Diabetes and its challenges for mental well-being
Depression, burnout and eating disorders. These are only some of the mental health issues that often plague people with diabetes – regardless of the type they have or where they are on their diabetes journey.¹ With almost one-third of people with diabetes affected by mental health issues,² and nearly half of these cases going undetected,³ it’s time to talk and listen to these unheard voices.
To mark the occasion of this year’s World Diabetes Day, curated by the International Diabetes Federation (IDF),* we’re drawing attention to the link between diabetes and mental well-being.
As a first step to raising awareness, we’ve put together a quick guide to some of the more common mental health struggles for people with diabetes. One thing you’ll notice as you go through this glossary is that prejudice, stigma and isolation are at the heart of many of them. The good news? We can work on this!
Inspired by the IDF’s efforts to educate the world on what it really means to have diabetes, we know that making visible the invisible sides of living with the condition can go a long way to fighting stigma and easing some of the burden.
The fight-or-flight response built into us to help us escape sabre-toothed tigers and other life-or-death situations works the same for all types of stressors – including the stress caused by years of tedious daily diabetes management. There’s a bitter irony here: the stress of living every day with diabetes and trying to keep it in check can actually make diabetes worse; stress releases hormones, causing more pronounced fluctuations in the blood sugar, making it even harder to keep levels in range. Repeated or constant diabetes distress can cause serious long-term damage.4
The symptoms of burnout vary between people, but can generally be described as a feeling of hopelessness that eventually leads to “giving up.” Feeling like there’s no longer a point to trying so hard to stay on top of diabetes can translate into skipping insulin doses, refusing to take tablets, avoiding check-ups and ignoring the annoying but essential elements of daily care. Diabetes burnout often develops after a longer period of time dealing with diabetes distress.6
A common misconception about diabetes is that, by consistently making bad choices, people bring it upon themselves. Even though there’s a host of factors all playing a role, including genetics, environment – even air pollution9 – the fact that this notion is outrageous doesn’t prevent people with diabetes from hearing, seeing and feeling rejection and blame every day. Because this stigma forces people to hide the realities of living with diabetes to avoid scrutiny, many postpone or ignore necessary diabetes management actions when out in public, threatening both their physical and mental well-being.5
Also known in the medical world as “type 1 eating disorder” or “ED-DMT1” (eating disorder-diabetes mellitus type 1)11 this term was popularised in the media as a catchy blend of the words “diabetes” and “bulimia.” This mental health issue attributed mostly to type 1 diabetes refers to the underuse or restriction of insulin with the aim of losing weight, although it can also include other behaviours such as binge eating and purging. Aside from trapping people inside their minds to battle an obsession with body image and weight, diabulimia is extremely dangerous and can cause incontrovertible physical damage and even death.12
Other types of diabetes-triggered disordered eating include bulimia nervosa (binge and purge), restricted eating and objective or subjective binge eating.16
Because hormonal and blood sugar fluctuations can profoundly affect the behaviours, thought processes, moods and emotions of people with diabetes,18 it’s not always obvious if they’ve become depressed. If someone struggles for around two weeks with some or all of the following symptoms, they should seek help from a medical professional: restlessness, distraction, suicidal thoughts, over- or undereating, trouble sleeping and getting out of bed, feelings of worthlessness and/or excessive anxiety.19
We can all contribute to preventing stress, anxiety, depression, burnout or a complicated relationship with food and insulin from going too far and causing long-term or irreversible side effects in people with diabetes. It starts with listening, learning and sharing.
Over the next couple of months – just in time for October 10th’s
Together, we’ll show the world that everyone can play a part in improving mental and physical health outcomes for people with diabetes, regardless of where they live.
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