The American Diabetes Association observes the fourth Tuesday of each March as Diabetes Alert Day, a day to recognize and understand your risk for diabetes. 

Why do we need an “Alert” about diabetes? 

There is a real chance that either you or someone you love has diabetes and may not even know it. The CDC estimates that 37.3 million Americans have diabetes (11.3% of the population), including 28.7 million diagnosed and 8.5 million not yet diagnosed. 

In addition, approximately 96 million American adults (more than 1 in 3) have pre-diabetes, and over 80% of those with pre-diabetes do not know they are at risk. Given how common diabetes is, it is essential that you get your A1C checked at least once a year and talk to your doctor about the results.

The Long-Term Impact of Diabetes

Diabetes is a serious medical condition in which the pancreas does not make an adequate supply of insulin. It can impact children and adults, and if left untreated, has the potential to cause serious long-term health consequences like heart disease, chronic kidney disease, stroke, nerve damage, blindness, amputations and even death.  

The very real impact on mental health

In addition to all the potential physical consequences of diabetes, there is also a bi-directional relationship between diabetes and mental health issues. Not surprisingly, when we feel physically bad, our thoughts and mood can be negatively impacted. And, when we feel emotionally stressed or down, that weight can bring physical consequences. 

The relationship can go both ways: untreated mental health issues can make diabetes worse, and problems with diabetes can result in increased mental health symptoms.

Managing the diagnosis and the person

Living with diabetes can be both physically and emotionally challenging. Managing diabetes well often means being constantly aware of what and when you eat. You have to monitor blood sugars, make healthy food choices, take medications as prescribed, give injections, and get adequate physical activity.  

For many people, this 24/7 focus on health, while also attempting to manage fears of potential long-term consequences of the disease, can become overwhelming. Additionally, diabetes can result in certain social (stigma, lack of understanding by family and friends) and financial implications (costs of treatment, healthy foods). 

For children who have diabetes, it can be challenging for them to understand why they can no longer have their favorite snacks or why they cannot have birthday cake at their friends’ parties. It can be overwhelming for parents and siblings, who often have to make major life changes to help keep their loved ones healthy.  

Diabetes Distress

Having to remain constantly vigilant, worrying about health outcomes, and experiencing such changes in daily routine can lead to something called “diabetes distress,” which is a common emotional response to living with the burden of diabetes, impacting between 33 and 50% of individuals with diabetes in any 18-month period.  

Diabetes distress can ebb and flow throughout someone’s journey with the disease. There may be times when managing diabetes feels easier and other times when it can feel impossible.   

Unfortunately, when diabetes distress is at its worst, it can negatively impact a person’s motivation and ability to care well for their health. They may start to focus less on maintaining a healthy diet, eliminate their exercise routine, or even begin skipping their doctor’s visits. Sometimes individuals will even try to ignore the fact that they have diabetes at all as a way to cope with the discomfort they feel emotionally about the disease. Of course, this can result in even worse physical outcomes.  

Steps to take if you think you may be experiencing diabetes distress:

1. Talk to your healthcare provider. Let them know you are struggling with managing your diabetes. You might ask for a referral to a mental health professional with expertise in helping individuals manage the emotions of living with a chronic medical condition.  

2. Consider joining a diabetes support group. Joining a support group would give you others to talk to who understand your current experience and who can provide encouragement and perspective that you aren’t alone.  

3. Focus on smaller health goals. Focus on setting smaller health goals to move you closer to managing your diabetes rather than trying to do it all at once. For example, start by checking your blood sugars once a day and then slowly increasing the number of times you check. Or commit to swapping just one of your typical snacks with a healthier option each day. As you can see, conquering these more minor challenges will make the bigger ones feel more possible.

4. Give yourself grace. Be gentle and forgiving with yourself. Managing diabetes is a marathon, not a sprint. If you stumble along the way, realize mistakes are part of the journey and pick back up and keep going.  

Managing Anxiety and Diabetes

Stress and anxiety are all around us, but people living with diabetes are more likely to experience anxiety and stress than those who are not. Sometimes we can feel anxiety in the form of an emotion, or we might experience it in our bodies. Sometimes we don’t even recognize we are stressed until we notice a headache or tightness in our shoulders or back.  

While some stress is a normal part of life, during times of significant pressure due to illness, injury, or emotional stress, we experience changes in our stress hormones, like adrenaline and cortisol, which can elevate blood sugars and make them more challenging to control. As a result, it’s extra important for people living with diabetes to be aware of the stress they may be experiencing and to learn ways to cope with it and manage it so it doesn’t negatively impact their health. 

To help keep stress and anxiety under control, putting some good self-care practices in place can be helpful. Here are just a few:

1. Get enough sleep. Be sure you are getting a good, healthy amount of sleep. The right amount of sleep can vary from person to person, but you will know if you are getting enough sleep if you wake up rested and have adequate energy to get through your day. If you consistently wake up exhausted and struggle to stay awake during the day, focusing on ensuring you get a good night’s rest is a great place to start.

2. Stay active! Exercise is incredibly helpful in reducing stress. Even a short walk around the block or having a brief dance party in your living room can help you release some stress.

3. Consider practicing mindfulness. Mindfulness is a well-researched way to reduce anxiety and stress in our lives. The goal of mindfulness is to become more aware of the present moment, experiencing our thoughts, feelings, and sensations and viewing them with a non-judgmental posture. There are many ways to get started with mindfulness, but one simple way is to sit quietly and concentrate on the sensation of your breathing for 3-5 minutes at a time. Feel your breath going in and out, and focus on that. You can also try a brief mindful walk outside, where you focus your intention on all you see, hear, smell, feel, and taste during your walk. 

4. Talk to someone. Reach out to a friend or family member for support. Sometimes a quick call or text with someone who cares can help reduce your stress. 
    

Navigating Depression with Diabetes

While we all feel sad sometimes, depression is different. Clinical depression is often present when someone feels down more days than not and loses interest in activities they usually enjoy. Depression can disrupt sleep, appetite, energy level, and sex drive and make it challenging to go about daily activities like work, school, or caring for things at home. Some people with depression will even experience thoughts of suicide or wish they were dead. Unfortunately, people with diabetes are two to three times more likely to have depression than people without diabetes and less than 50% of people with diabetes who have depression get diagnosed and treated. But, if you know the warning signs for depression as described above, you can seek help.  

If you are worried, you may have depression. Here are a few steps you can take to help with depression:

1. Seek options to help cope with depression. Know that help is available; you don’t have to feel this bad forever. Both psychotherapy and various medications have been shown to be very helpful for people struggling with depression, and when combined, the effects are often even more powerful. Ask your doctor to connect you with a mental health professional who can help.

2. Be aware of your substance use. While many people will drink alcohol when they are feeling down or cannot sleep, alcohol is actually a depressant and will make your depression and your diabetes worse and will further disrupt sleep.

3. Exercise. Recent research has shown that exercise can be as effective as antidepressants for some people. When we exercise, our brain releases several chemicals called neurotransmitters that improve our mood and reduce anxiety. So, hitting the gym regularly or getting out for consistent walks can be a powerful tool to combat depression, and it helps regulate blood sugar, which means you can care for your mental health and your diabetes at the same time. 

4. Choose help. If you find yourself having thoughts of suicide, please don’t wait to ask for help. You can text or dial 988 to reach the National Suicide and Crisis Line 24/7 or go to your nearest emergency room.

Receiving the diagnosis of diabetes is often scary for people, and learning how to navigate the new medication regimens and the many changes to diet and exercise needed to be successful in staying healthy can feel overwhelming and even lead to diabetes distress, anxiety, or depression. Help is available. 

Here to Help You Through Your Journey

Methodist Le Bonheur Healthcare offers integrated behavioral health services as a part of its primary care practices to serve adult and pediatric primary care patients. Skilled mental health providers can help individuals navigate the emotional aspects of complex medical conditions like diabetes, and they work collaboratively with your doctor to help you have holistic diabetes care. If you are interested in seeing a Behavioral Health Consultant through Methodist Le Bonheur Healthcare, ask your primary care provider or pediatrician, and you may even be able to be seen that day. Or call 901-567-7415 to schedule an appointment with one of our primary care behavioral health providers. 

Additionally, our Methodist hospitals and Community Outreach Division offers classes and support groups for those with diabetes. You can find more information about those opportunities at MethodistHealth.org/diabetesinfo.

Finally, remember, if you are living with diabetes, you owe it to yourself to be patient and kind to yourself as you adjust and navigate life with this disease. Diabetes is a lifelong journey, and asking for help when needed is okay. Your Methodist Le Bonheur Healthcare team is here for you and wants to support you in living a meaningful, wonderful, and healthy life!

“We have diabetes. It gets to come along with us. It doesn’t get to stop us.” - Chris Olsen