Living with diabetes can be exhausting. People with diabetes often liken it to having a 24/7 job with no days off and no retirement in sight. Diabetes patients have to juggle diet, medication, exercise, and stress along with other personal and work commitments.
A Fine Balance
It is estimated that people with Type 1 diabetes have to make an astonishing 180 health-related decisions every single day. Patients have to monitor their blood glucose levels at least four times daily, inject insulin before each meal, and adjust insulin levels based on their carbohydrate intake and intended physical activity. On top of this, they need to worry about their insulin levels when they sleep, as low blood sugar levels overnight can lead to seizures and coma.
For people with diabetes, being able to self-manage their condition requires a wealth of education and experience—and no small feat of effort. Despite their best laid plans, episodes of low and high glucose levels may still occur throughout the day. Hence, while diabetes is primarily a physical disease, its mental health effects are also cause for consideration.
Mental stress is a heavy burden for sufferers of diabetes. People with diabetes are at increased risk for anxiety and eating disorders and are twice as likely to have depression as the general population. On top of this, nearly half of people with diabetes suffer some level of diabetes distress.
Diabetes distress is similar to burnout. People with diabetes may feel angry about their diagnosis, frustrated with the constant self-care, unsupported by friends and family, and worried about the future. Although diabetes distress is not considered a psychological disorder, it can lead to poor self-care if left unaddressed.
In addition, the relationship between physical and mental health for people living with diabetes is complex. Fatigue, brain fog, and feelings of anxiety can be caused by fluctuating glycemic levels. Likewise, the mood of diabetes patients can affect how they view and manage their disease. A severe emotional episode could lead to a damaging downward spiral of poor mental health, unstable blood glucose levels, and disengagement from diabetes self-management.
Due to the preoccupation with food, eating, and weight, many people living with diabetes are also at increased risk of developing eating disorders as they struggle with control over their bodies. Some examples of eating disorder behaviors are severe dietary restriction, binge eating, and restricting insulin in order to lose weight.
Enter Covid
The Covid-19 pandemic has exacerbated an already stressful situation for people with diabetes. If life was challenging pre-pandemic, living with diabetes in the Covid era is absolutely daunting. Many people within the diabetes community have had trouble securing health and life insurance over the past 12 months. Says Matt Schmidt of Diabetes Life Solutions “Many insurance companies simply stopped offering health and life insurance to those living with type 1 diabetes. Life insurance for type 1 diabetes has always been a little more difficult in the past, but over the last 15 months it’s been nearly impossible.”
People with diabetes are six times more likely to have serious symptoms and twelve times more likely to die from Covid-19 than someone with no underlying medical conditions. It is understandable then, that fears of catching the disease are leading large numbers of people to put off important medical treatment.
A recent study found that nearly one in five people living with diabetes have missed at least one medical appointment since the start of the pandemic. Furthermore, 23 percent of adults with diabetes reported having trouble managing their blood glucose and 17 percent reported developing further health complications such as heart problems and eye disorders.
As people with diabetes avoid medical facilities, their poor glycemic control could worsen the chance of adverse Covid-19 outcomes in the event that they get infected. It seems that diabetes patients are stuck between a rock and a hard place as they navigate between risking infection and the deterioration of their diabetes management.
Being stuck at home has its own risks. Confinement and isolation could result in boredom and anxiety and, in turn, lead to binge eating or more unhealthy meal choices. Less access to exercise options can further impact people with diabetes, as they are unable to reap the benefits of lowered blood glucose levels and insulin resistance.
With social activities restricted due to pandemic control measures, people with diabetes may feel further stress and alienation. Without a keen social and medical support system, many diabetes sufferers could fall through the cracks in terms of their declining mental wellness—and subsequent physical health.
Providing Support
Because the signs and symptoms of blood glucose instability can be confused for depression or anxiety, many people with diabetes do not receive proper diagnosis and treatment for their mental health conditions. Online mental health tests can help diabetes patients figure out if they are facing symptoms of a mental health condition.
Due to the stigma around mental illness, many people with diabetes tend to avoid talking about their feelings during medical appointments. However, therapy can be very helpful. Mental health professionals can help diabetes patients work through their problems, identify triggers, and learn skills to cope with their daily struggles.
Outside of talking to a professional, talking to others can be beneficial in the management of diabetes distress and stress in general. Diabetes patients can help family and friends learn how to assist and support them by sharing their experiences and difficulties. Talking to other people with diabetes can also provide increased insight and mutual comfort.
It can be overwhelming when diabetes patients think of all the things they need to do to go through their day. To make life more manageable, people with diabetes should pace themselves and focus on small, realistic goals instead. Making a to-do list of all their tasks and checking them off one at a time may help to relieve some stress.
As the Covid-19 situation improves across the country, people with diabetes may have less to worry about soon. In the meantime, however, we need to ensure that both their mental and physical needs are met. Living with diabetes is tiring enough. The least we can do is not let people with diabetes have to worry about doing it alone.