By: Dallas G., Lagniappe Wellness Dietetic Intern

Mornings spent fishing on the lake, afternoons spent tubing behind the boat, and evenings spent on the back porch of my grandparent’s house were the summers I looked forward to as a child. I knew that once I arrived in Texas Hill Country, I would be fed Grandma’s biscuits and gravy and have unlimited trips to the back fridge where I could find my favorite orange soda in a glass bottle.

 

As the youngest of my sisters and my cousins, I was always trying to keep up. If suddenly I looked up, and I was left behind, I knew I was never truly alone. There was always Grandpa, sitting on the far right side of the brown leather couch near the window with his wooden cane, TV channel guide, and Judge Judy playing on the TV. It was a pleasure to play Grandma’s helper. I would transport Grandpa’s freshly made coffee to him as carefully as I could. However, when it came time for Grandpa to inject his insulin, I had to watch from afar. 

In my eyes, Grandpa’s insulin injections were part of his identity. My young mind couldn’t fathom the list of stressors that came with his T2DM diagnosis.Fourteen years and four college degrees later, the little girl running around her grandparent’s lake house is on the path of becoming a Registered Dietitian and I can’t help but wonder if my grandpa has ever experienced burnout while managing his diabetes. So, in memory of my grandfather and with the pursuit of enhancing the lives of others around me, this week’s blog post highlights diabetes distress and offers tips and tools on how to manage this common emotional state shared by people with diabetes.

 

Living life with diabetes is more than just a medical diagnosis. For most, life with diabetes feels like a constant balancing act, juggling things like glucose monitoring, carbohydrate counting, exercise regimen, medication administration, and doctors appointments. As the balancing act becomes increasingly more burdensome, feelings of emotional distress may occur. Diabetes distress can be defined as an overwhelming feeling that occurs when managing diabetes. 

The American Diabetes Association considers Diabetes Distress to be a psychosocial implication that can negatively affect self-care practices. In an article discussing the approach to treating psychological comorbidities of diabetes, Kathyrn Kreider makes a clear distinction between diabetes distress and major depressive disorder. Some of the symptoms of diabetes distress include burnout, denial, fear, shame, guilt, and lack of adherence to the diabetes regimen.
Just under half the population of people with T2DM in community settings suffer from diabetes distress (Kreider, 2017). When diabetes distress is left undiagnosed and unmanaged it may negatively impact the health status of individuals with diabetes. The first step in managing diabetes distress is to be properly screened and diagnosed. To assess the level of distress you or someone you know may be experiencing in relation to their diabetes diagnosis, take the diabetes distress survey here.
Once the diagnosis has been made, management can begin. One article highlights an approach to managing diabetes distress by, “minimizing the impact” using four pillars of management 

1.  Minimize discomfort associated with change 
   1. Break change into discrete bits 
   2. Prioritize actions for change
   3. Focus on essentials 
   4. Make full use of resources including human resources and technology 
2. Optimize coping skills
   1. Acceptance 
   2. Optimism 
   3. Planning 
   4. Action 
3. Strengthen self-care skills
   1. Diet 
   2. Physical activity 
   3. Self-administration of oral/injectable medicines 
   4. Self monotring 
   5. Get involved in a DSMES (Diabetes Self-Management Education/Support) program
4. Other support 
   1. Health care professionals 
   2. Family
   3. Community 
   4. Health care system 

The first step in managing diabetes distress is opening up with your care provider. Once your care provider is aware of the emotions you have been experiencing, they will be able to point you in the right direction of care. If the costs of your medication are too high, communicate this concern with your care provider. Communicate your worries and concerns with the people you trust. Having a support team will help minimize feelings of distress and may offer space for connection. Join support groups online or in person. Make an action plan and to-do list to lean on when things feel overwhelming. Make goals that are achievable and realistic. Lastly, consider engaging in hobbies, meditation, or other activities that bring you joy.

References 

Centers for Disease Control and Prevention. (2021, August 10). 10 tips for coping with diabetes distress. Centers for Disease Control and Prevention. Retrieved January 1, 2022, from https://www.cdc.gov/diabetes/managing/diabetes-distress/ten-tips-coping-diabetes-distress.html 

Centers for Disease Control and Prevention. (2021, August 10). Diabetes self-management education and support (DSMES) toolkit. Centers for Disease Control and Prevention. Retrieved February 18, 2022, from https://www.cdc.gov/diabetes/dsmes-toolkit/index.html 

Kreider K. E. (2017). Diabetes Distress or Major Depressive Disorder? A Practical Approach to Diagnosing and Treating Psychological Comorbidities of Diabetes. Diabetes therapy : research, treatment and education of diabetes and related disorders, 8(1), 1–7. https://doi.org/10.1007/s13300-017-0231-1

Diabetes distress assessment & resource center. Diabetes Distress Assessment & Resource Center. (n.d.). Retrieved January 1, 2022, from https://diabetesdistress.org/ Journal of Pakistan Medical Association. JPMA. (n.d.). Retrieved January 1, 2022, from https://jpma.org.pk/article-details/8412?article_id=8412