For many years a lot of people believed ‘burnout’ was nothing more than the tired feeling after a long day’s work – these days ‘job burnout’ is a heavily researched area, with a recognised clinical diagnosis and costs at least $125 billion year [1].
Diabetes burnout is much less understood than job burnout, while they share some similarities, there are important differences.
What is diabetes burnout?
Diabetes burnout is the frustration, emotional exhaustion and disconnect that happens when individuals with diabetes aren’t able to take keep up with self-care needs of managing diabetes Abdoli S 2, 3.
It’s the continuous lack of physical, mental, or emotional energy required to maintain diabetes self-care that’s a part of everyday life with diabetes[4]. Most people with diabetes will experience diabetes burnout at some stage of their life, though it can manifest quite differently across individuals.
How does Diabetes burnout differ from depression?
Diabetes burnout can be hard to distinguish from symptoms of depression symptoms (e.g. feeling fatigued nearly every day) or general tiredness after a long day.
Both diabetes burnout and depression take a toll on a person’s mental health and overall quality of life.
While the signs of burnout can differ across individuals, some aspects are universal. It’s likely that diabetes burnout will be experienced differently depending on the individual, with some shared experiences
How do you know if you’re experiencing a burnout episode related to diabetes?
Common signs of diabetes burnout include:
- Avoiding tasks related to diabetes self-care
- Feeling hopeless about diabetes, or a loss of control.
- Having a ‘long’ period of continuously high Blood sugar levels lasting days/weeks/months/years
It can still be incredibly difficult to tell the difference between feeling fatigued and burned out. Here’s how one t1D described a time they were starting to experience a diabetes-related burnout episode…
“It’s when my devices start alarming and I don’t care what happens, I just let it keep going, I’m sick and tired of chasing this untameable beast. You get to that point where you ask yourself – why bother?”
The 3 components of Diabetes Burnout
1. Exhaustion
Exhaustion in Diabetes burnout is can be a combination of mental, physical & emotional exhaustion from Diabetes itself.
Diabetes burnout can be trickier since the fatigue stems from everyday demands of living with diabetes.
It’s not impossible to plan to switch careers to a job with less demands. Whereas with the chronic demands of Diabetes, it’s not as simple.
2. Distancing & Detachment from diabetes care:
In job burnout, developing a negative attitude towards work itself (or coworkers) is the second hallmark characteristic [5]. This includes becoming apathetic, or a general unwillingness to take action, especially for important aspects of work. Apply this to Diabetes and the description fits almost perfectly..
Except Diabetes doesn’t just require your effort at ‘certain times of the day’ or in ‘certain situations’ as much as it is part of everyday life.
As well as a negative attitude, distancing is another important part of detachment. This is where an individual separates (physically, mentally, or emotionally) themselves from the idea that ‘Diabetes is a part of my life’ – or what’s called their illness-identity.
Like a mother who becomes consumed by the responsibilities of raising children, finding great relief from activities where they take a break from ‘being a mother’ 24/7.
Distancing falls into one of three types:
- Physical distancing – this could be missing Diabetes related appointments, distancing themselves from their diabetes support systems, ignoring alarms, avoiding situations where diabetes comes into discussion.
- Mental distancing – Avoiding thoughts related to t1D. ‘My blood sugar is all over the place, but I’m not going to think about it.
- Emotional distancing – Disconnecting from the emotional experience of t1D. Keeping diabetes related emotions at a safe distance to avoid being overwhelmed [6].
3. Loss of control & Powerlessness
When an individual’s achievements and efforts are not recognised or rewarded, they develop a low morale and start to see themselves less able to cope with the demands of their work.
Imagine you woke up this morning, did almost everything you could in terms of blood sugar testing, injections, carb counting…and your Blood Glucose (BG) was still all over the place (those days where nothing seems to work..).
Powerlessness is about feeling discouraged about managing t1D no matter what actions you take (e.g. seeing high/low blood sugars no matter what actions you take – you get the sense that you’ve lost control [7].
In some cases when this experience happens several times, it’s normal to find yourself questioning your ability to manage diabetes. Am I in control of my Diabetes, or at the mercy of it?
“…somedays it doesn’t matter whether I do things right, my sugars will still be out of control, so why bother with all this wasted effort?“
Appreciating your own efforts is important in these situations is important – good practices are still good practices, even when you can’t see the results of all your efforts reflected in your BG.
Why would you feel good about your efforts if your BG is out of range? It’s about trusting the process. Developing the habit of consistently managing t1D will reinforce good practices, regardless of your BG levels.
The goal is to reduce the mental effort of tasks until they become habitual [8], in the same way that washing your hands after using the toilet is subconscious (I hope).
Good vs Bad glucose readings – have we been missing a third option all this time?
The diabetic and the lucky coin
As you test your blood glucose, you can feel the tension building up inside you. Will it be in-range or out of range? To add a bit of fun to the routine, you decide to flip your lucky coin. Tails for ‘good glucose readings’ and heads for ‘bad glucose readings’. But instead of heads or tails, the coin lands on its side. It’s the option you didn’t know existed ( a one-in-6000 chance). It’s not good nor bad
Blood glucose readings are just data. Don’t get too caught up in the numbers.
Blood glucose readings are not good or bad, they’re simply a tool to support you make decisions, helping you to understand what’s working and what isn’t. Take it in stride and don’t let it bring you down.”
It’s not about the number, but how you use it.
Preventing Diabetes burnout & Risk Factors
When blood glucose is out of control, you’re likely to feel more exhausted or depleted of energy, it becomes more difficult engage in diabetes related self-care. This can create a negative cycle where you’re stuck in a rut.
Knowing the factors which increase the risk for diabetes burnout can be helpful in preventing the chances you experience burnout, and while some of these factors are more easily addressed than others, it’s still useful to keep them in mind.
1. Overcommitment to diabetes management
Having perfectionistic/unrealistic expectations of blood glucose control increases risk of developing diabetes burnout [9].
If you’ve ever found yourself setting ambitious goals for managing diabetes then falling short, you know how demotivating the experience can be. If falling short of goals once is demotivating, falling short over and over again can be exhausting.
Remember, diabetes management is a continuous process, and setbacks are a natural part of the journey. The “honeymoon” phase (1-2 years from first diagnosis) is quite deceiving in how much easier managing diabetes can seem in this period.
Cognitive Behavioural Therapy (CBT) for people with type-1 diabetes has been found to help people reduce perfectionistic tendencies as well as the emotional distress of living with type-1 diabetes.
If you’re unable to access CBT, there are t1D education programs which incorporate a CBT-based approach like DAFNE, DESMOND, although these certainly aren’t replacements for CBT.
2. Negative encounters with diabetes care providers
How were your past few experiences with diabetes care providers/consultants? Of course, they are often in the difficult position of being the bearers of bad news. But overall, would you describe your interactions with them as..supportive, helpful? Or negative, demotivating.
How often are personal, work and lifestyle factors affecting your diabetes discussed? Or are topics always strictly related to blood glucose control and diet reporting? How supportive when it comes to your individual challenges [10] with diabetes.
Multiple negative encounters with diabetes care providers can leave people at higher risk of developing burnout. When your diabetes is out of control is when you are most in need of outside support, the last thing you need is to be alienated from your healthcare providers.
Being brutally honest with your care provider can help them to understand the obstacles you’re facing. Let them know if you’re feeling overwhelmed or frustrated with managing your diabetes, it might be worth giving them more context about personal issues or challenges which may be affecting your ability to manage diabetes.
3. Highly intensive daily routines
Managing other chronic conditions alongside diabetes, or having a (relatively) intense daily regiment for managing diabetes often requires more planning and mental energy due to the increased day-to-day demands.
For those fortunate enough to have access to CGMs, not having to think about taking manual blood glucose readings with test strips up to 8 times a day frees up time, mental space and energy, the extra headspace is one of the most noticeable benefits.
Think back to how we described burnout as an imbalance between the day-to-day demands of diabetes and the individual’s capacity to meet those demands. The hopeful part is that there are things we can do to reduce the day-to-day demands and increase capacities (a whole topic in its own right).
Overcoming burnout
While there doesn’t seem to be any one-size-fits-all strategy in overcoming burnout, it can help to know to learn how others overcome burnout and what has helped. There will be a future post to explore managing diabetes burnout in depth.
How to Overcome Diabetes Burnout? What has worked for others
Some people described reaching a point in time where they had a conversation with themselves and made a firm commitment to change was the turning point that helped them get out of the burnout rut.
- For those who have the option, transitioning to CGMs/insulin-pumps was helpful in overcoming burnout by freeing up the hassle of manual blood testing.
- Reaching out to your diabetes care professional, doctor, or endo and being brutally honest about your struggles. An understanding nurse/doctor who really listens and tries to understand your situation can make a world of difference. A lot of people find online communities great for connecting with others who understand the challenges of diabetes.
- Consider visiting or calling your Diabetes healthcare practitioners when you are in a rut, some t1Ds found this helped give them that push to get out of their rut.
- How is your sleep? Often sleep quality will take a hit when blood glucose is all over the place so you end up not being well rested the next day. This can make managing your diabetes harder, which can lead to getting stuck in cycle of poor quality sleep & low energy.
For those who have experienced diabetes burnout – what was your earliest sign? How did you manage it or overcome it? What worked for you? Did I miss something important? Leave a comment
This article is the first in a series of articles around managing and preventing diabetes burnout.
No content on this site should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.