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Psychiatric Aspects of Diabetes—a Physician's View

Published online by Cambridge University Press:  29 January 2018

R. B. Tattersall*
Affiliation:
University Hospital, Nottingham

Extract

A raised blood sugar level no more defines a single entity than does a raised bilirubin or a low haemoglobin. Diabetes is a heterogenous group of disorders whose only common factor is hyperglycaemia (Tattersall et al, 1980). The classification of diabetes is being revised, although the changes are of more relevance to epidemiologists than clinicians. Previous standards of normal glucose tolerance were set too low, so that some people were labelled diabetic who had no symptoms and have proved on follow-up not to be at risk of developing complications such as retinopathy (i.e. they had a non-disease). Epidemiological evidence suggests that the cut-off point for ‘true’ diabetes (i.e. a condition which leads to complications and shortening of life span) is a blood glucose level two hours after a 50 G oral glucose load of 11.1 mMol/L (National Diabetes Data Group, 1979). This corresponds to a fasting blood glucose level of 7 mMol/L or below. Hence, a single blood glucose value, either in the fasting state or two hours after a 50 G glucose load, is enough to diagnose diabetes and glucose tolerance tests should hardly ever be necessary.

Type
Research Article
Copyright
Copyright © Royal College of Psychiatrists, 1981 

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References

Anderson, B. J. & Auslander, W. F. (1980) Research on diabetes management and the family: a critique. Diabetes Care, 3, 696702.Google Scholar
Bale, R. N. (1973) Brain damage in diabetes mellitus. British Journal of Psychiatry, 122, 337–41.CrossRefGoogle ScholarPubMed
Bradley, C. (1979) Life events and the control of diabetes mellitus. Journal of Psychosomatic Research, 23, 159–62.CrossRefGoogle ScholarPubMed
Cahill, G. F., Etzwiler, D. D. & Freinkel, N. (1976) ‘Control’ and diabetes. New England Journal of Medicine, 294, 1004–5.CrossRefGoogle ScholarPubMed
Cannon, W. B., Shohl, A. T. & Wright, W. S. (1911) Emotional glycosuria. American Journal of Physiology, 29, 280–7.CrossRefGoogle Scholar
Citrin, W., Ellis, G. J. & Skyler, J. S. (1980) Glycosylated hemoglobin: A tool in identifying psychological problems. Diabetes Care, 3, 563–4.Google Scholar
Craig, O. (1981) Childhood Diabetes and its Management. 2nd edition. London: Butterworths.Google Scholar
Dunbar, H. F., Wolfe, T. P. & Rioch, J. M. (1936) Psychiatric aspects of medical problems. American Journal of Psychiatry, 93, 649–79.Google Scholar
Fabrykant, M. & Pacella, B. L. (1948) Labile diabetes: Electro-encephalographic status and the effect of anticonvulsive therapy. Annals of Internal Medicine, 29, 860–77.Google Scholar
Fairburn, C. G. & Steel, J. M. (1980) Anorexia nervosa in diabetes mellitus. British Medical Journal, i, 1167–8.Google Scholar
Fletcher, C. (1980) One way of coping with diabetes. British Medical Journal, i, 1115–16.Google Scholar
Gale, E. A. M. & Tattersall, R. B. (1979a) Unsuspected nocturnal hypoglycaemia in insulin treated diabetics. Lancet, i, 1049–52.Google Scholar
Gale, E. A. M. & Tattersall, R. B. (1979b) Brittle diabetes. British Journal of Hospital Medicine, 589–97.Google Scholar
Gale, E. A. M. (1980) Hypoglycaemia. Clinics in Endocrinology and Metabolism, 9, 461–75.Google Scholar
Gath, A., Smith, M. A. & Baum, J. D. (1980) Emotional behavioural and educational disorders in diabetic children. Archives of Disease in Childhood, 55, 371–5.Google Scholar
Grant, I., Kyle, G. C., Teichman, A. & Mendels, J. (1974) Recent life events and diabetes in adults. Psychosomatic Medicine, 36, 121–4.CrossRefGoogle ScholarPubMed
Greydanus, D. E. & Hofmann, A. D. (1979) Psychological factors in diabetes mellitus: a review of the literature with emphasis on adolescence. American Journal of Diseases of Children, 133, 1061–6.Google Scholar
Haumont, D., Dorchy, H. & Pell, S. (1979) EEG abnormalities in diabetic children. Clinical Pediatrics, 18, 750–3.Google Scholar
Haunz, E. A. (1950) An approach to the problem of the brittle diabetic patient. Journal of the American Medical Association, 142, 168–73.Google Scholar
Hauser, S. T. & Pollets, (1979) Psychological aspects of diabetes mellitus: a critical review. Diabetes Care, 2, 227–32.CrossRefGoogle ScholarPubMed
Hill, E. M. & Hynes, J. E. (1980) Fostering self-esteem in families with diabetic children. Child Welfare, 59, 576–82.Google ScholarPubMed
Joslin, E. P. (1959) The Treatment of Diabetes (eds. Joslin, E. P., Root, H. F., White, P. and Marble, A.). 10th Edition. London: Kimpton, p 215.Google Scholar
Jovanovic, L., Peterson, C. M., Saxena, B. B., Dawood, M. Y. & Saudek, C. D. (1980) Feasibility of maintaining normal glucose profiles in insulin-dependent pregnant diabetic women. American Journal of Medicine, 68, 105–12.CrossRefGoogle ScholarPubMed
Kinsey, J. L. (1941) Incidence and cause of death in shock therapy. Archives of Neurology and Psychiatry, 46, 55–8.CrossRefGoogle Scholar
Koski, M. L. (1969) The coping processes in childhood diabetes. Acta Paediatrica Scandinavica, Suppl 198.Google Scholar
Laron, Z., Galatzer, A., Amir, S., Gil, R., Karp, M. & Mimouni, M. (1979) A multidisciplinary, comprehensive, ambulatory treatment scheme for diabetes mellitus in children. Diabetes Care, 2, 342–8.CrossRefGoogle ScholarPubMed
Loughlin, W. C. & Mosenthal, H. O. (1944) Study of the personalities of children with diabetes. American Journal of Disease in Childhood, 68, 1315.Google Scholar
Ludvigsson, J. (1977) Socio-psychological factors and metabolic control in juvenile diabetes. Acta Paediatrica Scandinavica, 66, 431–7.Google Scholar
Malins, J. M. (1968) Clinical Diabetes Mellitus. London: Eyre and Spottiswoode.Google Scholar
Martin, F. I. R., Hansen, N. & Warne, G. L. (1977) Attempted suicide by insulin overdose in insulin requiring diabetics. Medical Journal of Australia, 1, 5860.Google Scholar
Mechanic, D. (1961) The concept of illness behaviour. Journal of Chronic Disease, 15, 189–94.Google Scholar
Menninger, W. C. (1935) The inter-relationships of mental disorders and diabetes mellitus. Journal of Mental Science, 81, 332–57.Google Scholar
Menninger, W. C. (1935) Psychological factors in the etiology of diabetes. Journal of Nervous and Mental Disease, 81, 113.CrossRefGoogle Scholar
Mills, J. W., Sanders, K. M. & Martin, F. I. R. (1973) Socio-economic problems of insulin-dependent diabetes. Medical Journal of Australia, 2, 1040–4.Google Scholar
Minuchin, S., Baker, L., Rosman, B. L., Webman, R., Milman, L. & Todd, T. C. (1975) A conceptual model of psychosomatic illness in children: Family organisation and family therapy. Archives of General Psychiatry, 32, 1031–8.Google Scholar
Minuchin, S., Rosman, B. L. & Baker, L. (1978) Psychosomatic Families: Anorexia Nervosa in Context. Cambridge, Mass.: Harvard University Press, pp 2350.Google Scholar
Murawski, B. J., Chazan, B. I. & Balodimos, M. C. (1970) Personality patterns in patients with diabetes mellitus of long duration. Diabetes, 19, 259–63.Google Scholar
National Diabetes Data Group (1979) Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes, 28, 1039–57.Google Scholar
Oakley, W. G., Pyke, D. A. & Taylor, K. W. (1968) Clinical Diabetes and its Biochemical Basis. Oxford: Blackwell.Google Scholar
Peacock, I., Hunter, J. C., Walford, S. P., Davison, J., Clarke, P., Symonds, E. M. & Tattersall, R. B. (1979) Self-monitoring of blood glucose in diabetic pregnancy. British Medical Journal, ii, 1333–6.Google Scholar
Pelser, H. E., Groen, J. J., Stuyling De Lange, M. J. & Dix, P. C. (1980) Experiences in group discussions with diabetic patients. Psychotherapy and Psychosomatics, 32, 257–69.Google Scholar
Peterson, C. M., Jones, R. L., Dupuis, A., Levine, B. S., Bernstein, R. & O'Shea, M. (1979) Feasibility of improved glucose control in patients with insulin dependent diabetes mellitus. Diabetes Care, 2, 329–35.Google Scholar
Pickup, J. C., Keen, H., Parsons, J. A. & Alberti, K. G. M. M. (1978) Continuous subcutaneous insulin infusion: an approach to achieving normoglycaemia. British Medical Journal, i, 204–7.Google Scholar
Pond, H. (1979) Parental attitudes towards children with a chronic medical disorder: special reference to diabetes mellitus. Diabetes Care, 2, 425–31.CrossRefGoogle Scholar
Rimoin, D. L. & Rotter, J. I. (1981) Genetic syndromes associated with glucose intolerance and diabetes mellitus. In Genetics of Diabetes, (eds. Kobberling, J. and Tattersall, R. B.). London: Academic Press.Google Scholar
Rosen, H. & Lidz, T. (1949) Emotional factors in the precipitation of recurrent diabetic acidosis. Psychosomatic Medicine, 11, 211–15.Google Scholar
Rosenbloom, A. L. & Giordano, B. P. (1977) Chronic overtreatment with insulin in children and adolescents. American Journal of Disease in Childhood, 131, 881–5.Google Scholar
Sanders, K., Mills, J., Martin, F. I. R. & Horn, D. J. (1975) Emotional attitudes in adult insulin-dependent diabetics. Journal of Psychosomatic Research, 19, 241.Google Scholar
Sonksen, P. H., Judd, S. L. & Lowy, C. (1978) Home monitoring of blood glucose. Lancet, i, 729–32.Google Scholar
Stearns, S. (1959) Self-destructive behaviour in young patients with diabetes mellitus. Diabetes, 1959, 8, 379–82.Google Scholar
Sterky, G. (1963) Family background and state of mental health in a group of diabetic school children. Acta Paediatrica, 52, 377–90.Google Scholar
Stone, D. B. (1961) A study of the incidence and causes of poor control in patients with diabetes mellitus. American Journal of Mental Science, 241, 64.Google Scholar
Sullivan, B. (1978) Self esteem and depression in adolescent diabetic girls. Diabetes Care, 1, 1822.CrossRefGoogle ScholarPubMed
Swift, C. R., Seidman, F. L. & Stein, H. (1967) Adjustment problems in juvenile diabetes. Psychosomatic Medicine, 29, 555–71.Google Scholar
Tamborlane, W. V., Sherwin, R. S., Genel, M. & Felig, P. (1979) Reduction to normal of plasma glucose in juvenile diabetes by subcutaneous administration of insulin by a portable infusion pump. New England Journal of Medicine, 300, 573–8.Google Scholar
Tattersall, R. B. (1977) Brittle Diabetes. Clinics in Endocrinology and Metabolism, 6, 403–19.Google Scholar
Tattersall, R. B. (1979) Modern management of the insulin-dependent diabetic. Irish Journal of Medical Science, 148, Suppl 2, 4554.Google Scholar
Tattersall, R. B. & Lowe, J. (1981) Diabetes and adolescence. Diabetologia, 20, 517–23.Google Scholar
Tattersall, R. B., Pyke, D. A. & Nerup, J. (1980) Genetic patterns in diabetes mellitus. Human Pathology, 11, 273–83.Google Scholar
Tchobroutsky, G. (1978) Relation of diabetic control to development of microvascular complications. Diabetologia, 15, 143–52.Google Scholar
Vandenberg, R. (1971) Emotional aspects in juvenile-type diabetes and its complications, (ed.) Sussman, K. Springfield, Illinois: Charles C. Thomas.Google Scholar
Walford, S., Gale, E. A. M., Allison, S. P. & Tattersall, R. B. (1978) Self-monitoring of blood glucose. Lancet, i, 732–5.Google Scholar
Wellborn, T. A. & Duncan, N. (1980) Diabetic staff simulation of insulin-dependent diabetic life. Diabetes Care, 3, 679–81.Google Scholar
Williams, J. F., Martin, D. A., Hogman, M. D., Watkinson, J. D. & Ellis, E. V. (1967) The clinical picture of diabetic control studied in four settings. American Journal of Public Health, 57, 441.Google Scholar
Woodyatt, R. T. (1938) Diabetes mellitus. In A Textbook of Medicine, 4th Ed., (ed.) Cecil, R. Philadelphia: W. B. Saunders.Google Scholar
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