The burden of day-to-day diabetes management can be overwhelming - unending medications and/or injections, monitoring your blood sugar or wearing a continuous glucose monitoring device (CGM ) and checking it frequently, watching everything you eat, making time and remembering to exercise daily, worrying about managing or developing a complication or comorbidity, trying to manage your stress so your blood sugar doesn’t go up, and on and on, all while trying to live a normal life. So, it is no surprise that people with diabetes feel distressed. It is so common, more common than psychiatric disorders, that researchers and clinicians have given the negative emotions associated with diabetes that are interrupting your life the name: “diabetes distress.”
Diabetes distress symptoms
About one-third to almost one-half of adults and adolescents with diabetes experience diabetes distress.
Diabetes distress is characterized by a range of emotional experiences in response to living with and managing diabetes. People experience different symptoms, which can include:
- Feeling overwhelmed by the constant burden of managing diabetes 24/7.
- Feeling worried, scared, and/or anxious about possibly developing complications and/or complications progressing.
- Feeling discouraged and defeated when, despite best efforts, blood sugars are above targets goals or they do not meet their exercise and healthy eating goals (even though sometimes the goals that are set are unrealistic).
Diabetes distress is different from depression or anxiety because it is specific to how diabetes affects you in your daily life. It is not considered a psychiatric disorder, does not respond to medication nor does it meet any criteria for major depressive disorder (although shares some similar symptoms).
Often people experience diabetes distress for only a short period of time such as at diagnosis when they are learning about diabetes and taking care of themselves in a new way. Other times it is when a person starts a new treatment or when they develop a complication or a complication progresses. Other people can experience a constant state of diabetes distress that lasts for longer.
What can you do about diabetes distress?
Getting some help to reduce diabetes distress is important, not only to your mental health but also to your physical health. Diabetes distress is directly linked to high blood sugars and HbA1c (hemoglobin A1C) and poor self-care.
The American Diabetes Association (ADA) recommends screening for psychiatric disorders such as depression and anxiety. They also recommend that healthcare providers regularly screen their patients for diabetes distress because it has such a negative impact on their diabetes management. There are several different questionnaires they may use to assess this.
If a person does have a high score on a diabetes distress measure and appears to be experiencing diabetes distress, then the healthcare provider can make an appropriate referral and assist the person in addressing it such as: helping people problem solve, set realistic goals, help people find their motivation for managing their diabetes, assist them in changing their treatment plan or providing additional diabetes education, and helping them use different coping techniques.
Do not hesitate to ask for help
No one should live in a state of distress – working with your healthcare team to address the specific issues you are struggling with is key.
For some people, finding a different way to manage their diabetes (e.g., different medications or multiple daily injections versus an insulin pump) may be helpful.
Others need to learn more about management options and adjusting their treatment goals. People may also need a referral to a mental health provider or support to get some extra help in coping, problem solving, and getting support.
If you think you may be experiencing diabetes distress or are too overwhelmed with emotions to manage it according to your treatment plan, please talk to your diabetes health care provider. There are many things your healthcare team can do to help you be successful in managing your diabetes and living a full life.
Remember: you need to fit your diabetes into your lifestyle not your lifestyle into your diabetes management.
Diabetes distress is a common condition. About one-third to almost one-half of adults and adolescents with diabetes experience it at least for a short period of time.
It is characterized by a range of emotional experiences, but is different from depression or anxiety.
People may experience different symptoms from feeling overwhelmed to feeling defeated.
Getting some help to reduce diabetes distress is important to both mental and physical health.
Beverly, E.A., Ivanov, N.N., Court, A.B., Fredericks, T.R. (2017). Is diabetes distress on your radar screen? Journal of Family Practice.
Fisher, L., Gonzalez, J.S., Polonsky, W.H. (2014). The confusing tale of depression and distress in patients with diabetes: a call for greater clarity and precision. Diabetic Medicine.
Kreider, K.E. (2017). Diabetes distress or major depressive disorder? A practical approach to diagnosing and treating psychological comorbidities of diabetes. Diabetes Ther.
Gonzalez, J.S., Fisher, L., Polonsky, W.H. (2011). Depression in diabetes: have we been missing something important? Diabetes Care.
Polonsky, W.H., et al; DIAMOND Study Group. (2017). Diabetes Care.