Burnout: When Managing Your Diabetes Becomes Too Much

If you have diabetes, then you know that taking care of yourself can feel like a full time job. Blood sugar levels, which becomes the central number in your health universe, can be affected by many common activities of daily living - and it can feel exhausting. Many diabetes management behaviors are in-line with recommendations we are familiar with for everyone - eat well, exercise regularly and manage your stress, are some of the main ones. But it can feel entirely unfair that while other people can sometimes eat well and at other times splurge, managing your diabetes requires one to be on their best behavior - most of the time. Falling of the wagon, like you see friends and family often do, is not an option. No wonder that burnout is a chronic risk for diabetes sufferers.

And while keeping a handle on stress levels is one of the key factors in managing diabetes, managing diabetes can itself contribute to stress. This creates a cycle that when it gets too bad can lead to depression, which leads to less effective diabetes management coping skills and so on. In fact, in a recent study conducted by the Harvard School of Public Health, it was found that women suffering from depression were 17% more likely to contract Type 2 diabetes, and that women struggling with diabetes were 28% more likely to end up with depressive symptoms.*

According to the lead researcher on the study, while BMI may account for some of the findings, the likeliest reason for this correlation has to do with stress. Cortisol, the main stress hormone found in the body, is often found at elevated levels in people with depression - and in turn it plays a negative role in blood sugar levels and insulin resistance, increasing risk factors found in diabetes. 

The feeling that one has to be on "their best behavior" all of the time when managing this illness is not limited to food and exercise. Relationships, too, take on extra importance as diabetes sufferers need to look for extra support and understanding from the important people in their lives. Those people in turn need to be supported in order to be adequate supports to you - and need to be educated to the needs of diabetes management just as you are. 

If you have diabetes, remember to ask for help when you need it. Find your supports and use them wisely. Remember that managing your illness is doable and manageable and perhaps may even be an opportunity to "do all the right things" that we are all supposed to be doing anyway. But also don't forget to give yourself a break - diabetes management is a marathon not a sprint. And while getting into a comfortable routine is crucial, so is the realization that as your life circumstances and body changes, so can your relationship to food, exercise, your medical procedures, and to friends and family. If you find yourself experiencing "burnout," which may include feelings of anger, sadness, helplessness, withdrawal from activities of everyday living, and "forgetting" to take care of your diabetes regimen, then it may be time to sit down and reexamine what has been going in your life, and most importantly, not to forget to ask for help. Diabetes is easier managed when you are not doing it alone.

* As reported in WebMd: http://www.webmd.com/depression/news/20101122/new-links-seen-between-depression-and-diabetes

I am a Licensed Psychologist. Many of my patients are older adults, and while illness is not necessarily linked to aging, some of my patients also suffer from chronic pain and other physical ailments. My office is in Conshohocken and I can be reached at (484) 534-8830 or at dan.livney@gmail.com. For more information please go to www.danlivney.com

Our Bodies, Not Ourselves?

The popular book on women’s reproductive health, Our Bodies, Ourselves was published quietly in 1971, and quickly became a best seller, claiming no fewer than 9 domestic and 26 foreign editions. The book sought to encourage women to get in touch with the sexual and reproductive parts of themselves; parts that in that era, and perhaps still now, are, as the book points out, often more unfamiliar to women than other parts of themselves.

The important message of this book came to my mind recently because it seems to me to raise some interesting questions about our relationships to our bodies – and when I say “our,” I speak of men and women both. Let me start with the possibly odd-sounding suggestion that our bodies are not ourselves. True, legally speaking, if you commit a crime they will take a mug shot of you. That photo is intended to identify you, the person who committed the crime, and so from a legal standpoint we and our bodies are one. On the other hand, if you think about the point of the book: that we can go through life not knowing about our own basic feelings and biologies, then perhaps we can also say that “we” – let’s for the sake of simplicity call this entity our minds – our minds are in a constant state of relationship with our bodies. We learn about them, we discover them, we enjoy them when they give us pleasure, and we lament them when they give us pain. It is also true that our minds are in a special kind of relationship with our bodies, different than the kind of relationship we have with other people – precisely because our bodies are always there. But still, just because our minds and our bodies are not one and the same, it is also possible for us to have quite complicated relationships with them.

Let me give you some examples of what I mean. When our bodies give us pain, we actually have a range of emotions and options with which we can react. We can tense up, angry that the pain is there. This often leads to more tension and therefore more pain. Or we can relax and accept, and the pain becomes more tolerable. We can make decisions about the pain: how do we know to enjoy the pain of a strenuous workout, but not the pain of a toothache? It turns out these are not simple decisions. For some people the idea of pain from a workout can be just as painful as a toothache and may be part of why it is so hard for many of us to start an exercise routine. That is also an example of our mind making a decision or a judgment about the feelings our bodies are giving us.

Now what happens when our bodies are sick? Let’s use for our example just an everyday cold. For some people that can be quite stressful, others take it in stride. What’s the difference? Maybe just in personality type, but maybe also in the difference between someone who has sick days they can enjoy (and the kind of job where taking them is minimally intrusive), while for someone else it may mean lost wages and complicated child care arrangements. In both cases what we often find is that the ways our bodies react to illness (or pain) is in part based on all of these thoughts and feelings which our minds have about what is going on with our bodies. Depending on what we think, the pain in our body can feel worse, the illness can feel more oppressive.

Most importantly, this means that our way to health, or at least improvement, is also affected by the thoughts and feelings our minds produce about the experiences of our bodies. The same kinds of injuries or illness conditions in two different people – or even in the same person under different circumstances, can have wildly different outcomes. One researcher found that back surgery done to relieve chronic lower back pain is predominantly unsuccessful for people with a history of abuse and trauma in their lives; while the exact same type of surgery is far more likely to eliminate pain in people without such a history.

Next time you are sick, or under stress, or even when you’re not, take heed of the messages your mind is having about your body. As it turns out, an important part of taking care of our bodies involves getting to know our minds, and most importantly, nourishing the relationship between them.

I am a Licensed Psychologist who works with people who suffer from medical conditions and chronic pain. My office is in Conshohocken and I can be reached at (484) 534-8830. For more information please go to www.danlivney.com

Psychology and Medical Illness

A few years ago I was at a reception held at a restaurant, and I was sitting with some friends, several of whom were also psychologists. A husband of one approached, himself an educator, and seeing all of us therapists sitting together joked: “Someone just ate some of the soup and now she’s feeling sick… is there a doctor in the house?” To which, the table's resident smart alec quipped: “Not the useful kind.”

It was a good joke, and we all laughed. Of course, what he had meant was that none of us at that table had been trained in medicine and physiology, and we were not going to the ones best able to help this hypothetical person in that moment. When someone needs to get rushed to the ER, you don’t call a psychotherapist. So what is therapy good for? Is it, as some have asked me, “just talk?” Well, it can be. For some people just talking is something that can be useful in many ways and for many of life’s problems, as some of you already no doubt know or have some personal experience with. But what about when it comes to your health? If most people will agree that talk therapy can help with all kinds of relationship and emotional difficulties, what about when we’re sick or just worried about our health, or that of a loved one? Is it “useful” then?

A great deal of research says, “yes.” Studies have shown that depression and/or anxiety often accompanies major illnesses. This may not seem so surprising. When patients come down with the debilitating effects of conditions such as diabetes, coronary artery disease, cancer or COPD, it raises all kinds of difficult questions about the quality and the length of their lives. People who have these conditions often have to make adjustments to their lifestyles and their day to day activities in response to their symptoms. Major depression can play a role in decreasing their ability to make these adaptations, which leads to further impairment, and so, cyclically, to further depression. Certain illnesses can even mimic, or cause, symptoms of depression or anxiety; for instance, hypo- and hyperthyroidism, some forms of hepatitis, Alzheimer’s and Lyme disease.

But while depression can be the result of a feared diagnosis, it can also contribute to developing various medical conditions in the first place, and in can do so in a number of ways. People who are depressed are more prone to engage in a wide range of behaviors associated with medical illness such as smoking, excessive drinking, or having sedentary lifestyles. Depression can also result in nonadherence to prescribed medication regimens, and to diminished social functioning…all of which can frequently cycle into more depression.

Finally, depression and anxiety are strongly associated with stress, in all of the many complicated ways that modern life is heir to.  Physicians call this condition, “allostatic load,” which is just a way of saying that stress, when it occurs not just in brief periods but when it’s prolonged over the long term, causes all kinds of wear and tear on the body, such as impaired immunity, atherosclerosis, obesity, bone demineralization, and atrophy of nerve cells in the brain. Lastly, data also shows that when people are matched for similar medical conditions, but one group has depressive symptoms and one group does not; the depressed group incurred significantly higher medical costs to treat the exact same condition ($4,246 vs. $2,371 per year according to one study).


Now this really can change the answer to the question “what is the use of talk therapy?”

I am a Licensed Psychologist. Many of my patients are older adults, and while illness is not necessarily linked to aging, some of my patients also suffer from chronic pain and other physical ailments. My office is in Conshohocken and I can be reached at (484) 534-8830 or at dan.livney@gmail.com. For more information please go to www.danlivney.com