More than 29 million Americans are living with diabetes, and around 86 million are living with prediabetes. Patients diagnosed with this chronic disease are typically considered type 1 or type 2 diabetic. If you are diagnosed with type 1 diabetes, this means your body does not produce enough insulin to allow blood sugar to enter the cells used for energy. If you are diagnosed as type 2 diabetic, this means your body cannot use insulin properly. Both types of patients with diabetes are faced with several challenges when working to control their diabetes, including the psychological effects. These psychological effects can lead to depression or diabetic distress.
Depression can cause depressed moods, difficulty concentrating, disordered eating (eating more or less than normal), headaches, fatigue and loss of sleep. While many diabetics do suffer depression, diabetes distress is separate from depression. Most of the public is aware of depression, but diabetic distress is a less commonly known challenge for patients. Lovelace Medical Group Nurse Practitioner, and certified diabetic educator, Karla Giese, DNP explains what diabetic distress entails. “Diabetes distress effects up to 46 percent of patients with diabetes and refers to the emotional distress patients with diabetes deal with day in and day out,” she says. “They can experience worries and burdens throughout the day working to keep their glucose under control.”
Three common themes found in focus group discussions regarding diabetes distress are worry, relationship stress and medications. “Worry and stress over blood sugar readings is common,” says Karla. “Always looking at that number can be discouraging, leading to stress.” Medications are a costly challenge diabetic patients face. “Taking medications every day, the cost of medications, along with worrying if they will develop hypoglycemia can cause distress. Some diabetic medications contribute to mild hypoglycemia so that is also a concern.” Hypoglycemia is when your blood sugar gets to be too low and your body does not have enough sugar to use as energy.
Diabetes distress themes can be categorized into four buckets:
1. Regimen-related distress
2. Emotional distress
3. Interpersonal distress
4. Physician/Provider-related distress
Regimen-related distress focuses on the distress patients feel when overwhelmed by the day-to-day management of their diabetes. “They have to manage their diet, exercise, medications and possibly insulin intake throughout the day,” says Karla. “This can cause higher levels of regimen-related distress for those patients.”
Emotional distress refers to the personal worries and fears diabetic patients experience. “Some patients experience fatalistic fear of diabetes,” shares Karla. “They can begin to feel like diabetes is controlling their lives, and no matter what they do they will have complications.”
Interpersonal distress centers around the support the patient has from their friends, family and medical providers. “Patients sometimes feel they are not getting the desired level of support they would like,” says Karla. “They feel like the people who surround them do not fully understand all of the difficulties they face. I encourage spouses of my patients or other family members to ask the patient this question: ‘How would you like me to be involved in your diabetic care?’ Sometimes patients do not want help or advice from their spouse, so this question helps open up that conversation.”
Physician/provider-related distress refers to the level of confidence the patient has in the diabetic knowledge of their provider. “Some patients feel they do not receive enough empathy from their provider, which causes a lack of confidence in their provider’s knowledge of all of the challenges diabetic patients face,” says Karla. “Understanding diabetes distress will help open up the conversation between patients with diabetes, their loved ones and medical providers.”
American Diabetes Association also shares several coping strategies that have helped patients with diabetes distress. These strategies include:
- Accept that you can’t control everything (patients with diabetes cannot always control what happens to their body)
- Look for support from people who can relate (finding other patients who have the same fears and anxiety helps patients cope with day-to-day stress)
- Tap into faith and family (coping with diabetes and the effects diabetes has on your body can be discouraging, but reaching out for support through your own faith groups and family have helped patients go through different stages of diabetes)
If you or a loved one are struggling with diabetes distress, another resource we offer to our patients are the diabetes workshops offered through our Lovelace Diabetes and Metabolism Care Clinic. For more information, please click here. To learn more about Karla Giese, DNP or schedule an appointment, please click here.