Diabetes Distress, Causes, Symptoms, Identifying It, Remedies

Posted March 13, 2020 by Michael Chamberlain - See Editorial Guidelines

Diabetes is one of the most daunting challenges anyone could experience. With the increasing level of diabetes patients and related medications, diabetes is a prevalent ailment.

However, this disease and its unavoidable medication needs can affect people in several ways. Diabetes medication needs and monitoring have led to several mental imbalances of which diabetes distress is the most common.

This article will give a thorough understanding of what diabetes distress is, how it’s caused, symptoms, why it’s important to manage, how to identify it, remedies, and much more.

But first, let’s give you a quick overview answer as to what diabetes distress is, then we’ll get into more details.

What Is Diabetes Distress? Diabetes distress is an emotional and psychological response among diabetes patients. This condition develops as a result of the complications, and patients must take certain medications or follow an insulin-dependent lifestyle. Continuous diabetes distress leads to diabetes burnout.

What Is Diabetes Distress

Diabetes Distress

People with diabetes are continually thinking about their health condition, be it from their diet to even walking around town on a sunny day. All the extra concerns and careful decisions diabetes patients have to make every day of their life can, at times, cause psychological distress.

Diabetes distress isn’t depression. However, studies suggest those with diabetes are twice as likely to develop depression compared to the general population. The distress is a condition that comes along with the need to monitor and regulate oneself 24/7, especially to those who use insulin.

From the very first day a patient encounters diabetes, they’re suddenly forced into a full-time job role, or perhaps a lifelong one.

This is more like a job than you might think. It’s a form of life management, and diabetes patients will have to deal with this along with their other typical day to day life activities.

But this lifestyle is not something you choose to participate in as and when you want. It can have a persistent and significant impact on a diabetic patient’s life and overall health. It is more like a second job that one will have to do without any pay or vacation.

Diabetes distress is the extra burden patients will have to carry while continuing their normal day to day lifestyle.

For example, patients will still need to lead their family and work-life, while making sure they’re monitoring and regulating their blood sugar levels as well.

Patients will also have to keep checking their blood sugar levels, remember to take their medication or insulin, adjust the insulin dose according to the requirement, and even keep a count on the carbs when they eat throughout every single day of their life.

This is the day-to-day or even minute-to-minute burden that patients will have to carry, which may already be stressful.

Diabetes Distress Spikes

What could spike up this stress further, is that while doing all these activities and managing their health throughout the day, a patient may still see their blood sugar levels rise. This can create an overwhelming feeling and can eventually lead to the condition of diabetes distress.

So, diabetes distress is a series of emotional responses patients go through and deal with when handling medications for diabetes and even merely living with it.

Emotion and Diabetes Distress

As we know, emotional distress comes in many forms. In diabetes distress, this form manifests itself in a feeling of total overwhelm and futility, eventually resulting in a surrendering toward the concerns and effects of diabetes.

This is akin to feeling powerless and becoming overpowered by the risks of diabetes.

This distress progresses as patients realize, even despite their best efforts, that blood glucose levels will rise, and it will seemingly become impossible to control the influences of diabetes in their life. This has a negative impact on the quality of life, which, in turn, causes diabetes distress.

Exceptions to Diabetes Distress

However, we should mention that not all patients are affected by diabetes distress. Much of this is dictated by the severity of their disease, and the psychological impact on the individual. But, it’s common among most diabetes patients to suffer from diabetes distress at least at some phase of their condition, and it’s certainly more common than depression.

It’s said that around 30 percent of people going through diabetes are likely to experience diabetes distress at some point in life. This psychological condition of diabetes is so common that the American Diabetes Association has recently added a separate section dedicated to covering diabetes distress.

The standards of medical care in diabetes – 2017 has outlined guidelines on screening and the treatment of patients who are going through diabetes distress, depression, and related mental health concerns.

Some new guidelines have also suggested healthcare providers screen and monitor diabetes patients for diabetes distress, and have recommended a set of tests for these conditions. 

So, to sum up what diabetes distress is, it’s sometimes known as diabetes-specific-distress or diabetes-related distress. It is the emotional response diabetes patients show when going through diabetes and its medication requirements.

Patients feel restless and even powerless about managing their daily lifestyle, medication needs, and all the complications involved in spending a normal day, unlike others.

Diabetes distress can also arise because of society and societal impacts. Things like stigma, discrimination for health conditions, dependency, unhelpful reactions, and lack of societal understanding of the diabetic conditions lead to more significant distress. Of course, financial struggles such as treatment and insurance cost add to the distress also.

Causes of Diabetes Distress

Most diabetes patients will have to deal with two types of diabetes, either type one and type two. Type 1 diabetes is a condition where the body doesn’t produce insulin. So, patients will have to rely solely on insulin injections or pumps that are attached to the skin, where insulin is delivered through a tiny catheter.

Whereas people with type two diabetes are insulin resistant, and the body is not able to process sugar correctly. So, the patients will need to take certain diabetes medications or sometimes insulin, depending on the severity of the condition. 

When patients try to balance the insulin intake or medication use, along with their diet and overall lifestyle, it becomes a huge task. It can be an exhausting set of processes daily.

Diabetes Distress

Insulin can be very difficult to balance, where too much or too little can cause many risks, even life-threatening ones. When the blood sugar levels drop too low because of too much insulin, patients can quickly become disoriented. If hypoglycemia is left untreated, then patients can potentially pass out.

If insulin intake is too low, blood sugar levels will be too high, and this can cause kidney, heart, and eyesight problems. The level of blood sugar can be heavily affected by food, alcohol, physical activities, and even things like emotional stress and other illnesses.

As such, to keep track of the blood sugar levels, patients must rely on instruments like a glucose meter and a lancing device.

These instruments prick the finger and get a drop of blood. This painful and tiring process will sometimes have to be done 4 or as many as 12 times a day, depending on the fluctuation of blood sugar levels. So, as one may be able to see, diabetic management is mentally and physically tiring, and diabetes distress is common.

The Extreme End of Diabetes Distress

Diabetes burnout is at the extreme end of diabetes distress. This state of physical and mental exhaustion is caused by continuous distress.

This is where patients feel that despite all their efforts to manage and control diabetes, the glucose levels keep fluctuating unfavorably, making diabetic management seemingly meaningless.

It creates a feeling in which diabetic management feels helpless, and patients feel the need to disengage in its management.

Patients can eventually build up a “don’t care” or “can’t be bothered” attitude towards diabetes management. This mindset can be temporary or can continue for long periods of time. Many doctors and health professionals see these patients as unmotivated, disengaged, or unfocused because they’re struggling to cope with and manage a lifelong health condition.

Some of the signs of diabetes burnout are:

  • Disengagement from diabetic self-management. This means either skipping or stopping insulin doses, tablets, and even discontinuing to monitor blood sugar levels.
  • An unfocused diet which includes uncontrolled eating patterns.
  • Unusual risk-taking attitudes.
  • Stopping attendance at clinical and related consultations.

Diabetes Distress

We should also say that patients with diabetes burnout do understand the importance of diabetic management and related consequences. However, they tend to be overpowered by the negative outcomes, which makes them feel they’re unable to take control of their diabetic conditions.

Most patients who go through diabetes burnout can often be unresponsive to advice. They can be seen making a series of disinterested statements such as, “I’ve’ tried this method, but it didn’t work,” or “I stopped regulating because my blood sugar levels will be high regardless,” and so on.

This kind of disengagement develops long-term complications and a sense of powerlessness in taking control of diabetes or its management. Health professionals generally report that patients going through diabetes burnout feel they’re at war with their diabetes, and they’re losing the fight.

Diabetes burnout can also occur along with depression, anxiety, and other negative moods.

But, since diabetes burnout is a condition occurring with prolonged diabetes distress, little research is conducted on it. The main focus of diabetes burnout is to offer timely assistance in addressing the concerns and signs of diabetes distress as soon as they arise.

Symptoms of Diabetes Distress 

Diabetes distress can occur in many ways, of which the most common are:

  • Sub-optimal HbA1c or unstable and continuously fluctuating blood glucose levels.
  • Reluctance to attend clinical appointments or missing appointments.
  • Disengagement with diabetes medication management or self-management. This includes not monitoring or regulating blood sugar levels, or the food one consumes and skipping medication doses.
  • Emotional eating increases, leading to uncontrolled eating patterns. 
  • A sequence of adverse life events causing stress or chronic stress such as unemployment, financial difficulties, and homelessness.
  • Unhealthy relationships with family, friends, spouse, and health professionals.
  • In-person conversations and general behavior may appear aggressive towards diabetes management.

It’s important to note that even if a person has normal blood sugar levels, the person may not be free of diabetes distress.

Escaping diabetes distress takes a lot of effort that impacts other areas of life, such as social, family, and even work routines and professional relationships.

Continuously worrying people with diabetes self-management by recommending them to regulate blood sugar, and so on may increase the burden of diabetes distress, even if it may seem like the right thing to do.

How to Identify If a Person Is Going Through Diabetes Distress

Although it may be hard to ask anyone how they feel about their diabetes condition, it’s always good to ask a few questions about the person’s mental state on a routine basis.

This could be done by starting with simple questions like, “Did you get your insulin” and “How is your blood sugar level this week?” and so on. It’s also good to ask open-ended questions like, “how do you feel?” and sharing stories about people with diabetes, which can then encourage them to share theirs and how they feel.

You can also start to talk in general terms about the complications of living with diabetes. Eventually, the patient may be more open to discuss the difficulties they are personally facing. Empathizing with their situation can also have a positive impact. 

In situations, where you need more in-depth discussions about diabetes distress, it’s advisable to choose an approach or a set of questions that best suits the person with diabetes. The following are some questions that you could make use of:

  • What do you feel is the most challenging part of living with diabetes is for you?
  • For you, what is the greatest burden of living with diabetes?
  • What are the times when you feel diabetes gets in the way of your normal lifestyle?

However, despite these questions, the best that one can do is to observe patients’ behaviors and their social and family interactions.

This is because some may not like talking about their personal life openly and therefore may not even want to discuss anything about their diabetes condition at all.

Refusing to talk about their diabetes condition is a good sign that they could be going through diabetes distress. Most patients’ mistake diabetes distress as depression and would often prefer keeping it to themselves. As such, the best thing to do with patients who don’t like engaging in any diabetes-related conversation is to observe their behaviors and attitudes before approaching the subject.

Treatment of Diabetes Distress

This article is designed to offer some understanding and guidance. We hope it enables you to understand the condition, to identify it, and understand when and if to take further action. 

If you determine that further action would be beneficial, we always recommend consulting your physician or the doctor of the patient living with diabetes. Your doctor will have advice, options, and remedial paths to recommend.

To Close

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