One of the most unique and important distinctions about diabetes is that it is primarily self-managed (as opposed to being treated by a doctor at clinic visits). Because diabetes is 24/7, there is a whole other level of constant background noise during the course of every day life. People with diabetes are constantly making choices (which tend to boil down to: do I attend to my diabetes or don’t I?) that will affect their prognosis. They very well may choose the latter, and for a number of reasons. From having just completed a diabetes task (I just took insulin so I can relax for the next hour while I eat dinner) to just being sick and tired of it (I know my CGM is beeping high but I have to pick up the kids, get them started on homework and put dinner on the table) and the many spaces in between, there is usually a a reel of nonstop dialogue from a vigilant part of themselves that is always watching, anticipating, checking in, planning ahead, and whatever else diabetes-related. This part can get tired though, and it's normal for the part who wants the doughnut and cares not what it will do to spike blood sugar to win out sometimes.
As we look at the responsibility that comes with choice, the ability to self-monitor can be empowering because it means that the PWD can, for the most part, affect change in their own health; they are not “at the mercy” of their disease. The other side of this—which is often difficult for folks to understand and validate, is the thoughts of guilt, shame, and fear that can come from not being on top of diabetes. “If only I had taken better care of myself, not had that doughnut, checked my blood sugar before bed, I’d be okay. This is my fault. I should be doing more.” If you are a parent or caregiver of a child with T1D, these feelings can come on strong in a different way since the stakes are the wellbeing of your child. Parents will make incredible sacrifices to protect their children. Many have told me that they would take child’s diabetes and have it themselves if they could, but diabetes doesn’t make those kinds of deals. Whether diabetes is yours or it belongs to someone you love, this kind of thinking can be toxic, isolating, and complex though not uncommon.
When mental health issues come up and diabetes is in the picture, you need a clinician who can tease out Diabetes Distress from related conditions such as depression, anxiety and general stress. Many symptoms of these conditions overlap (see the chart below) and you need a trained therapist who knows where to look and has specific knowledge of each in order to correctly identify and effectively address whatever is going on.
Are you experiencing difficulties with your diabetes and aren’t sure which is causing what or whether they’re related? Perhaps you’re struggling with Diabetes Distress and need some help with strategies to overcome these situational issues. Whichever it is, I can help. Get in touch today.