S. Sethu  Reddy, MD
Biography

	What can I do to get past feelings of denial about my diagnosis? Can you talk about the emotional impact of having a permanent condition? My family believes diabetes isn't serious. How can I educate them? I want to lose weight but am anxious about my sugar going low. What can I do?
	Diabetes Meal Plans

A chronic condition like diabetes can have a profound effect on the mind. Did you know depression is three times more common among people with diabetes than the general population? We'll discuss the emotional side of this physical condition with S. Sethu K. Reddy, MD, director of the Department of Endocrinology, Diabetes, and Metabolism at the Cleveland Clinic.

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Support for this University course was provided by Medical Mutual.

MODERATOR:
Welcome to WebMD University: "Diabetes: Get the Advantage." Your instructor today is Sethu Reddy, MD, FACE, director of the department of endocrinology, diabetes, and metabolism at The Cleveland Clinic. He joins us for a look at the psychological side of living with diabetes.

Dr. Reddy, can your emotions raise your blood sugar?

REDDY:
Yes, emotional stress can raise blood sugar and also cholesterol levels. Stress can raise adrenalin levels hugely, and adrenalin can raise your blood sugar, sometimes as much as 10 to 30 milligrams percent. Some of our patients note that when their sugars are higher they tend to be more tired and frustrated and maybe prone to feeling more stress than usual.

MEMBER QUESTION:
My blood sugar yo-yos up and down regardless of what I eat or when. How can I cope with that?

REDDY:
A good question. I think we need to remember that sugars do fluctuate. One misconception people have, when they are put on medication or some regimen, is that their sugar levels will be flat.

In reality, whenever we eat food, normally our sugar can go up to as high as 199 one hour after eating and come down below 140 two hours after eating. These kind of fluctuations are considered normal. Also, exercise can have different effects on blood sugar. If you have type 2 diabetes, which 85% of people with diabetes have in the U.S., exercise typically improves blood sugar levels.

On the other hand, if someone performs extremely strenuous exercise, one can elevate the adrenalin and other hormones so high that sugars can actually become elevated. This is not a problem for most of our patients.

For individuals who may have type 1 diabetes and are taking insulin injections for therapy, they are much more likely to have wider swings of blood sugar. If they exercise and don't have much insulin on board, then their sugars can go very high, and if they have lots of insulin on board and exercise strenuously without enough food, they can have severe low blood sugar reactions. Typically, exercise does not improve the overall control in individuals with type 1; however, exercise is very important for lowering risk of heart disease, raising your good cholesterol, and psychology of well-being.

"Stress can raise adrenalin levels hugely, and adrenalin can raise your blood sugar, sometimes as much as 10 to 30 milligrams percent."

MEMBER QUESTION:
I have been recently diagnosed as type 2 and seem to be in denial. What can I do to get past this stage?

REDDY:
This is a very common. It's important to have a family member or a tolerant physician you can discuss these thoughts with, and certainly recognizing that one is in denial is the first step to improvement.

In the old days, we used to think of hypertension as a silent killer, but now diabetes should also be considered a silent killer -- most of us have no symptoms when our sugars rise to high levels. Many of us think we don't have diabetes until we're put on insulin therapy. But in reality, despite having no symptoms, high sugar levels continue to damage:

• Eyes

• Kidneys

• Heart

• Nerves

I think the first step is to be more educated about the future ramifications of high blood sugars and to think about the management, like you would in getting a life insurance policy.

Remember that life insurance premiums at age 30 are very low, but at 65 are very high. Very early in the state of diabetes, very minor diet and lifestyle modifications can have tremendous benefits. We are getting safer and more tolerable treatments each year; for example, inhaled insulin is also around the corner. Artificial pancreases will also be the new state of technology in five to 10 years. All these advances allow a person to lead a fairly normal life.

Remember, we don't expect individuals to follow many of the dietary and lifestyle principles 100% of the time. We would be very happy if people followed them 85% to 90% of the time. I often tell my patients that if they're very compliant with their lifestyle changes, perhaps once a month or once every few weeks they can reward themselves with a more pleasing lifestyle experience with respect to diet or exercise.

It is sad, sometimes, when we see individuals that do not seek medical attention until they start losing vision or start losing sensation in their feet. So we see the denial quite often, but it's an ongoing challenge.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician.