What are some examples of psychological issues diabetics face?

There are a range of issues that bring Type 1 and Type 2 diabetics into therapy. Here are a couple of examples, although they are not found in every person:
“I feel like my diabetes is a punishment for something I’ve done wrong,”
“Just having the disease makes me feel guilty,”
“I don’t want other people to know I’m diabetic, they’ll think less of me,”
“I hate the disease and can’t escape it”
“My sister doesn’t have to deal with this, why me?”
“My blood sugar goes up and down, so I must be doing something wrong”
“My father/mother/husband/wife always tries to control me. What can I do?”
“I don’t trust my body, how can I become sexually involved with another person?”

Is therapy like seeing an endocrinologist or diabetes educator?

A psychologist cannot take the place of a medical provider. Thus, advice about adjusting medications, about counting carbohydrates, and about steps to avoid long-term complications is not part of the focus with a psychologist. Diabetes educators are a very necessary part of treatment in both Type 1 and Type 2 diabetes. Also, regular blood glucose monitoring, healthy food choices, and exercise are a very necessary part of self-management. Endocrinologists play an important role also, especially around the point of first diagnosis and in dealing with medication regimens and handling long-term complications of illness for those who develop such complications. So, I don’t become involved in these other areas, but serve a complementary role in the management of the illness, aimed at addressing the psychological and behavioral dimensions of the illness and its treatment.

What can psychotherapy do for me to improve my management of my illness?

Psychotherapy is a helpful addition to the other types of treatment you may be using. The challenges for Type 1 and Type 2 diabetics are often different, so they will be discussed separately.

For Type 1 (a.k.a. juvenile, or insulin-dependent) diabetes, the initial diagnosis often comes in childhood or young adulthood. It is likely caused by an auto-immune response to a virus or other illness. Thus, the diagnosis is a blow to an otherwise healthy person who is starting out in life, and probably has few other medical challenges. The person’s acceptance of the illness, and their way of facing the illness directly, is important. This is especially true when you think about the many things that have to be dealt with, from blood glucose monitoring and medication dosages, to the need to carry “rescue carbs”, to the process of discriminating the sensations of low and high blood sugar from other body sensations. The disease, and the burden of self-management may feel like an unfairness, or carry a sense of guilt and shame for a person. Type 1 diabetes can wreak havoc in a person’s life with they are unable to normalize blood sugar, or when the illness cuts them off from sense of healthy and vitality. Finally, the disease is uncommon, and can leave a person isolated and ashamed of their illness. Psychotherapy is instrumental in addressing issues like this, and “fills the gap” of psychological intervention, where endocrinologists and diabetes educators are unlikely to tread.

For Type 2 (a.k.a. adult-onset) diabetes, the initial diagnosis brings a different set of challenges, and is almost a different illness from Type 1. Diagnosis often accompanies other health problems, such as weight gain or cardio-vascular problems, and may present itself at a stage of life where people are confronted with the process of aging and the conflicts of middle age. For Type 2 diabetics, the greater need for self-care and a perceived loss of personal power or other anxieties of aging, often accompany the first diagnosis. Thus, psychotherapy can address the anxieties and conflicts of diagnosis and management, which are often a “wake up call” to a person who is already confronting issues that occur in normal aging.