mr. Eagle Tail: Well, it is a complicated subject but I can tell you some basic information. Sexual complications can be psychological or physical. Men and women lose interest in sex and experience complications such as impotence in men and vaginal dryness in women. These complications may be due to nerve damage caused by diabetes.
Dustin: Thank you, Mr. Eagle Tail, for the information. I will give this information to my sister to give to my mother.
Mr. Eagle Tail: I'm glad to help. If you need any more information, come back to my office.
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*(Skinner 12-13 This case story was based on studies from "Diabetes and Native American: Socio-Cultural, Stress and Coping." University of Arizona; Paul Skinner, Ph.D. and Dana Silverman-Peach, M.A. 1989)