Healthcare professionals should be treating mental health just as carefully as they treat blood sugar control. When one is out of control, more than likely both are, and to ignore one is allowing the snowball to keep building.
Mental health is not discussed enough in the diabetes world. And the affects that mental health have on blood sugar control is not to be underestimated, and vise versa.
My mental health is always in constant assessment and I doubt that I am alone in this. On my Instagram I asked fellow type 1’s if their doctor has ever discussed mental health with them, 69% of respondents said no. However, 87% feel that discussing mental health with their doctor is important. Clearly there is a discrepancy here. Why do Type 1’s find it an extremely important issue, but it’s not discussed?
I believe type 1’s deal with mental health issues disproportionately simply because of the intense management of the disease. If T1 isn’t managed, life is not sustainable or enjoyable. For this reason, T1’s automatically seek out information regarding nutrition, exercise, sleep, etc. and all of this independent decision making comes with life on the line. But what about emotional and mental health because of this constant management and assessment? My opinion, this is far under-researched and not discussed often enough.
Managing blood sugar is often the most evaluated measurement in regards to type 1 diabetes, and the emotional toll typically takes a back-burner. No matter how great blood sugar control is, the emotional toll is still outstanding; although poor blood sugar control has an even greater emotional toll. Should healthcare practitioners start discussing mental health at every appointment? Absolutely.
I did some further research and this is a bit of what I found most interesting regarding diabetes and mental health.
In children with diabetes, the following is incredibly interesting:
They concluded that youths with well-controlled diabetes reported more cohesion and less conflict among family members and their parents, in wich their family members were encouraged to behave independently. In addition, parents of adolescents with poorly controlled diabetes believed that the disease negatively affected the child’s personality, physical well-being, schooling, and participation in activities away from home. These findings suggest a complex interplay between the diabetic adolescent’s psychological and physical functioning, metabolic control, and the family environment.
Source: The Psychosocial Impact of Diabetes in Adolescents: A Review by Suhel Ashraff,1 Muhammad A. Siddiqui,2,* and Thomas E. Carline2.
In the diabetes community, stress is often a scapegoat for poor control. In the same article above, there is no medical consensus as to the relationship stress has on blood sugar control. It could be that high levels of stress effect blood sugars through the release of cortisol, or it could be that because of stress, type 1’s do not provide adequate self-care. As a type 1 myself, I believe it is the latter of the two. Long-term stress simply cannot elevate blood sugars and cause poor control. If that was the case, I’d be through the roof each day (international move, anyone?). But it is a viscous cycle. If self-care is lacking, then blood sugars will be less than desired. When blood sugars are bad, self-care lacks. This of course causes denial and blame and fuels emotion instability. Can short-term stress cause a cortisol release and raise blood sugar, sure. But more often than not, I believe stress is not a direct player on blood sugar control.
Anxiety is also experienced often in the Type 1 world. And according to this study:
Anxiety symptoms were associated with higher glycosylated hemoglobin (HbA1c) levels, poorer self-management and coping behaviors, depressive symptoms, fear of hypoglycemia, and lower blood glucose monitoring frequency.
Source: Anxiety in Youth With Type 1 Diabetes by Kaitlyn Rechenberg, MA, MPH, MSN,* Robin Whittemore, PhD, and Margaret Grey, DrPH
In addition, people with diabetes are three times more likely to be diagnosed with depression than non-diabetics, according to Diabetes.co.uk.
What does all of this have to say about living with type 1 diabetes?
In the simplest form, good blood sugar control should reduce the risk for mental illness.
Of course this is sometimes easier said than done. It’s a cyclical issue. That’s why I strive to make each decision with my blood sugar in forefront. I pose the question, what can I do right now to make this burden easier? For me, that’s eating low carb. This reduces the carbohydrate guessing game and constant blood sugar fluctuation. Nevertheless, I realize it is not that easy for everyone to adapt to, but posing the question of, “what can I do right now to make this burden easier”, could help.
Healthcare practitioners need to start discussing mental health at each and every appointment, in addition to blood sugar. Without one in control, both suffer.
To what extent has your HCP discussed mental health with you?