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Author Q&A: “Diabetes Sucks and You Can Handle It”

Psychologist and diabetes specialist, Mark Heyman, talks about his new book on his personal type 1 diabetes story. He discusses why he wrote this book and what he hopes people with diabetes and their loved ones gain from reading it.  

Diabetes Sucks and You Can Handle It is truly a self-help, easy-to-read book that you can work through like a workbook. Dr. Mark, as he refers to himself in the book, includes pertinent stories from people with type 1 diabetes he has counseled in his private practice, along with his own struggles over 20 years with type 1.

Each chapter contains exercises to complete and chapter takeaways. Dr. Mark writes in a supportive (“I know what it's like”) tone, which serves up tough love at times (“I know you can do this”). The flow is logical and builds through the pages as it helps you build resilience and confidence. The QR codes on pages throughout the book offer additional information and resources.

Hope Warshaw: Please share a bit about your diabetes story.

Mark Heyman: I was diagnosed with type 1 diabetes on June 1, 1999. It was the end of my junior year of college. I had all the classic symptoms of type 1 – extreme thirst, frequent urination, and fatigue ­– but I was hesitant to go to the doctor. I had plans to spend that summer in Paris as an intern at the US Embassy, and I was worried that if I went to the doctor, they would tell me I couldn’t go. However, eventually, I felt so sick that I had no choice. I went to the student health center, and they sent me to the emergency room by ambulance. I was discharged a couple of hours later with an appointment to see an endocrinologist the following day.

The next day, I met my new doctor [the renowned endocrinologist, Dr. Anne Peters!], who gave me a crash course in diabetes. At the end of my appointment, she asked if I had any questions, and I told her about my upcoming trip to France. I expected her to say to me that I couldn’t go. Instead, she told me diabetes wouldn’t get in my way, and I could do anything I wanted, even with type 1. These empowering words stuck with me and still influence me today.

Just over two weeks after my diagnosis, I boarded a plane and spent the summer in Paris.

Warshaw: What is your why for writing this book?

Heyman: People tell me that they feel like something is “wrong” with them because they are experiencing emotional challenges because of diabetes. But the reality is that emotional challenges are a normal reaction to stress­ – a reaction that any human would have in the same situation. I want to normalize the fact that life with type 1 is challenging and then give people practical tools they can use to deal with this stress.

Warshaw: How did you set the book up for people to gain maximum value?

Heyman: I tried to set people up for success by letting them know that there are aspects of diabetes that will be challenging no matter what. I tell people the only way to navigate these challenges is to be honest with themselves about what the challenges are.

I also put in a lot of personal stories about my experience of living with diabetes and the stories of people I have worked with in my private practice. I want readers to see themselves reflected in the book.

Finally, I included exercises readers can do to practice the skills they learn from the book. I want people to take what they know and put it into action.

Warshaw: Why is type 1 diabetes overwhelming and burdensome?

Heyman: The short answer is people with type 1 are constantly making decisions that can impact their health and well-being. Unlike other activities, you cannot take a break from making these decisions. This constant work makes diabetes feel overwhelming at times.

Warshaw: Can you differentiate between diabetes distress, sometimes referred to as “diabetes burnout,” and depression or other psychological/psychiatric diagnosis?

Heyman: On the surface, diabetes distress and depression can look the same. They share many symptoms, including depressed mood, difficulty with sleep and concentration, and even feelings of hopelessness. The difference is what is causing these symptoms. With diabetes distress, the cause is the never-ending work of managing diabetes. If you were to remove diabetes from the equation, the symptoms would go away. With depression, diabetes may be a contributing factor, but the person would still experience depressive symptoms even if they did not have diabetes.

Warshaw: If a person or their loved ones believe they may have a psychological/psychiatric diagnosis beyond diabetes distress, what actions do you recommend?

Heyman: Consult with a licensed mental health professional.

Warshaw: You are very clear that type 1 diabetes will continue to “suck,” but you stress it is the person’s ability to learn how to handle diabetes that can turn one’s mental outlook around. What are the first few steps in this process?

Heyman: The first step is to be honest about what makes type 1 diabetes difficult. If you are not honest with yourself about the very real challenges that come with type 1, you can’t do anything to address them. Next, you must lean into your diabetes management. It’s common to want to ignore diabetes when things get stressful but ignoring it and the high glucose levels that follow make it harder to handle.

Warshaw: Honesty is a theme you discuss. Why is honesty with yourself and others so important?

Heyman: If you are not honest with yourself about the challenges of living with diabetes, you are helpless to address these challenges. On the other hand, if you are not honest with yourself about how you sometimes make diabetes more difficult for yourself than it has to be, you put yourself in a place where handling type 1 becomes impossible.

Warshaw: What are the essentials that people with type 1 diabetes need to master to, as you say, “handle it?” Why can’t people get rid of the stress?

Heyman: Until we don’t have to think about managing our glucose levels, life with diabetes will involve a certain amount of stress. While we can learn to navigate the stress, we cannot get rid of it. When you try to control something like the stress of diabetes, which is not always possible to control, it gets even more burdensome.

An essential step to handling the stress of type 1 diabetes is to stay in the present moment. You can’t do anything to manage stress when you are lost in your thoughts about the past or the future. The only place you can take action is in the here-and-now.

Warshaw: How does a person with type 1 or their loved one know they need to find and work with a psychologist on their diabetes care as a person or couple? 

Heyman: If the emotional burden of diabetes is getting in the way of a person’s ability to engage in their life (i.e., work, go to school, have relationships), they may benefit from seeing a mental health professional.

Warshaw: How do you recommend people with type 1 optimize their working relationship with their diabetes care providers?

Heyman: The best way to optimize your relationship with your healthcare providers is with clear communication about what you need from them and about your experience with type 1 diabetes. It is helpful for people with type 1 to go into their appointments with an agenda. Also be ready to be honest with your healthcare provider about your emotional experience with type 1 and how your emotions are getting in the way of your diabetes management.

Warshaw: How can interacting with others with type 1 diabetes be valuable, whether you are getting or giving advice or support?

Heyman: Getting support from others with type 1 is an essential aspect of handling the stress of this condition. Peer support can make you feel like you’re not alone and that the emotions you are experiencing are normal. It can also inspire. You are more likely to follow when you see others pushing themselves to live full lives without letting diabetes hold them back.

Warshaw: Do you think the book is just for adults with type 1 diabetes or are there others who surround a person with type 1 that can benefit?

Heyman: This book is for anyone with type 1 diabetes or who loves someone with type 1. This book can help people who are not familiar with the emotional burden of living with diabetes understand what their loved ones may be experiencing. This book is also a valuable tool for healthcare providers to help them better understand and support the people with diabetes they care for and counsel.

Warshaw: How can people learn more about Diabetes Sucks and You Can Handle It as well as how to purchase it? How can people learn more about you and your podcast?

Heyman: The best place to learn more about me is my website, www.thediabetespsychologist.com. You can buy the book on Amazon using this link: https://www.amazon.com/dp/1643888730/.

Warshaw: Thank you Mark!