Anyone living with diabetes knows that successfully managing the condition isn’t easy. Diabetes self-care can involve eating a diabetes-friendly diet, getting enough exercise, measuring your blood sugar levels at least once a day, taking medication or insulin and more. Moreover, diabetes can be challenging for your mental health.
In this video, San Diego Health host Susan Taylor talks with Karla Espinosa De Los Monteros, PhD, a clinical health psychologist at the Scripps Whittier Diabetes Institute, about the mental health issues often associated with diabetes. Dr. Espinosa De Los Monteros specializes in diabetes behavioral health.
According to Dr. Espinosa De Los Monteros, the way others talk and think about diabetes can impact how people with diabetes feel about themselves.
“Many people are under the impression that when people get diagnosed with diabetes, it’s because they didn’t take care of themselves,” she says. “So when people first get diagnosed, a lot of times there’s a lot of guilt or shame that comes with the diagnosis.”
This, in turn, can affect your thoughts, emotions and even what you say to yourself. Dr. Espinosa De Los Monteros says negative self-talk is common among her patients, who often believe that they caused their diabetes or lack the self-control or willpower to manage their disease.
“It’s really important to remind people that while lifestyle definitely impacts your risk for diabetes, it is absolutely not the only reason why people get diabetes. There’s a huge genetic component there that you didn’t get to choose,” says Dr. Espinosa De Los Monteros.
In addition, life with diabetes can be stressful. Not only do you need to continually take care of yourself, you may also be working, caring for family and have other day-to-day concerns. Plus, notes Dr. Espinosa De Los Monteros, we don’t live in a diabetes-friendly world.
“You may be living and navigating in environments where you’re constantly going to be around things that maybe you’re trying to avoid or around people who don’t understand the challenges of living with diabetes, which can increase the stress,” she says.
Stress hormones can cause unpredictable blood sugar spikes, and long-term stress can keep them high — even if you are eating well, exercising and taking other steps to control your glucose levels.
According to the Centers for Disease Control (CDC), people with diabetes are 2 to 3 times more likely to have depression. Symptoms of depression often include feeling sad or hopeless, a loss of interest in activities you normally enjoy, fatigue or lack of energy, and trouble concentrating or making decisions. Any of these can make life feel more difficult, including managing your diabetes.
Stress often goes hand in hand with anxiety. For some, the stress of managing a chronic illness like diabetes leads to increased fear and worry. In fact, people with diabetes are 20 percent more likely to feel anxiety.
Fortunately, with treatment, you may feel better as well as find it easier to manage your diabetes. Behavioral health therapists can help people with depression or anxiety through counseling and, in some cases, medication.
While depression and anxiety can affect anyone, a condition known as “diabetes distress” specifically affects people living with diabetes.
“Diabetes distress is a term that we use to describe a set of symptoms that people who are living with diabetes often have, and they can look a lot like depression,” Dr. Espinosa De Los Monteros explains. “In fact, often times it is misdiagnosed as depression. But the difference here is that when people are feeling down or hopeless or discouraged or overwhelmed, it’s because of their diabetes.”
Diabetes distress is especially common if you are not making progress in your diabetes care, or you develop complications despite taking good care of yourself. As a result, you may be less committed to your diabetes care.
Though the symptoms may feel like depression or anxiety, diabetes distress doesn’t respond to medications. However, it may help to work with an endocrinologist or diabetes educator and join a diabetes support group, where you can share your concerns and find answers together.
Dr. Espinosa De Los Monteros also recommends programs that offer emotional and mental support targeted to the needs of people living with diabetes. Through the Behavioral Health Integration (BeHIP) Program at the Scripps Whittier Diabetes Institute, clinical psychologists are available in the clinic to provide mental health support and help you make important changes to improve your diabetes management.
“You don’t have to go through this alone. It can absolutely get better,” says Dr, Espinosa De Los Monteros. “It’s really important that you’re kind to yourself. This is hard, and if you’re struggling, don't hesitate to get support.”
If you have diabetes and are interested in behavioral health support, talk with your physician or diabetes educator.