A new report shows that living with and managing type 2 diabetes isn’t just taking care of the physical body but the mental and emotional aspects of the chronic disease.
For Canadians living with type 2 diabetes, managing their disease amongst the daily stressors of life can be difficult. That challenge is often compounded by stigma, discrimination, and well-meaning but often detrimental unsolicited advice from friends, family members, or even “health influencers” on social media.
In reality, type 2 diabetes develops due to many factors, only one of which relates to a person’s lifestyle and diet. The others, including a family history of diabetes, ethnicity, taking medications for other chronic diseases, or having other health conditions, all play roles in the development of type 2 diabetes.
Once a person has type 2 diabetes, their ability to manage their blood sugar levels is also more complex than those without it seem to think.
Dr. Jeremy Gilbert, an endocrinologist based in Toronto, Ontario, works closely with people with diabetes and knows that managing the chronic condition is not as cut and dry as eating right and exercising.
“There’s a lot of factors that impact a person’s sugar. It’s dependent upon their diet, exercise, medications,” he said. “But a lot of other external factors too, like stress, menstrual periods, alcohol, caffeine. There’s a lot of variables that affect a person’s sugars, which makes it challenging to manage.”
Emotional and mental stress and diabetes
When the body is under stress, it releases hormones to prepare it to either flee or fight the threat. These hormones are released in that fight-or-flight response when a person is facing any range of issues, including financial hardship, dealing with a significant life event such as the loss of a loved one or a divorce, or feeling work stress.
These hormones, namely adrenaline and cortisol, cause blood sugar levels to rise in an effort to ensure the body has enough energy to do what it needs to overcome the situation. When a person is under stress constantly, keeping blood sugar levels down becomes increasingly challenging for people living with diabetes.
“People who are going through life challenges, taking care of elderly parents, children that have issues, financial strains in today’s economy, like all of life’s challenges are just impacted even more because this person has diabetes,” said Dr. Gilbert.
Even having a chronic disease on its own can be stressful. The report found that people with type 2 diabetes, especially, experience stress and anxiety at rates of 25 and 21 per cent, respectively.
Unsolicited advice and diabetes stress
Unsolicited advice, such as friends and family telling people living with diabetes to eat this and not that or exercise this way and not that way, can also add to the already-heightened state of stress, data from the report shows. Even if well-intentioned, these suggestions drive unnecessary negative feelings and emotional distress in people with diabetes.
This advice often stems from the stigma that still surrounds the disease, according to Dr. Gilbert, leaving those with the condition to contend with misinformation perpetuated by people they know and other inadequate health resources, such as social media.
“I hate to use the term fake news, but it’s out there, right?” he said. “People Google, and they ask their friends and their cousins, and I have a lot of patients that come in, and they’re misinformed.”
With this misinformation driving unsolicited advice, people with diabetes are often left confused about what they should and shouldn’t be doing when it comes to managing their disease, making the entire ordeal that much more difficult.
Dr. Gilbert notes that the most notable unsolicited advice surrounding diabetes care focuses on medications.
“It can be very empowering if you have the right information, but if it’s a bunch of like medications, ‘all meds are bad for you’, and you see that stuff or like ‘insulin will cause you to go blind,’ and that’s completely false,” he said. “Then, it’s a harder job on us to steer things correctly.”
When people living with diabetes have the correct information, though, managing their condition becomes much easier.
According to the report, many who were surveyed said that having the right tools and education about their diabetes helped them understand the effects their lifestyle choices have on their condition and kept them motivated to manage their condition more effectively.
Finding a way forward through the power of positivity and proper tools
Constructive criticism has no place in diabetes management, according to the report. Roughly 82 per cent of participants found that positive language was far more motivating than negative language. When their successes were reinforced, they were even more able to effectively keep their blood sugars at adequate levels.
Positive language and reinforcement can come from various areas, including healthcare providers, family and friends, and even media. When it comes to healthcare providers, 77 per cent of the survey respondents stated that small supports helped them stay consistent in managing their disease.
The important thing for people to remember about positive language and reinforcement, especially if they interact with someone living with diabetes in any regard, is basic respect for the person standing in front of them.
“It’s all about respect. I mean, that’s the bottom line. So, I don’t have a ‘For sure you say, or for sure you don’t say,’” said Dr. Gilbert. “I think it’s just really supporting and respecting the person in the way that they’re most comfortable.”
Being supportive can take many forms, including using respectful language, supporting people in their endeavours to manage their lifestyle factors, and offering positive feedback if it’s welcomed. It can also be allowing people with diabetes to keep that part of their lives to themselves if they don’t wish to discuss it. These are all ways to change the narrative.
“When it comes to diabetes management, we know there is power in encouragement,” said Dr. Michael Vallis, a health psychologist specializing in psychosocial adaptation to chronic disease, in a news release. “Our supportive words, paired with the real-time feedback offered by tools like flash glucose monitoring systems, can give our loved ones a boost and help them feel like their diabetes goals are achievable.”
The power of positivity also lies in providing support and access to tools, such as the aforementioned flash glucose monitoring systems, that help people with diabetes take complete control of their real-time blood sugar levels for better disease management.
“Part of positive reinforcement is empowering people to live with diabetes better,” said Dr. Gilbert.
These monitors give people with diabetes the ability to see their own efforts in actual data in a simple phone app, providing them with even more motivation and positive reinforcement that what they’ve been doing is working. Instead of just hearing they need to do this or that to manage their blood sugar levels adequately, they’ll be able to tap into their own data, fostering a more positive internal experience as well.
“You literally are following it along, and you’re seeing, ‘Oh, look, you know, I’m too tired to go for a walk, but I remember yesterday when I did that, and the numbers were so good. OK, fine. I’ll push myself. I’ll do 10 minutes,’” said Dr. Gilbert. “You’re at a restaurant, and you have a choice between this or that, and you know that the monitor is on and watching your sugars. You’re going to be motivated to make a better choice, perhaps.”
“So, I think around that, making people living with diabetes more empowered, more satisfied, a better quality of life – that whole disease burden and stress levels that we discussed, I think can be not completely resolved, but can be certainly mitigated by this empowering tool.”