How Diabetes Affects Mental Health

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By: Sam Bickford

Imagine if on top of your busy life there was another entire life that you had to deal with. Only this other life isn’t easily seen or understood by other people. 

Sam and his sister right around the time of his diagnosis.

This other life is having a chronic illness.

I’m a Type 1 Diabetic and have been since I was 7 years old. Growing up I didn’t understand how different my moment-to moment-experience was from other kids. Sure, I understood that when it was someone’s birthday I couldn’t eat a cupcake and instead had to walk to the nurse’s office to get a sugar-free Jello. 

But what didn’t make as much sense was the alienation and isolation that came with that walk to the sugar-free Jello.

I didn’t know I felt alienated by that walk until I realized most other people not only didn’t have to eat sugar-free Jello, they also didn’t have to do the calculations to understand why sugar-free Jello was the best choice. 

How Diabetes Affects the Body

As a Type 1 Diabetic, I try to keep my blood sugars between 90 and 180.

A low blood sugar makes me feel shaky, confused, and a little sweaty. That’s in the case of a minor low, and  I can treat with a snack. A serious low blood-sugar, one below 55, can result in a seizure and potential death. That kind of low blood sugar has to be treated with a special shot called Glucagon that makes you vomit but saves your life. 

On the opposite end of the blood sugar spectrum, having a high blood sugar makes me sad, tired, and a little nauseous. If  I have a prolonged high blood sugar, it’ll  put me into something called Diabetic Ketoacidosis (DKA) which results in me going into a coma or dying.

DKA is when the body doesn’t have enough insulin to let glucose into cells. This is sometimes also called diabetic distress. Other symptoms include weight loss, vomiting, frequent urination, and fatigue. 

How does type 1 diabetes affect daily life?

Here’s an example of a few hours of living with Type 1 Diabetes.

It’s a Tuesday morning, and I wake up to find my blood sugar is 122 and trending down–something  I know because I have a thing called a Dexcom. It is a long metal catheter attached to an adhesive that I insert in my body and remove and replace every 10 days. It tells me my blood sugar through an app on my phone.

For those millennials not as familiar with the world of diabetes or the specific details of friends managing this condition , the Dexcom is possibly the most revelatory thing that has ever come into my life. (I used to have to prick my finger and check my blood sugar about 12 times a day. Now I look at my phone every five minutes and see my blood sugar.). 

 The reason it is trending down is because I was tired after working yesterday and didn’t eat a very filling dinner because I didn’t feel like cooking. This means the insulin I gave myself the night before is about 10% more effective meaning my blood sugar is going to go low. I give myself two kinds of insulin every day.

The coffee shop Sam went to on this day and visits regularly.

One, Humalog, is short acting. I inject it into myself to correct high blood sugar and when I eat. The other is called Lantus and is long acting. I give it to myself every night at 8:30 pm. Lantus acts to give my blood sugars stability. A working pancreas secretes a small amount of baseline insulin at all times to manage the glucose in our blood from the food we eat. My Lantus injections act like that small amount of insulin. 

Like many of my fellow millennials I start my mornings with coffee, but on this morning I go into the kitchen, and realize I’m out. So, I decide to go to a coffee shop. On the way there, my blood sugar goes low. To treat that low blood sugar I eat 20 grams of carbohydrates, or 8 Sour Patch Kids. Once I get my coffee I receive a notification on my phone that my blood sugar is now high! For some reason, those Sour Patch Kids were a little more effective than I expected. 

A half hour into the walk my phone is beeping at me because my blood sugar is now plummeting. This is happening because Sour Patch Kids often spike blood sugar, but don’t raise it for prolonged periods. I stop my walk, eat half a Clif bar, and wait for it to go up.

Sam (right) with his friend, Gregor, on one of the many long bike rides that he loves to do.

I drink my coffee (caffeine also spikes blood sugar, very slightly for some diabetics and in a more exaggerated way  for others) and give myself two units of insulin by injecting myself with a shot. I wanted to go on a bike ride this morning but because my blood sugar is ping ponging that would be a very labor intensive choice, so instead I opt to go on a walk. 

When I return home, my blood sugar is finally stabilizing at 144. Now, I have a choice to make. I can eat a normal mid-morning snack: a piece of toast, a couple eggs, maybe an apple. However, that toast and apple have carbohydrates in them meaning I’d have to continue doing this insulin dance.

Considering my morning has been a little chaotic blood sugar wise, I decide to eat no carbs for the snack. I stick with kale and eggs, so that I can focus on other tasks I have that morning besides wrangling my blood sugar.

The Psychological Impact of Diabetes on Patient and Family

I tell you this story not for pity or to make you nervous or to prove a point. Instead, I think it is important to understand that the people in your life with chronic illnesses are doing all these types of calculations every second of every day.

There is no break. And not included in this summary are the tasks of everyday life: keeping up with personal relationships, having a job, trying to go on vacation, wanting a dog, etc. 

Having a chronic illness is not only a demand on time and resources, it is an emotional drain. Constantly managing your body and mental health is exhausting and difficult. And again, this is not a plea for pity but instead a PSA that the task of being ill is not only something that is fought in your body it is also fought in your mind and spirit. 

Sam hanging out at a local bar socializing on the weekend.

Be kind to the people around you not just because it is the right thing to do but because you don’t know what other kinds of wars or battles they might be dealing with.

How Diabetes Can Affect Mental Health

Chronic illness is not only a time suck, a money suck, and a burden: it is a constant companion in my life. I think about it more than I think about anything else. And I don’t mind that. 

It’s made me more grateful and more considerate of other people. But this is just to say, remember that your body doesn’t have to cooperate with you. It doesn’t have to be your friend. And if that ever happens to you, that your body suddenly won’t cooperate with you, won’t listen to what you ask of it, that it is ok to be upset. It is ok to be angry. It is ok to be sad. 

The intersection of a chronic illness and mental health is a busy one. Remember the hidden battles, the quiet ones. Allow people space to navigate their lives.

You never know when one little moment of quiet understanding can make someone’s walk to get some sugar-free Jello feel a little less lonely.

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