2. Consult your health-care provider. Diabetes distress should be part of the conversation that people with diabetes have with their health-care providers on a regular basis. Admittedly, however, many people feel awkward bringing up issues about distress and feelings of discouragement, particularly when office visits are short and a large amount of material must be covered during any one visit. Furthermore, practitioners often make suggestions for care that overload people by asking them to do too many things too quickly, not explaining things clearly, or proposing a management plan that is not practical and realistic given each person’s unique life context. One can leave a practitioner’s office far more distressed than when one arrived.
While many health-care providers fail to initiate discussions about the feelings a person is having, most know that even the best diabetes plans will not work if the person is distressed, depressed, or burned out, and most will attend to these issues if a person brings them up directly. Sometimes a short course of antidepressant drugs can be helpful; sometimes reworking the management plan or coming up with alternative coping behaviors can address the problem; or sometimes a referral to a behavioral specialist is in order. In many cases, a simple airing of the problem relieves much of the tension and distress and helps put things back into perspective.
3. Talk to family members, friends, or others with diabetes. Put your feelings into words and express yourself. Talking about how diabetes feels is not necessarily whining or complaining; it is sharing what is going on internally in ways that inform others and in ways that force you to articulate your concerns verbally. Talking it out can help a person gain perspective, identify specific aspects of self-management that have become problematic, and make plans to address each aspect of the problem in a focused way. Keeping feelings inside and unexpressed often forces them into an internal box, where they fester and build upon one another. When this occurs, the risk of expression at the wrong time, at the wrong target, or with the wrong intensity increases dramatically.
Seek out others who are understanding about diabetes and are willing to listen without necessarily providing solutions. Telling the tale is often more helpful than finding the supposed solution.
4. Do one thing at a time. When distressed, many people with diabetes attempt to tackle all of their problems head-on or to alter their entire management plan in the hopes of making diabetes more tolerable. They double their physical activity regimen, sharply reduce calories with a new diet, or perhaps purchase a new blood glucose meter as a cue to monitor more frequently. The greater the number of things changed in a management plan at one time, though, the greater the probability that none of them will be accomplished. The lack of accomplishment then increases feelings of frustration and failure, and the process escalates to another level. To deal with diabetes distress effectively, create a list of priorities for change, and address each separately, one at a time.
5. Pace yourself. This tip follows directly from #4. The slower the pace of change, the greater the probability that a goal will be achieved and, even more important, sustained. For example, people who drastically increase their physical activity may do very well for a week or two, even with sore muscles. But the probability is low that they will be able to sustain the program over time. Fatigue will increase, other lifestyle factors will compete for time, and motivation to continue will suffer. The primary goal of most aspects of diabetes management is sustained behavior, not just reaching a target in the short term. A slow pace of change enables the new behaviors to become more easily incorporated into a person’s general lifestyle, and the new behaviors become self-reinforcing because many small goals are achieved sequentially over time. Furthermore, a slow pace enables each individual to experiment with alternatives in ways that make the most sense, and barriers to success are less overwhelming and can be dealt with more slowly and consistently.