Any helpful tips for depression, perfectionism in relation to diabetes?

Type 1 and LADA
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Hi everyone... it's been quite a while since I've been active here, and I'm really looking forward to joining in again :) This one might be a long one, so hang in there... I'm so grateful if you even take the time to read this, so thank you in advance. It's a lot to digest, but I promise I'll actually ask a few questions at the end to which hopefully some of you will hopefully share your wisdom ;)

So since I was last here, I've completed 3 years at university in Scotland (studying Psychology, 1 year to go!), met some of the most amazing people, and have even begun a relationship and moved in with my amazing partner of 2.5 years! I enjoy my degree and have concrete, achievable goals for after graduation. Despite all of that... I've been struggling with depression for about the last year or so, if not longer. It took me a while, but I finally realised this spring that hormonal birth control and me just DON'T mix, and I put down most of my depression as side effects of the IUS and later, the pill that I was on. I know it's not a scapegoat, as there are also a lot of what I used to call "little things" that have a tendency to bring me down. It wasn't until I started seeing a counsellor that I realised that my estrangement from my father and subsequently changing my surname, having difficulty establishing any sort of identity because of having lived in quite a few places, and my guilt of leaving my mom and brother in order to study and start my own life weren't so "little" afterall, and that I should stop putting on such an armour and pretending like things are OK. I'm off the birth control and have a much more positive outlook, and I'm constantly working on getting better!

The part that some of you may be able to relate to is that my counsellor made me realise that a huge part of what makes me struggle with these "little" niggles in life is... my DIABETES. This year was my 15th anniversary, and I came to realise that my perfectionism and overall being hard on myself for mistakes in life may not just be aspects of my personality, but I now believe that they were largely shaped by the fact that at when diagnosed at age 7 I had to start being incredibly careful and controlled with most aspects of my life in order to take care of my diabetes. It really threw me for a curve to realise that my diabetes had been such a huge contributor to how I think about things and deal with life in general... and that made me ANGRY. Diabetes has such a huge part in my life (our lives?!) anyways, so I was furious that it had shaped me in such a profound way without me realising. The problem I feel I'm facing now is that while I need to try to change the way I think about things so that I'm not berating myself for small mistakes like I used to, and to stop requiring absolute perfection of myself... diabetes makes that incredibly difficult to do!! 100% perfection is unattainable, and since decreasing quality of life and health is the consequence of poor control, I'm finding it difficult compromising with what I'm expecting of myself.

My diabetes care at the moment is OK. Not great, by any means... mostly because my depression made me quite listless and de-energised to actually care about taking care of myself. As most of us know... it's always a challenge, and you always have to work at it!

What I want to ask, then, is:
- has anyone else has similar experiences of anger and frustration at your diabetes? Times when you've HATED how it controls your life?
- how have you come to terms with it and kept working at better control? I know that being healthy, being able to bear children, and having a great quality of life in old age are the ultimate motivators... but how do you forgive yourself for being less than perfect when the stakes are clearly so high?
- I also have my yearly endo appointment coming up in a few weeks, and am really struggling to figure out how to talk about all of THIS too, rather than just my numbers?

If you've made it all the way here: THANK YOU. I'm learning to be more open and to talk about things, and this it the only place I know of where I can talk to other diabetics. I'm so grateful for anyone at all listening, so THANK YOU!

<3, Emma About me: Type 1 since 1998; pumper for last 10ish years (Paradigm 722 atm)

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I would like answers also... I should warn you that I have been T1 for over 50 years and still have overwhelming "issues."

- has anyone else has similar experiences of anger and frustration at your diabetes? Times when you've HATED how it controls your life? YES. We all do if we are truthful. This is a medical condition that wears on you everyday. The people on Tu are fantastic, but if you peruse our issues, you will see a lot of angst.

- how have you come to terms with it and kept working at better control? I know that being healthy, being able to bear children, and having a great quality of life in old age are the ultimate motivators... but how do you forgive yourself for being less than perfect when the stakes are clearly so high? I try. Some days it really sucks. (I have been in a two week hourly overlook at my control and am totally flummoxed on what to do.) In my life, I am SO not perfect, but try in my diabetes and it never works. BUT, I am over 60, have only some retinopathy as a complication, a lovely son, two beautiful grandbabies, and a loving husband. I try to stay on the bright side, but it does not always work.

ENDO talk. - I also have my yearly endo appointment coming up in a few weeks, and am really struggling to figure out how to talk about all of THIS too, rather than just my numbers? I am not good with Endo talk. Personally, I think they are pretty useless. They look at numbers, feel superior, hand out weird advice, and most importantly DO NOT have diabetes (normally.) I only use mine to re prescribe my pump supplies, so I am no help here.

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Thank you, Spock, for taking the time to read and leave such a lovely comment :) I'm truly warm inside! I think what I've been missing in life is a bit more diabetic support and I'm so glad to find it here... I'm really going to use this as a go-to when I'm feeling a bit rough. From what you said, it sounds like you have a lot of things to be happy about! Your gorgeous family and lack of complications... I'd say that's pretty much the goal for a lot of diabetics, so I'd give you a huge pat on the back for that.

You've also summarised my feelings about Endos to the T! It's so useless to go chat to them once a year to crunch numbers and try to magically make everything better! Have you ever attempted to engage more with your endo team? I'm unsure of how to approach my upcoming meeting... should I go in and nod, say "yes sir, that sounds good sir" and leave... or actually try to get them on the same page with me in terms of what's going on? Any advice there on what you've experienced before?

Again, thanks so much for your comment :) <3

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I know that I have felt like my being diagnosed with diabetes and my struggle afterwards were like passing through the five stages of grief from Elisabeth Kübler-Ross in my recovery. Those five stages : D'Nial, Anger, Bargaining, Depression and Acceptance have happened over years and are still happening.

I wish I had answers for you. All I can say is that many of us struggle with exactly the same questions. In the end, I found the Serenity Prayer was comforting

God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And wisdom to know the difference.

And while you may not have realized it, just talking about it, whether to a counselor, a friend or family member or someone in this community, that can be a really big part of getting better.

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Hi there! While I don't understand completely what you're going through, I have definitely experienced depression myself in high school and college mostly and diabetes was and can still be part of it all! I've done counseling and medication, which both helped me so much. I'm glad that you are reaching out and getting the help you need. It definitely gets better!

So, how to deal with diabetes and depression and perfectionism, etc.? Here are few things that have helped me:
1. Getting support from other diabetics was SO helpful. For me, this meant mostly spending time reading and participating on tudiabetes. :)
2. Reframing my thought processes about "good" and "bad" blood sugars. So much of our diabetic lives are wrapped up in data, that it's easy to see "high"s and "lows" as "bad" and in range numbers as "good". But, if you view things that way, you're on a constant emotional roller coaster, because chances are you will have at least 1 high or low a day. Reframing my numbers as "in-range" vs "out-of-range" and taking the value judgement out of them has helped a lot. Instead of seeing a low or a high as a personal failure, I try to just see them as a data point that tells me what I need to do next (eat or take insulin or exercise).
3. Another thing that helped me is to realize that as diabetics, we are being asked to do an incredibly difficult thing by basically performing the function of a human organ that other people's bodies perform all on their own. We are tasked with trying to replicate normal insulin and pancreas function with extremely imperfect tools. Synthetic insulins are not the same as real insulin, blood sugar meters and pumps have margins of errors, and none of those tools we've been given can even remotely approach the amazingness that is the human body when it is working like it should. So, while our first inclination when our diabetes isn't "in control" is to blame ourselves, we really should cut ourselves some serious slack! This is a hard job!
4. Several things that have helped me to be able to cut myself some slack and not feel constantly guilty or shamed when my control isn't the best are to live by the "80/20" rule. I had a CDE tell me when it comes to carb counting, you'll never be able to count every carb perfectly or get it right all the time, but if you can do it most of the time (like 80%) that's all that matters. So, I kind of transfer that to everything, if I'm trying my best and measuring food, counting carbs, bolusing correctly 80% of the time, that's enough. Also, several people on Tudiabetes have suggested taking an occasional "diabetes break" for a day. Basically, you just take a day where you don't worry about what you eat or how much you exercise and sort of "check out" from being so vigilant about diabetes care for a day. Obviously still take your insulin, but just take a day every once in a while to mentally relax.

Anyway, I hope some of that is helpful for you. Sorry it ended up being so long! Good luck with everything, you have lots of support here!

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Thank you Brian, for your kind words. Those 5 stages... exactly it! And you're right... being able to open up rather than keeping everything inside is already making a difference... and to remember that I'm not the only one struggling makes it all that much more doable :)

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I was a bit different. I was dx'ed when I was 16 and went off to college and sort of interpreted diabetes like "beer" and various other "party" gear that I ran into so, in the long run, I just look at it as taking drugs all the time so I can eat. If I screw up, I screw up and either eat more or take more drugs and get on with it. I was able to fake my way through it from 1984 (I graduated from high school in 1985, college in 1989...) through 2008 and then got pump and started paying attention to what I was doing and stuff fell into line.

I have a child, who is 14 now and is inclined to say "is your blood sugar low?" if I yell at her to clean up her room or various other crap. She is pretty active (poms, dancing, etc.) and I'm the "designated driver" so a lot of times I'm hurrying home, running her to class, trying to work out, then picking her up and making dinner and all that so it can be a bit hectic. A few times, I've thought, "these 'monthly bills' are driving me nuts, we need to put her on birth control" but we haven't quite got there as things have calmed down a bit with the increased hectic activity with high school approaching. It's good to know there's other reasons not to do those!!

It's always been good for me to have a hobby to sort of balance with diabetes. Partying and rock bands when I was younger and then I sort of slacked off but got into exercise a bit before I got my pump. It was sort of the motivation to get the pump as my BG got a bit out of whack during this strenuous martial arts class and my SWAG approach to management at the time. When I got my pump I was working out 6x/ week and have pretty much kept it up, except for few times when I've been on the DL (like now, eek, psycho!! eek!) since then. I think exercise is a great thing to do, with or without diabetes but really anything, knitting, singing, trap shooting, whatever, can help you say "I need to knit tonight so my BG can't be screwed up..." and it can help lead you to better control.

RE Endo, I like to give my endo my download info and get it to them a week or so early so that part of the conversation can be concise and leave time for more other stuff.

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I don't share a great deal of your demographics but I understand your feelings. I'm older (almost 60), male, and wasn't diagnosed in childhood (age 30).

I think diabetes teaches us every day that we cannot truly control it. Diabetes doesn't permit perfection but neither does life. Perfection is only useful as an ideal. We reach for it and while we don't attain it, hopefully we benefit from the attempt. We can, however, always get better. That is what I always strive for -- better. If I'm at 145 (8.1) and want to be at 85 (4.7) then I'll take some insulin and/or walk. Maybe I get to 100, not 85, but better.

I don't know how your medical system is set up in Scotland but here in the US, 15-30 minutes with the endo is about max. The endo just seems to have enough time to update his/her file, ask a few questions, and mostly concerned with keeping to schedule. I have low expectations for my endo; write the scripts, order the labs for next time, move on with my life. It's not a very satisfactory relationship for me and I would never expect him/her to take any interest in my emotional/psychological health. Your counselor is better suited for that. Don't waste any time at all worrying how to connect with your endo, he won't!

Diabetes is frustrating and has made me angry. It demands my attention and if I don't give it due respect, it will make my life harder. It's counterintuitive, if you spend the extra time seeing to all the details that diabetes demands, instead of taking over your life, it gets easier.

Writing about your diabetes/life is a great coping mechanism. Instead of issues going round and round in your head, you nail them down onto the computer screen. Life is complicated. Other people struggle, too. Count your blessings, enjoy your youth and blossoming career. As someone once said, "See everything. Overlook a great deal. Improve a little."

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Wow, those are some incredible tips, Erin! Don't apologise for it being long, that was quality advice... thank you so much. What you mentioned especially in points 2 & 3... I've literally never thought about diabetes like that, but I definitely should! What's ironic is that because I study psychology, I constantly see the human brain as this wondrous, complex organ that is so essential to life... but somehow I've never turned the tables to see the pancreas that way. To say the least, what an eye-opener!!!

I'm currently gathering up some motivational thoughts and guidelines for what I hope to achieve, so your tips are definitely going on there for me to look at every day :)

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Thanks for the reply, acidrock23! Your attitude to exercise and staying in control are really admirable... I especially like the idea of doing a hobby or being active so that sugars stay in line. I've just started work for the summer and since the gym is on my way home I'll hopefully be able to add that into my daily routine so that the basal changes etc. are happening at the same time every day and things are a bit more controlled... fingers crossed!

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No bad numbers, just data to use to refine stuff...keep pounding it until it does what you want!!

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Your comment really made me smile... especially about how "better" is always the goal! I think that's what I theoretically try to do in aspects of my life... but somehow I get too caught up in the details and get frustrated at myself for not being good enough. That's what I really have to work on. That's definitely being added to my motivational thoughts poster!!!

I was actually diagnosed in the US (I lived there for 11 years) and really liked my endo team there, but I think that might have been because I was still an adolescent and they needed to give me a lot more guidance and "start-up" help. The best diabetic care I've received (out of US, Finland, and now Scotland) was in the US, although I'm sure the care would be more like what you're describing if I were an adult out-patient rather than an adolescent. Sigh... I guess we all have to make the most of what we've got, and rely on loved ones and fellow diabetics for support when we need it! Thank you for your support... you are incredibly wise, no doubt due in part to your long experience with T1 :)

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Hi Emma. I greatly agree with what everyone else has said. I too was diagnosed in adulthood - a month before retirement actually, and I have nothing but admiration for those who balance D management with all the other parts of life calling for your attention in your young adulthood!

I've been subject to mild depression most of my life. When my life becomes nothing but difficulty and struggle, the balance tips. I find the need to consciously add (back) in activities I find pleasurable and satisfying.This balances things out and my spirits are uplifted out of the "life is struggle" zone. D takes up a great deal of space in our lives. Most of the time I have a pretty matter of fact attitude to it. D doesn't usually stress me out but, oddly, I find it makes me more susceptible to stress from other - sometimes seemingly innocuous things. It's like my plate is already full.

You mentioned therapy so you have that piece of the puzzle, especially if he/she has a good understanding of D or managing a chronic condition. Having a positive and supportive endo is a big prize, but emotional support of any depth is probably too much to expect - unless medical care in Scotland is day and night from the U.S.

Finally, having others who TRULY understand is of paramount value if not necessity! I don't know what I would do without TuD on so many levels. But sometimes cyber D buddies is not enough. I started a Type 1 women's group where I used to live and it was (still is) incredible! I moved out of that area and there isn't enough support/interest in the rural area I now live in and I miss it a lot. Connecting once a month with other Type 1 women of all ages, time of diagnosis, etc was amazing. It made me see what is possible, and helped support me when I lost sight for a minute. It also was fun being around others who got the jokes we made about gushers, D gremlins, etc! I highly recommend it. if there isn't a group in your area, start one!

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I definitely agree in that D (ooh, I like calling it that... makes me feel like we're all in a secret club!) makes me more susceptible to other stressors; that's a really good way to put it, Zoe!

I might actually follow your advice on starting a group... today's been a day full of diabetes research for me, and it's surprised me to find out that Scotland in particular (not counting the rest of the UK) has one of the world's highest rates of Type 1... and yet has one of the lowest rates of pump usage in the developed world! In trying to find out more, and about D groups in particular, I'm definitely coming up short here. Maybe there's something I can do to connect people! Thanks so much for your encouragement!

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"Scotland Yes" intrigues me a lot too. I'm a pretty big Mogwai fan and they tweeted about that but a lot of the arguments, e.g. "Trident is stupid", etc. make a lot of sense and you can see how a lot of £ could be redirected towards perhaps more meaningful, social service types of things...hee hee...

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I never want to be the one to bring it up because people tend to be so passionate about it... but YES!!! There's a lot of room for improvement in my opinion, even though I've only lived here for 3 years... improvement that hopefully includes the social services, like you said. That's pretty much the basis of my vote next year :) We'll see what happens, eh?

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I started my group with the backing of our local JDRF chapter. And yes, JDRF has a branch in Scotland and here is the link: http://www.jdrf.org.uk/more/in-your-region/scotland

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Thank you Zoe, I'll definitely get in touch with them!

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Thanks, Emma.

I have posted before about my "success" with a psychologist who specialized in chronic disease. Check it out! It really helped me a lot. I mean, seriously check it out.

Endo-I freak also. Frankly, I just look at them at them as prescriptions. I nod, think about the advice... I find it really hard to engage the endo team...I have never really found a same page. They are too busy seeing 200 patients per day.

And Emma, support is amazingly helpful--you will no longer feel apart--stay here and talk.

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But what happens to your life, after many years of D, when the Denial, Anger, Bargaining, Depression and Acceptance do not find the answer?