With over 30 years of experience living with type 1 diabetes, Spain-based psychologist and school counsellor Iñaki Lorente has spent half his life developing strategies for balancing his emotions with his condition, and helping others navigate similar situations. In the following interview, Iñaki explains that, by learning how to change the inner talk, it’s possible for people with diabetes to build a happier reality.¹

Roche Diabetes Care: In what ways can mental health issues affect people with diabetes, and how can diabetes contribute to mental health problems?

Iñaki: Many studies conclude that people with chronic conditions such as diabetes are more likely to have mental health issues. Depression, anxiety and distress are prominent mental health complications among people with diabetes, which we know can have a negative impact on their diabetes management and physical health. Furthermore, people with diabetes can also experience eating disorders, such as anorexia or bulimia, but it is much more complicated than for a person not living with diabetes and requires strong coordination of psychiatric-endocrine consultation. There’s also "diabulimia" which is a media-coined term that refers to an eating disorder, typically related to type 1 diabetes, wherein the person purposefully restricts insulin in order to lose weight.

Another contributing factor to mental health issues is that people with diabetes have to make countless therapeutic decisions throughout the day on their own, and they don’t always have all the information they need. The likelihood of making mistakes is extremely high, potentially leading to feelings of incompetence at controlling their diabetes. For instance, diabetes involves mathematical calculations to balance carbohydrate consumption and insulin doses, which many people find difficult and can cause further feelings of inadequacy. All of this pressure can quickly become overwhelming, especially since diabetes management isn’t about getting cured – rather, it’s there to stop a person’s health from getting worse. But not getting worse is much less motivating than getting better, and this can be really challenging for people with diabetes.


Roche Diabetes Care:  How can people with diabetes protect themselves from mental health issues?

Iñaki: There’s no recipe for prevention because everybody is different, but there are a few key principles that can apply to most people:

  1. Strive for balance between quality of life and health status: “Quality of life” relates to how you want to live your life, while “health status” focuses solely on your physical well-being. A person with a poor health status and poorly managed diabetes may likely have a lower quality of life. However, having a good health status doesn’t necessarily mean a good quality of life, because this depends on what “good” means to each person. My recommendation is for you to negotiate with yourself what good means to you and how you can achieve that while still prioritising your health.

  2. Rephrase the question: Many people living with diabetes fall into the trap of believing they can't be happy with diabetes. I advise them to ask themselves what they want to do with their lives, identify their goals and desires, and then consider what has to happen in order to achieve these objectives without diabetes getting in the way.  And this goes for everybody – don’t let having to take a different path to get to your dreams discourage you.

  3. Build a support system: Surround yourself with different types of support – friends and family for your emotional needs, a medical team and healthcare professionals to plan your diabetes management and, finally, other people with diabetes that can answer day-to-day questions about the reality of living with it.

  4. Ask for regular mental health assessments: Regular mental well-being check-ups are always important, though even more so during significant treatment changes, such as introducing an insulin pump or with a diagnosis of secondary health complications. Big life transitions and personal changes can also leave you vulnerable. If regular assessments aren’t being offered, take your mental health into your own hands and ask for them. If you’re struggling, tell somebody – there is help available.

  1. Accept diabetes: There will be difficult days and moments of low spirits, which is all part of living with diabetes. Try to reframe the tough times as opportunities to learn, recharge and become an even better version of yourself.

  2. Start journaling: Writing down the things you’re most thankful for each morning in a journal is a great way to start the day with a positive outlook.

  3. Forgive yourself: Acknowledge the importance of speaking kindly to yourself. We all slip up from time to time, and it’s important to accept that sometimes we just feel like doing something we’re not “supposed” to do, like eating junk food. When this happens, don’t beat yourself up about it. Just adjust, forgive yourself and move on.

  4. Blow off some steam: Daily diabetes management is a huge burden, and it’s not unusual for stress and frustration to build up. At least once or twice a week, make a point of venting and getting rid of your negative emotions by sharing your thoughts with your friends or family, getting some exercise or doing any activity that offers stress relief. It’s important to let bad feelings out so you can keep moving forward.

Roche Diabetes Care: How can people who don’t have diabetes support those living with the condition and managing their mental-well being?

Iñaki: Offering help is actually very easy. You just need to ask: ‘How can I best support you?’ Let people with diabetes tell you what they need, whether it’s related to medication, carb counting or expressing their feelings. On the other hand, it’s crucial for healthcare professionals to regularly engage with people with diabetes on their emotional well-being throughout their diabetes journey, and ensure that the recommendations and treatments they propose are customised to each individual. This involves asking what they still need to learn in order to create healthy routines based on the physical activities they like to do, their schedules, family life and so on. By doing so, people with diabetes are more likely to adhere to enjoyable and healthy routines and prevent negative emotions about daily diabetes management from clouding their positive experiences.

Furthermore, everyone can support people with diabetes by being informed. Diabetes stigma is still prevalent, and it arises from a lack of knowledge amongst the general public. For example, people often talk about "diabetics" instead of "people with diabetes," defining individuals solely based on their condition. Language constructs realities, and it's important to use appropriate, positive language so society can adjust and be more inclusive. Educating the public about what it’s really like to live with diabetes can be a powerful weapon against stigma.


Roche Diabetes Care: What would you say to a family member, friend, partner or co-worker of an individual with diabetes struggling with mental well-being?

Iñaki: If someone you know is going through emotional challenges related to diabetes, I would tell them that, even though diabetes is for the most part a permanent condition, the pain they’re feeling at the moment will pass. Make sure they know that you’re there for them, no matter what. If you think they need professional support, tell them there’s help available and that, together, you’ll find the right person to talk to.

Disclaimers

  1. This content is part of a paid collaboration with José Ignacio (Iñaki) Lorente. The views, thoughts, and opinions expressed herein are personal to the interviewee and do not necessarily represent the views, thoughts, and opinions of Roche. This content is not, and is not intended to be, relied upon as medical or mental health advice nor is it intended to be relied upon for any medical/mental health diagnosis or treatment. Roche is not providing medical or mental health advice. Always seek the advice of a physician or other qualified healthcare professional regarding any medical/mental health questions you may have. Do not ignore medical/mental health symptoms, medical/mental health advice previously obtained from a physician or other qualified healthcare professional, or delay in obtaining medical/mental health advice based upon this content.

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