By Barry Simon, MD FRCP
Psychiatrist, Mount Sinai Hospital, Toronto, Ontario
Assistant Professor of Psychiatry, University of Toronto
What is diabetes distress?
Living with diabetes can be stressful. For some, the stress goes beyond everyday concern and leads to a condition known as diabetes distress. This condition has been described as the long-term sadness and emotional turmoil related to having diabetes. The distress can manifest in a number of ways, including feeling emotionally burdened by the disease, thinking that family or friends are not supportive, worrying about future complications of diabetes, or sensing that the diabetes healthcare team is not available or helpful.
How do you know if you suffer from diabetes distress?
First, your experience is a clue. If you find that diabetes weighs heavily on your mind and you feel that you need to take a break from the disease, you may be struggling with diabetes distress. Like any condition, it is a matter of degree of suffering. The Diabetes Distress Scale will help give you a clear sense of whether your level of distress is concerning.
What can you do if you do have diabetes distress?
Diabetes is a demanding illness. It’s not as simple as taking an aspirin tablet to treat a headache. There are two critical things you can do about diabetes distress. The first step is to review your knowledge of diabetes care. Many people who score high on the Diabetes Distress Scale need to improve their problem-solving skills around managing low or high blood sugars, managing blood sugars during or after exercise, or other challenges affecting their comfort with self-care. You may want to reach out to your diabetes healthcare team or review your favourite diabetes community website for helpful tips.
The second step is to better manage your emotional relationship with diabetes. Breathing strategies, improving your ability to ask for help from family and friends, and sharing your experience about living with diabetes can all be helpful ways of easing distress. Talking about your feelings with people who care about you can help greatly. Moreover, talking to family and close friends will help them to better understand what you’re going through, and will allow them to offer you the support you need.
Another issue that leads to diabetes distress is your thinking style. Many people expect their care to be perfect. As a result, any slip-up leads to a worry that complications are around the corner. Excellent care is the goal, but perfectionism leads to burnout and distress.
Finally, for the past few years, I have been using life purpose to improve my patients’ ability to live with diabetes distress. Dr. Victor Frankl, an Austrian psychiatrist who wrote Man’s Search for Meaning, said that ‘“Distress is suffering without meaning.” I have helped my patients realize that few people enjoy taking care of their diabetes, but they are willing to do so because something significant is more important to them.
The next time you feel stressed, burdened or distressed by your diabetes, begin by acknowledging that it is entirely normal to feel that way. Acceptance of some level of distress eases your shame or expectation that you should be calm about diabetes. Next, take a few slow, deep breaths and calm your body down.
If you find your mind racing with negative thoughts and feelings about your diabetes, remember that they are a by-product of the stress and fear of living with a chronic illness. You can remind yourself that they are just thoughts, feelings or bodily tension by repeating the following phrase: your first name and the words “let go.” For example, I would say to myself, “Barry, let go.” I would time the phrase to either my in-breath (inhalation) or out-breath (exhalation) and repeat it continuously with each breath about 10 to 15 times. This truly has a calming effect on your mind and body.
After your mind has calmed down, think about something in your life that you value and are willing to take care of, despite your diabetes distress. It may be your children or grandchildren, a cottage where you hope to spend time, or a hobby or activity that you enjoy. This is the reason why you are willing to take your diabetes medication or insulin, count carbs and test your blood sugar.
You can ease your diabetes distress by reviewing your diabetes skills, reaching out to the right people for support, and reminding yourself that no one wants to take care of their diabetes but they’re willing to do it for something that matters to them more. If your diabetes distress persists, reach out to your diabetes healthcare team for further support.