Stress, Depression, and Diabetes: How to Manage Your Self-Management

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If you are not managing your self-care well, you are not alone.

The DAWN (Diabetes Attitudes, Wishes and Needs) study, an international survey of adults with diabetes, found that patient-reported adherence to diabetes self-care regimens was poor.

Fewer than 40 percent of respondents said they were able to precisely follow exercise and diet recommendations. This inability to comply with medical guidelines frustrates health care providers and patients, alike.

But what’s the cause of this seemingly lackadaisical attitude?

Doctors who were interviewed for the study mentioned two likely factors common in diabetes: stress and depression.

Both depression and stress can lead to low motivation, poor concentration, and lack of energy, which in turn make patients more likely to neglect their self-care behaviors, driving up the risk of acute and chronic complications.

Depression is a serious medical condition, requiring medical treatment. The risk of depression in people with diabetes is about twice the rate in the general population. But even those who are not suffering from overt depression can be sidelined by the stress of diabetes.

That diabetes is stressful for many people is not surprising. Caring for diabetes presents innumerable challenges every day; from simple decisions, like what lunch foods will fit into meal plans, to worrying if the additive effect of high morning blood glucose will lead to complications.

Richard Rubin, in a chapter of Clinical Diabetes, elucidated some of the reasons why diabetes can cause such distress:

  • The regimen is complex, generally unpleasant, and unremitting
  • Good outcomes are not guaranteed
  • Care is demanding and restrictive
  • Acute symptoms of hypoglycemia and hyperglycemia
  • Long-term diabetes-related complications
  • Diabetes-related interpersonal conflict with family and friends
  • Diabetes-related occupational problems

To keep an eye on stress and depression, many diabetes programs like to check up on how well their patients are coping with the many requirements of diabetes self-care. Joslin uses a survey tool called PAID, or Problem Areas in Diabetes Scale.

This survey, developed by W.H. Polonsky and colleagues, is made up of 20 diabetes stress-related statements that patients rank on a scale from “not a problem” to “a serious problem.”

This helps health care workers concentrate their efforts on providing targeted support in areas highlighted by the patient’s completed survey.

Patients can often be helped with some of the following techniques:

  • Apply past workable strategies to today’s problems. Remembering specifically what you did and said to yourself during past successes of any kind can be a good motivator.
  • Set realistic goals. It is important that goals be doable. Many people with diabetes set impossible objectives for themselves. For example, getting all of your blood sugar readings to always stay below 120mg/dl is not likely to happen. But you could certainly meet a goal of getting 75 percent of your readings below 200 mg/dl. Set yourself up for success!
  • Get backup. Family and friends want to be supportive. Articulate what the people in your life could do to help you through, and both sides win.
  • Adopt a positive emotional outlook. Humor and optimism can go a long way in helping people cope with stressful situations
  • Get professional help. For unmanageable stress or depression, a trained mental health professional is the best solution

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