Diabetes is a unique condition as the burden of management is placed mainly on you, the person living with diabetes. For other chronic health conditions, a physician or other healthcare team member prescribes medications and intermittently monitors progress. In contrast, people living with diabetes are expected to identify and understand the many factors that affect blood sugar levels, adjust for these on a daily basis, and respond and react to their own data. If you are living with diabetes, you are expected to adjust your nutrition and physical activity. If you are using insulin, you are expected to determine and adjust your insulin doses based on your blood sugars and the food you are eating.
The demands on people living with diabetes have perhaps increased even more in recent years with the growing use of continuous glucose monitors, which have a number of important benefits but could also lead to data overload.
Can emotional well-being affect blood sugars?
More than 40 factors are known to affect blood sugars. Stress and inadequate sleep directly raise blood sugars by increasing levels of stress hormones. However, emotional well-being affects blood sugars indirectly through one’s ability to perform the necessary tasks of self-monitoring and self-managing. Given the numerous times per day an individual must think about diabetes and make decisions that will affect their blood sugars, it is not surprising that one’s emotional state affects their ability to perform these tasks. Managing diabetes is a full-time job. Like any other job, it is difficult or impossible to perform well when you are struggling with your emotional well-being.
If your diabetes seems out of control, it is important to reflect on the causes for this. Although high blood sugars could be due to progression of diabetes and the need for additional medications, a much more common reason is impaired emotional well-being, making it difficult for you to perform the job of managing your diabetes. This can be triggered by disruptions to your usual lifestyle or routines by challenging events, such as the breakdown of a relationship, an illness in a family member, or losing your job. Poor emotional well-being is often associated with a sense of hopelessness or helplessness when it comes to diabetes self-management. This leads to poor choices for nutrition or physical activity, and can progress to avoidance behaviours such as not wanting to monitor blood sugars or forgetting to do so, or neglecting to take diabetes medications.
Set realistic goals
Checking in with yourself on a regular basis regarding your emotional well-being is helpful, especially when major life changes or disruptions occur. Reflect on how these stressors have affected you, and what impact this is having on your ability to perform your job managing diabetes. Although you may not be able to control external events and stressors, you can control your reaction, awareness and acceptance of these events. This alone can have a positive impact.
It is important to avoid the pitfall of an ‘all-or-nothing’ mentality when it comes to diabetes self-management. Although there are times you may not be capable of devoting 100% of your usual effort to diabetes management, you can acknowledge and accept this temporary disruption. If you are struggling, setting incremental and realistic goals is helpful. For some, this may mean the initial goal is simply to start monitoring blood sugar levels, without needing to act on the results immediately. Another pitfall to avoid is feeling judged or shamed by the numbers. Your healthcare team wants to meet you where you are at and work with you on making positive changes.
Develop positive coping strategies
When I am seeing a patient who is struggling or is very anxious or distressed by their diabetes, there are 2 questions I like to explore. First, I ask the patient how overwhelmed they are currently feeling with the demands of living with diabetes. When someone is feeling highly overwhelmed, the next step is to discuss what specifically they are finding most overwhelming so we can work on developing some strategies around this. Second, I ask patients how often they feel they are failing with their diabetes routine. If this is occurring often, the next step is to explore what they specifically feel they are failing at so we can develop positive strategies to improve these distressing feelings.
Succeeding at your job as your diabetes manager requires strong emotional well-being. Fortunately, emotional well-being is a skill that can be practiced and improved, and therefore requires the same level of self-monitoring and self-reflection as blood sugar values.
Tips for emotional well-being
- If your diabetes seems out of control, reflect on how your emotional well-being could be contributing to your ability to perform your job managing diabetes.
- Avoid an all-or-nothing mentality when it comes to managing diabetes. Instead, set incremental and realistic goals.
- Separate your emotions from the numbers. Your self-worth is not defined by your blood sugar values.
