Key points:
- Diabetes can be challenging! It’s normal to find yourself feeling angry, sad or frustrated.
- Diabetes distress is real. Diabetes Canada uses this term to describe the difficult emotions that accompany living with diabetes.
- Protecting your mental health is a key part of managing diabetes well.
Each day, we experience a wide range of emotions, from highs to lows – joy, sadness, excitement, anger, pride and anxiety. If you are living with a chronic health condition like diabetes, it’s normal to feel difficult emotions. Still, looking on the bright side can help to protect your mental health.
Learning that you have diabetes can often bring feelings of anger, sadness and denial. As time passes, frustration or continuing anger can deepen into depression. Being diagnosed with diabetes can change the way you feel about yourself. People often have a new vision of themselves as ‘sick’ or ‘not quite well.’ It is tempting to use denial as a way of dealing with this changed body image. You may feel that if you just eat and do as you want, no one will ever know about the disease. You can pretend nothing has changed.
However, denial is both physically and mentally dangerous. Uncontrolled diabetes (high glucose levels) makes depression worse. A struggle with depression may keep you from even trying to learn more about your diabetes, an essential part of managing this condition. Depression makes it harder than ever to eat well and get enough physical activity. It is common to feel that life is over, and not even try to manage your diabetes.
Even if you are managing your diabetes well, it’s easy to fall prey to depression and negative feelings. Both types of diabetes get more difficult to manage as time goes on. In Type I diabetes, the number of working beta cells (cells that make insulin) continues to decline. Once they are nearly all gone, blood glucose levels tend to swing even with regular food intake, exercise, and insulin doses. As glucose levels become more difficult to predict, you may feel very frustrated and frightened.
Type 2 diabetes is also progressive. It doesn’t just seem to get harder to manage – it really does get harder. As time passes, more medication and often insulin may be needed to manage the diabetes. Even if you have come to terms with your diabetes, eat well and exercise daily, this progression in itself can be depressing.
Difficult feelings and depression can often come from the way others respond to your condition. Imagine – you have waited all day to enjoy a carefully measured treat. It is not pleasant to be told, “You have diabetes – you can’t eat that!” It’s just as bad to have someone force a treat that you know you shouldn’t eat, saying, “I made this especially for you, surely one little piece won’t hurt.” Or to overhear, “I would love to have them over, but I don’t know what to give them to eat.” Some comments are rude, insensitive, and unthinking. Others are said in ignorance. Helping your friends and family learn that people with diabetes can eat a wide variety of foods can be empowering for you and make your life – and theirs – more fun!
The fear of being excluded can also make you feel helpless and depressed. Though you want to be included, the fear of changing glucose levels is very real. If the level is too low (hypoglycemia), you may stumble, have embarrassing mood swings or, more seriously, go unconscious. Such symptoms can put you and possibly others at risk. If the level is too high, it is difficult to concentrate. You may be very thirsty and need to go to the washroom very often. Social events can become more difficult. You may begin to refuse social outings, and to narrow your circle of friends.
If your diabetes stays out of control with high readings, it can lead to long-term complications. These include blindness, kidney disease, nerve disease, amputation and early heart disease. All of these conditions can make you feel different from everyone else.
Fighting negative feelings and overcoming depression is hard work in itself. If you are also dealing with the daily and unceasing demands of diabetes, it becomes even harder. No matter what you do, some days are difficult. You may need a lot of hope and emotional energy just to keep going. For some people with diabetes, life can be a constant battle for control.
Diabetes Canada defines diabetes distress as the negative emotions and burden of self-management related to living with diabetes. The term describes the difficult emotions that accompany a diabetes diagnosis. This includes the need to continually monitor your diabetes and treatment, ongoing worries about complications, and the potential changes to your personal and professional relationships.
HELPFUL WEBSITES
How can you protect your mental health?
One way to get through is to expect tough times and have a plan. Use ways of coping that have worked for you in the past. For instance, you might play or listen to music, go to the theatre or a movie with friends, or take a walk in the park when you are feeling stressed. Make a list of favourite things that make you feel happy. Refer to this list when you are feeling down.
Try exploring how diabetes fits into your life. Make a list of all the roles you play. These could include parent, child, grandparent, friend, volunteer, colleague, boss, employee, and client. Now list all the skills that you have, such as typist, teacher, musician, athlete, team player, reader, knitter, cook, and gardener. List your physical features: eye and hair colour, tall, short, thin, overweight, high blood pressure, hammer toes … diabetes. Of all the things you are, having diabetes is only a small piece. Though diabetes is part of the list, it is not the whole list.
Spend time each day listing the positive things in your life. One idea (borrowed from Oprah!) is to keep a gratitude journal. List a few things each day that you are thankful for, such as a loving spouse, a cuddly pet, or a beautiful afternoon. Reread your lists to remind yourself of everything good in your life. Move your attention away from problems and errors.
Although they won’t go away, you have shifted gears. This is the ‘power of the positive.’ It can take some practice if you have allowed the negative to take over.
Another important strategy includes incorporating regular physical activity to benefit your mental health. This could be a walk with a friend, enjoying gardening or other yardwork, or participating in a team activity. (If you have been inactive for some time, talk to your doctor before starting any exercise program that is more strenuous than brisk walking.)
Other alternatives include employing a mindfulness practice or learning specific physical or mental relaxation strategies. There are many resources to help you get started. Ask your diabetes health care professional to help you determine your personal goals in order to develop a plan.
Some negative things, however, will always need sorting out. Do you find it easier to solve a problem if you discuss all the aspects with others? Or do you like to put all the good things about a plan in one column and all the bad things in another? There are many ways to help rehearse possible results. The key to good problem solving is thinking ahead to all good and bad possibilities.
If you need to talk things out, do you have a network of well-informed people? Do you value their input? Having social support has a very positive impact on overall health. Going over the same ground again and again can be difficult and lead to burnout. Consider saving your friends for fun, and use a diabetes health professional or a diabetes support group to discuss issues and concerns. This can also help your loved ones.
Family is important. Your family members are closest and most involved with your life and diabetes. However, they also have their own emotional responses to your diabetes. While some responses are helpful and supportive, others can make it harder for the person with diabetes. The relationship may need to change. For instance, parents feel concern and grief for their child who has diabetes. They may feel guilty and helpless. They worry and struggle with finding the limits of supervision and independence. All of the extra work and planning and balancing can leave parents feeling very overwhelmed. They may become angry with each other, the child with diabetes or other children in the family.
Brothers and sisters worry that they will also get diabetes. Sometimes they are so relieved it is not them that they feel guilty. If food and activities change for the entire family, other children may feel angry with the one with diabetes.
Learning about diabetes as a family is one way to work through negative responses. With time and support, children and families usually find a way to help each other. Favourite food choices may change or be spaced out, but they can usually be included. Since food for managing diabetes is healthy, everyone can eat the same way. It’s easier when everybody is involved in learning how to develop healthy eating habits.
For adults, a partner may be the one who is most involved. Finding the balance between supporting food choices that are healthy and acting like the ‘food police’ is a challenge. Nagging or know-it all attitudes are not very helpful. Though learning about diabetes together is useful, remember who it is that has the disease. One partner may be more involved in food purchasing and preparation, but both should know what will be on the shopping list and then the table.
Remember that every added problem or change in managing diabetes is difficult. It can be like being newly diagnosed again. The partnership may be stressed too. Some might view it as their own failure to keep on track. A partner who has tried to choose appropriate food and has supported and participated in the daily exercise program may feel the same sense of failure – “If only I had been more careful and encouraging.” While it is OK to feel this way, remember that failure may just be a change in the body’s ability to function efficiently and may not reflect anyone’s management choices. We cannot slow time and aging.
Finally, find the diabetes educators in your community. These experts can work with you and your family to help you get through rough spots. They may be nurses, dietitians, pharmacists, social workers, or doctors.
Keep in mind that it is normal to experience feelings of grief, denial, and sadness when dealing with diabetes in your family. If these feelings persist and interfere with your usual sleep, eating and social patterns, see your doctor. Clinical depression and anxiety are more common in people with diabetes, and other therapies such as medication may be required. As with all health issues, your mental health can change over time. Make sure that you are discussing your mental health with your diabetes health care professional on a regular basis. By asking certain questions, they can quickly assess how your mental health is at that moment and provide specific recommendations for treatments.
Remember, your family and friends love you and usually want to be supportive in whatever way is best for you.
WRITTEN BY: Susan Roe-Finlay, RN, MSc, CDE.
EDITED BY: Stacy Johnson, BSc (Pharm), MBA
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