The Diabetes of Today Type 2

Type 2 Diabetes and health psychology

Historically, this serious chronic disease affected people of low-income groups and professionals thought the causes were due to poor environmental conditions related to food. Scientists continue to agree that poor nutrition and a sedentary lifestyle are leading causes of obesity and diabetes. The rise in statistics is no longer associated with lower income levels and probably represents a cultural shift, in terms of how people psychologically view healthy eating habits.

The Diabetes Type 2 Epidemic

People with diabetes live in a society that does not recognize their situation. The overall opinion that people with Type 2 diabetes is a relatively mild disease remains popular worldwide. What is dangerous is that just a few people realize that diabetes is a disease that cannot be only managed by prescriptions. The appearance of diabetes considerably alters the experiences of individuals and their relationships. The typical causes involve obesity produced by inactivity and/or toxic diets. The epidemic calls for routine exercise, sustaining a healthy body weight, healthy nourishment, and avoiding smoking to inhibit or stop the spread of Type II Diabetes.

According to the World Health Organization (WHO) one in ten adults has diabetes. The American Diabetes Association states that there are over 25 million people in the US who have diabetes and almost a third of them are not aware of their condition. This disease is the seventh most common cause of death and the leading cause of blindness in the United States. In 2004, more than 3.4 million people died in the world from the complications of diabetes with the expectation that this figure will double before 2030. The prevailing form of diabetes endured by over 85 percent of diabetics is Type 2 in which the body needs to cope with a resistance to, or insufficiency of, insulin.

                                                US Diabetic Statistics from 1980 through 2011

  1. 0–44 years old the percentage of people with diagnosis increased 167% (from 0.6% to 1.6%)
  2. 45–64 years old the percentage of people with diagnosis increased 118% (from 5.5% to 12.0%)
  3. 65–74 years old the percentage of people with diagnosis increased 140% (from 9.1% to 21.8%)
  4. 75 years and older the percentage of with diagnosis increased 125% (from 8.9% to 20.0%)

In 2011, the percentage of diagnosed diabetes among people aged 65–74 (21.8%) was more than 13 times that of people younger than 45 years of age (1.6%). Throughout the time period, the percentage of people with diagnosed diabetes increased among all age groups.

The Two Types of Diabetes         

Type 1 Diabetes is an autoimmune disease in which the immune system damages beta cells in the pancreas that produce insulin. Insulin is a hormone and is vital for transferring sugar and several other nutrients from the blood to other body cells. All cells require sugars and other nutrients to allow the body to function properly.  Type I Diabetes ordinarily affects young people, but can take place at any time in life. Along with genetic factors, experts now conclude that a virus or toxin may cause the immune system to begin destroying these insulin-making cells.

Type 2 Diabetes or Diabetes Mellitus is by far more prevalent than Type 1. Approximately 90 percent of Diabetic sufferers today are of this kind. Indications occur later in life, and the causes are due to the pancreas not manufacturing enough insulin, or the body does not use insulin efficiently (insulin resistance). The physiological outcomes are the same as with Type I Diabetes as sugar and other nutrients accumulate in the blood instead of being transported to the cells. The accumulation of glucose (sugar) in the blood affects the whole body and can have long-term severe consequences.  Increased urination can cause dehydration and pressure on kidneys. Severe dehydration can lead to Diabetic Coma. Long-term high levels of blood sugar can affect the eyes, heart, small blood vessels and kidneys: All of which can lead to infections, strokes and heart attacks.

In order to cope, the diabetic must avoid prolonged periods of high blood glucose levels (hyperglycemia) and also periods of low blood glucose levels (hypoglycemia). To check these two extremes, a diabetic needs to monitor and manage their blood sugar levels on a routine basis. Diabetics may confront a multitude of side effects and unpleasant complications if glucose levels are not under satisfactory control. There are two ways to maintain a physically fit body and two ways to prevent diabetes: Introducing an exercise program and following a healthy dietary regimen.

Obesity CDCType 2 Diabetes and Obesity

 Approximately 90 per cent of people diagnosed with Type II Diabetes are also overweight. This excess weight influences the ability to manage blood glucose levels and can cause the body to become resistant to insulin. On account of this insulin resistance overweight people who do not have diabetes are at extremely high risk for Diabetes Type 2.

The Cell Metabolism journal published in the July 2009 issue findings from Matthew Watt, Associate Professor from the Monash University discusses a new protein which ultimately explores the relationship between obesity and diabetes. According to this study, fat cells release a protein, which desensitizes muscles and the liver to insulin which causes the pancreas to produce more insulin to counteract this effect. The overworked pancreas eventually slows the production of insulin, causing type II Diabetes. Professor Watt explains his excitement about the potentials for counteracting this effect with new medications, but the writers for the medical journal Lancet believe that treating diabetes with drugs is the wrong approach. In their June 2010 issue, Lancet writers call the epidemics of obesity and type II diabetes “a public health humiliation.” They call diabetes a ‘mostly preventable disease’, which requires changes in lifestyle and nutrition, and claim that, by treating diabetes with medications, “the medicine might be winning the battle of glucose control, but it is losing the war against diabetes.”

The New England Journal of Medicine, Diabetes Prevention Program Research Group discovered that as little as a 7% weight loss can cause a 58% reduction in the risk of developing diabetes from pre-diabetic stage. They are asserting that lowering weight in the prediabetic stage, by only 7% can diminish the possibilities of acquiring Type II Diabetes by nearly fifty percent.  For example, a 200 lb. overweight person will reduce their chances of getting diabetes type 2 if they lose 14 lbs. Changing ways people cope and manage an illness is the health psychology relationship.

Diabetic Complications

Detecting the early onset of type II diabetes can be difficult as signs are so mild that many people do not notice them: Some may not even be cognizant of the fact that they have diabetes. Mild symptoms, such as increased thirst, hunger, blurred vision, frequent urination, weight gain, tingling in feet, are often easy to ignore, but prolonged accumulation of sugar in the blood can ultimately be life-threatening.

Complications of Diabetes Type 2

  1. Eye Damage is often the first problem. Damage to the small blood vessels of the retina can lead to an increased risk of developing cataracts, glaucoma, and blindness.
  2. Nerve Damage: Accumulation of sugar in the blood can damage the walls of the small blood vessels that feed nerves, particularly in the legs. The first symptoms are tingling, numbness and pain at the tips of the toes or fingers. If untreated, this can cause loss of awareness of feeling in the limbs.
  3. Foot Infections due to poor blood circulation in the feet increases the risk of various complications. Simple cuts can become seriously infected, and if left untreated, may require amputation.
  4. Cardiovascular Problems:  Diabetes increases the risk of heart attack, coronary artery disease, stroke, atherosclerosis and high blood pressure.
  5. Kidney Damage: Pressure from frequent urination due to dehydration and damage to the small blood vessels in kidneys can lead to kidney failure or kidney disease, treatable only with dialysis or a kidney transplant.
  6. Osteoporosis, Alzheimer’s’ disease, skin problems and many other health issues can be affected by diabetes, if left untreated.
Health Psychology and Diabetes

Photo Creative Commons

Psychology, Psychopathology and Diabetes

The value of psychology begins when it is essential for a diabetic to make fast and radical modifications to their lifestyle. Virtually overnight a diabetic must move from a sedentary lifestyle of consuming junk food and watching TV, to having to consume regular healthy meals, exercise routinely as well as monitor blood sugar levels. This rapid change in lifestyle can generate many problems for diabetics.

Mood and stress disturbances are most prevalent and occur significantly more often in patients with diabetes than in the overall U.S. culture. Roughly one-third of sufferers with diabetes have psychological difficulties at some period during their life. These disturbances can affect inadequate glycemic control through changes in neurotransmitter and neurohormonal functioning and cause disruption in diabetes self-care. Major depression effects approximately one out of every five patients with diabetes and critically reduces the quality of life and influences all phases of daily functioning. Depression has significance in diabetes because of its association with treatment noncompliance, inadequate glycemic control and increases the chance for micro- and macrovascular illness developments. Depression continues to be unrecognized and untreated in the majority of cases despite its connection to diabetes. Greater levels of depression correlate with many health practices and beliefs, in particular less physical activity and belief that they do not have the ability to change dietary practices. Depressive signs also relate to clinical risk factors, such as having a higher BMI and higher fasting blood sugar levels.

One in every four diabetic patients suffers from reappearing difficulties with anxiety, depression or may have an eating disorder. These ailments respond favorably to psychological treatment, and in countless instances, relief of suffering correlates with enhanced glycemic control. A separate field of concern is the rising amount of documented eating disturbances among individuals with diabetes. Whether these problems are more common in diabetes compared to the general population continues to be under investigation. Despite, eating disorders are clinically relevant because of their connection with inadequate glycemic control and an increased risk for complications. Eating disorders can be adequately managed with psychotherapy. However, both eating disorders and depression tend to be repetitive and require repeated treatment.

Shifting social views and implementing a lifestyle modification is a challenging goal for many nations. A relentless worldwide crusade advocating the importance of maintaining a healthy lifestyle should be executed. This campaign will entail viewing obesity as a manifestation of a problem that does not just associate with physical appearance. Therapy should be incorporated into the treatment of diabetics because this is one condition that can be avoided by shifting cultural views and implementing a healthy lifestyle. The majority of diabetes treatment is self-care and there can be severe problems if the person requires motivation. The habits needed to control blood sugar levels and curb the diabetes can be very complicated. The patients health can degenerate and result in blindness or the amputation of limbs. It is crucial that doctors employ psychologists to help the patient recognize the seriousness of the disease.

While there are several regimes accessible that promote as being “diabetes-fighting” foods, to prevent the assault of type II diabetes experts recommend following a healthy food plan. This schedule should incorporate a diet abundant in vegetables, fruits, and fiber, coupled with consistent exercise. Though, people who already have type II diabetes might require a more individual food program, depending on other difficulties they have as a result of the ailment. For a generic guideline, nutritionists promote a diet that is low in calories, high in different complex carbohydrates (fruits, beans, vegetables), low in saturated fats (stay away from cheese, butter and fatty meat) and high in monounsaturated and polyunsaturated fat (use olive oil.). This recommendation is no great shock as this is the identical diet suggested for sustaining a healthy weight.

Click to watch video from the International Diabetes Federation

Click to watch video from the International Diabetes Federation

The Role of the Psychologist in Diabetes Care

Seven of the ten dominant causes of death in the United States partner with practices of overeating, using tobacco, and extreme alcohol consumption. Emotional difficulties (stress, depression) also have unfavorable impacts related to numerous physical illnesses via physiological and behavioral pathways. The importance of the psychiatric health care worker in the management of medically unhealthy individuals has expanded with the production of data associating health and behavior.

The psychiatric healthcare worker intervenes to promote healthful behaviors, eliminate unhealthful behaviors and to alleviate emotional suffering in clients with obvious psychopathology. The psychologist furnishes personal services to the diabetic via the development of health behaviors and therapy for emotional difficulties, and further gives consultation to the medical team in what ways to combine psychological principles into the clients diabetic care to improve clinical results.

Despite the widespread opinion, that the life of a diabetic is not all that challenging  only those endured with the ailment understand the everyday challenges associated with the regular monitoring of their food and fitness. The world of a diabetic requires following a daily system monitoring insulin regulation and consuming medicine along with following a diet and exercise. This lifestyle change demands fortitude and motivation on the part of the sufferer. So a complex plan of self-care management needs to be reinforced rigorously, and psychologists can support diabetics in adhering to the regimen.Common everyday difficulties, adverse life situations and the added strains of coping with diabetes cause tension. Stress may have primary influences on fitness via high blood glucose values and incidental impacts on health via interruption in behavioral patterns and habits (sleeping and eating). The psychologist can be a helpful source in recognizing maladaptive responses to stress including encouraging sufferers to acquire more beneficial and efficient techniques of coping.

Current investigations have assessed the use of psychological interventions and employing clinicians in the care of diabetics. The treatment of diabetes with counseling has not been acknowledged as a highly recommended method by diabetics or the medical specialists administering care. This position has been changing over the course of the last decade with numerous physicians recognizing that the everyday world of a diabetic will improve in quality with the assistance of a psychologist.

This specialization can perform a vital role in assisting people cope with diabetes and help them become more comfortable with the prescribed precautions. Studies confirm that cognitive behavior therapies along with behavioral interventions are effective methods in increasing the ability of diabetics to regulate stress. Diminishing anxiety and depression are crucial to ensure a desirable quality of life while living with diabetes. Psychological intervention encourages diabetics to stay motivated to preserve their health. Diabetes treatment co-existing with counseling should be considered complementary treatments because with the aid of therapy the life of a diabetic can be drastically improved.

The Health Psychologists role in treating Diabetes

  1. Promote adherence to the diabetes treatment process
  2. Stifle high-risk health activities (alcohol consumption, smoking)
  3. Provide assistance to physical discomfort associated with diabetes
  4. Support pro-diabetic coping behaviors (exercise and diet)
  5. Assess and manage psychopathology, especially associated with anxiety, eating disorders and depression.
  6. Increase family unity because it links to information and problem- solving abilities concerning diabetes
  7. If required refer to a psychiatrist for a medication assessment.

Clinical health psychologists are an advisable inclusion to the diabetes healthcare team for the evaluation, analysis and treatment of mental health frustrations of clients diagnosed with diabetes. Health psychologists that are proficient in motivational methods, cognitive learning approaches, and behavior modification techniques are very helpful because having these abilities will boost wellness practices. It is recommended that clinical psychologists treating diabetic patients have training in health psychology because not all mental health professionals are aware of how to manage the illness.

Diabetes Prevention

Millions of Americans are at high risk for diabetes, a severe and expensive condition that has attained epidemic dimensions. The critical message is that diabetes can be prevented. Most of the food people consume changes into glucose, or sugar for the body to use for energy. The pancreatic cells produce insulin to assist glucose to move into the cells of the body, and with diabetes, the body does not create adequate insulin or cannot utilize insulin efficiently. This causes sugars to increase in the bloodstream. Diabetes can be dangerous, but living a more active life and making proper food selections can significantly inhibit or even prevent diabetes from developing.Diabetes prevention is as plain as increasing physical activity, dropping the excess weight and consuming healthy food. Developing a few modest health practices and making adjustments in lifestyle will avoid the grim health difficulties associated with diabetes. It is not ever too late to begin. Here are a few recommendations.

Diabetic Prevention Tips

Image Credit to b33fn00dles

  1. Eat Healthy Eat extra fresh vegetables, fruits, and whole grains. Purchase leaner meats (chicken, turkey, lean cuts of pork or beef) and lower fat dairy products (low-fat, skim milk and yogurt). Buy whole grain breads and cereals. Reduce soda, sweets and chips.
  2. Boost Physical Activity Helps maintain and keep blood glucose, blood pressure, HDL cholesterol and triglycerides on target. Activity lowers the risk for pre-diabetes, type 2 diabetes, heart disease and stroke along with reducing stress.
  3. If Overweight Lose those Extra pounds Being overweight increases your risk for type 2 diabetes, heart disease and stroke. It can create other difficulties, like high blood pressure, unhealthy cholesterol, and high blood glucose (sugar). Losing weight can help prevent and manage these problems. People do not have to lose a lot of weight, losing 10-15 pounds can make a significant difference.
  4. Family History Anyone can develop diabetes, however, a physician can help determine hereditary factors that can place people at risk for developing diabetes. Those at high risk are Latinos, African Americans, Asian Americans, Native Americans, Pacific Islanders and older adults.

Clinical psychologists are an appropriate resource to the diabetes treatment team for the diagnosis, assessment, and treatment of mental health problems of patients with diabetes. Psychologists with expertise in reinforcement strategies, learning principles, and behavior modification are highly desirable given the usefulness of these skills for developing health behaviors. While not all psychologists are trained in diabetes, it is recommended that clinical psychologists working with diabetic patients have training in health psychology. With the estimate of diabetes to increase to 300 million in the next 20 years, it is essential that doctors begin to recognize the undeniable benefits of psychology and incorporate clinical psychologists as part of the treatment program.

Thousands of people from all over the planet are struggling to regulate, and maintain their blood sugar to prevent diabetes from creating severe harm to their bodies. In the meantime, remarkably little is being done to reduce the chief culprit inducing the disease: A harmful lifestyle with little or no exercise and poor nutrition. Children who are modeling their parents’ lifestyle are becoming obese and increasingly manifesting the onset of Type 2 Diabetes in early adolescence.  The fundamental message that I would like people to realize is that there is a choice concerning Diabetes Type 2,  a portion of maintaining physical health is in our own hands and it is possible for anyone to reach these expectations.

Live Well

© Dr. Cheryl MacDonald

Health Psychology for Everyday Lifethe book

Video of Health Psychology and Therapy


Health PsychologyCheryl Ann MacDonald, RN., Psy’D.

To ask a question schedule an appointment, seminar or lecture go here

or feel free to call 1 669-200-6033

Health Psychology of San Diego

Health Psychology



Cover Image: canstockphoto|dizanna

  1. Anderson BJ, Rubin RR (Eds.): Practical Psychology for Diabetes Clinicians: How to Deal With Key Behavioral Issues Faced by Patients & Health Care Teams. Alexandria, Va., American Diabetes Association, 1996.
  2. Boehm S, Schlenk EA, Funnell MM, Powers H, Ronis DL: Predictors of adherence to nutrition recommendations in people with non-insulin-dependent diabetes mellitus. Diabetes Educ 23:157-65, 1997.
  3. Crowe, Seamus, Wu, Lindsay, Economou, Catherine, Turpin  Sara M., Matzaris,  Maria, HoehnKyle L., HeveneAndrea L., JamesDavid E., DuhElia J. , Watt, Matthew J. (2009). Pigment Epithelium-Derived Factor Contributes to Insulin Resistance in Obesity. Cell Metabolism. Volume 10, Issue 1, 40-47. Retrieved 28 August 2013 from
  4. Diabetes Prevention Program Research Group. (2002). Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. New England Journal of Medicine. 346:393-403. Retrieved 18 August 2013 from .
  5. Hu, Frank. (2003). Sedentary lifestyle and risk of obesity and type 2 diabetes. PubMed, US National Library of Medicine National Institutes of Health. 38(2):103-8. Retrieved 18 August 2013 from
  6. Lustman PJ, Clouse RE, Alrakawi A, Rubin EH, Gelenberg AJ: Treatment of major depression in adults with diabetes: a primary care perspective. Clinical Diabetes 16:122-26, 1997.
  7. Lustman PJ, Griffith LS, Clouse RE: Depression in adults with diabetes. Sem Clin Neuropsychiatr 2:15-23, 1997.
  8. Pevelier RC, Boller I, Fairburn CG, Dunger D: Eating disorders in adolescents with IDDM. Diabetes Care 15:1356-60, 1992.
  9. Rubin RR, Peyrot M: Psychosocial problems and interventions in diabetes. Diabetes Care 15:1640-57, 1992.
  10. The Lancet, Volume 375, Issue 9733, Page 2193. (2010). Type 2 diabetes—time to change our approach. Retrieved 22 August 2011 from
  11. World Health Organization. Diabetes Fact sheet N°312 (2011). Retrieved 18 August 2013 from