Is Managing Your Diabetes Stressing You Out? 5 Ways to Recognize Diabetes Distress

Loretta Hsueh, PhD - College of Liberal Arts and Sciences, University of Illinois Chicago; Biswadeep Dhar, PhD - School of Agricultural and Natural Sciences, University of Maryland Eastern Shore; Kristen Allen-Watts, PhD, MPH - School of Medicine, the University of Alabama at Birmingham

Living with diabetes is anything but simple. Managing blood sugar levels, ensuring you have enough medication, remembering to take medication daily, dealing with needle sticks, buying, and preparing heart-healthy meals, maintaining recommended amount of exercise and sleep—taking care of your diabetes can become overwhelming. This emotional response to the demands of living with diabetes is known as diabetes distress.

What is diabetes distress and what is it not?

Diabetes distress arises from the constant pressure to “be good” about managing diabetes. Diabetes distress can also be in response to broader social and cultural response to living as a person with diabetes, such as dealing with the “food police.” While negative feelings are expected, this can make it hard to stay motivated in taking care for yourself, creating a vicious cycle where emotional burnout leads to neglect of self-care.

Diabetes distress can sometimes be mistaken for depression, but they are distinct. It is an expected reaction to the burden of managing diabetes, whereas depression is a mental health condition that impacts how a person thinks, feels, or behaves, often interfering with daily life.

Diabetes distress is more common than depression, affecting 1 in 4 people with type 1 diabetes requiring insulin, 1 in 5 people with type 2 diabetes who use insulin, and 1 in 10 people with type 2 diabetes who do not use insulin. However, people with diabetes are 2-3x more likely to have depression. Whether you, or a loved one, have one or the other, or both, there are steps you can take to improve your emotional well-being.

What are five ways to recognize diabetes distress within yourself?

There are currently two questionnaires you can fill out to see if you may be experiencing diabetes stress. There are separate ones available for type 1 diabetes and those with type 2 diabetes (both are available here: https://diabetesdistress.org/take-dd-survey/).

Common Signs of Diabetes Distress:

Some common signs of diabetes distress include:

1. Poor A1C control or fluctuating blood glucose levels
2. Missing clinic appointments
3. Decreased participating in diabetes self-care tasks (e.g., checking blood sugar less often or skipping medication)
4. Unhealthy coping mechanisms for managing stress (e.g., emotional eating)
5. Experiencing multiple life stressors or ongoing non-diabetes-related stress (e.g., financial difficulties, unemployment, or homelessness)
6. Strained relationships with healthcare providers, partners, family, or friends
7. Acting passive or aggressive during medical visits

What can you do to combat diabetes distress?

• Talk to your healthcare team: express your concerns and frustrations to your doctor, diabetes educator, or nurse. A modification to your treatment plan may be needed and can offer emotional support.
• Connect with others who understand you. Join a diabetes support group to share experiences and receive advice from others that are facing similar challenges.
• Consider seeking professional support: talk to a mental health professional who has experience in treating people with chronic conditions.
• Prioritize self-care: focus on activities that help you relax and feel good, such as exercise, meditation, mindfulness, or hobbies you enjoy.
• Set realistic goals: break down larger diabetes management tasks into smaller, more achievable steps to prevent feeling overwhelmed.
• Educate yourself about diabetes: Learning more about the management of diabetes can empower individuals to manage it with more confidence.
• Challenge negative thoughts: replacing self-critical or negative thinking with positive affirmations to improve your mindset.
• Get Loved ones involved: Ask your family and friends for support and let them know how they can best help you manage your diabetes.

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