Managing Diabetes in Festive Times

The diabetes crisis continues to grow creating holiday stress for patients.

Posted Nov 15, 2017

Another holiday season is approaching, a time for connecting with old friends, spending time with family, and visiting neighbors. It is also a time to celebrate food—lots of cooking, eating, and drinking. Large traditional holiday feasts provide comfort. They help us to remember good times. For more than 30 million Americans living with Type 2 diabetes and the millions more who are pre-diabetic the holidays are also a time filled with anxiety and stress—over illness management. Diabetes is a debilitating disease that affects approximately 10 percent of the world’s population, 79 million people worldwide are pre-diabetic and millions more are undiagnosed (diabetes.org).

For Americans over the age of 65 the situation is even worse. More than 25 percent have Type 2 diabetes and an even greater percentage being pre-diabetic. According to The American Diabetes Association[VK1], in 2015, diabetes was the seventh leading cause of death in the United States. Direct and indirect medical costs associated with diabetes management total more than 400 billion dollars. Not only is diabetes a serious lifelong disease, it also increases the risk for conditions such as heart disease, the number one killer in America (NCOA, 2015). In the U.S., millions of new diabetes cases are diagnosed each year. Approximately 90-95 percent of adults with diabetes have the Type 2 version (National Institute on Aging, NIH, 2014).

Type 2 diabetes is treatable, often through healthy living. Yet, it is also one of the most difficult chronic illnesses to manage, especially during the winter holidays. Social and emotional support, reinforced during holidays, plays a significant role in how well men and women cope with any chronic illness. Relationships with family and friends, community groups, and accessibility of economic resources help to develop and promote feelings of social integration and well-being. Support can help minimize distress and increase the effectiveness of illness management. By the same token, the desire to connect with family and friends at social gatherings can present a challenge for diabetes patients who are attempting to manage their illness. Satisfaction with social support is associated with better self-management, adherence to medication, and adoption of better dietary habits and active lifestyles.

In my work, I have found that Type 2 diabetes patients experience greater anxiety over family visits—especially during the holidays. This anxiety is also gendered. Women, especially if they are the family matriarchs who have a satisfying history of preparing large family meals over the holidays, experience greater anxiety over maintaining their medical regimes. Most of these women gained considerable satisfaction from their role and did not wish to disappoint family or change traditions.

Clearly, Type 2 diabetes presents major challenges to any person’s quality of life. In addition to related physical concerns, anxiety over social gatherings infused with food and drink may prompt diabetes patients to avoid such gatherings. Such avoidance, which results in isolation, can increase the possibility of loneliness and depression. Food consumption is often the central ingredient of social gatherings. Gatherings that feature an array of traditional foods contribute positively to a sense of cultural connection and continuity. Indeed, holidays traditions are shaped by specific foods. A diabetes diagnosis can pose a challenge to person’s sense of cultural connection. Imposed diet restrictions can result in disengagement from social gatherings, particularly over the holidays. Social isolation and loneliness are common phenomena among older adults who have been diagnosed with a chronic illness. These factors may also shape the success or failure of chronic illness management.

Any illness diagnosis increases feelings of sadness, vulnerability, and concerns about mortality. Satisfying social support helps reduce feelings of loneliness. For diabetes patients relationships can also increase feelings of vulnerability, especially in situations that might require disclosure of diagnosis in order to avoid the celebratory pressure to eat and drink. Illness disclosure leads to self-vulnerability. Research has shown that women appear to have an easier time disclosing illness; men were more likely to report feelings of shame and embarrassment over chronic conditions, which makes it psychologically difficult to self-disclose at holiday gatherings. For men who have partners, however, the spousal support makes it easier for them to reveal and manage their illness.

Sharing concerns with partners or close family members and requesting illness management help is an effective way to garner much needed support, especially during the stressful holiday period. When facing such stressful and negative life events as a serious illness, emotional coping can be effective. Emotion-oriented coping can help regulate negative feelings associated with chronic illness diagnosis. Talking about one’s feelings about illness can reduce the distress and anxiety associated with treatment. Positive-approach coping and negative-avoidance coping are also helpful. Positive-approach coping, or task-oriented coping, can help patients view their diagnosis as manageable and determine a plan of action in which they maintain previously adopted personal and lifestyle changes during the holidays. Negative avoidance coping is helpful when patients find their diagnosis as uncontrollable and consider the diabetes progression as irreversible. This negativity can lead patients to suppress their anxiety and uncertainty, which can, in turn, lead them to avoid illness management strategies and overindulge, will have negative impact on health and psychological well-being.

Type 2 Diabetes can be effectively managed over the holidays. Meal planning, focusing on other festive aspects of the season, increasing physical activity to compensate for occasional overindulgence are only some of the possible management strategies. By making a plan, patients can maintain a sense of control. You don’t have to skip food to compensate for overeating. You can choose a small plate and sample everything. When you slip up, you can forgive yourself. You can make certain that you get enough rest (cdc.gov).

The incidence of Type 2 diabetes has reached epidemic proportions, especially among older adults. Clearly there are barriers and challenges to managing Type 2 diabetes. Type 2 diabetes is the type of illness that can be, to a large extent, managed through radical life-style changes. Men and women can empower themselves to increase feelings of control over their illness by talking about their struggles, by self-disclosing their illness, by relying on their social and emotional support, by meal planning, and by forgiving themselves occasional dietary lapses.  These practical strategies make the holidays a wonderful season for Type 2 diabetes patients.