emotional health

Diabetes Burnout

In previous years, psychology has acquired a new term to help identifying what can happen in an individual who has been given a very difficult task to develop continuously.

At the beginning, we only used the English term «burnout» to define a process in which a patient, after a long-term effort in the management of a cronical problem, becomes extremely tired. As time goes by, the capability to manage stress is lost and interest in life vanishes slowly. This process is very similar to a depression, although we can find mayor differences between them. This “burn-out” appears as a result of a specific problem, in this case, living with a cronical disease.

As this problem has a specific cause, it is not always necessary to receive psychotherapy in order to recover. If the patient is willing to find new and better solutions to this problem then it is possible to recover strength and to cheer up.

The term «burnout» is not very specific, it is often misunderstood and compared to depression (please read the article about depression posted in our website). This term is mainly used to describe different aspects of a process of psychic tiredness that appears after trying to solve a conflict without obtaining positive results. In people living with diabetes we can understand it as follows. The patient has a severe problem that must be solved, finding the solution is quite difficult and the search never ends. The results and answers found seem always worse than the problem itself, does this sound familiar?

For many patients, this is the main conflict of diabetes. Each person tries to manage his/her diabetes correctly but this always has the risk of «diabetes burnout». The person living with diabetes tries hard to achieve normal glucose values, uses al methods taught and searches for most suitable treatment, and medical advice. However, this specific patient only manages to get between 3 or 4 normal glucose values per day.

In the diabetes real world there are hypo and hyper episodes without explanation even when the best treatment is used and even when the same treatment is repeated over and over. Unfortunately, this type of patient thinks that he/she must have done something bad to get these results. The more ambitious the patient becomes, he/she will try to get a more intensive therapy, a better insulin treatment, and best blood glucose methods.

However, there are times when mediocre results keep showing despite of the effort and technique used. This is when the burnout process begins. This patient will try day after day to get normal glucose values, sometimes not getting the desired result. As time passes, hope disappears. This patient keeps trying and does not stop. The conflict’s solution is frequently to reduce activities in order to relief stress but, how to reduce activities and control, who will grant permission to do such a thing? The doctor? The diabetes care team? The patient himself will have to become responsible of reducing activities.

After taking a deep view of the conflict the person realizes that he cannot reach optimal glucose values or the better treatment. He realizes that the treatment is an incomplete solution to a faulty metabolism that cannot reestablish it’s original health values. What is more important is to correct treatment goals and accept that it is not possible to get the same values as a person that does not live with diabetes. It is then necessary to give up getting the perfect diabetes solution.

So, what shall we do with the fear to get sicker with less therapy? It is not simple. But having burnout makes us sicker. The answer is to become realistic with every item that makes us have a better life with the tools that we already have.

There is no healthy individual forever. We must learn how to live with our condition instead of trying to eliminate it. It is like getting old and our death. The solution is to find a balance of all life’s motives and put them in their correct place. Diabetes speaking, the solution implies less therapy and to make our goals objective and accessible.

There was this patient “Jose” a 38 year old man who has used an insulin pump for 5 years. I asked him what was his HbA1c goal and he answered, “I work hard to get an 8%” The rest of the patients exclaimed and wondered if 8% wasn’t too high. He replied that no matter what he did, he already had the most advanced therapy and that he had never been over 8%. He didn’t want to become negative and get burn out in a struggle that he just couldn’t win. He explained that he needed time to enjoy life.

So, besides getting the better therapy, we must stop and think what are the metabolic values that we can get with a normal strength, and how can we get them and maintain them for a long period of time. If this is not possible we have to think if we will be able to live with the possible complications and put more effort enjoying every day life?

This solution is found by many people who were able to go beyond the main problem and that suffered from burnout for a long time. This is not easy but is definitely possible. It is possible to put everything back in place and to overcome fears before things cannot be avoided or solved. Life is not only diabetes but is a lot more: Life is not limited to health it is also friendship, happiness, adventure, emotion and enthusiasm.

Here are some advices to prevent and treat burnout

1.  Look for a therapy that helps you reestablish health with better metabolic values. Your health professional team should help you.

2. Stop and think: Have I met my goals? If the answer is no. Ask yourself if you can commit to more and a different therapy? Have I reached a point where I can do no more? How much strength do I have left to try other therapies? Am I burned out?

3. When you feel close to tiredness, relax a little and stop giving extra effort to the therapy. Think of reaching the lower limit that you do not want reach in order to achieve an acceptable therapy and that you are capable of maintaining without getting burnout. Keep in mind that we are all different. Do not forget that not every rule is suitable for everyone.

4. Do not stop talking about your thoughts and plans with your diabetes care team. They will understand your problems and will not ask you to do more than what your capable off (if they do not act this way then you should think getting another diabetes care team). Probably they can suggest ideas and points that you missed of forgot to accomplish. Try it.

5. Without clear evidence that convinces you, do not let anyone else to convince you to avoid trying new treatments. Stop looking for the optimal treatment and stay with the best one. Only you can decide the best therapy in your life. As you are the one living with some of the possible complications (same complications that no one can guarantee you will avoid) focus your attention in your life and enjoy as much as you can
  Dr. Axel Hirsch
  Translation: Mariana Gómez
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