What Makes Diabetes Management So Stressful?

Why is having diabetes so stressful? What is it about the disease management that makes it so stressful?

 Judgement/stigma:

  -Blood sugar values provide constant good/bad (pass/fail) feedback

  -Prescribers often shame or guilt people with diabetes for not meeting goals

  -Worry over complications

  -Being part of a “high risk group”

  -Media stigma of diabetes being a disease that is brought on by poor lifestyle choices (brought on through one’s own actions).

  -Under-representation of persons of color and younger age groups

Judgement/Stigma Providers Pass/fail Complication fears Being labeled as “High risk” Under-representation

 

Diabetes “burn out”- diabetes is one of the few diseases that requires management multiple times/day, every day, for years or even for life.

Daily tasks of diabetes management:

  -Blood sugar checks

  -Taking medications

  -Calculating dosages of medications

  -Monitoring nutrition/carb counting

  -Emergency treatment/prevention

  -Exercise

  -Wearing/responding to devices.

 

Financial burdens:

In 2016, T1International’s Insulin & Diabetes Supply Survey found that people with type 1 diabetes spent 10% of their monthly income on diabetes management. In the US, while the percentages are a little different, the average person with diabetes spent over $16,000 on medical care annually, 4 times that of a person who did not have diabetes.

Financial burdens Medications Specialist visits Transportation Childcare Time off from work Health insurance premiums Higher life insurance rates Higher car insurance rates Insulin users denied short term disability insurance Discrimination

 

Diabetes is also a disease of isolation: lifestyle changes and food-related restrictions can make social gatherings and celebrations stressful for people with diabetes, causing them to avoid them. The rarity of type 1 diabetes can cause people with this form of diabetes to feel alone in their struggles.

Isolation Food expresses love, celebration, togetherness Limiting foods can make gatherings stressful Type 1 diabetes represents less than 1% of the US population Under representation of ethnic groups and age groups leads to a feeling of not being seen or heard.

 

Diabetes-Specific Anxieties

Needle phobia:

There are devices available that can reduce encounters with needles such as co9ntinuous glucose monitors use that reduces the number of fingersticks, and the Medtronic Iport to reduce the number of needle sticks per day.

Hypophobia:

Symptoms of low blood sugar can trigger panic attacks in many people with diabetes, even a swiftly dropping blood sugar that is within target range can trigger an adrenal stress response. Tailoring medication use to reduce hypoglycemia, and slowly working toward tighter blood sugar controls using higher targets can be helpful in reducing highs associated with over-correction of low blood sugars. CGM therapy can relieve hypophobia by providing a sense of security by having a warning on the device before going low, but can also feed into hypophobia as the user can now see blood sugars actively dropping causing undue fear, and repeated alerts can cause over correction.

 

Diabetes and Mental Health Risks

And finally, studies have shown that persons with diabetes are 4x more likely to struggle with clinical anxiety or depression than the non-diabetic population.

Persons with diabetes are 3x more likely to struggle with eating disorders than the non-diabetic population. And these issues tend to emerge at a younger age in persons with diabetes. These correlations may be directly tied to the burden of living with diabetes, as well as genetic and physiologic predispositions that have not been identified.