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What is Diabetes Distress? Why is it So Hard to Care for My Diabetes Day After Day?

What is Diabetes Distress?

Diabetes distress refers to the emotional response to the daily and unending demands of self-managing one's diabetes. Diabetes is a disease that is mostly managed by the patient in their own environment. Although people with diabetes may have many healthcare providers that help them manage their diabetes, there are still way more diabetes-related care tasks that the patient does on their own. Examples of these tasks are checking blood sugars, taking pills, injecting insulin, counting carbohydrates, calculating insulin doses, reading nutrition facts labels, and exercising.

person who is thinking

Decision Fatigue in Diabetes

All these tasks require thought and decisions. Remembering to check blood sugar at the right time, remembering to take pills, taking the insulin at the right time, looking up carb content of food, doing mathematical calculations to determine insulin dose, interpreting nutrition facts, and planning exercise into the day All take mental energy.

The person with diabetes can barely get a moment of their day when they do not have to be thinking about their diabetes. Decision fatigue can set in. Decision fatigue is when people are mentally and emotionally depleted by all the decisions they have made and still have to make that their ability to continue making decisions is decreased.

Why Diabetes Care is So Challenging

In general, we don't want one aspect of our life to take up all our time an energy. Life has so much in it, and it is hard to live a good life if all your emotional and mental space is diverted to one specific area. Even with nutrition and eating, we don't want peoples' lives to revolve around what they are eating. When someone's life does revolve around their eating, it can be very stressful to the patient--they are always thinking about what they can eat, where they can eat, when will food be available, and if the food they ate before was OK for them. These mental processes that take over a person's life are often a sign of disordered eating.

Yet with diabetes, it is what healthcare providers seem to be asking from their patients. With the multitude of diabetes-related tasks a person has, there seems to be nothing the patient can do besides think about and plan their life around their diabetes. No wonder patients end up with diabetes distress. As a dietitian and diabetes care and education specialist, my role is to help patients live a wonderful life where diabetes care tasks do not overwhelm them.

How to Combat Diabetes Distress and the Decision Fatigue of Diabetes Care

Many of my patients try to avoid decision fatigue by decreasing the number of decisions they have to make. They try to automate as many of their diabetes tasks as possible. They may keep one glucometer at their bedside so that they don't have to worry about forgetting to check fasting glucose, and they will keep a second glucometer on their kitchen table to check premeal numbers. They fill their pillbox at the beginning of the week and keep it on their kitchen table to take their medication with breakfast. They use a chart that lists insulin doses for carb amounts to that they have less math to do. They may even have some go-to meals with known carb amounts to that they don't have to carb count their most frequently eaten foods.

Another important way to decrease diabetes distress and get back to living life is to work with a mental health provider who understands diabetes. It is not uncommon for diabetes distress to last and then morph into depression or anxiety. Taking care of yourself well with diabetes is hard, and it can take a toll on you. Ask your healthcare provider for a referral to a mental health provider.

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