When I tell people – especially people who don’t know much about diabetes – about my work, they usually look confused. Most people think of diabetes as a physical condition and have never really thought about the mental aspects with living with the condition. Even some people with diabetes are surprised that there are organizations like CDMH that focus on diabetes and mental health. They know that living with diabetes is hard for them, but often they are surprised to hear that their concerns are actually (and unfortunately) quite common. What is it about diabetes that is so hard?
I tend to think about diabetes and mental health issues very broadly. While some people with diabetes have a mental health condition (that may or may not be related to having diabetes), there are many others who struggle with issues that are very real, but which may not meet the (sometimes arbitrary) criteria for a mental health diagnosis.
Psychology is the study of how situations, emotions and relationships in our lives interact and impact our behavior. I think that this definition provides us with a framework we can use to talk about how diabetes impacts mental health.
Situation: Diabetes is a self-managed condition. This means that it is the person with diabetes, not their doctor, who is responsible for taking care of him or herself on a daily basis. Diabetes involves making frequent, sometimes life or death decisions under sometimes stressful and physically uncomfortable circumstances. In addition, diabetes management is constant and can feel overwhelming. If you or someone close to you has diabetes, take a minute and think about all of the steps you take in your diabetes management everyday. What to eat, how much insulin to take, when (or whether) to exercise, how to interpret a glucose reading, how many carbs to take to treat a low, the list goes on. Decisions, and resulting behaviors (and their consequences) are critical aspects of diabetes management. However doing everything necessary to manage diabetes can become overwhelming – and feeling overwhelmed is usually no fun.
Emotions: Many people with diabetes know that that having diabetes can result in some unpleasant and uncomfortable emotions. One question that I get asked a lot why living with diabetes is so tough and what causes these negative emotions. Unfortunately, this is not an easy question to answer. Being diagnosed and living with a chronic condition like diabetes can be really hard, and as we talked about before, managing balancing everything that’s necessary to live well with diabetes can be overwhelming. Even if you do everything that you are ‘supposed’ to do, diabetes can be unpredictable and frustrating. And if you aren’t able to do everything you are ‘supposed’ to do, it can cause feelings of anxiety, guilt and even hopelessness. And we haven’t even talked about the emotional impact of not feeling well. As you can see, there is no easy answer to this question because well, diabetes is complicated.
Relationships: Diabetes can have a big impact the way that people with diabetes live their daily lives and interact with the world, and this can be especially challenging when it comes to relationships with family and friends. Stress and other negative emotions can affect the ability to be present in relationships, and sometimes the ability to have relationships at all. And that is without even throwing diabetes in the mix. Relationships are an important part of the human condition and in many people’s emotional well-being, and when diabetes affects relationships – and it does – this can cause a significant level of distress.
Behavior: I am a big believer that everything we have talked about up to this point leads back to behavior. People often seek mental health treatment because of how their situation, emotion or relationship is causing them to behave. Having diabetes and the stress it involves (the situation), the way it makes you feel (the emotions), and the impact it has on your relationship with others intersect, and can sometimes make it difficult to behave in the way that you want to. For some people, this means adhering to their diabetes treatment plan and taking care of themselves. For others this means feeling so depressed, anxious or helpless that they have trouble going to work or school, or doing things they enjoy. Still for others diabetes causes strain or conflict in a relationship, making it hard to be a loving supportive friend. And for others, it is a combination of all of these issues and others we haven’t talked about here.
Even though the intersection of diabetes and mental health is complex, I want to re-assure that there’s hope. There are many people living with diabetes who live fulfilling lives and who have fulfilling relationships. If you are struggling with diabetes-related stress issues, know that it can get better. I will use future posts to talk about some things you can do to take care of yourself. But before we can solve a problem, it’s important to think critically and define it. I hope that this gives you a good place to start.