When Patients With Diabetes Have Posttraumatic Stress Disorder

Why do some people with diabetes have such a difficult time controlling their blood sugars while other seem to regulate them with ease? Every person with diabetes has likely received advice that controlling their blood sugars is one of the keys to preventing the devastating complications that chronically elevated blood sugars can bring to their eyes, kidneys cardiovascular system and feet. 

Most people get it. They acknowledge the need to adhere to a diet that avoids sugar and limits carbohydrates. Many fear the risks associated with chronically elevated blood sugars and perhaps some of them have seen the impact of this on the lives of friends or family members who ignored this recommendation. In one study, patients with diabetes  reported fearing a lower extremity amputation more than death.¹

Despite having the knowledge of and methods to control blood sugars via diet, why do some patients continue to have chronically elevated blood sugars? Part of the problem is often unintentional. After talking with many patients with diabetes, I have come to better understand the issues. Sometimes, it is a matter of lack of education. Sometimes, educated patients do not follow recommendations. Sometimes, patients do not take their medication or do not take the right dose at the right time. Sometimes, they do not exercise. Sometimes, it is due to the rarely considered or often unrecognized psychosocial issue of post-traumatic stress disorder (PTSD).

What Is The Relationship Between PTSD And Hyperglycemia?

In my experience, people who have PTSD are usually miserable. During my career, I have observed that patients with diabetes and PTSD may be educated about nutrition but still have elevated hemoglobin A1c values. Why does this happen? In an attempt to mitigate their misery, they search for something in their day that gives them a moment of pleasure. It could be something small, like smoking a cigarette or drinking an alcoholic or sugar sweetened beverage. They might eat something forbidden, like candy, or foods high in carbohydrates like french fries, pizza, cake or cookies. That moment of pleasure, repeated daily, can lead to chronically elevated blood sugars and the consequences of blindness, kidney failure, foot ulcers and amputations.

Post-traumatic stress disorder is the result of an experience or experiences that are so emotionally overwhelming that people become “stuck in them.” They cannot resolve them or have closure about them. Most people associate PTSD with military service but it can be the result of any traumatic emotional experience. For example, the loss of a loved one or surviving the devastation of a hurricane and the aftermath of putting one’s life back together qualifies as PTSD-triggering experiences. These experiences and the resulting psychological pain may be responsible for the behaviors that lead to a person with diabetes searching for that moment of pleasure gained by consuming foods or beverages that can negatively affect and elevate his or her blood sugars. 

What Is EMDR?

In my experience, in order to return the A1c levels back to normal in a patient with diabetes and PTSD, one must heal the mind first and the body, along with the A1c, can follow suit. Removing the psychological stress relieves the person from the compulsive eating and drinking behaviors caused by his or her PTSD. While there are a variety of treatment strategies, including group therapy and medications, to help address PTSD, an alternative and potentially innovative approach is eye movement desensitization and reprocessing (EMDR) therapy. 

The World Health Organization, the American Psychiatric Association and the Departments of Veterans Affairs and Defense have all endorsed EMDR therapy.² Over 30 randomized controlled studies have empirically validated EMDR therapy in the treatment of trauma.^2,3 Over 25 studies have demonstrated the positive effects for the eye movement component used in EMDR therapy.^2,3

Trained therapists have successfully utilized EMDR therapy to help patients literally rewire their own brains. While patients will not forget the traumatic experience or experiences that caused their PTSD, those experiences will stop causing them psychological stress in the same way. The ultimate benefit of the therapy to patients with diabetes, PTSD and chronically elevated blood sugars is the opportunity to change their aberrant social behaviors concerning food and beverage choices, ultimately leading to better control and normalization of their blood sugars. For more information and to locate a therapist who utilizes EMDR, please visit (https://www.emdr.com/).

Dr. Hinkes is President and Chief Medical Officer of ePrevenir, Inc. He is board-certified by the American Board of Foot and Ankle Surgery. Dr. Hinkes is a Fellow of the American College of Foot and Ankle Surgeons, and the American Professional Wound Care Association. He is the author of “Healthy Feet for People With Diabetes” and “Keep the Legs You Stand On,” available at www.amazon.com .

References

1. Wukich DK, Raspovic KM, Suder NC. Patients with diabetic foot disease fear major lower-extremity amputation more than death. Foot Ankle Spec. 2018;11(1):17-21.

2. EMDR Institute website. Available at: www.emdr.com . Accessed March 16, 2021.

3. Research Overview. EMDR Institute website. Available at: https://www.emdr.com/research-overview/ . Accessed March 16, 2021.