Putting the Brakes on Diabetes Burnout

Diabetes burn out is a common problem for many people, but what is it? Basically this occurs when you grow very tired of managing your diabetes. You might experience feelings of exhaustion and instead of sticking to your regular blood glucose checks, medications, exercise, insulin and other self care tasks, you only do them partially or possibly neglect them altogether for a period of time. It is more than just having a bad day. You just can’t seem to muster the motivation to keep on managing  and the guilt and stress about what this is doing to your body just builds up…..adding to your distress.

The challenge for people living with diabetes and this includes family members and caregivers, is to walk the fine line between stress and worry about diabetes, with feeling comfortable about where diabetes sits in your life. You need to try and have perspective about what your goals are and what you can realistically manage at this moment. When you balance this you are able to better manage under times of stress and prevent burn out.

One of the biggest things that can help is to have good support. This includes from family, friends, other people with diabetes and your health care team. Exercise and relaxation strategies really help. Learning mindfulness, which teaches you to worry less and be present in your daily life helps to reduce anxiety and distress. Being able to feel in control and have a tool kit for what to do when things feel like they may be getting out of control in any aspect of your life really makes a difference. Diabetes is not just about your blood glucose and stress and problems in other areas of life will have an impact on you control. So it is important to make sure you stay healthy in all areas of your life and keep on top of stress.

Diabetes is different to other chronic disease as it requires self management by you on a daily even hourly basis, with guidance from your health care team. It can be easy to become overwhelmed by all the tasks you need to do and the day to day effort needed to manage. Burn out is particularly likely if you work really hard at managing your diabetes but the results are not what you would like. It is also more likely when you have pressure or stress in other areas of your life that you feel you can not control. Diabetes burn out can last a short time, be ongoing, or can come and go. Studies have shown that a majority of people living with diabetes do experience worries, fears and negative feelings at some stage. Some high risk times where you may experience burn out due to added stress or changes in your life include:

1. If you are not meeting diabetes targets, frustration with lack of movement towards your health goals
2. Experiencing family/relationship problems, breakdown or violence
3. Transition or times of change in your life
4. Loss of someone you care about or other grief/loss
5. Experiencing poverty or homelessness
6. Drug and alcohol problems
7. Problems with work and financial stress
8. Other physical or mental health problems – such as another chronic disease, depression, mental illness, eating disorders
9. Pregnancy –  planning pregnancy and trying to conceive, during pregnancy and parenting when you have diabetes yourself
10. Growing older and dealing with changes to your body, your health and your diabetes
11. Diagnosis of diabetes complications

• The recent 2011 study Diabetes MILES which surveyed over 3000 adults with diabetes in Australia found that overall, people were least satisfied with their health, as compared to other aspects of their life.
• Adults with type 2 diabetes who were using insulin had lower levels of satisfaction across all life areas (e.g. health, relationships, safety, standard of living) as compared to adults with type 1 diabetes or with those who had type 2 diabetes but were not using insulin.
• Adults with type 2 diabetes who were using insulin were also more likely to experience moderate to severe symptoms of depression and anxiety than other respondents.
• Moderate to severe depressive symptoms affected 35% of adults with type 2 on insulin, as compared to 22% of those with type 1 and 23% of those with type 2 who were not using insulin.
• Moderate to severe anxiety symptoms also affected 19% of adults with type 2 who were using insulin, as compared to 15% of those with type 1 and 14% of those with type 2 non-insulin-managed diabetes.
• Adults with type 1 diabetes were more likely to experience severe diabetes-related distress than other respondents. 28% of adults with type 1 diabetes experienced severe distress, as compared to 22% of people with type 2 insulin-managed and 17% of type 2 non insulin-managed diabetes.
• The most commonly reported problem area for respondents (consistent across diabetes types and treatment regimens) was worrying about the future and the development of diabetes related complications.

Rates of diabetes related distress are high yet people are often scared to ask for help, particularly if they have not been managing well.

It is important that you DO ask for help and remember there is no such thing as a silly question! Most of us get tired of doing everyday tasks and diabetes sure adds to those! Few people can maintain all the tasks of diabetes care week-in, week-out AND keep blood glucose and HbA1c’s in the narrow target range all the time.

Without realistic expectations and practical strategies for managing the thoughts, feelings and emotional side of diabetes, the risk of burnout is higher.

• The way ywe think and talk about diabetes has a major impact on how you feel and manage diabetes. Using words like “ high and low” blood glucose instead of “good and bad” can help and so does using CHECK instead of the word TEST when talking about blood glucose monitoring.
• The reality is most people have an immediate reaction to a high or low BGL.
• That is normal and fine, but once you have this reaction move on to looking at the number and working out how to manage this and prevent it in the future if possible.

Seven Steps to dealing with Burn out

1. Consider what particular areas of diabetes are causing you problems – usually it is not all of it! Then develop steps for sorting these areas. Get help if needed.
2. What else is happening in your life that might be conflicting with diabetes care, or making it harder?
3. How might you address these things?
4. What are your expectations for your diabetes management? Do you need to lower or increase your expectations?
5. What sorts of thoughts and feelings are you having about diabetes/
6. How are you managing these and are these strategies working? What have you tried?
7. Do you have any support? Is it the right support? Is it enough support? If not, how can you get this?

Support is vital. Make sure you get this from a variety of sources:

• Health Care Team
• Family and friends
• People with diabetes
• Online and in person
• Books, magazines and other sources of information
• Counselling and other specialists
• Take time out from diabetes and other stress – try to be a “human being” not always a “human doing”!

Diabetes might thrive on maths – to be corrected and added up BUT You are not a maths problem! See yourself as a sunset – not something to be solved, but appreciated –your achievements, attempts at change, dreams and goals – sit back and appreciate them from time to time and remember there is more to life than diabetes.

 

Helen

You can find our diabetes burn out book here and an online learning module in managing diabetes burn out and depression here.