Aaron Price, LICSW, clinical social worker and lecturer at the Joslin Diabetes Center in Boston, an affiliate of Harvard Medical School. Joslin.org
You know the health consequences of not managing your diabetes. But even when you’re doing a good job of it, the lifestyle that diabetes demands—from constantly checking your blood sugar levels to analyzing every bite of food to maintaining a strict exercise schedule—can take a different kind of toll on you. Stress and depression are complications that might not be as openly discussed as getting A1C tests and balancing carbs. Yet left unchecked, they can have devastating emotional consequences such as suicide and alcoholism. Heavy drinking can lead to the fatal liver condition of cirrhosis and accidental deaths from falling or other mishaps while under the influence.
According to a sweeping study done in Finland, deaths from alcoholism—both directly from diseases such as cirrhosis or from accidents related to drinking, such as falling while under the influence—and suicide are higher among people with diabetes than the general public, and even more so for people taking insulin.
The study: Researchers followed more than 200,000 men and women with diabetes over a seven-year period and compared their mortality rates to a similar number of people free from diabetes.
The findings: Men with diabetes taking oral medications and insulin-dependent patients of both sexes, particularly those with type 1 diabetes, had a greater suicide risk than the general population. Alcohol-related and accidental deaths were higher for both sexes. Surprisingly, women with diabetes, including those on only oral medication, had a risk for death related to alcohol use that was 10 times higher than the general population (for men with diabetes, that rate is seven times higher than the general population). In addition to increasing the risk for fatal accidents and suicide—roughly twice the number for men and slightly more than 50% higher for women, excessive drinking impairs self-care and can worsen diabetes itself. It’s also linked to severe hypoglycemia (low blood sugar), which can be fatal. Though the researchers can’t explain exactly why alcohol has a deadlier impact on women with diabetes than men with diabetes, they suggest that it could be because women in general experience greater levels of depression than men do.
Diabetes brings with it a wide range of emotions. Fear over complications can trigger anxiety and depression. You might feel guilty that you’re not managing it as carefully as you think you should. Or you’re meticulous about managing it and get overwhelmed, developing diabetes burnout as you try to meet the demands of the condition. The CDC estimates that in any 18-month period, 33% to 50% of those with diabetes are suffering from “diabetes distress.”
Alcohol isn’t the answer, but what is? These three tweaks to your diabetes management style can help…
Clarify the areas of self-care you need to improve on, and create a clear plan to meet them. That may sound daunting, but you can make it easier on yourself by breaking down the steps into manageable pieces. Let’s say that you should check your blood sugar four times a day, but you can’t reach that number on a steady basis. Start with one or two daily checks, and tie them to existing lifestyle habits to make them easier to remember. For example, check your blood sugar every morning before you walk the dog and every evening after you eat dinner. After twice-a-day becomes rote, gradually add in more checks, ideally attached to other existing habits, such as after exercise and after lunch until you reach the best frequency for you. Important: Working with a diabetes coach can help you establish vital habits.
Let your family and friends become your partners in care. There are many lifestyle changes to make when you develop diabetes, and few of them are easy. Rather than try to tough it out yourself, allow family members and friends to help you stay on track. Maybe one person wants to exercise with you every morning, and another wants to cook meals with you every evening. As a bonus, you’ll strengthen your relationships in the process.
Get professional support. If you find that you’re feeling down more days than not, are losing interest and pleasure in things, not eating or are overeating, sleeping too much or not enough, and certainly if you’re drinking too much (more than one drink per day) or having thoughts of suicide, reach out to your doctor or a licensed mental health professional. A therapist who has been through the Mental Health Provider Diabetes Education Program, a joint program developed by the American Diabetes Association and the American Psychological Association, is specially trained to help people overcome their struggles with diabetes, set reasonable goals and show how to incorporate them into everyday life to avoid much of the anxiety caused by diabetes. You can find a practitioner near you through the search function at the American Diabetes Association website.