The person and diabetes in psychosocial context.

This review spans life with diabetes from the first year through the succeeding period of relatively good health, into the phase when the patient needs to accommodate for more symptoms and impaired functioning. Focusing on autonomy, vulnerability to fears, and vocational choices, this article compares effects of diabetes on children and youths with effects on those with onset in later life. A concept of biopsychosocial homeostasis helps to explain: (1) why patients turn to a physician when they do; (2) how the physician may often save the patient time and money by helping that patient to change psychological and social components of well-being and functioning--and highlights the importance of these; (3) how to treat depressive disorder; (4) how to discuss worst fears and encourage patients to play with their unpleasant imaginings; and (5) how to reduce hypoglycemia. Repeated hypoglycemic episodes have the cumulative deleterious effect of undercutting the patient's and others' sense that the patient is dependable, with impaired performance and even serious occupational and marital repercussions. Educational tactics are suggested for the patient with IDDM who finds it harder to identify early levels of hypoglycemia; that patient must learn to respond to specific clues of mild hypoglycemia, stemming from defective thinking and emotional and sexual functioning. There is no substitute for a full history and an empathic understanding of the patient's imaginings, relationships, and circumstances.