Diabetes & Mental Health
Good day, and welcome to the first of what I hope to be many blogs. SOOO, why am I writing about this topic? Great question, many people with diabetes, and without I am sure, are aware that diabetes can be very impactful on their mental wellness; depression, anxiety, eating disorders, and the stress of having to make an average of an extra 180 decisions per day to do their best at keeping their blood sugar levels in range, are a few examples of what people with diabetes face. Many of the people that seeks services with someone like me already know all of this, they live with it every second, of every minute, of every hour, of every day, well you get the point. What many find surprising though, is how their mental health impacts the ability to maintain blood sugars in range, better known as time in range.
Here’s an example; there is this magic range, typically somewhere between 70mg/dl and 180mg/dl, that people with diabetes are told to keep their blood sugars between. For non-sugar warriors, (people without diabetes) that may seem easy, that appears to be a significant range. As Adam Brown wrote about in his book, Bright Spots & Landmines, The Diabetes Guide I Wish Someone Had Handed Me, for people with diabetes, (you guessed it, sugar warriors), there are 40+ factors that contribute to blood sugar management, with only about 8 or 9 of those factors in direct sugar warrior control. So as blood sugars are shifting, people can become anxious about potential low (hypoglycemia) or high blood sugars (hyperglycemia) and feel the need to address it without considering all of the factors. They can become so focused on the number and/or the arrow, (there is an arrow on continuous glucose monitors CGM’s that indicates whether blood sugars are rising, falling, or maintaining) that they ignore important factors such as insulin on board, previous meals, stress, weather, menstrual cycle, and exercise, etc. This can become a vicious cycle of trying to make sure they do not become hypo or hyperglycemic without an awareness of how their actions and the anxiety itself is impacting time in range.
All of this is a balancing act, how aggressive one should be to maintain time in range vs when to let it ride, is a very personal decision. Technology now gives us the ability to see, and hear, what are blood sugars are doing in near realtime. This allows us to make adjustments sooner so that we can avoid the terrible physical and emotional burden of hypo and hyperglycemic events, both of which are very draining and definitely worth avoiding. The challenge is not so much the effort put into avoiding hypo and hyperglycemia, or trying to maintain tight time in range, it is the effort and its impact on our lives that can become the challenge that leads someone to feeling anxious, depressed, burnt out, or distressed that may warrant seeking out the support of a mental health provider.
Many sugar warriors are able to manage the challenges associated with having diabetes just fine without the need for support from a coach or therapist. There are plenty of examples, especially with the recent summer olympics, of folks that are accomplishing great things despite having diabetes. If however, someone is finding it difficult to focus on their life goals or they are hyper focused on blood sugar numbers or arrows on the CGM so much that they can’t seem to function in what they define as a normal life, that might be time to connect with a mental health provider that specializes in working with people with diabetes..