Chapter 14

Managing Your Emotions and Mental Health

IN THIS CHAPTER

check Considering your emotions

check Coping with anger, denial, stress, depression, and anxiety

check Identifying diabetes distress and burnout

check Seeking support from others

check Treating yourself with kindness

How did you feel when you were first diagnosed with type 2 diabetes? Likely, the diagnosis elicited strong emotions and concerns. Perhaps you felt like it wasn’t fair or wasn’t real. Perhaps you felt lonely or overwhelmed.

Everyone feels differently when they’re diagnosed with diabetes, in part because the circumstances of diagnosis can vary widely. Some people may find out they have diabetes because they notice complications such as changes in their vision or high blood pressure. Other people may find out they have diabetes because they check into the hospital or see their doctor for another concern. Some individuals may realize that they’ve been at risk for diabetes for years because they have a family history of diabetes or because they’re older.

Whatever the circumstances, it’s shocking to find out that you have a chronic condition. It’s a burden to discover that you need to take care of your body and mind in new ways to stay healthy. And people feel varying degrees of anger, denial, fear, and stress about diabetes.

Recognizing these emotions can help you channel this energy in positive ways. You may feel like your diagnosis is a sudden wake-up call to take better care of yourself, or it may take a while to figure out your strategy.

remember Your emotional well-being is integral to your health. When you feel good, you’re more likely to take better care of your blood glucose and other areas of diabetes management. When you let stress, depression, denial, or other negative emotions get the best of you, your health suffers, and you’re more likely to struggle with controlling your diabetes.

In this chapter, you discover emotions common to people with diabetes — as well as strategies for coping with them. Stress, anger, denial, and even diabetes burnout are part of the discussion, as well as more serious concerns such as depression and anxiety disorders.

Support groups for people with type 2 diabetes abound, in communities and online. In this chapter, you find out about how reaching out to others can help. Finally, we explain the importance of being kind to yourself — it can’t be overemphasized.

Getting in Touch with How You Feel

Ask yourself how you feel about your diabetes. What does that mean? Well, certain emotions probably pop into your heart and mind when you think about your diabetes. What are they, and how do they make you feel?

Think about common stressors, those moments in the day when you get frustrated. Some of these circumstances may be out of your control, but naming them is a first step in getting in touch with your emotions. Alternatively, identify those times when you feel satisfied and unconcerned about your health.

You may want to change your attitude and behaviors, or you may be doing a great job managing certain circumstances, and you want to do more of that positive coping.

Getting in touch with how you feel may seem like a luxury, but it’s a practical step in better managing your health. Use the following questions to help you get in touch with your feelings:

Facing Feelings of Anger and Denial

Anger and denial are common feelings when people are first diagnosed with diabetes, but these feelings can occur throughout a lifetime of living with a chronic condition.

tip If you consistently experience feelings of denial or anger, talk to your healthcare provider about coping strategies. Join a support group of other people with diabetes, online or in your neighborhood, so you can express your feelings with people who may be experiencing the same things.

Acknowledging feelings of anger

Anger is that genuine feeling of infuriation and annoyance about diabetes. You may feel anger at your physician or diabetes educator for delivering an unwanted diagnosis or bad news about a complication. You may feel angry about your health insurance if you don’t have enough coverage for diabetes supplies and treatment. You may feel angry with your family, friends, and co-workers if they’re unsympathetic and unsupportive of your efforts to eat healthy and exercise.

You’ll definitely feel angry with yourself. Feeling angry about your diabetes is normal because you can’t always control it. Despite your best efforts to lower your blood glucose, eat healthy foods, and exercise, you’ll have days when your numbers are off. It’s frustrating, but it happens to everyone.

Anger can be positive if it inspires you to change your behavior or environment, but it can be negative if it overwhelms you and paralyzes you in a state of hostility. Recognize that anger is common and find new ways to channel that powerful energy.

tip Here are some tips for alleviating anger:

  • Try to recognize common triggers by writing down episodes or circumstances when you become angry. Is there a pattern?
  • Try to avoid blurting out criticisms and frustrations in the heat of the moment. Take deep breaths and collect your thoughts before following the next two steps.
  • If another person says or does things to make you angry, try to talk with them about it in a calm moment. Try not to place blame, and be specific and kind.
  • Take a timeout or count to 10. (Get more strategies for de-stressing in the “Managing Stress” section later in this chapter.)
  • Focus on actions and solutions to avoid or lessen anger in stressful moments.

Dealing with feelings of denial

Denial is another emotion that people with type 2 diabetes commonly experience as they begin to cope with diabetes. You have so much new information to absorb — and the education itself can be overwhelming. You may also feel scared about the path forward, including the risk of complications.

Although denial is a natural emotion when you’re given shocking or unwanted news, it’s not a healthy long-term strategy. Denying you have diabetes won’t help you take care of your blood glucose and avoid complications. Denial only gets in your way. After all, diabetes is largely a self-care condition. You are the primary caretaker of your body.

Denial can take many forms. Perhaps you’ve tried to wish away your diabetes or just not think about it. Or perhaps you’ve told yourself and others that you’ll take care of your diabetes later. This is particularly dangerous because the symptoms of diabetes can go unnoticed while still causing long-term complications or deterioration of blood vessels. Still others may feel that they’ve had an incorrect diagnosis or their providers don’t know what they’re talking about. These are all typical feelings of denial that many people with diabetes experience.

You can move past denial by revisiting your diabetes care plan. Remind yourself of your blood glucose goals, such as an A1C below 7. Try to focus on why that number is important — such as preventing complications like eye or kidney disease. Strategize for ways that you’ll reach that goal, such as exercising a little bit each day or eating smaller portions or taking your medications on schedule.

Tell others, such as your healthcare provider and friends or family, that you’re struggling with feelings of denial. Enlist the help of a certified diabetes educator (CDE) to refresh your diabetes care plan — and brainstorm on ways to meet your daily goals.

Managing Stress

Stress is an all too common emotion in our lives. Everyone deals with the stresses of work, family, friends, and other commitments. However, people with diabetes may be more affected by stress because it impacts both body and mind.

In the body, stress causes the release of hormones that can raise blood glucose. In addition, stress can make it more difficult to effectively manage a chronic condition such as diabetes in which you need to eat healthy foods, exercise, and sleep well. Even though you know you should maintain your healthy habits, stress can undermine your good intentions and management plans — and result in higher blood glucose.

remember Stress is individual. We all perceive different situations as stressful and have different responses to stress. Something that may be inherently stressful to you, like going to the doctor, may be reassuring and comforting to another person. It all depends on your environment and mood. Also, something that stresses you out today could feel totally fine tomorrow.

Believe it or not, you already have a toolbox of strategies for managing stress. We all have strategies from our upbringing, values, and life experiences. Some of these strategies may be proven winners for managing stress, like laughing out loud, praying, or meditating, while others, like drinking too much or smoking, may create other stressors.

tip Luckily, several useful tools can help you manage stress in the short and long term. Here are a few you may find helpful:

warning Choosing alcohol or tobacco to relieve stress is unhealthy for people with diabetes. Drinking in moderation is fine (no more than one drink for adult women per day and no more than two drinks per day for adult men). However, drinking alcohol can increase your risk for lows and highs and weight gain. Lowered inhibitions while drinking excessively could also derail your efforts to eat healthy and exercise. Tobacco increases your risk of cardiovascular disease and early death.

remember Throughout the book, we tell you to exercise. Not only does exercise help you physically — by losing weight and maintaining a healthy blood glucose level — but it also helps you mentally — by boosting your mood and lowering your stress. When you exercise, your brain produces chemicals called endorphins, which make you feel good.

Exercise can help you combat stress by focusing your mind on something other than the stress at hand. You may feel more calm and meditative, or you may feel energized. Either way, you’re less likely to think about your daily irritations and struggles. Exercise can also help you sleep better, which can help you feel less stressed throughout the day.

Recognizing Diabetes Distress and Burnout

Diabetes distress, also called diabetes burnout, is a term for the feelings of frustration, worry, and fear that come with managing a chronic condition such as diabetes. These feelings are common; 18–45 percent of people with diabetes report experiencing diabetes distress.

Diabetes distress is a distinct set of emotions that is unique to people with type 1 and type 2 diabetes. The unpredictability of blood glucose levels and the stresses of everyday life can wear on people with diabetes. They can lead to a feeling of burnout where you feel overwhelmed and fed up, which sometimes stops people from taking care of themselves. This in turn can lead to higher A1C and other complications.

It’s normal to feel overwhelmed by the responsibility and duty of taking care of yourself 24/7. Watching what you eat, trying to exercise more, and checking blood glucose can feel like too much work.

It’s also normal to feel frustrated by the way your friends, family, or complete strangers may treat you differently because of your diabetes. Someone may tell you that you shouldn’t eat a certain food or shame you about your behavior. That’s not fair or kind.

It’s also normal to feel fearful of the complications of diabetes, such as heart or kidney disease. You may worry that you’ll have an episode of low blood glucose and not be able to treat it adequately.

Although diabetes distress is common, you still need to address it. You’ll want to recognize and cope with diabetes distress so that it doesn’t get in the way of your diabetes self-care. For example, high levels of diabetes distress may prevent people from taking their medications as directed and are linked to higher A1C and poorer exercise and eating habits.

Tell your provider if you’re experiencing symptoms of diabetes distress. A questionnaire called the Diabetes Distress Scale (DDS) may help measure your feeling of distress and clarify areas that cause you the most hardship. Your healthcare provider may use it, but you can also access it online at the Behavioral Diabetes Institute (www.behavioraldiabetes.org).

Ask for a referral to a diabetes educator, who can identify areas of stress and propose solutions to alleviate diabetes distress. If working with a diabetes educator isn’t helpful, you may ask to see a mental health specialist. Diabetes distress is nothing to be ashamed of, and you shouldn’t be embarrassed to talk about it with members of your healthcare team — or friends and family.

tip Talk to your diabetes educator or other healthcare provider if you’re experiencing diabetes distress. Measuring your diabetes distress and finding ways to alleviate these emotions can help.

warning Don’t assume your physician will ask you about diabetes distress. In one study, 45 percent of patients reported diabetes distress and yet only 24 percent said their healthcare teams asked them about it.

Looking at Depression and Anxiety Disorders

Anger, denial, stress, and diabetes burnout (all of which are addressed earlier in the chapter) aren’t the only emotions people with diabetes experience. Separate from those emotions are the clinical disorders depression and anxiety.

People with diabetes are twice as likely to experience depression as people without diabetes. Anxiety symptoms and disorders are also common in people with diabetes. No one knows exactly why depression and anxiety commonly coexist with diabetes. The causes of these mental health disorders are also unknown, although contributors include certain medications, family history, and living with a chronic disease.

Knowing the symptoms of depression

Depression can happen at any time, either immediately after your diagnosis or after you’ve been living with diabetes for many years. Not everyone experiences depression in the same way or for the same amount of time. However, there are common symptoms of depression:

  • You don’t enjoy things that normally make you happy.
  • You’re tired during the day, and you have trouble falling asleep or you sleep all the time.
  • You don’t enjoy eating foods that you once adored, and you eat much more or less than usual.
  • You may lose or gain a significant amount of weight.
  • You have difficulty concentrating, sitting still, or making seemingly straightforward decisions.
  • You don’t feel good about yourself, and you may even feel like everyone else would be better off without you.
  • You think about harming yourself or feel suicidal.

Depression is one of the most common mental health disorders in the United States, affecting at least 16 million adults each year. It is also treatable, so talk to your healthcare provider if you have any of these symptoms. You find out more about treatments later in this chapter.

technicalstuff Depression and diabetes are bi-directional. People with diabetes are more likely to have depression. But people with depression, a history of depression, or who take antidepressant medications are also more likely to have type 2 diabetes. It goes both ways.

Introduction to anxiety disorders

Anxiety disorders are the most common mental health illnesses in the United States, affecting at least 18 million adults each year. They include general anxiety disorder, obsessive-compulsive disorder, and many others.

Some are specific to diabetes such as an obsession with checking your blood glucose numbers, keeping them on target, or having a fear of insulin injections. One study found that 19 percent of people with type 1 or type 2 diabetes had generalized anxiety disorder during their lifetimes.

tip If your worries, anxieties, and fears get in the way of your life, talk to your physician. He may be able to help, or he may refer you to a mental health professional.

Treating depression and other mental health disorders

tip Talk to your primary care provider about symptoms of depression or anxiety disorders. It may seem challenging or intimidating to carve out time during your regular checkup, but it’s important to discuss your concerns. Your mental state and your emotions have an effect on your physical health, including your blood glucose levels.

Your primary care provider may feel comfortable diagnosing and prescribing a medication. Or she may refer you to a mental health professional such as a psychiatrist, psychologist, licensed social worker, or therapist.

Talking through your emotions and feelings with a professional can help treat mental disorders. Cognitive behavioral therapy is a common technique in which you modify your thoughts and change your behaviors. It has been shown to ease the symptoms of depression in people with various disorders, including diabetes. One study showed it has positive effects on anxiety, well-being, and diabetes distress in people with type 1 or type 2 diabetes.

Medications such as antidepressants can help rebalance chemicals in the brain and body. Many people find that a combination of talk therapy and medication helps.

Reaching Out to Others

Talking and sharing experiences with others is one of the most common ways of coping with type 2 diabetes. Many people feel like they’re alone with their diagnosis or diabetes care until they make connections with others. You can connect with others through support groups that meet in person or online.

Joining a local support group

In this day and age of digital friendships and virtual connections, you may appreciate the chance to connect in person with other people who have diabetes. If nothing else, you can exchange a sympathetic smile with someone else who’s dealing with a situation similar to yours, or you can receive a hug from an understanding group leader.

tip Ask your primary care provider or diabetes educator for names of support groups in your area. Hospitals are also good sources for this information.

A diabetes education class may be the first place that you meet others with type 2 diabetes in your community. The class instructor should offer suggestions for finding local support groups, but you should also feel free to ask. Don’t be shy about turning to the people next to you to see whether they might be interested in joining you or helping you find a local group.

The American Diabetes Association hosts hundreds of events throughout the year where the organization raises money and awareness for diabetes. The events are a great opportunity to meet others with type 2 diabetes by participating or volunteering your time. There are Diabetes Expos where you can find out about the latest information on diabetes, camps for kids, and bicycle tours and walks for all ages. Check them out at www.diabetes.org.

Connecting with others in online support groups

Going online is a wonderful way to find others with type 2 diabetes going through the same emotions and experiences. You’ll find discussions about food, exercise, blood glucose numbers, and more. The advantages of these online support groups are that you can be anonymous and you have access 24/7.

tip You can find support groups on the American Diabetes Association’s website at http://community.diabetes.org.

Being Kind to Yourself

Thinking positively and taking positive actions are important for your diabetes. Don’t underestimate the power of being kind and compassionate to yourself. After all, you are the most important part of your diabetes care. If you feel good about yourself, you’re more likely to take care of your blood glucose and make other healthy choices.

In the following sections, we give you some tips for taking care of yourself, in the big picture and in smaller moments of stress and uncertainty. (Check out Chapters 15 and 19 for advice on dealing with family members and co-workers, respectively.)

Gaining education and empowerment

Educating yourself about diabetes is an important step in taking care of your health. Just reading this book is a step forward in learning more about how to eat healthy foods, exercise more, and check your blood glucose.

tip Take a diabetes education class so you can find out more about type 2 diabetes. Ask your CDE whether she can recommend new tips or techniques for taking care of your diabetes or managing complications. Subscribe to a magazine like the American Diabetes Association’s Diabetes Forecast (www.diabetesforecast.org) so you can receive healthy living tips in your mailbox every other month.

remember The more you educate yourself about diabetes, the more empowered you may feel to make changes and take healthy steps. Education is the key to feeling empowered in managing your diabetes on a day-to-day basis, from keeping track of your blood glucose levels to building a healthcare team you trust.

Taking time for yourself

With the daily demands of taking care of your diabetes, you may find that it’s harder to make time for yourself. However, it’s just as important to carve time out of the day to relax, rejuvenate, and refresh. It may help with your stress levels and diabetes distress as well.

Taking “me” time means taking a break from work or caring for others like children or spouses. It’s an escape from the daily demands of work and life. Some people like to take a walk, read a book, draw a bath, or just sit quietly. Others find that meditation and listening to music are good ways to spend “me” time. You may have to schedule “me” time so it actually happens in your busy day. It could be 5 minutes or 30 minutes, once a week or even every day.

Trying mindfulness and meditation

Mindfulness is the act of being present in the moment, focusing on what you’re doing and noting each particular detail. You pay attention to your thoughts, as well as what’s going on around you. You can be mindful doing anything, whether reading to your kids at night or checking your blood glucose or mowing the lawn.

In the current age of multitasking, mindfulness has garnered attention for helping people live in the present and focus on what’s important. It seems like everyone is embracing mindfulness, from schools to workplaces.

Mindfulness may help people with diabetes recognize how their own bodies react to changes in blood glucose, food, or exercise. It may help some people focus positively on eating nutritious, delicious foods or some other aspect of diabetes self-management. In a small study in New Zealand, people with type 2 diabetes who practiced mindful self-compassion had improvements in depression, distress, and A1C.

Meditation is another practice that can help relieve stress and create a sense of empowerment. During meditation, you focus your mind. You may try to relax your body and use your breath to focus inward and release other thoughts. People also use meditation to improve their health, from lowering blood pressure to reducing pain. People with diabetes may find meditation helpful for all these reasons and more, including a sense of physical and mental calmness.