Diabetes Distress

Diabetes Distress

Dr Sanjay Kalra discusses the emotional impact that Diabetes has on one's mind and how to deal with it

Diabetes distress defined

Living with Diabetes may sometimes be challenging. The complexity of having to learn and assimilate various self-management strategies along with the need for regular health care may weigh heavily on some people living with Diabetes. This may lead to emotional stress, which is termed as Diabetes distress (DD).

Diabetes distress is defined as an emotional response characterised by extreme apprehension, discomfort or dejection due to the perceived inability to cope with the challenges and demands of living with Diabetes (Kalra et al). Such significant emotional reactions may occur at diagnosis, due to the threat of complications, with self-management demands, or because of an unsupportive social ecosystem (Fisher et al). Diabetes distress can occur not only to people living with Diabetes but their family members as well.

Is Diabetes distress common?

Diabetes distress is common in people with Diabetes. Nearly one-third to half of all people with Type 1 or Type 2 Diabetes experience Diabetes distress at some point in their life. Diabetes distress is seen more commonly in young people and those on insulin therapy. A lack of motivation, low self-image, and a sudden, severe onset of disease or complications may predispose to Diabetes distress. Poor support from the healthcare system as well as family and society may worsen the condition.

While Diabetes distress may occur at any time in the course of Diabetes, there are a few 'dangerous bends' that makes one vulnerable to the condition. These include:

• a change in life status, e.g., change of school or job, residence, marital status, or family structure,

• a change of disease state, e.g., onset or worsening of glycemia/complications

• a change of therapy or therapist (e.g., the start of insulin, dialysis; referral to a specialist), and

• a change in financial status

Diagnosis

Diabetes distress can be diagnosed by various validated tools that can be self-administered. These include the Diabetes Distress Scale (DDS), Hypoglycemia confidence scale, and Problem Areas in Diabetes (PAID) scale. DDS has different versions for people with Type 1 Diabetes, Type 2 Diabetes, parents and partners of people with Diabetes. The PAID scale has been validated as a one, five and twenty-item questionnaire. The Gluco Coper is a validated questionnaire that helps a person assess how he or she is coping with distress.

Diabetes distress is somewhat similar to but different from depression. Some of the symptoms, such as extreme apprehension, discomfort and dejection, may overlap with complaints voiced by people with depression. Diabetes distress, however, occurs in the context of Diabetes or its complications and does not meet the diagnostic criteria devised to diagnose a person as having a major depressive disorder. You may have Diabetes distress if you feel extremely:

• Apprehensive

• Uncomfortable

• Dejected about facing life with Diabetes

Feeling apprehensive, uncomfortable or dejected about Diabetes does not mean that one is ailing with something. Diabetes distress is not considered a disease; rather it is an emotional response to living with Diabetes, albeit a slightly exaggerated one.

Diabetes distress can be managed through psychosocial support, including training for coping skills, and will usually not require intervention from a mental health professional.

Managing Diabetes distress

Diabetes distress is defined as an extreme emotional response due to a perceived inability to cope with Diabetes. Thus, it is a disorder of coping. It stands to reason that the management of Diabetes distress will hinge on patient education, including learning how to self-manage and cope with Diabetes. This does require some degree of change in lifestyle, which may be associated with discomfort. The discomfort of change can be minimized by active support while allowing the person with

Diabetes some time to contemplate, choose and create change for him or herself. Required change can also be structured into smaller decisions and behaviors, which is easier to manage.

One can handle Diabetes distress by strengthening his or her:

• Self-care ability

• Coping skills

• Interaction with family/friends

• Communication with the healthcare team

Positive coping skills

• Finding partnership, e.g., joining advocacy or a support group

• Pleasant thoughts and behaviour, e.g., group for a walk

• Finding positive spin-offs, e.g., Diabetes keeps me disciplined

• Putting in perspective, e.g., insulin takes only one minute to administer; the rest of the day is mine

• Planning for the future, e.g., saving money to buy a glucose meter

To conclude

Diabetes, if managed well, can bring out the best in us. Learning how to cope with its challenges and demands will help ensure good blood sugar control and better overall health. One must learn how to identify and manage Diabetes distress, on time, to ensure a happy life with Diabetes.