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Diabetes distress and burnout: what to do about it?

It turns out that living with a chronic condition, like diabetes, during a pandemic is ever so slightly stressful. A lot of us have gone through periods of diabetes distress and burnout – or are still going through it. And we’re not talking about diabetes and mental health enough. 

Diabetes distress and burnout

When we asked our community on Facebook – South Africans with Diabetes – about diabetes burnout, the answers came flooding in.

Lyn’s reponse really resonated with me. “This is a day to day struggle for me. The daily numbers and checking and checking and calculating and tracking carbs and proteins, taking meds, doctors…the endo, the ophthalmologist the nephrologist, the gynecologist, the dieticians. The fatigue of it all.”

Grace said something similar. “Going through it now. I am so tired of everything. I’m tired of taking my medication, I am tired of pricking myself daily, I’m tired of worrying about which foods I should probably not touch. I am fatigued of everything that has to do with this chronic illness.” 

Diabetes burnout isn’t just for those of us with diabetes, either – it’s also for those who love us. Delouise said that for Type 1 parents it’s the worst – to pull yourself back up. That emotional and financial burden.

And Joan’s comment really made my heart sore. “They should really make a plan with this sickness I am just so tired, HELP PLEASE.”

So to help us have insight on this conversation , we asked clinical psychologist Daniel Sher to join us. Daniel has been living with Type 1 diabetes since he was a baby, so he has a deep understanding of what it’s like to juggle the many demands diabetes places on us.

“Be gentle with yourself.”

Daniel Sher, Type 1 psychologist

Why are diabetes and mental health so closely linked? 

Because diabetes is a tough condition to live with. And there are just so many different things that we need to think about on a day to day basis. And with that level of of stress, and that level of preoccupation, and that level of planning and problem solving and troubleshooting and thinking ahead, it can be burdensome. That can spill over into a sense of stress, or distress, or exhaustion, or even depression or anxiety.

But importantly, and I always like to bring the science into this conversation, it’s not just that diabetes is a tough condition to manage. We are inevitably going to have blood sugar fluctuations, that’s how it goes. When that happens, the quantity of glucose that is filtering into our brain is fluctuating – sometimes it’s going to be low, sometimes it’s going to be high. And we know it can have an actual impact on the neurons and certain areas of the brain that are linked to, for example, thinking skills, and emotions. But it’s also that much tougher on us emotionally, because of the way that it’s going to affect our brains.

What is diabetes burnout?

Diabetes burnout, quite simply, is a state of overwhelm and exhaustion that most people with diabetes will encounter at a certain point in their diabetes career. And I think this is really important, because people with diabetes burnout,they often feel like this is yet another affliction. This is something they’ve done wrong – they haven’t been on top of it. And that’s really not the case.

Diabetes burnout is not a mental disorder.
It is simply a natural, emotional response to a very difficult situation.

Daniel Sher, Type 1 psychologist

The four areas of diabetes distress and burnout

  1. Emotional burnout
  2. Doctor related distress
  3. Regimen distress related to what we need to do on a daily basis to look after our condition
  4. Interpersonal distress, or interpersonal burnout
  1. Emotional burnout is quite easy to recognize, because it presents with some pretty powerful emotional experiences, many of which we will be familiar with.

Some of the common emotional responses that serve as red flags for diabetes burnout are: frustration, anger, sadness, guilt, resentment, worry, hopelessness and overwhelm.

So we’re not just feeling overwhelmed, resentful and worried. We’re also having thoughts along the lines of: there’s just no point in doing this. This is so hard, I’m failing, and I’m never going to be able to do this correctly. Those sorts of thought processes feed into the sense of emotional burnout, and they can actually set you up in a vicious cycle where that gets increasingly worse.

2. Doctor related distress is also a very common one. A lot of the people who I work with speak to me about not feeling entirely understood by their doctors, or at times feeling a bit judged, for example. That fear can vary, and very often lead to a tendency that I think we’re all familiar with – at least those of us who’ve had diabetes for a long time – which is postponing and avoiding appointments.

3. Regimen distress is when all the daily management that goes into diabetes just feels like too much. The testing and injecting and carb counting and checking again… It’s just all too much.

4. Interpersonal distress is the fourth one. And that is a sense of isolation. That’s the most frequently occurring phenomenon that I see: people feeling isolated, disconnected, they feel like no one understands what they have to deal with. It can be very hard for somebody who doesn’t know the day to day management requirements of diabetes to actually understand what it means to have this condition.

How do you move through diabetes burnout when you don’t have the energy to do anything?

It’s really important that if you are struggling with diabetes distress, or depression or anxiety, that you don’t only just rely on what I’m saying , but actually seek out the necessary support from your doctor or your therapist. (Here’s how to access mental health services in the public sector.)

The first skill that I like to explore with my clients is quite simply problem solving. So we want to do some brainstorming around:

  • What does my diabetes burnout look like?
  • What are the things that are causing or increasing the state of burnout?
  • And are these things that I am able to affect any degree of change?

So , let’s say that your flavour of diabetes burnouts is the interpersonal distress component. So what’s causing your diabetes burnout is the fact that your spouse is sick and tired of your condition, and they’re just not making you feel as supported as you would like.

“Diabetes burnout is something that can affect spouses and parents as well. So this is not an uncommon situation, unfortunately.”

Daniel Sher, Type 1 psychologist

How can you support someone you love who is feeling burnt out?

We need to have conversations with our partners and explain to them how we feel and find a way of compromising, of working together so that we can support one another. Even just expressing that you’re frustrated in general with diabetes can be helpful. And then another problem solving strategy that is often helpful for emotional distress in particular, is meditation. Meditation can help us to soften the impact of the emotions that we’re feeling.

Try not to be the diabetes police and instead offer support to loved ones with diabetes.

Daniel Sher, Type 1 psychologist

If we then think about doctor related distress, the obvious solution, if we are seeing a doctor who is judging us and not being there in the way that we need them to, we want to try and bring that up with them. It’s not the easiest thing to do, but it’s important to remember that if there’s not a good fit between you and your doctor, then you need to find somebody who does work for you. Because ultimately, you are building your own treatment team. And not everybody will be a good fit.

Any final words of wisdom you’d like to impart while we’re on the topic of diabetes and mental health?

It’s important to note that as people with diabetes, we’re at a high risk of developing burnout, but also clinical depression and anxiety disorders. Sometimes, when you’re feeling completely overwhelmed, the last thing that you’re able to do is think about more skills and strategies to add to your life, it can make it even more overwhelming. And if you’re finding that you’re feeling this way, it’s not uncommon. And it’s okay to feel that.

What I would encourage you very strongly to do, though, if you’re feeling that you’re burnt out, and that you don’t know how to move forward, is bring it up, ideally,with your doctor, or else if you have one with your psychologist. If it’s to your doctor, tell them how you’re feeling and ask them if they can refer you to somebody who can help.

You are not alone in this.

Would you rather listen to this information?

Here’s an episode of our podcast about it!

About the podcast guest

Daniel Sher is a a clinical psychologist living with Type 1 diabetes.

He works online and from Cape Town, supporting others with diabetes to thrive. 

Find out more at www.danielshertherapy.com

What to read next?

Do people with diabetes need to worry about heart health? Heart disease is one of the most common diabetes complications. But does that mean all people with diabetes need to worry about heart health?

Dealing with diabetes burnout: Dealing with diabetes burnout is complex. There is no “one solution fits all” because the experience isn’t the same for everyone.

Diabetes and depression: a helpful guide to know what to do next

Photos by Priscilla Du Preez, Sasha Freemind and Fernando on Unsplash

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Sweet Life is a registered NPO/PBO (220-984) with a single goal: to improve diabetes in South Africa. We are funded by sponsorships and donations from aligned companies and organisations who believe in our work. We only share information that we believe benefits our community. While some of this information is linked to specific brands, it is not an official endorsement of that brand. We believe in empowering people with diabetes to make the best decisions they can, to live a healthy, happy life with diabetes.