Emotional Complications of Type 2 Diabetes

When we say the word ‘pain’, physical pain is often what comes to mind. I'd suggest most people have had physical pain at some point in their life even if it was only from a paper cut. Many people with diabetes live with chronic physical pain from things like finger pricks to the more serious neuropathy that can affect our feet and other parts of our body. I believe the emotional pain and anxiety that some of us live with is often overlooked. Similar to other chronic diseases, diabetes is not something that people can ‘see’. It is invisible to those around us. It only becomes visible if someone sees you checking your blood sugars or they see your continuous glucose monitor or insulin pump attached to your body. Or if you choose to share this part of your life with others. So if diabetes is invisible, how would anyone know the emotional pain that some diabetic folks live with? The simple answer is they don't. It is very real for many people. This emotional pain can eventually move to anxiety or depression which complicates coping with diabetes even further. Diabetes and judgement Imagine living your life feeling like others look at you, or speak, with blame. "You have always been overweight (or obese) and now you have diabetes, that's your own fault." "You are doing nothing to fix this." "Why don't you just lose weight?" "The reason you have diabetes is..." If you think folks with diabetes don't hear these callous and mean-spirited comments, you are mistaken. We all know, people can be very judgmental about things they know nothing about. Unfortunately, many read an article and consider themselves educated or the authority on diabetes. They can’t wait to tell you what they know. Or worse yet, what you did wrong. Let's say now I take those comments to heart. To begin with, they hurt, big time. Then I question myself. Did I do this to myself? Why didn't I lose weight? I blame myself...if only I had done this or that... Now the pain, the emotional pain, becomes real. My self esteem has likely been affected and maybe even lowered. It takes great resiliency to be able to deal with those types of comments and not be affected by them. It is hard enough to deal with diabetes itself and the huge learning curve without having to deal with painful comments! There is naturally some anxiety attached to diabetes. It is scary and many people are afraid of what it means to them long term. For some people that fear or anxiety is not easily controlled. Diabetic routines are rigorous and at times complicated. Most of the time these routines must be kept to ensure healthful living without complications. Anxiety can be heightened by all the negativity we read about on the web related to diabetes or our innate belief that we have to have perfect numbers, to be perfect. I’m not sure perfect exists and if it does, what would it take to get there? Is it any wonder depression is prevalent among people with diabetes? Diabetes is not an easy health concern to live with. Professional and personal support All is not lost though. There is help and support both professionally, and, personally in our own diabetic community. No one, I repeat, no one knows what it’s like to live with diabetes better than another person with it. But we have to find each other out there to get the support. We look after all our physical needs. We need to look after our emotional ones too and deal with the emotional pain. As the ones living with diabetes, we shouldn’t hesitate to ask each other how we are coping, not as a replacement for professional care but in addition to. Hopefully we can reduce the emotional pain felt just by caring enough to ask and being there for one another. I’ll go out on a limb and say we all live with some degree of anxiety or emotional pain related to our diabetes. Let’s reduce both if we can. Hugs. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] Living with a chronic disease increases a person’s risk of developing depression, and type 2 diabetes is no exception. Studies have found that people living with type 2 diabetes are approximately 25% more like to be diagnosed with depression and anxiety.1 Depression is more than just sadness – it is a serious mood disorder that affects how a person feels, thinks, and handles daily activities. Depression can affect a person’s ability or desire to care for their diabetes, and depression is associated with higher blood glucose levels and worse health outcomes among people with type 2 diabetes. Proper treatment for depression is important for a person’s mental and physical health.2 Symptoms of Depression Depression is characterized as experiencing some of the following symptoms most of the day, nearly everyday, for at least two weeks: Persistent sad, anxious, or empty mood Feelings of hopelessness or pessimism Irritability Feeling guilty, worthless or helpless Loss of interest or pleasure in hobbies or activities that were previously pleasurable Decreased energy Increased fatigue Difficulty concentrating or making decisions Difficulty sleeping or sleeping too much Appetite or weight changes (either too much or not enough) Aches or pains without a clear physical cause Thoughts of death or suicide3 Comparison of treatments for major depression in type 2 diabetes A recent clinical trial evaluated the effectiveness of talk therapy and exercise on depression among people with type 2 diabetes. The study included 140 adults with diabetes, and participants were randomly assigned to one of four treatment groups: 12 weeks of exercise with a person trainer 10 individual talk therapy sessions 12 weeks of concurrent exercise and talk therapy sessions Usual care Compared to those who received usual care, the participants who received exercise training, talk therapy, or both, all showed significant improvements in their symptoms of depression, diabetes-related distress, and quality of life. People who received talk therapy were significantly more likely to be free of major clinical depression symptoms than those in the usual care group. Those who received exercise also showed a reduction in the A1C levels (a measure of blood glucose levels for the past 3 months), compared to those receiving talk therapy or usual care. The findings of this study were significant in proving that exercise, guided by a personal trainer, is effective in treating both depression and type 2 diabetes.4 [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"],Many studies that have been done have shown a higher risk of depression in people with diabetes than people without it. A recent study showed there may be an actual link between insulin resistance and stress. Hyperglycemia has ties to stress A study published in the journal Psychosomatic Medicine found that people with diabetes had larger reactions to negative visual stimuli than those without diabetes. The study measured brain activity with an EEG while giving the patient negative visual stimulation. It also measured urinary cortisol levels. Cortisol is a stress hormone. They concluded, "dismetabolism, [such as in hyperglycemia] is associated with increased emotional reactivity and a predisposition toward negative affect."1 In other words, hyperglycemia is associated with increased stress. [ad_slot mapping="video"] Why is stress concerning? Ask anyone who has lost their job, dealt with a health issue, or lost a loved one and you will learn why stress can be such an issue. Not only does it lead you to feel negative emotions such as anger and sadness, it can actually keep you from being motivated. This study shows that because hyperglycemia leads to more negative reactions, people with prediabetes or diabetes have frequent feelings of pessimism. These sad feelings can lead to mood disorders such as depression and anxiety, which in turn can lead to a lack of motivation. “If people with prediabetes and diabetes are trying to reverse or treat the disease, stressful events may hinder their goals. Frequent negative reactions to stressful events can lead to a lower quality of life and create a vicious cycle that makes it difficult to be healthy."2 How can you find motivation when you feel stressed? Anytime someone is under stress, gathering a support system should be step number one. Whether it is a family member, a physician, a friend, or all three, establishing a solid support system can help lead to more motivation. When we have someone that can help us be accountable, we are more likely to stick with changes. It is also easier to make changes with someone. If you have a spouse, ask him or her to make some diet and exercise changes with you so that you don’t feel alone. Step two in getting motivated is to start slowly. If you need to eat more vegetables, have that be the one thing you work towards instead of piling on extra things that may feel too overwhelming to conquer. Once you have established that change, add on another goal. What if you need additional support? Mental health is just as important as physical health. If you are struggling with feelings of depression, sadness, or a lack of motivation, be sure to speak with your physician. He or she may be able to refer you to a counselor that can help you tackle your feelings and become a more solid version of you. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] ,I have struggled with depression most of my life. For most of my life, it was undiagnosed. The struggle is real, though. Merely having a chronic health condition can make you susceptible to depression. Already having depression and then adding any chronic health condition makes the depression worse in many cases, as it did with mine. For people with diabetes, this can be especially dangerous as not taking meds and being inactive can cause other complications of diabetes and irreversible damage to the body. In the last 2 years, I have faced the effects of dealing with depression more frequently and for longer periods of time. When I experience these episodes, I am lethargic and have no energy. All I want to do is sleep. I don't move much, eat much, and typically neglect to take my medications. When I do eat, I often go straight for comfort foods. Obviously not a great game plan for a person with diabetes. Living with type 2 diabetes and depression Type 2 diabetes and other health issues are a constant stressor in many people's lives. It often requires the development of new coping mechanisms as well as building different support systems. Some people can easily make these adjustments. Someone dealing with depression may not be able to connect those dots easily. Depression can affect your ability to perform tasks, communicate, and think clearly. I think this is especially true when you are experiencing massive changes in your life. 7 tips for depression management with diabetes There are 7 tips, besides therapy, that have helped me begin to handle my two diagnoses. They align with things that have been suggested on several diabetes and mental health platforms. Enlist support Lean on supportive friends. Ask them to check on you when your struggling. Have them ask you if you are taking your meds, staying hydrated, and moving daily. It doesn't have to be a big deal or even in person. A text message will suffice. Be honest with them if you're not doing what you need to do. Set goals What are your health goals concerning diabetes? Determine how/what you want to eat. When will you take your meds? How often will you exercise? When you set goals, post them in places where you will see them regularly. Setting goals assists people in obtaining success in every area of life. Make a schedule Get your calendar out or helpful tracking apps on your phone or tablet and put your tasks on them with reminders. Try taking your medication and exercising at the same time daily. Doing so helps develop the habits and ensures that you take the time to do all the important things that will maintain and/or improve your health. Journal That's right, journal! It doesn't matter if you do it electronically or on paper; write it out or do a voice memo, just do it! Journaling helps you acknowledge all those feelings that you don't want to deal with while allowing you to release them so you can move through them to a different place. Exercise Get up and move! Move your body! Even if you walk in place for 30 minutes a day. Yoga, walking, hiking, canoeing, elliptical machine it...whatever gets you interested and moving, do it. Get some fresh air Whether you exercise outdoors or not, get outside and take in some sunlight and fresh air. Sit on your porch, deck, patio, or balcony and inhale deeply. Sunlight and fresh air have a multitude of benefits. Among them is combatting depression. If you can't get outside, try opening up the blinds and windows for a bit. Interact with other living things Even if you are not the type of person who wants plants and animals around, get out and interact with them. Since I live alone, it really helps me to have plants to take care of. My apartment is not conducive to having my own pets, so I visit a friend with pets if I need a critter interaction. Interacting with people works, but I find plants and animals a bit more conducive to pulling myself out of a funk than dealing with humans who can criticize me for where I'm at mentally. I still struggle from time to time, but doing these things helps me a lot. I also partake in therapy in addition to these things and others. If you're dealing with depression, know you are not alone, and there is plenty of help and support out there. All you have to do is reach out. [lead_gen showIfLoggedIn=“0” campaign=“shortcode” source=“site”] Many things in life can put you in the position of feeling overwhelmed. Diabetes is one of those. Whether you are newly diagnosed or not, diabetes is tough. Fitting it into your life and schedule isn’t easy either. And, diabetes or not, life will throw you curveballs at some point that are sure to leave you feeling overwhelmed. Feeling overwhelmed with type 2 diabetes Feeling overwhelmed can be caused by your body’s natural response to stress, which results in the fight, flight, or freeze response. You have likely experienced one or more of these. Fight may look like taking action to address the situation, flight may look like avoidance, and feeling frozen may look like being in a state of panic or not knowing where to start. If you find yourself in any of these, it’s okay and it’s natural. But, ultimately, we need to address your overwhelmed feeling. When taking action, you may be tempted to just get busy doing anything. But it’s easy to get caught up with busywork that may be distracting you from addressing your bigger areas of need. Action steps when feeling overwhelmed Often times it is helpful to first hit the pause button, take a step back, and calm our circuits. But then what? Some of the best next steps involve a pen and paper, gaining support, and self-care. Here are some productive action steps to take if you are feeling overwhelmed: Journal For many people, this act of putting pen to paper helps you to see things more clearly. That’s because you have to actually slow down your thoughts since your hand doesn’t write as fast as your brain thinks. When we slow down for writing, though, it can sometimes help to bring things into focus. Plus, the process of journaling can be highly therapeutic. Remember, do what works for you to journal, even if it means typing on a computer or other device. Journaling can also help you to better identify emotions. Feeling overwhelmed can sometimes be the first line emotion for other deeper feelings that you may not be able to pinpoint just yet. That overwhelmed feeling may be related to fear of complications, fear of failure, fear of having to give up foods/habits you enjoy, etc. If there are other emotions you identify, you can begin to address those directly. Make a list Take all of those tasks, responsibilities, and thoughts that are bouncing around in your head like a pinball and put them to paper. When you make a list of things that you are overwhelmed by, you can then evaluate them. When evaluating your list, here are some things to consider: (1) What do you have control over? (2) What can you delay, delegate and delete? Focus on the things you have control over and the things that are relevant. Focusing on things that you have no control over is senseless worrying. And, to quote Vance Havner, “Worry is like a rocking chair. It will give you something to do but it won’t get you anywhere.” Delete anything that is not worth your time and energy. When examining your list, you may identify some things that don’t even seem to be relevant in the context of the other things you are facing. This often involves setting healthy boundaries and saying no when needed. Delegate where possible and appropriate. Notice anything that you are trying to take on yourself that could easily be done by others. Consider the cost versus benefit of hiring a professional for certain tasks. What items on your list can you delay? If there is something you are not quite ready to tackle, don’t be afraid to put it on the backburner, as long as it’s still on your radar. This delay could be a week, a month, or a year even. Establish areas of priority. What are the most important things on this list? What are you ready and willing to take on? Are there important deadlines for some? Focus on one thing at a time After focusing on what’s in your control, what's important and a priority, your list may start to look a bit more realistic. Now, hone in on one specific task and work towards incorporating that first. You may find that you need to give yourself permission to focus on one thing at a time, but this can be a critical step. In reality, nearly everyone stinks at multitasking and, the result is usually that we get less done and feel more frustrated and overwhelmed. Set effective goals With one goal in mind, set an effective and confident goal. Effective goals are S.M.A.R.T. (Specific, Measurable, Achievable, Relevant, and Time-bound). You want to make sure that you just start somewhere and start small, remember you can always build on behaviors later. Be as specific as possible about what you will do to achieve this goal, when and how much or how often. An effective goal gives you a clear plan of how you will accomplish a task. When we are feeling overwhelmed, that’s exactly what we need; your overwhelmed feeling is naturally going to decrease when your confidence increases. When feeling consistent and secure with one goal, move on to another priority on your list. Take it to a calendar Next, apply your list and goals to a calendar. Go ahead and mark the delay items further out so you don’t forget about them. This will give you a sense of relief knowing that you don’t have to keep that bookmarked in your brain. Look at your usual week and day and identify where the larger priorities may fit in. Applying your priorities to a realistic schedule and having a plan for accomplishing them demonstrates that it is possible to accomplish these things; this alone boosts confidence. Find support Use a lifeline: phone a friend, recruit a family member, call a professional, etc. We all need support. And, when it comes to dealing with the difficulties of diabetes, this is especially helpful. You are not alone in dealing with diabetes and anything else that may be overwhelming you. Many people are currently and have been through the challenges you are facing right now. Tap into that support, learn from what worked for others, be the support for others in need. There are many different types of support. Consider what you need most right now. You may just need a sounding board or maybe you need some practical help or education. Maybe its professional support such as talking to a dietitian about healthy meals. Keep moving and get outside Engage in any physical activity. This could be big or small, such as a 10 minute walk or a spin class. Physical activity is a natural stress-reliever and antidepressant. Plus, it helps to boost your energy, mood, and confidence! And when we have more of those things it will reduce overwhelming feelings. Get outdoors for some fresh air. You are generally more likely to do more deep, nourishing breaths when you are getting fresh air outside. This helps you to get more oxygen to the brain which, in turn, helps you think more clearly. Deep breathing also helps to slow down your heart rate and reduce stress. Both of these things can be beneficial but I highly recommend getting activity outdoors for combined benefits, especially if you’re feeling overwhelmed. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site],Even when you are not feeling a strong emotion, you may resort to eating without the presence of physical hunger cues. This may happen if you are bored or if you lead a generally stressful life. According to a survey from the American Psychological Association, 1 in 3 Americans are under extreme stress.1 When your body experiences stress, it releases two hormones called adrenaline and cortisol. One of the hormones, cortisol, is known to increase appetite. If the stressful episode is temporary, then these hormones usually go back to the normal levels after the stressor is gone. But when the stress is ongoing - which is the case for a lot of us leading a modern lifestyle full of financial worries, work demands, frustrations, and societal pressures - cortisol in the body can stay elevated, which may cause you to overeat on a daily basis.2 Removing or reducing the causes of your stress will help you manage your mindless or stress eating tremendously! But this can be easier said than done - some stress-causing factors may be more difficult to eliminate than others. For example, you may not be able to quit your high-stress job and start a less stressful one the next day. However, you can make small changes to your perspective and your lifestyle that will help put the kibosh on stress. While you work on leading a less stressful life, here are some tips for identifying and putting a halt to stress eating: When an urge to eat comes on suddenly: As mentioned before in The Secret to Ending Emotional Eating article, physical hunger takes time to build up. If you are suddenly craving comfort foods, it is quite possible that it is due to stress you are experiencing. Rather than reaching for food, try one of these stress management techniques instead: Squeeze a stress ball for 10 minutes. Enjoy a hot cup of tea in a quiet place. Blast your favorite music and dance or sing along. Move your body. If you are working at a desk, head to the stairs, go one flight up and come right back down. Do some stretches to relieve the tension in your body. Set an alarm for 10 minutes and see if you still want to eat when the alarm goes off. Cravings tend to come and go, unlike your real physical hunger. This is a great tip for telling the difference. When you find yourself munching mindlessly: You may be so out of touch with your body’s own hunger cues that you don’t even realize how full or hungry you are. This could exacerbate your emotional eating. Use these mindful eating tips to help you rediscover what your physical hunger feels like: Before you sit down for a meal, try to figure out how hungry/full you are. Ask yourself, on a scale from 0 to 10, how hungry/full am I? (0 is starving, 5 is neutral, and 10 is completely stuffed) If you are at 6 or 7, there is no physical need for you to eat at the moment. Besides, nobody likes to be stuffed. It is so uncomfortable! If you are physically hungry and decide to eat, focus on noticing the texture, smell, mouth feel, and other sensations the food provides. This will increase your satisfaction from the meal and help you stop when you are comfortably full. Savor every bite! Take your time and enjoy the eating experience instead of gulping down the food. A great tip is to put your fork down on the table in-between the first four bites to make sure you are taking your time. When you’re about to stock up on junk or trigger foods Ask yourself what is your vision for your health? Remind yourself of these goals. Whether it is better health, more energy, looking better, feeling better, more confidence, or better blood glucose control, use these long-term goals to help you get through your current cravings and rethink your lifestyle. What steps can you take right now towards this vision? For example, you could buy a healthier option, shop only from your list, buy a single-serve portion, or leave the store. Remind yourself of things that motivated you in the past. Perhaps you’ve heard that 100 extra calories per day alone can lead to a 10-pound annual weight gain. If this is not something you desire, decide to make one of the healthier choices that is in line with your vision. Remind yourself that you can successfully change habits; people do succeed at creating better habits, and so can you! It’s all about the day-to-day choices you make. Small daily behaviors, not short-lived dramatic changes, will lead to long-term success. Limit the co-habits. For example if watching TV brings out the cravings – cut back on TV time or try exercising to your favorite shows. You can lift weights or do aerobics in front of the TV, or play a favorite show on your iPad or other electronic device while walking on the treadmill or exercising on the elliptical. As you gradually reduce the stress in your life, you will find yourself emotionally craving food less and less often. Conquering emotional eating requires a lifestyle approach, including reducing stress, sleeping well, and learning healthy ways to manage your emotions without the use of food. While it sure isn’t easy, making these lifestyle changes can dramatically improve your life. Never give up, and continue to prioritize your health! Check out 10 Everyday Behaviors That Could Be Leading to Weight Gain. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"]

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The Emotional Pain of Diabetes

Treating Depression in People with Type 2 Diabetes

Did You Know People with Diabetes May Naturally Be More Stressed?

7 Tips for Dealing With Depression & Type 2 Diabetes

What to Do When You are Feeling Overwhelmed

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When Type 2 Diabetes Leads to Burnout

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What I Feel When I Think About Diabetes

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