Many people experience considerable distress about having diabetes and the amount of hands-on management that diabetes requires. This often includes frustration with the ongoing obligations of diet, physical activity, blood glucose monitoring, and taking medicines. Other equally important but less frequently acknowledged stresses can center around fears about the future, concerns about complications, difficulties dealing with caring but potentially intrusive friends and family members, and keeping up with all of the new drugs, treatment options, and related recommendations from the diabetes community. It is no wonder that as a group, people with diabetes report relatively high levels of personal distress, fatigue, frustration, anger, burnout, and feelings of poor mood and depression. Diabetes can feel overwhelming because of the unending demands of self-management.
The distress associated with diabetes and its management can have an effect on diabetes itself. For example, several studies have shown that people with diabetes who report more depressive symptoms have poorer management of their diet, physical activity, oral diabetes drug usage, and blood glucose monitoring, report more family conflict around diabetes, have more contact with the health-care system, and have higher levels of both diabetes complications and death from any cause over time than people with diabetes who do not have elevated levels of depressive symptoms.
The reasons for these associations are not completely clear, but two mechanisms have been proposed. First, research has indicated that distress and symptoms of depression are linked to the production of cortisol, a hormone produced by the adrenal glands. Among other actions, cortisol has been shown to reduce insulin sensitivity and to affect cardiovascular functioning. Second, stress and depression interfere with diabetes management behavior. It can be very hard to keep up with a complicated diabetes routine when you are having intense feelings of tension, distress, sadness, and frustration. So distress and depression can have both biological and behavioral effects on diabetes management. In fact, many clinicians consider a person’s levels of distress and depression to be as important to his or her care as measures of blood glucose, cholesterol, blood pressure, and weight.
In light of the considerable impact of distress on diabetes management—and on a person’s well-being in general—what can be done in response to feeling burned out, overwhelmed, and blue? The good news is that diabetes distress can be managed and reduced if a few important tips are kept in mind. Not every tip will work for every person, because people with diabetes have different personal styles, life contexts, and preferences. But the ideas underlying these tips are applicable to most people with diabetes.
1. Feelings of being overwhelmed and burned out are to be expected. Almost everyone who has diabetes feels frustrated and distressed from time to time, and some more than others. Diabetes is burdensome, and it is normal to react to this burden. Some people feel particularly depressed and frightened when a new development occurs, such as a new eye or kidney problem. They may blame themselves, other family members, or their health-care practitioners, or they may simply feel that they should give up (“What’s the use anyway?”). Others are more likely to feel burned out because of the unending demands of diabetes management. Having these feelings for more than a week or two signals that these feelings need to be attended to, just as other aspects of health and well-being need to be attended to on a regular basis. Disregarding or ignoring one’s feelings often makes matters worse, while paying attention to the intensity and type of feelings experienced often provides a clue for what to do next.