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Under the umbrella theme of “Access to Care,” which is at the heart of this year’s World Diabetes Day, curated by the International Diabetes Federation (IDF),* is the prevention of diabetes-related complications. Cardiovascular disease, vision loss, kidney failure, lower-limb amputations are all well-known consequences of unchecked diabetes.4 But with mental well-being so tightly bound to living well with diabetes, Roche would like to make sure mental health risks get the attention they deserve as potential complications.
As a first step to raising awareness, we’ve put together a quick guide to some of the more common mental health struggles for people with diabetes. One thing you’ll notice as you go through this glossary is that prejudice, stigma and isolation are at the heart of many of them. The good news? We can work on this!
Inspired by the IDF’s efforts to educate the world on what it really means to have diabetes, we know that making visible the invisible sides of living with the condition can go a long way to fighting stigma and easing some of the burden.
The fight-or-flight response built into us to help us escape sabre-toothed tigers and other life-or-death situations works the same for all types of stressors – including the stress caused by years of tedious daily diabetes management. There’s a bitter irony here: the stress of living every day with diabetes and trying to keep it in check can actually make diabetes worse; stress releases hormones, causing more pronounced fluctuations in the blood sugar, making it even harder to keep levels in range. Repeated or constant diabetes distress can cause serious long-term damage.5
1 in 4 people with type 1 and 1 in 5 people with type 2 diabetes have high levels of diabetes distress likely to negatively affect how they manage their diabetes.6
The symptoms of burnout vary between people, but can generally be described as a feeling of hopelessness that eventually leads to “giving up.” Feeling like there’s no longer a point to trying so hard to stay on top of diabetes can translate into skipping insulin doses, refusing to take tablets, avoiding check-ups and ignoring the annoying but essential elements of daily care. Diabetes burnout often develops after a longer period of time dealing with diabetes distress.7
Based on a recent study in Australia, 80% of people with diabetes report feeling judged, blamed, shamed or treated differently due to their diabetes.8
A common misconception about diabetes is that, by consistently making bad choices, people bring it upon themselves. Even though there’s a host of factors all playing a role, including genetics, socioeconomics, environment9 – even air pollution10 – the fact that this notion is outrageous doesn’t prevent people with diabetes from hearing, seeing and feeling rejection, blame and discrimination every day. Because this stigma forces people to hide the realities of living with diabetes to avoid scrutiny, many postpone or ignore necessary diabetes management actions when out in public, threatening both their physical and mental well-being.6
The more stigma a person perceives, the poorer their blood glucose control will be.11
Also known in the medical world as “type 1 eating disorder” or “ED-DMT1” (eating disorder-diabetes mellitus type 1)12 this term was popularised in the media as a catchy blend of the words “diabetes” and “bulimia.” This complication attributed mostly to type 1 diabetes refers to the underuse or restriction of insulin with the aim of losing weight, although it can also include other behaviours such as binge eating and purging. Aside from trapping people inside their minds to battle an obsession with body image and weight, diabulimia is extremely dangerous and can cause incontrovertible physical damage and even death.13
According to literature, women with type 1 diabetes are twice as likely to live with disordered eating, and patients with weight-related insulin restriction are likely to die an average of 13 years younger than those who didn’t restrict insulin.16
Other types of diabetes-triggered disordered eating include bulimia nervosa (binge and purge), restricted eating and objective or subjective binge eating.17
In women with type 1 diabetes, bulimia is the most common eating disorder, whereas women with type 2 diabetes are more likely to deal with binge eating.18
Because hormonal and blood sugar fluctuations can profoundly affect the behaviours, thought processes, moods and emotions of people with diabetes,19 it’s not always obvious if they’ve become depressed. If someonestruggles for around two weeks with some or all of the following symptoms, they should seek help from a medical professional: restlessness, distraction, suicidal thoughts, over- or undereating, trouble sleeping and getting out of bed, feelings of worthlessness and/or excessive anxiety.20
Studies show that people with diabetes are twice as likely than the general population to suffer from depression.21,22
We can all contribute to preventing stress, anxiety, depression, burnout or a complicated relationship with food and insulin from going too far and causing long-term or irreversible side effects in people with diabetes. It starts with listening, learning and sharing.
Over the next couple of months – just in time for October 10th’s
Together, we’ll show the world that everyone can play a part in improving mental and physical health outcomes for people with diabetes, regardless of where they live.
*Disclaimer: Roche is a partner of the International Diabetes Federation to support the advocacy and awareness activities of the Federation.
References
Speight J, Holmes-Truscott E, Scibilia R, Black T (2021). Diabetes: Stigma, blame and shame. Diabetes Australia, Canberra. (Last accessed 15 September 2023)
Mannucci, E., Rotella, F., Ricca, V. et al. Eating disorders in patients with Type 1 diabetes: A meta-analysis. J Endocrinol Invest 28, 417–419 (2005). (Last accessed 15 September 2023)
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