Even though adulthood isn't quite as free as most of kids think, it still involves many choices. But, living with diabetes means that you will have to be more disciplined than you thought you would have to be as an adult. You must plan your day carefully, and say "no" to some indulgences along the way. (no doughnuts at work, controlled portions, only a certain amount of fat. You have to eat on schedule, even if you're not hungry – unless you're using an insulin pump).

Limitations and self-discipline have different meanings to different people. Some people don't mind. They are not bothered by self-discipline. Other people hate it. They feel that they are losing something when they have to exercise control over their eating and their schedule. Some feel a loss when they can't eat what everyone else is having. In therapy, we can explore what these things mean. These losses and moments of sadness are important. We want to understand what they are about - for you. Sometimes we may discover deeper meanings that are affecting you.

 Sometimes, just talking about these things will help. Some people  define their freedom differently. (For example- "If I do this, I will have a clear conscience and feel good." "No one gets to eat all the junk they want – if they do, they wind up sick early in life, or very obese, or both.") For others, particularly those who have had lives with a lot of deprivation (whether it was physical or emotional deprivation), the struggle may be a difficult one. However, they will be dealing with it actively in therapy, and not building up resentment that may boomerang into poor eating habits.

Sometimes, these issues about deprivation and limitations bring up really important life issues. In what areas of your life do you feel free to express yourself? Is food the only way you can express yourself? What is important to you in life? Are you on a track that is where you want to be?  This can become a rich subject for therapy exploration. .

Sometimes, when people experience feelings of deprivation, they are affected by things that also happened to them when they were young. Sometimes they grew up with a lot of emotional or material deprivation, or both. They have less of a "reservoir" to deal with feelings of deprivation, then, when they are older.  

Diabetes can be a "wake up call" to figure out your life priorities and make them primary. If you are feeling too deprived to be able to follow through on a diabetes routine, you may want to get some help with those feelings of deprivation.

You may be overweight, you may have less than perfect blood sugars, and you may really dislike dealing with the medical system.  It is easy to react to your nurse, dietician or doctor as the bad guy. He or she is the one who is telling you that you can't do what you want, right?

"What I'm most concerned about today is..."

Let's face it. There ARE moralistic-sounding doctors, nurses and dieticians who act like you're a bad person if you are overweight, if your blood sugars are high, or if you don't exercise.  Sometimes they come across moralistic because they feel helpless and are frightened for you. They have seen complications, and they don't want them to happen to you. They may have always loved sports, and cannot understand what it is like for a person who hates to exercise. They may not understand how difficult it is for a person to stop using food for comfort.

Sometimes, they may be frustrated because they'd like to be more supportive, and sit down and talk with you. They may be under tremendous pressure to see too many patients in a day.  Sometimes they are upset because they have just seen someone who has suffered a complication that could have been prevented with better care. Since health professionals usually go into the field because they want to "help people,"  they may feel helpless and guilty when they see a patient with complications.

A few healthcare professionals think that shaming or scaring a patient will result in better diabetic control. WRONG! While those tactics may work temporarily, they will not work in the long run. Why do they act this way? Sadly, they probably learned this lousy approach from their own parents!