Reduce diabetes burnout to help patients maintain healthy self-management
Patients with diabetes may become overwhelmed and exhausted after managing their disease for years. Medical providers often misinterpret this diabetes burnout as a patient’s deliberate resistance to self-management. If the burnout is not addressed, the patient’s diabetes control can worsen, leading to reduced self-esteem, symptoms of depression and other emotional and physical issues.
Often, people experiencing diabetes burnout have had relatively good disease management before their current episode. Patients may go through several periods of burnout during their life. The key is to help your patients move past the burnout while helping them reduce the likelihood of recurrence.
Understanding the symptoms
Everyone becomes frustrated with different aspects of management from time to time, but burnout symptoms — including general feelings of exhaustion, guilt, resentment, shame and isolation — last for extended periods. The symptoms cause clinically significant distress or impairment in social relations, self-care or diabetes management. These may appear as depression due to poor motivation, sadness and anger, but diabetes burnout is not clinical depression.
Some common burnout behaviors are struggling to check blood glucose levels, not addressing low or high levels and not eating or taking insulin at mealtimes. Patients may have stopped caring about managing their disease. Behaviors may also include isolating from friends and avoiding doctor appointments and other diabetes supports.
In the face of diabetes management tasks, patients may experience a general feeling of paralysis or anxiety, anger, sadness or despair. They may begin to neglect relationships, hygiene and other activities of daily living.
Finding the cause for burnout
Diabetes management is complex and involves factors that are out of the patient’s control. Few patients understand the factors that cannot be controlled, such as biochemical shifts, day-to-day metabolic changes or the release of other hormones to balance glucose levels. Inability to control diabetes may lead to frustration and self-blame, whereas multiple daily blood tests, medication or insulin adjustment, constant monitoring and immediate response to high and low blood glucose levels can lead to emotional exhaustion.
As diabetes burnout progresses, diabetes management becomes cognitively and emotionally more difficult. That is where greater emotional support is needed to help the patient regain control.
Prevention is possible
Good diabetes management goes beyond the physical to include taking care of patients’ emotional health. Without emotional health, motivation and focus suffer, causing poor self-care behaviors and eventually leading to burnout. Emotional health can include everything from how patients view themselves as unique individuals to how they view their diabetes.
Providers must encourage their clients to seek out other support, including a diabetes educator, psychotherapist and support groups, if available. Seeing a diabetes educator once a month for continued education and accountability is important to learning effective management. Weekly psychotherapy sessions can teach patients skills needed for change and diabetes management, as well as address diabetes- and nondiabetes-related emotional issues. Support groups can help reduce feelings of isolation and loneliness.
For follow-through when setting up a support team, patients need to trust and feel supported by the referring provider.
The patient–provider relationship is the foundation that good management is built on. The provider may have only a few minutes with a patient but must not underestimate the effect this time might have on the patient.
This relationship can open the door for help or close it. Many times, patients avoid asking for help out of fear of being punished or scolded for not doing what the provider asked or for having a high HbA1c.
Out of frustration or lack of understanding, some providers may appear to their patients as punitive. Others may not realize how a seemingly helpful statement may negatively affect a patient. “This isn’t good. Your HbA1c is 13%, and you need to get it down to a 7, if you want to avoid future complications.”
The patient may interpret the statement as blame and leave feeling ashamed, guilty and scared.
The provider should take a more neutral or supportive approach: “I see your HbA1c is 13. That is an improvement over your last reading. How can I help you continue to improve?” The patient may still be afraid, but will be more willing to open up about where they are having problems, so the provider can make the appropriate referrals.
The best solution is to avoid burning out altogether. If your patient is already in the grips of diabetes burnout, referral to a psychotherapist and certified diabetes educator can help.
Most people living with diabetes will go through a period of diabetes burnout at some point. When that happens, referral to a psychotherapist specializing in cognitive behavior therapy, client-centered therapy or motivational interviewing is ideal, as these approaches tend to work well with people who live with diabetes.
- LeBow EL. How to understand, identify and resolve diabetes burnout. Available at: www.diabeticconnect.com/diabetes-information-articles/general/1642-how-to-understand-identify-and-resolve-diabetes-burnout#bbwKytBBdYYzfcEJ.99. Accessed Jan. 19, 2016.
- Polonsky WH. Diabetes Burnout: What to Do When You Can’t Take It Anymore. Alexandria, Virginia: American Diabetes Association; 1999.
- For more information:
- Eliot LeBow, LCSW, CDE, is a diabetes-focused psychotherapist, presenter, author and founder of DiabeticTalks and Diabetes-Focused Psychotherapy. His private practice is in New York City and is also available via Skype. LeBow, who has been living with type 1 diabetes since 1977, treats the many diverse cognitive, behavioral and emotional needs of people living with diabetes. He can be reached at: email@example.com.
Disclosure: Lebow reports no relevant financial disclosures.