Type 2 Diabetes continues to be in the headlines as a health crisis because more people are getting the disease and not enough of them are doing what it takes to minimize the complications that come with it. This is hard for those around them to understand. Friends, family and co-workers can’t grasp why it is so hard to get a healthier lifestyle if it means less suffering and pain. They wonder why those with cancer or other life-threatening diseases take action, while those facing diabetes seem stuck and unwilling to take better care of themselves. Are you one of those asking this question?

Unfortunately many of those at risk or who already have diabetes don’t understand it themselves. They don’t know why it is so hard to make changes or maintain better habits. It just is. But what so many of them do know is they feel misunderstood, frustrated and sick of dealing with the disease. The result is that millions of them simply give up trying and shut off their feelings, which leads to resignation and a denial of their situation.

I have worked with enough pre- and diagnosed type 2 diabetics (people with insulin resistance) struggling with lifestyle changes to understand their mental state, why it is so hard to take action and what can help them turn things around. And I will admit right up front that not everyone can be helped, but many can by understanding that diabetes is often a personal crisis for the individuals involved. They just can’t see it.

The typical person diagnosed with insulin resistance has not lived a healthy lifestyle, is often overweight, probably suffers from low self esteem (due to their weight, feeling out of control around food or other issues) and may be depressed. Upon diagnosis their life changes immediately. They must change the way they eat, monitor their carbohydrate intake and blood sugar levels throughout the day, and take an insulin sensitivity medication at specific times. The guidelines are very specific and rigid. They must also lose a certain amount of weight and given a deadline for when their blood sugar levels should get into the normal range. Many leave their appointments overwhelmed, in shock and frightened.

Initially people follow the guidelines fairly well and attempt to do what is asked of them, but it is a dramatic change from what they are accustomed to doing. As with dieting, they inevitably have days when it is too hard to do. This makes them feel guilty, believing they are bad and failing, further impacting their self esteem and depression. The more often this happens, the lower they feel. And the lower one’s self esteem or depression, the less likely they will take care of themselves. This becomes a downward spiral. If you have ever been depressed, you can appreciate this.

For most it is also challenging to comply with the exercise requirements. Many try, but it is tough to create a regular routine, especially if they’ve been sedentary. So despite their initial efforts to eat right and get exercise, the majority can’t keep it up and they discover something interesting. It doesn’t seem to make much difference in how they feel when they don’t exercise or eat so well. Sure their blood sugar levels go up or down too much, but it doesn’t seem so urgent or important when there aren’t obvious ramifications. What they can’t see or feel is the damage building up and the slippery slope of no return when they get past a certain point. But that can be several years from the initial diagnosis.

As an onlooker, what we see is their denial and refusal to do more. What they are actually experiencing is something far deeper: the repression of their emotions. They are dealing with feelings (many that contributed to their eating habits, lifestyle and diagnosis) such as shame, unworthiness, not being good enough or perfect enough. Add to that fear, stress, and all their other painful feelings that are pushed down and out of reach. Hiding beneath the surface is a personal crisis driving their behaviors.

The way to address it is with a non-judgmental approach to lifestyle intervention that is flexible and slowly rebuilds confidence through small goals and successes and provides a place for feelings to be released and beliefs to be changed. It can be done, but it may take about a year of weekly coaching and lots of patience. Even if they don’t believe it at first, those struggling with insulin resistance are worth it. This week reconsider what it is like to be struggling with this disease and understand that there is more than meets the eye.