Carb counting, injecting insulin, verifying blood sugar, changing site, calibration of sensor, correcting for a low, worrying about a high or a low, timing meals, balancing diet with exercise and the list goes on! Diabetes comes with a lot of life changes that can, to some extent, become exhausting or overwhelming. Feeling the emotional burden of living with diabetes and with the diabetes self-management regimen is recurring every day.
What is Diabetes Distress?
Recently, doctors and researchers have been paying closer attention to the rational emotional response that stems from that overwhelming feeling. Diabetes’ Distress, or DD, is a product of the emotional adjustment and burden that is rooted in the demands of diabetes management.
It refers to all the fears and worries that people living with diabetes, mainly type 1 diabetes, experience on a daily basis. The diabetes distress includes also the stress associated with social relationships (couple, family, friends, school and work environment) and the stress associated with the patient-provider relationship (with doctor, nurse, nutritionist, etc.).
How does it affect our daily life?
The fear of hypoglycemia is a prime example of the types of concerns that may cause DD.
The perceived lack of support, whether from family and friends, or even from healthcare professionals, can further exacerbate DD and be a birthing ground for the adoption of coping mechanisms that could be harmful. One of the most common adaptations is when individuals with DD choose purposely remain in a constant state of hyperglycemia, or choose to intentionally allow for their blood sugar level to rise before and during social gatherings, events, trips, and work to avoid having a low blood sugar episode (hypoglycemia). Hence why DD has been found to be significantly associated with undesirable high glycated haemoglobin (HbA1c) level.
Work-related Diabetes Distress: intentional hyperglycemia at work?
Given the importance of the social context of work life, a group of researchers sought to study the association of DD and work life factors.
They surveyed more than one thousand working adults living with type 1 diabetes to explore the relationship between work-related factors (such as ability to work, job demands, and opportunity to self-manage at work), work-related DD, intentional hyperglycemia at work, and glycemic control.
They found that work-related DD was associated with individuals’ tendencies to intentionally remain at a hyperglycemic state while at work, which in turn was associated with undesirable glycemic control.
While maintaining a hyperglycemic state might provide some temporary comfort (i.e. knowing if you’re too high, you can’t go low), it can be harmful in the long term. In fact, this study found that overall glycemic control was only affected by DD if the individual engaged in intentionally maintaining a high blood sugar level. It is important to note that if you are worried about hypoglycemia, a more efficient approach would be to discuss it with your healthcare professional to evaluate the cause and how to address it. Blood glucose awareness training and cognitive behavioral intervention (for example relaxation techniques and cognitive restructuring exercises) can reduce levels of fear and improve disease management.
Diabetes distress is a reality to many individuals who live with type 1 diabetes. Feeling overwhelmed, scared, or lost can happen and having access to sound information to make informed decisions, as well as access to a positive support system are paramount for their wellbeing.
At BETTER, we believe that your experience as an individual living with type 1 diabetes deserves to be heard and shared and you deserve a judgment-free space to further your knowledge and be a partner in advancing overall care.
1- Berry E, Lockhart S, Davies M, Lindsay JR, Dempster M. Diabetes distress: understanding the hidden struggles of living with diabetes and exploring intervention strategies. Postgraduate medical journal. 2015;91(1075):278-283. doi:10.1136/postgradmedj-2014-133017
2- Hansen UM, Skinner T, Olesen K, Willaing I. Diabetes distress, intentional hyperglycemia at work, and glycemic control among workers with type 1 diabetes. Diabetes care. 2019;2019 Feb 14. doi:10.2337/dc18-1426
3- Robinson DJ, Coons M, Haensel H, Vallis M, Yale JF. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Diabetes and Mental Health. Can J Diabetes 2018; 42 (Suppl 1): S130-S141
4-Wild D, von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L. A critical review of the literature on fear of hypoglycemia in diabetes: implications for diabetes management and patient education. Patient education and counseling. 2007;68(1):10-15. doi:10.1016/j.pec.2007.05.003