A global pandemic can lead to anxiety and depression for healthy adults faced with a host of unknowns. For people with diabetes, underlying disease-related distress or mental health concerns can be further amplified by the stressors of financial strain from job loss, questions about access to insulin and other medications, disruptions to daily routines, and a lack of access to healthy foods.
Healio spoke with two certified diabetes care and education specialists and behavioural health experts who offered several tips for people with diabetes on the best ways to address mental health concerns, develop new healthy routines and manage blood glucose during the COVID-19 pandemic.
‘Diabetes adds another layer’
There is mixed research that suggests people with diabetes are at greater risk for mental health issues vs. people with any other chronic health condition; however, diabetes distress often looks a lot like both depression and anxiety, and any of these conditions are amplified during this pandemic, according to Susan Guzman, PhD, CDCES, a clinical psychologist and director of clinical education at the Behavioural Diabetes Institute in San Diego.
“When talking about underlying depression or anxiety, some of the things you worry about are social isolation, a lack of physical activity, and a lack of connection with self-care in general,” Guzman told Healio. “A person with diabetes may still have access to a health care professional telephonically, but their access is limited. HbA1c can’t be done, and everything is modified now. Access to self-care — a gym, the ability to go for a walk and get fresh air, all the things we recommend for good self-care with depression — are affected right now. The two core feelings we evaluate in depression are feelings around hopelessness and helplessness. You can see how, during these times, both of those could be elevated and triggered. The underlying anxiety is the baseline for most, and diabetes just adds another layer to all of that.”
The loss of income resulting in potential loss of health insurance can also be distressing for people with diabetes, as can uncertainty about access to healthy foods to manage blood glucose, according to Nicole Bereolos, PhD, MPH, MSCP, CDCES, a clinical psychologist and certified diabetes care and education specialist.
“We’re told to limit our trips to the grocery store, when supplies are running short,” Bereolos told Healio. “For someone who has to worry about treating hypoglycaemia, this is worrying. If you have a meal plan, can you get good quality, high-fibre carbohydrates and low-fat proteins? This is very new for all of us, there is no precedent, and there are so many different opinions, all coming from good sources. I tell people, especially those with anxiety, that time is not their friend. Too much time to focus on those racing thoughts, plus exposure to media, can really amplify a lot for people with diabetes who already have a predisposition to excess worry.”
Bereolos said that, now more than ever, people with diabetes must follow a routine and consider the routine a part of self-care.
“Self-care seems to be a buzzword lately,” Bereolos said. “Right now, people may feel like they can’t worry about self-care, but it is key. Sleep is a foundation for so many things, as is staying on a schedule. It may mean shifting your schedule forward a bit, but if you do make a change, that is fine. Stick with whatever schedule you put in place as if you were going out to your job or the kids were going to school.”
The many changes associated with the pandemic will likely lead to changes in blood glucose, and self-monitoring of blood glucose becomes more important, according to Bereolos, who has lived with type 1 diabetes for 30 years.
“We may be bombarded with new challenges and a decrease in physical activity, so we anticipate a change in our blood glucose management, because our routine is very different,” Bereolos said. “For me, having type 1 diabetes, I have had to increase my basal insulin rates a little bit. ... Someone could be used to running between 100 mg/dL and 160 mg/dL, and now, they’re running between 130 mg/dL and 180 mg/dL. That is not a drastic change, but it is enough for someone to notice. This is new, and you need to learn how your body is responding to all of these new stressors that you didn’t anticipate.”
Small increments of physical activity — however they can be worked in — can make a difference in glucose management, Bereolos said.
“Take that time to get in physical activity. Use what you have. Take the kids or the dog out for a walk. Even yoga or meditation, Tai Chi or Pilates can all be very much modified for people who are less physically able,” Bereolos said. “Each of these can reduce cortisol levels to help with blood glucose management.”
Regaining control
Guzman said there are three factors that can make coping with any stressor more difficult: unpredictability, inability to influence, and no known end.
“If you think about it, those are not only elements of COVID-19; those are elements of diabetes,” Guzman said. “Keeping that in mind, the tips for managing it all have to do with regaining a sense of control when you feel you don’t have any. Focus on doing what you can. We can influence our exposure; staying at home may feel like inaction, but it is an important action. In the realm of diabetes, I have been suggesting that people take something from their diabetes to-do list that they have said they would like to do if they had the time, and it might be something as simple as trying a low-carb recipe they heard about. Take the walk after lunch, if safe to do so. Focus on what you can do instead of what you can’t to gain a sense of control.”
“We know that planning for the future is important, and planning when things are so unknown is difficult,” Guzman said. “We recommend pulling your mind back as much as you can to what you can today. What is on your plate today? When people notice their mind is off into the future, think about what you have to tackle today.”
Reach out for help if needed
In cases of severe distress, worsening anxiety or depression, experts recommend people with diabetes contact their health care provider for guidance. The American Diabetes Association website includes a list of diabetes-competent mental health professionals, and endocrinologists can also provide referrals, Guzman said.
“Most providers are allowing pretty liberal telehealth options,” Bereolos said. “There are practitioners out there ready to help, and many of my colleagues say they are not so swamped right now and they can accommodate new people. They may or may not be a diabetes expert, but they can help with the anxiety or depression.”
Bereolos said people with diabetes should also lean on whomever they turn to for emotional support.
“This situation calls for physical distancing, but we are not truly socially distanced,” Bereolos said. “These recommendations do not mean we don’t interact at all. Talk to someone outside your walls — either a close confidant or a nonbiased professional. Reaching out for help is not a sign of weakness. It is just another tool for the tool kit.” – by Regina Schaffer
Disclosures: Bereolos reports she is an advisor for Diabetic Living. Guzman reports no relevant financial disclosures.
https://www.healio.com/news/endocrinology/20200618/tips-for-managing-diabetes-distress-during-covid19
No comments:
Post a Comment