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Let’s be clear: Diabetes burnout is normal. Practically no one is exempt from it. After all, managing your diabetes care every single day can be downright tiring, frustrating, all-consuming, and depressing at times.
No lengthy medical translation needed here. “It is literally when a person with diabetes stops caring for themselves due to the stress or the demands of the disease,” says Jordana Turkel, a certified diabetes educator (CDE) at Park Avenue Endocrinology in New York City. Turkel says this often includes things like guessing mealtime insulin doses, not checking blood sugars, or skipping appointments with doctors or diabetes educators. Managing diabetes can be physically and emotionally overwhelming; many different study findings like diabetes with an increased risk of depression. Research in the journal Diabetes Care suggests that people with diabetes are twice as likely to have depression as people without diabetes.
No one *chooses* to develop diabetes burnout, and no one is exempt from getting some degree of diabetes burnout at some point, but don’t let that discourage or scare you, especially when you factor in the many facets of self-care along with the normal demands and stressors of life. “Who wouldn’t have diabetes management burnout at some point, considering the relentless self-care demands and the knowledge and skill acquisition required,” says Carol White, CDE, a diabetes educator at Banner University Medical Center in Phoenix. Just knowing burnout is expected can help you get through it.
The daily vigilance it takes to for managing your care can be downright daunting at times. But you don’t have to go it alone. “Many people with diabetes can feel overwhelmed with all the responsibilities this condition requires on a daily basis,” says Karen Seifert, RN, CDE, MSN, ACNS-BC, a diabetes educator at Banner University Medical Center Phoenix. Don’t try to ride it out on your own. Seifert says if you’re experiencing any of the following symptoms, call to discuss it with your healthcare provider.
The emotional signs of burnout are a bit easier to see coming but sometimes you get hit by something unexpected and crash into the wall. Let’s say you’ve been attentive to following your diet and exercise. You’ve even lost a few pounds. You’re feeling empowered and pretty hopeful when you show up at your appointment—but then find out your A1C reading barely budged. That can be incredibly frustrating. Or maybe a change in the cost of your meds and supplies changed, just when you managed to figure out your budget.
University of Illinois at Chicago authors of a paper published in the Journal of Psychosomatic Research describe it like this: “When patients with diabetes do not experience positive results from their efforts at diabetes self-management, or when they experience unanticipated or negative results, they may experience a sense of ineffectiveness or lack of accomplishment. Over time, they may experience emotional fatigue, cynicism, and resultant detachment from their health care provider's recommendations.”
There are some naturally stressful periods in life where people may be prone more to burnout. “In my experience I have noticed burnout during the preteens to high school years when the individual starts caring more for themselves and their caretaker starts take a step back, then again around the late twenties and thirties typically when people start their own families and individuals with diabetes own health has to take a step back,” says Turkel.
Another common time for experiencing diabetes burnout is after patients with type 2 diabetes start insulin therapy, according to the Journal of Psychosomatic Researchstudy. The increased responsibilities and day-to-day management of insulin therapy led to emotional and psychological stress and fatigue, even though people started experiencing better blood sugar control.
Every diabetes burnout presents its own potential health issues, no matter what your self-care management plan is. However, for people with type 1 diabetes, diabetes burnout has serious health risks. “Allowing diabetes management to fall completely by the wayside for even a short period of time can be dangerous. Type 1 patients risk developing diabetic ketoacidosis, which is life threatening. Type 2 patients are less likely to develop diabetic ketoacidosis, but they can become severely hyperglycemic, sometimes requiring hospital admission,” says Jacqueline Lonier, MD, an endocrinologist at the Naomi Berrie Diabetes Center in New York City.
Diabetes burnout is also closely linked with depression; burnout can contribute to feelings of depression and feeling depressed can make it harder to actively take care of your diabetes. If symptoms of burnout and depression last longer than two weeks—you may feel hopeless, irritable, anxious, sad, helpless, fatigue, have a lack of interest in doing things you normally enjoy, or experience changes in your eating or sleeping habits—talk to your doctor. Clinical depression isn’t just a rut you can overcome on your own. Your provider can recommend a variety of treatment options, including medication, therapy, and lifestyle changes, that best suits your specific needs and preferences.
So when you find yourself dealing with a bout of diabetes burnout, how do you motivate yourself to get going again? We asked people with diabetes and diabetes educators for their best advice:
Brian Cohen, a talent producer for Fox Sports, First Things First was diagnosed with type 1 diabetes when he was 13. “For 27 years there have been some downs, but the moment that really broke me was a few years ago,” Cohen says. “I had been on [an insulin] pump for over 10 years, and at this point my skin was so rough and hard that trying to put the pump on was becoming really difficult. It got me to a breaking point where I just couldn't get the needle through my skin.” He tried several things, including calming techniques, but nothing worked. He got angry and felt sorry for himself. In defeat, he sat on his bed and wept. But then something remarkable happened. “I remember looking out my window and grabbing my phone and looking at pics of my family. I put myself in a place that was fun, safe, a memory that made me happy,” recalls Cohen.
Even though it was difficult to get the needle through the skin yet another time, he knew it needed to be done. “You have to take yourself out of it. It's mental and that's something I don't think a lot of people with the disease think of.”
Sure, your family and friends are supportive of your diabetes, but it can be difficult for them to really tap into what your day-to-day life is like managing diabetes. There are numbers, meds, carb counting, and other details that only other people with diabetes (PWD) can relate to. “People can really benefit from being in a group of people experiencing the same issues without feeling judged,” says Seifert. “You may be able to relate with that person more than a family member and might even be able to get a bit of motivation from them in order to help lift you out of your current diabetes burnout.” You can find communities of both type 1 and type 2 diabetes patients on Facebook; as well, the American Diabetes Association offers online communities for people with type 1 and type 2 diabetes, prediabetes, and caregivers. You can also ask your doctor if nearby hospitals or community organizations have diabetes support groups.
Seifert encourages her patients to develop stress reduction techniques, such as yoga and meditation. Yoga brings about a feeling of mindfulness, which simply means being present in a given moment while acknowledging and accepting the thoughts and sensations that come your way. Science backs this up too. A review in the Journal of Diabetes Research says people with type 2 diabetes who practice yoga showed improved mood and sleep, and even improved blood glucose control, cholesterol profiles, blood pressure, and weight.
You constantly hear about people backsliding when they try to quit smoking or slip up on a diet. Managing diabetes is no different. Maybe you didn’t hit your target A1C range and you feel pretty crappy about it. That’s OK. But if you dwell on it, you could open the door to more negative thoughts and before you know it, negative thoughts and emotions are on overdrive. “As soon as your diabetes starts to feel overwhelming, step back from the situation and take a deep breath. Don't blame yourself for failing if you don't always hit your blood sugar, diet, and physical activity goals. Nobody gets it right every time. Keep at it, but don't expect perfection,” says Seifert.
“Sporadic ‘heck with this’ feelings are unavoidable,’” says Bob Tupper, a type 2 diabetes patient and a travel writer. “My suggestion is to avoid the concept of ‘zero’ in anything that's really important to your quality of life. I love grits, but they act like sugar syrup in my bloodstream. So I have grits rarely, but butter and salt them up good and keep the serving to about two or three ounces. If I exercise a bit the spike isn't all that bad. No-sugar-added ice cream isn't sugar-free, but it's easier on the system and a smallish portion with a big topping of crushed baker's chocolate—it’s essentially sugar free—is good enough. After all, three ounces of ice cream isn’t really different from 16 ounces; when it's gone, it's gone, and it goes too fast in either case,” notes Tupper.
If you’ve been skipping visits with your diabetes educator or haven’t seen one in awhile, it’s time to make an appointment. Diabetes largely focuses on self-care, meaning you’re the one in charge of the day-to-day decisions, but that doesn’t mean you have to depend solely on yourself. While there is a plethora of information at your fingertips courtesy of Google, a certified diabetes educator (CDE) can help you decipher what is safe, reliable, and helpful for you. Plus, a CDE will work with you to create a personalized plan for eating, glucose monitoring, exercise, goal setting, as well as preventing and coping with diabetes burnout. “Speaking openly about the stresses of having diabetes and things you can do to help manage the stress related to the disease is what I have seen my patients respond the best to,” says Turkel. Some insurance plans cover diabetes self-management education. If you don’t have insurance or your insurance plan doesn’t cover this, you may be able to find free or reduced-cost programs through a local hospital, clinic, or health department.