Diabetes Burnout

Hair Loss and Diabetes

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Hair loss is a common condition affecting millions of people each year. Hair loss occurs for a variety reasons. Diabetes is one of them.

One of the lesser-known effects of fluctuating blood sugar levels is losing hair all over the body. Understanding and acknowledging the relationship between diabetes and hair can help you handle the issue effectively. This article will explore the connections between hair loss and diabetes.

When Should You Worry About Hair Loss?

According to the American Academy of Dermatology (AAD), adults lose about 50 to 100 strands of hair a day, which is to be expected. AAD calls this hair shedding, which is different from hair loss. 

Hair loss occurs when there is excessive hair shedding. Here are some signs that may tell you that you could be losing hair. 

  • Visibly receding hairline
  • The appearance of bald patches
  • Widening center or side partitions
  • Unusually increased hair fall
  • Hair falling out in clumps
  • A noticeable reduction in hair thickness or density

While hair loss is a natural part of aging (for both men and women), you’ll probably know when your hair loss has accelerated to an unexpected level.

How Diabetes Causes Hair Loss

Diabetes mellitus can affect every part of the body, including the hair follicles. The relationship between diabetes and hair loss is complex and multifaceted.

Unfortunately, there’s not much data on the prevalence of diabetes-related hair loss. One academic survey suggests that African American women with diabetes could have a 68 percent increased risk of severe hair loss in the central scalp area, though these results were based only on self-reported responses to an online questionnaire.  

Here are different ways in which this chronic condition affects hair.  

Poor blood circulation 

The hair follicles need oxygen-rich blood flow to grow. Chronic hyperglycemia (high blood sugar levels) will damage blood vessels, including those carrying blood to the hair follicles. This, in turn, will disrupt hair regrowth and lead to shedding. A 2016 article suggests that uncontrolled diabetes leads to diffuse hair loss, characterized by hair thinning and low hair density. 

In fact, your blood sugar concentrations affect hair so directly that your hair preserves evidence of your recent blood glucose history. Some researchers have even proposed using chemical analysis of hair to improve upon a traditional A1C measurement.

Diabetes-induced vascular damage can make you lose hair in other parts of the body, like in the legs or the arms. Losing hair in the extremities could be a definite sign of high blood sugar levels, which should be addressed immediately.

The diabetes -autoimmune relationship

People with type 1 diabetes frequently experience additional autoimmune conditions. One interest here is alopecia areata (AA). According to Everyday Health, AA is a condition where the body’s immune system attacks the hair follicles, leading to hair loss. 

A 2013 study analyzed the prevalence of AA in 3,568 individuals between 2000 and 2011. According to this study, 11.1 percent of individuals with AA also had type 1 diabetes. If you have type 1 diabetes and experience an itchy, tingly scalp with hair falling out in clumps, talk to your healthcare provider so they can test you for this autoimmune condition.  

Use of certain diabetic medications

Certain diabetic medications may encourage excess hair loss. In particular, dipeptidyl peptidase 4 (DPP-4) inhibitors have been associated with hair loss and alopecia in case reports. 

Semaglutide (Ozempic), the diabetes drug the world’s raving about, reportedly causes hair loss. Ozempic controls type 2 diabetes by increasing insulin secretion, reducing appetite, and promoting weight loss. While semaglutide doesn’t directly affect the hair follicles, the dramatic weight loss can cause hair loss due to a condition named telogen effluvium. The metabolic stress of rapid weight loss leads to thinning hair, but thankfully, Ozempic-induced hair loss appears to be temporary.

Other medications commonly taken by people with diabetes are also associated with hair loss, including medications for hypertension, high cholesterol, gout, and depression.

Interestingly, some studies say that metformin, one of the most commonly used medications for treating type 2 diabetes, may actually be beneficial in promoting hair follicle regeneration and helping individuals with male or female pattern hair loss. 

The diabetes -thyroid relationship 

Did you know that there is a relationship between diabetes, thyroid dysfunction, and hair loss? People with diabetes, particularly type 1 diabetes, have a higher risk of developing both hyperthyroidism and hypothyroidism. 

These thyroid conditions are strongly associated with hair loss. According to a 2023 study, 33 percent of people with hypothyroidism and 50 percent of people with hyperthyroidism may experience excessive hair shedding.

Diabetes-induced iron deficiency 

There is a positive correlation between higher A1C levels and iron deficiency. Iron deficiency, on the other hand, directly contributes to both androgenetic alopecia (pattern baldness) and telogen effluvium (excessive hair shedding due to stress).

Polycystic ovarian syndrome (PCOS)

PCOS may affect as many as 10 percent of women during their reproductive years. It shares a common cause with type 2 diabetes — insulin resistance — and the two conditions often coexist.

Polycystic ovarian syndrome is generally characterized by an excess of androgen, a family of sex hormones associated with masculinity, including testosterone. When women secrete too much testosterone, hair thinning is a common side effect, along with facial hair growth, weight gain, and irregular periods. There is no cure for PCOS, but doctors can use many medications to help manage its diverse symptoms, including hair loss.

Mental health challenges

We all agree that managing a chronic condition like diabetes can get challenging. People with diabetes have a higher risk of developing diagnosable mental health issues like depression and anxiety, or of experiencing diabetic distress.

These mental health conditions can affect the body in different ways, including increasing your stress hormone called cortisol. Higher levels of cortisol reduce the levels of certain proteins needed for the hair follicles to function well, causing hair loss. Some studies suggest that stress can also extend the hair resting phase, reducing regrowth. 

Tips to Manage Diabetic Hair Loss

Managing blood sugar levels

If high blood sugars are causing alopecia, stabilizing it as quickly as possible with drugs, diet, and lifestyle changes may help curb and hopefully reverse the condition. 

Early screening for hair loss

If you have type 1 or type 2 diabetes, speaking to a doctor can help you understand what’s your ‘normal’ hair loss. If you think you are suddenly losing a lot of hair, spotting bald patches, or finding an unexplained reduction in hair density, early screening will help identify the root cause and get preventive measures in place.

Medications

There are many medications approved to treat hair loss.

Minoxidil is an FDA-approved topical medication that may help in hair regrowth. Minoxidil also comes in a pill — in this form, it is only approved as a therapy for hypertension, but some doctors prescribe it off-label to help with hair loss.

Corticosteroids (oral, injectibles, and topical) are commonly used in treating AA. However, there is a risk of steroids causing or worsening hyperglycemia, which may make them less appropriate for people with diabetes.

Other medications that may be used to treat hair loss include:

  • Birth control pills that contain estrogen can help address androgenetic alopecia.
  • Spironolactone (topical and oral applications) to treat both male and female androgenic alopecia.
  • Finasteride (5-alpha reductase inhibitor for male pattern baldness).
  • Dutasteride (for male hair loss)

Dietary supplements

There is a strong connection between diabetes and nutritional deficiencies, which studies may cause changes in hair structure and affect hair regrowth.  

Metformin can cause vitamin B12 deficiency, which can lead to hair loss. Low vitamin D levels, which are common in people with types 1 and 2 diabetes, may also contribute to hair loss. It is possible that dietary supplements could help address these deficiencies.

Aesthetic solutions 

A more direct approach is to adapt your look to hide hair loss. Everyday Health recommends experimenting with coverings, including wigs, scarves, and hats, or using other cosmetics to camouflage hair loss. A new haircut or hairstyle could help, as well as clip-in extensions and wiglets.

Platelet-rich plasma (PRP) is a treatment in which your own blood is collected, refined, and injected directly into the skin along the scalp. This refined blood is especially rich in platelets, which secrete growth factors that can act directly on hair follicles, stimulating hair growth. PRP is used specifically to treat androgenetic alopecia.

Finally, hair transplant surgery is always a solution to permanent balding or excessive hair shedding. 

Takeaways

Diabetes is one of many factors that can contribute to excessive hair shedding. There are no easy answers, but optimal blood sugar control, good nutrition, and stress reduction can all help curb hair loss and may even promote new hair regrowth. While you concentrate on getting your diabetes management under control, a doctor can also recommend medications that may help your scalp, and there are many aesthetic solutions available, from wigs to hair transplant surgery.

Pain from Diabetic Neuropathy? Experts Now Say to Try This First

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A new expert guidance states that people with pain from diabetic neuropathy should seek treatment for sleep and mood disorders first, before they explore pain-relieving medication.

The new advice comes from The American Academy of Neurology (AAN), the leading professional society of neurologists and neuroscientists.

In treating patients with [painful diabetic neuropathy], it is important to assess other factors that may also affect pain perception and quality of life… Mood and sleep can both influence pain perception. Therefore, treating concurrent mood and sleep disorders may help reduce pain and improve quality of life, apart from any direct treatment of the painful neuropathy.

An accompanying press release stated, “a doctor should first determine if a person also has mood or sleep problems since treatment for these conditions is also important.”

Diabetic neuropathy is a type of nerve damage common in people with diabetes. Neuropathy can affect many parts of the body, including the digestive system, the heart, the eyes, the bladder, the sweat glands, and sexual organs.

The nerve damage that mostly affects the feet, hands, legs, and arms is referred to as peripheral neuropathy. This condition is often very uncomfortable, with patients feeling pain, tingling, burning, prickling, numbness, and complete loss of feeling in the extremities. Pain may be worse at night. These symptoms are generally noticed first in the feet.

To support the new recommendation, the guidance cites two studies: one showed that chronic back pain is significantly resolved by improved mood; the other that fragmented sleep significantly reduces pain tolerance. (There are many other studies in the scientific literature that offer similar conclusions.)

To put it simply, while mood or sleep do not actually address the root cause of painful diabetic neuropathy, they do significantly alter our perception of pain.

It stands to reason that a well-rested and happy person is better equipped to deal with chronic pain. If that sounds too obvious, consider that people with diabetes suffer from both depression (and related mental health issues) and sleep disorders far more frequently than average, and that these conditions far too commonly go unrecognized and untreated.

Disordered sleep is itself a complication of diabetes, and is actually a risk factor for cardiovascular disease. Likewise, depression is a huge problem in the diabetes community. Scientists have estimated that roughly 20-25% of people with diabetes experience depression. The prevalence of diabetes distress – a lower level of anguish tied specifically to the stress involved in managing this chronic condition – is even higher.

Not only do disordered sleep and mental health issues have a direct negative effect on pain tolerance and overall health, but they also negatively impact glycemic control. Because diabetic neuropathy is ultimately caused by high blood sugars, addressing sleep and mood problems can create a virtuous cycle of improvement.

For patients that require pharmaceutical relief, there are many options available. The new guidance directs doctors to offer one or more of the following prescription medications:

Some of these drugs also have benefits for mood and sleep, which may partially explain how they work.

There are also many topical treatments for peripheral neuropathy, although the scientific proof of their efficacy is a bit murky. In the new AAN guidance,  four treatments were rated as “possibly more likely than placebo to improve pain.” Those treatments are:

  • Capsaicin
  • Nitrosense patches
  • Citrullus colocynthis
  • Glyceryl trinitrate spray

Another treatment people have found effective is exercise. A 2014 review concluded that “it is critical to understand that routine exercise may not only help prevent some of those causes [of neuropathic pain], but that it has also proven to be an effective means of alleviating some of the condition’s most distressing symptoms.” As a bonus, exercise is known to improve both mood and sleep, which means it should also help reduce the perception of pain, as explained above.

Like other complications, nerve damage is ultimately caused by chronic high blood sugar. About half of people with diabetes develop nerve damage. It can happen at any time but chances of developing nerve damage go up with age and the longer a person has diabetes. It is also more common in patients with obesity, high cholesterol, and high blood pressure. But it is never too late to improve blood sugar control.

The next time you see your healthcare provider, consider whether you should be discussing your sleep and mental health, in addition to your neuropathy pain and discomfort.

Disordered Eating with Diabetes

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eating disorder with diabetes

 

“Are you hungry?” my husband asked me after a particularly difficult hike in the Rocky Mountains last summer that lasted over 12 hours, where all we ate during the day was trail mix and some dried fruit. He was starving.

“I’m fine,” I replied. “My blood sugar is 115.”

He looked at me quizzically, and lovingly reminded me that blood sugar and hunger are not the same thing.

As a person with diabetes, I have had to separate my hunger from my need of food. There have been countless instances when at dinner time my blood sugar was over 400, and I had to wait until insulin brought me down to a safe level before digging in. Conversely, there have been many times (too many to count) where I was not hungry at all, but of course had to eat something because my blood sugar was under 60. I am always cognizant of my blood sugar, but not always of the crucial hunger and fullness cues. This is problematic.

People with diabetes have a tricky relationship with food. Diabetes requires one to be diligent when it comes to tracking what and how much they eat. There is also constant monitoring of food intake (carbohydrates in particular), exercise, and insulin. Additionally, people with type 1 diabetes, whose beta cells have been destroyed by the body’s immune system, secrete none of the hormone called amylin at all. Amylin is a peptide hormone that is co-secreted with insulin, and inhibits glucagon secretion, delays gastric emptying, and acts as a satiety agent. This may be why some people with diabetes struggle to feel full after meals. As a result of all of this constant tracking of food, plus the inability to regulate our hunger cues, people with diabetes may be inherently more prone to issues around disordered eating.

According to the National Institutes of Health, adolescents (ages 12-21) with type 1 diabetes experience elevated rates of disordered eating behaviors in 37.9% of females and in 15.9% of males. For adolescents without diabetes, the rates are 3.8% and 1.5%, respectively. The most common type of disordered eating among people with type 1 diabetes is a little known condition called diabulimia, where people intentionally reduce their insulin intake to lose weight. This is a serious condition that leads to diabetic ketoacidosis (DKA) and even death, if not treated.

One in three teenagers (more often than not a girl) will face disordered eating in her lifetime with type 1 diabetes. We’re bombarded with magazines and ads, fad diets and “quick fixes.” We also have to maintain a healthy HbA1c, measure every portion of food we eat, and make sure we get adequate exercise and take our insulin appropriately. It’s stressful. And how “normal” is it that every 12 year old with diabetes knows the carb counts for not only every sandwich they eat, but all of the snacks they eat at sleepovers, as well as their birthday cake?

Holding all of that healthy knowledge inside is overwhelming, especially in a society that values thinness over all else. It is also powerful that every diabetic holds the keys to their health literally in their hands. If they mismanage their diabetes, they will lose weight (losing weight is also a classic symptom of diabetes, so it stands to reason that diabulimia and the mismanagement of the condition leads to weight loss). People with diabetes face many tough battles, and food is a major source of stress for most people with the condition.

Since many people’s relationship to food is warped, it’s important to note the symptoms of diabulimia if your loved ones are showing any of the following signs, and to seek help if you think they have a problem:

According to the National Eating Disorder Association, signs of diabulimia include:

  • Hemoglobin A1c level of 9.0 or higher on a continuous basis
  • Unexplained weight loss
  • Persistent thirst/frequent urination
  • Preoccupation with body image and a fear that insulin will cause weight gain
  • Blood sugar records that do not match hemoglobin A1c results (falsifying sugar logs)
  • Depression
  • Secrecy about blood sugars, shots, and eating
  • Repeated bladder and yeast infections
  • Low sodium/potassium
  • Increased appetite especially in sugary foods
  • Cancelled doctors’ appointments

If you think that you or someone you know is struggling with disordered eating or diabulimia, contact the diabulimia helpline or call their hotline, open 24 hours a day: (425) 985–3635.

Have you seen drastic dietary or behavioral changes in someone you love that has diabetes? Do you recognize any of the aforementioned symptoms in your own life? If so, please seek the help you need. Your diabetes and your life depend on it.

 

What Does It Mean to Be Healthy With Diabetes?

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Being healthy, and being healthy with diabetes, means different things to different people!

Because there’s no single answer when it comes to what constitutes being “healthy,” this post won’t be about how I think you should live your life in order to be healthy, but rather the different components of being healthy with diabetes and how I think about them.

Then it’s up to you to make your own definition of what health looks like to you.

Why is it important to think through what health is and how you would define it, you might ask? Well, it’s important because:

  1. It can help you evaluate what health aspects of your life you need to focus on,
  2. It can help you set tangible goals for what you want for your health and can make goal setting easier, and
  3. It can remove some of the emotional noise surrounding the word “health,” making it less important how others define it and only truly important how you define it.

When identifying the components of health, I lean towards the definition that health includes physical, mental, and social balance rather than simply the absence of illness.

What I like about that definition is that it recognizes that those of us living with a chronic condition can still be healthy. And I truly believe that we can be!

I have diabetes, but I still consider myself quite healthy.

Physical Health

When it comes to physical health, I think of it as a body that is well nourished, exercised, rested, in general balance, and with well-managed blood sugars. That’s a tall order and it could be even taller, for as mentioned, the exact definition will be up to you.

If I were to evaluate my physical health, I would ask myself:

  • Am I eating the right amount of calories and macronutrients to fuel my activity level and fitness goals?
  • Am I drinking enough water?
  • Is my exercise routine (volume and intensity) giving me energy and building stamina and strength or is it taking energy, making me feel drained or bored?
  • Am I getting enough quality sleep?
  • How do I feel? Is my digestion working as it should, am I energized, etc.?
  • Is my diabetes affecting my physical well-being, and if it is, am I spending the energy needed to manage my diabetes according to my diabetes management goals?

An assessment like this is, of course, subjective, but I think it’s a good starting point for identifying what’s important to us individually when it comes to physical health and help make an improvement plan if needed.

Mental Health

There is a lot of overlap between our physical and mental health, especially when it comes to living with diabetes. Mental health, of course, encompasses so much more than what’s related to diabetes, but I will focus on diabetes in this post.

My top 3 list for a mental health self-check would be:

  • Am I at risk of any degree of diabetes burnout and what are some of the preventive measures I can take?
  • Am I being kind to myself by building myself up and not talking myself down? Am I accepting that I can’t control everything about my diabetes and therefore never will be in complete “control?”
  • Do I prioritize my happiness and continue to have a positive outlook on life and my diabetes management?

I find that just thinking through these three points can help address unhealthy mental behavior and be a cornerstone for making positive changes if needed.

Social Health

Finally, we have social health. This one took me a little longer to define since I tend to bundle it in with mental health checks. However, the more I think about it, the more I think that it needs to stand on its own.

When I think of social health in a diabetes context, I think of how we as people living with diabetes allow others to interact with our condition. It’s how we react when people ask about it, how we interact with other people living with diabetes, and how we tackle food choices when “in the wild.”

The things I’ve found useful to work on when it comes to my social (diabetes) health are:

  • How do I handle times when I’m not comfortable sharing my diabetes with others? I think it’s okay to not want to talk diabetes with others sometimes, but I also acknowledge that people don’t necessarily know or understand that, so I need strategies to handle those situations.
  • Acknowledging that my diabetes management is “mine” because only I can define what success is. It may differ significantly from other people’s definitions of success when it comes to blood sugar control and food choices. And that’s okay.
  • Learning how to say no to food pushers or people implying (or telling me directly) that there are certain things I can’t eat.
  • Developing strategies for dealing with food (carb counting) uncertainty when I am eating out or in social settings.

As mentioned, this is how I think about the three health categories and what’s important to me when it comes to my physical, mental, and social balance.

I encourage you to think of minimally three things for each category that are important to you and then make them a priority. Sometimes all it takes to see a significant improvement in one’s health is to focus and make a few small adjustments.

The Relentlessness of Diabetes Management

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relentness of diabetes management

There are days where I find myself exhaling loudly out of exhaustion. My alarm wakes me for work at 6:30 a.m., while I want nothing more than to close my eyes and go back to sleep. I find myself unable to muster any enthusiasm for the new day ahead of me, nor for the people around me. I find myself walking around with a long face and an expression that will put a damper on everything and everyone around me. There are days where I feel like coffee, toast, and swear words are the bane of my existence. Then, there’s the inevitable feeling of limping toward the finish line on a Friday afternoon.

Over the years, I’ve told myself that I was burned out. Or that I wasn’t eating the right kinds of foods. That I was overworked and trying to juggle too many different things. I wondered if it was the exhausting nature of roller coaster blood glucose levels. Or the mixed bag of emotions that came from dealing with an unpredictable condition that was downright isolating.

Time has gone by, however, and I think it’s safe to say that I’ve addressed each of these issues to the best of my ability. The variability in my glucose levels is far less significant than they once were. I am more connected, supported, and engaged in my management. I have a far better understanding of a condition that even at the best of times makes no sense. I am far more conscious of taking time out for myself and not burning out.

time for oneself

But I’d be lying if I said that those feelings don’t linger, like flames from a fire that simply will not go out. There’s only one rational explanation that I keep coming back to.

Diabetes.

Diabetes is relentless. The physical and mental effort required to keep those flames at bay is huge. Throw in a full-time job, freelance writing, friends, family, and time out for myself, all while working towards financial independence, a career, and other life goals, and it’s no surprise that at times I feel like I’m only further fanning those flames.

Diabetes is no easy feat.

When I look on in envy at the person with a spring in their step while I’m limping it toward the finish line of a Friday afternoon after a challenging week, I remind myself that most people around me don’t have to deal with the relentless diabetes demands that I do.

T1D Real Talk: Confronting the Harder Truths of Living a Life with a Chronic Disease

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type 1 diabetes real talk

By 

 December 30th, 2017

“If there ever was a good time to have diabetes in history, now is that time,” said an optimistic, caring, and very knowledgeable endocrinologist at a quarterly appointment with a patient, “…plus, the cure is probably 5 years out, so there’s that.”

Oh, how I loathe that last sentence. It seems as though the cure is always 5 years out. It was 5 years out when I was diagnosed at 12 and thought we’d have a cure before I finished high school. It was 5 years out on my 21st birthday and I thought I would be cured before I walked down the aisle at my wedding. It was 5 years out when I first started seriously considering if I should ever really try to have kids with a chronic disease and experience a difficult, high-risk pregnancy. The magical “5 years out” is a myth, and hurtful to people, especially children, when they are first diagnosed.

I love all of the optimism and positive aspects of the diabetes online community (DOC) and the power behind people and our ability to connect across space and time (zones). When children are first diagnosed with type 1 diabetes (or type 2), there’s a lot more hope out there for people than there was even 10 or 20 years ago. But sometimes I think all of that optimism and hope sets kids up to think that diabetes isn’t difficult and that there won’t be struggles in their future at all and, when they face those struggles, they don’t have the coping mechanisms to deal with them.

According to the National Institutes of Health, the prevalence of major depression in patients with diabetes ranges from 8-18%, while milder types of depression are reported to be present in 15-35% of people with diabetes. That is huge. It’s important to look out for the symptoms of depression and to not misguide those that are newly diagnosed with the notion that everything will always be normal and easy.

Depression and type 2 diabetes

Here’s some T1D real talk. Diabetes is hard. Diabetes is chronic. There is no cure, and it’s invisible. That’s really, really tough. It’s tough when you’re 400 mg/dL on a Tuesday morning, but still have to make that 8:00 a.m. meeting, because no one can see how awful you really feel. It’s tough when you’re trying to hike with friends, but you’ve gone low 23 times on the trail and want to give up.

It’s tough when job applications ask, “do you have a disability?” and you know the answer is a resounding yes, but in the back of your mind, you’re worried that you’ll be discriminated against and not get the job. It’s tough when people say, “Well, at least it’s not cancer.”

It’s tough when you’re a struggling college student and it’s just not fair that you have to buy insulin, and syringes, and test strips, and glucose tabs, and pay for specialists and pump supplies and lancets on top of being a college student and it makes you want to scream. It’s tough when you cry. And you’ll cry.

It’s tough when you have to know the vernacular of insurance companies and can translate the EOB (explanation of benefits) on bill statements for all of your family and friends. It’s tough when you have to introduce not only yourself, but your diabetes to every single significant person in your life, for the rest of your life. It’s tough that diabetes always seems to tag along.

It’s tough. Diabetes is painful. People who say it isn’t are under an illusion. A person with diabetes often feels like a pin-cushion and skin isn’t infallible. The number of bumps and bruises that diabetes causes is infinite. People will question everything you eat; people will question everything you don’t eat.

People will stare. People will ask if you’re carrying a pager (Hello, it’s 2017!), and most people won’t really understand the physical and emotional toll that diabetes takes on the body. (No, I don’t really want to answer the “So is your diabetes under control yet?” question again.)

People will always relate your diabetes to that of their grandma. People will ask if you can eat salt. People will regale you with stories of their second cousin’s girlfriend’s mom who had to have her foot amputated from diabetes (thanks). People will be scared, but the ones who stick around are worth their weight in gold.

But people will try. People will prove to you that they care. You will make real, deep connections with people that just get it. When you fall, you’ll fall hard, but when you stand, you’ll be taller (even by an inch). You’ll triumph. When we talk with kiddos and people that are recently diagnosed, let’s keep in mind to keep it real for them, so they’re not whiplashed with the reality of a chronic disease in a cruel, unforgiving world, leaving them ill-prepared for success.

Yes, diabetes is hard. Diabetes is tough. But diabetes makes people more persevering, more disciplined, more determined, and some of the hardest working people in the world. They’re tougher than diabetes. And so are you.

Diabetes Burnout – There’s no way out but through

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“I felt as if I couldn’t do it anymore. So I didn’t,” explains Sarah Kaye, a mother of two, now 31 years old, who was diagnosed with type 1 diabetes as a preschooler.

Sarah is talking about burnout. Diabetes burnout. The phrase can mean so many different things to anyone who lives with any type of diabetes, and it can be triggered by any number of events or by nothing more than the daily physical and mental burden of living this disease.

blue flame

“In my own practice,” explains William Polonsky, MD, founder of the Diabetes Behavioral Institute and author of Diabetes Burnout. “I have met far too many people who, because of diabetes burnout, have chosen to ignore their diabetes for years or, in some cases, decades. They are male and female, young and old, new to diabetes and veterans of the disease. They are not bad, stupid, or weak people. They are normal folks who are struggling with diabetes for understandable reasons. And their struggles take many shapes.”

While some feel helpless and defeated by the disease, explains Dr. Polonsky, others’ burnout may be the result of denial an  “never truly accepting the reality of diabetes in their lives.”

But all forms, no matter the severity or the duration, qualify as burnout.

Checking Out

For Sarah, burnout is something she has endured at least five or six times in the past 27 years of pricking her fingers, counting carbs, taking insulin and hoping it’s somewhat close to the amount her pancreas would’ve given her in an effort to avoid frustrating high blood sugars and exhausting low blood sugars.

Sarah burnout

When Sarah is feeling diabetes burnout: “My brain feels as if it has physically closed a door to all that I know about diabetes care and diabetes management.”

“I think of burnout as the inability to take care of myself due to mental and physical exhaustion,” explains Sarah. “It’s like a door has closed in my brain that is barring me from the place where all I know about diabetes care and diabetes management is stored. I can’t enter because my body can no longer take the toll of swinging back and forth from happiness and elation to sadness,anger, guilt and frustration in a never-ending cycle. Like a clothes dryer, but in slow-motion.”

Burnout is a personal experience—but is usually accompanied by a layer of shame and guilt. Others with diabetes may even become judgemental perceiving burnout as a weakness or giving up, but it’s not that simple.

For some, burnout is an exhaustion. You somehow manage to keep your blood sugars in their usual ranges but you aren’t as vigilant about checking them as you know you should be.

  • For others, burnout is an unbearable and overwhelming feeling of defeat, leaving you convinced that you can’t possibly keep up with the demands of the disease, whether you’re a type 1 or a type 2.

And for others, burnout is driven by the challenging combination of managing an intensely-demanding disease with other real-life stressors. Like any human being, you survive by coping. For some, coping is stepping back from diabetes management in order to devote energy to another part of your life.

Burnout Triggers

“For me, diabetes burnout means I’ve grown tired of all that I have to do and think about in order to attempt to control my diabetes,” saysKate Cornell, now 61-years-old, who has lived with type 2 since 2005. “It means I’m tired of talking about it, thinking about it and making the necessary sacrifices.”

Kate and burnout

For Kate, diabetes burnout means: “I’m tired of talking about it, thinking about it and making the necessary sacrifices.”

Both Sarah and Kate will tell you they know exactly what led to their burnout. Kate’s burnout is the result of intensely caring for her 97-year-old mother on top of her own recently-diagnosised fibromyalgia.

“I admit I haven’t given much thought to my diabetes since November. I decided to eat what I want and deal with the blood sugars later. I still check them at least once per day, and mostly try to eat a lower carb diet, but I haven’t been giving any thought to anything long-range. That’s not a good thing for someone with diabetes.”

For Sarah, burnout came following a long stretch of doing her very best and achieving her goals. “My worst phase of burnout, by far, was after my first pregnancy,” she explains. “While trying to get pregnant, I knew I had to be on my game. I kept myself in the best control I could for a couple of years before finding out we had conceived.”

Burnout started to set in about the time she learned she was expecting—certainly not the time to take a break and recharge her diabetes management energy stores.

“So, that began the most nerve-wracking diabetes management time in my life. It wasn’t just my health I was fearful about. I was constantly worried about harming my baby. Sadly, I never experienced the joy of pregnancy or the feeling of awe about the growing life that many woman have.”

Sarah gave birth to a healthy baby boy—all her hard work paid-off—but she was exhausted, and the rollercoaster blood sugar levels that accompany diabetes management while adjusting to breastfeeding and life with a newborn took its toll.

For the next 9 months, Sarah tested her blood sugar sometimes only once a day, always seeing a high number that she’d only treat with insulin if it were above 300 mg/dL to prevent her body from reaching a state of DKA (diabetic-ketoacidosis). DKA is a dangerous state in which toxic levels of ketones are produced due to a severe lack of insulin.

Turning Around Burnout

While it’s important to acknowledge and work through your own burnout, it’s also crucial to do what’s necessary to keep yourself safe and out of the hospital. In addition to the emergent dangers of DKA and severely high blood sugar levels, long-term burnout that leads to long-term high blood sugars increases your risk for all of the many diabetes complications you’ve been warned about: neuropathy, retinopathy, nephropathy. Rather than inspire change, this list of warnings can unfortunately make the burnout burden even worse.

Dr. Polonsky recommends “diabetes vacations” to help curb or prevent burnout, but emphasizes the difference between a safe diabetes vacation and an unsafe break.

“A safe vacation doesn’t last too long and involves planning ahead so your diabetes control isn’t compromised,” explains Dr. Polonsky. “This doesn’t mean quitting your diabetes care altogether. You might, for example, decide to take a night off each week from your diabetes-friendly meal plan. A good vacation can restore your energy for managing diabetes.”

Dr. Polonsky describes an unsafe vacation from diabetes as something that goes on for a long time and may threaten your health. “Perhaps you have been ignoring your diabetes for years, or you take your medications faithfully but decide you don’t ever want to check your blood sugars again.”

For those stuck in a burnout phase that could easily be classified as unsafe, seeking help and support is crucial. If you can’t admit to your healthcare team that you’re severely struggling, tell a friend or family member whom you trust. Asking for help doesn’t mean you have to suddenly snap out of your burnout. It just means you’re going to acknowledge and work through it in a way that is safe, with the support that you need.

Including your healthcare team in a plan for moving from burnout to responsible diabetes management again is important. For instance, if you’re burnt-out by trying to maintain an A1C near 7.0 percent, you can talk to your team about aiming for blood sugars that would lead to an 8.0 A1C instead. The point is involving your team may be a comfortable way to lighten the burden and responsibilities of diabetes management while also keeping you safe. The more intense your burnout feels, the more necessary it may be to seek out professional help from a therapist who can support you.

Sarah found middle-ground by staying below 300 mg/dL and doing the very basics of her diabetes management responsibilities: taking her insulin, avoiding extreme highs or extreme lows, and occasionally checking her blood sugar.

“I didn’t care to correct mild highs because I had a baby to take care of, and the last thing I wanted was to go low and not be able to take care of him,” she explains. “I would let my sugars cruise in the 200s without batting an eye. I would blind-bolus for carbs, rarely even taking the time to guess at the carb-count when taking my insulin. Diabetes was the absolute last thing on my mind, and I didn’t want it on my mind at all. I hated diabetes and all that the management of it entailed.”

Sarah’s post-partum burnout lasted 9 months before she felt as though she could give energy towards the daily demands again.

“I firmly believe that diabetes burnout is much like the saying, ‘Depression is not a sign of weakness; it’s a sign of being strong for too long.’ Diabetes burnout is very much the same—trying to be perfect for too long can set oneself up for a quick fall into diabetes burnout.”

For Kate, who’s burnout cloud is just starting to clear, she feels as though she’s coming out of the phase as gradually as she entered it three months ago.

“Be kind to yourself,” says Kate. “It was always in the back of my mind that this trend couldn’t go on forever but I needed time to let other things in my life settle down first.”