Balancing physical health and mental health with Diabetes

I recently watched a show on the balance between trying to live healthy, and mental health. In particular, they had a panel where a number of people had started out by changing their diet and exercising more, all in the name originally of health and fitness, but this spiralled and for most of them ended in serious mental health conditions and eating disorders.

It resonated with me strongly, as I’ve often found in a quest to optimise my blood sugars I’m potentially sacrificing my mental well being.

Do others face this struggle? Is it worth sacrificing some control over your blood glucose to improve your mental well- being?

What strategies to people have in place to deal with these?

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This is a very interesting question. My wife (who is a medical professional) thinks her mental well-being is improved by not worrying too much about keeping our son’s BG in tight control, and thinks paying frequent attention to his BG is bad for my mental health. I’m the complete opposite, if he’s trending high it drives me nuts to think about not correcting it promptly, but even more nuts if I see a dexcom trace that has been out of range for hours. It’s funny because in most things I’m a major procrastinator, but at the same time I’m very geared towards efficiency, so I hate the wasted opportunity of time spent at 9.5mmol/L that could have been taken down to 5.5 with a quick correction or temp basal.

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This study looks at a similar question:

It’s interesting to consider whether there is causality in the relationship between early treatment and lower anxiety & depression, and if so, which is the cause and which the effect? I guess it depends which is the greater stressor; is it the activity of monitoring and treating high/low BGL (hypervigilance), or is it the worry about the consequences of the high/low BGL (and/or concern about your ability to successfully treat the high/low). No doubt this varies between people, and also for the same person at different times.

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I think that is an interesting question. I’d suspect there is some causation with higher BGL for longer periods, that come potentially with not taking immediate action, but that’s just a guess.

Personally I know high BGL make me irrationally angry.

I think with CGM I have found a lot less stress with regards to monitoring and acting, it’s really just a part of my day. However, I do still stress a lot about my decisions regarding what I do. So I found this interesting " avoiding situations that may lead to hyperglycemia were associated with higher generalized anxiety, depression, and diabetes distress."

I’d have to say there probably also needs to be an important distinction around what is good control?

If you’re running fairly tight numbers, is it worthwhile sacrificing a bit of that to relax a bit here and there?

Having said that if you’re running high numbers all the time and your anxious about that, potentially that’s a different question?

This is interesting and I think there exists a range of outcomes for a range of personalities. Some people would consider my habits as hypervigilant. Before CGM and for several years after, for instance, I would check my blood glucose with a meter about 15x/day. The thing is, for me, that protocol became a habit that I did not consider burdensome. It taught me a great deal about how my metabolism worked and I used that information to tweak my insulin, exercise, and eating habits.

I do go to great lengths to treat my diabetes and many people are not willing to make the changes I’ve made, in part, based on the psychological burden they represent. For me, however, I find that my efforts pay off in long periods of metabolic tranquility. How much does it help your disposition to sleep with glucose levels ranging from 70-99 mg/dL almost every night?

I view my treatment habits like a game. I am skilled at this game and frequent winning motivates me to continue my habits. It’s a virtuous cycle.

I know my style can be criticized as hypervigilant but I don’t think of it as hypervigilant for me. Habits take over most of the burden and feeling well powers my motivation to keep things running well. I realize that this does not work well for all personality types but it does for me.

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Thanks for sharing @Terry4. Before CGM I also would test roughly that much each day. My endo would often say I was testing too much, I’m not sure I found that side of things a burden.

I think what I found a burden was I would, and sometimes still do, though I’ve become better at dealing with it, get so frustrated and angry at myself when even with all the effort I would put in I would go above my range, which generally is around 3.8 - 8 mmol.

I’ve heard some people say that people with chronic illness sometimes do better when they view it as, like, two diabetes fairies - one good one that helps you some days and one bad one that tears things up. Sometimes the bad one sits of your shoulder, sometimes its the good one. As long as you feel like you are doing your best and developing as a diabetic, over the long period, you should feel good.

I have found that approximately every ten yeas, I drop an a1c point. I feel good about that. But, I don’t attribute it specifically to anything that I have done, more to advances in technology and our communal understanding of the disease. (although, I have kinda put in a lot of time and effort - enough that no one can tell me that I haven’t done my best. :slight_smile: I think thats important because people will try to imply that and you have to have the confidence that people can’t guilt you about that. )

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At one diabetes conference several years ago, someone voiced an outlook about diabetes numbers that helped me put things in perspective. They said to view any diabetes number as a signpost, just one datapoint that suggested where you should travel next.

That helped me to look forward instead of backwards and see the opportunity I now had to make things better going forward. My impatience was served well by my adoption of Afrezza and also intramuscular injections to rein in high glucose levels. I would also use exercise in a tactical fashion when my blood sugar was high. It’s amazing how fast glucose can drop when exercising as an insulin correction dose peaks!

This treatment philosophy nests nicely in the larger idea that we can only act in the present, the past is unalterable and the future has not yet arrived. Taking advantage of the present, of course, can make the future better.

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We all go out of range, Donman90. All of us.
Where are you at? What’s your treatment regime? What do you hope to achieve in the long run?

I have been diabetic since age 11. I used manual injection and ran an a1c in the 7’s. Then, I started a pump and almost died. I went back to MI. It took a long time for my Doc (and people on this site) to persuade me to pump again. We started by trying split MI dosages. But, once I got hardware that worked for me, my a1c dropped into the 6’s. Now, with some basic system automation, I expect to drop into the 5’s. That is possible because the automated system has decreased system variability - something that was a real problem for me when I joined this site years ago. I used to ■■■■■ about it with Terry. That was not something I was ever going to overcome without appropriate tech and putting in a lot of time.

I, too, reacted to CGM data with rage. I felt as if I had been lied to, for my whole life, about how things worked. Medical practitioners did not understand what the data revealed. It took us all a long time to adjust to the new understanding of diabetes. Many people are still not there in medicine. But, many people are. I immediately wanted system automation and analysis. It took many years, but it is here. There will be many more options for us soon.

It might be helpful to start preparing for the tools that you will use in the future. Stuff takes time. If you have a goal or a target, I think people here can help get you where you want to be.

That’s very important to me. I have very tight control. But not to the point where diabetes is controlling me, not vice-versa. I won’t hesitate to loosen my control and have pizza with friends, enjoy cake at a birthday party or enjoy a vacation without continuously second guessing myself. But it’s the exception, not the rule, and I need to take care not to over-correct when I’m high or I’ll simply change my anxiety to fear of hypoglycemia. On the latter point, Afrezza is a huge help.

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Right now I’d say my control is good. Usualy my A1c is below 6, if not at the lower end of 5, and I’m usually within 85% of time in range between 3.8 to 8 mmol/l. I have too many hypo’s, and my standard deviation could be a bit better, it’scurrently 1.5 generally I’d like to see it at 1.2-1.3.

I’d say though the reactions I have are more to one of instances, I sometimes find it hard to separate the overall data from a specific scenario. To be honest I’ve become better at it, I think where I still feel guilty these days is things like treating myself to stuff.

I hadn’t drunk for 4 years up until the other night where I had one glass of wine at a friends house, and I felt innately bad about it after like I had somehow betrayed myself.

I’d like to be able to do that without feeling guilty I guess.

But, I was more so just starting a conversation here because I feel like it’s a topic that maybe gets underlooked a little.

Frankly, it was one of my criticisms of the work of someone like Dr Bernstein, because people end up following him with some dogmatic approach, and that in itself can actually be quite dangerous.

But it could be applied to a whole range of things, that was just an example.

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Your in fantastic shape. Cut yourself some slack.
I see your motivations. Makes sense.
I am, personally, so sick of diabetes that I could puke.
I need a break. Period.

Hmmm…this is interesting because I literally eat whatever I want. as long as it’s vegan. Although I try to always prebolus so I don’t spike as best as possible. I will still eat if I want too, even if I haven’t remembered to prebolus. (unless my Bg is high of course) My A1C is 6% and I am happy with that and I was happy with my 6.4% before. I don’t think I stress about it. I just try to plan the best I can and accept when I can’t or haven’t. I admit to getting a little irritated if I forgot to prebolus and muck up my range but I quickly move on. My range is 65-170 (3.65-8.3) It literally doesn’t bother me if I do go out of range which isn’t often. (my DP is the most culprit).

Don’t get me wrong, I believe I am a little OCD about looking at my CGM, I do over correct probably a little too easily, the CGM has spoiled me on that, but I just drink OJ or eat pineapple usually as I love both of them. I’d rather veer lower versus higher.

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This is how I try to think of my numbers, and it’s really helped. So has having access to a CGM. I used to get so utterly frustrated and emotional about my diabetes. And I can’t say that never happens anymore…on days when I am throwing all my resources at diabetes and still have 0% time in range, that does get to me. But, in general, I’ve calmed down a lot.

I think sometimes on these forums it’s easy to lose track of the bigger picture. I was being trained on my new pump today and when the nurse heard what my last A1c was (6.6%) her response was, “Wow, that’s great! You must put a lot of effort into your diabetes. An A1c that low is very rare, almost unheard of!” The vast, vast majority of people with Type 1 diabetes are not able to hit the 6% range, much less the 5% range (which I’ve never been able to hit). I think sometimes it’s easy on here to feel as if we’re not doing that great when, in reality, we are in the top 5% and many here are in the top 1%.

I, for one, used to drive myself to burnout trying to get an A1c in the 5% range. I could not understand (and still can’t!) how many people could keep their blood sugar so steady for such long stretches of time. I’ve tried to stop making a low A1c my goal and stop comparing myself to others, because both were really bad for my mental health. I’m still hopeful that once tools like closed-loop systems are available to the masses, that it may allow me to break into the 5% range just as a CGM allowed me to break into the 6% range. But until then, I won’t cause myself mental distress by continuing to strive for something I continually fail at.

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This is very true, and some great perspective. I think sometimes even just being on this forum at all probably says that you’re not like a lot of other diabetics.

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The concept of “good enough” is a difficult one for many people to grasp. It requires judgment, self-love, and wisdom. Good enough means after honestly doing all you can and making sincere efforts to do your best, that you grant yourself permission to let go of the false certainty of black and white numbers and respect your status quo.

The real tragedy of undue comparison is when someone gives up caring about their health because they cannot “measure up” to the tyrannical norm. Good enough is good enough. It looks like you’ve achieved that, @Jen.

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This is me to a T. Before getting on a CGM, I tested my BS around 15x a day, which of course my Endo considered obsessive. But the frequent testing gave me a ton of insight into foods, exercise, stress, sleep, etc. That being said, now that I’m on a CGM I have even more insight and feel like I’m a little more obsessed about my blood sugars. I definitely look at my phone (Dexcom app and clarity) way too much.

As for my physical health, I significantly changed my diet two years ago. I now eat very clean (limit processed foods) and exercise around 5x a week. While I do believe my physical health has improved, I also believe my mental health has suffered due to my excessive healthy way of life. It’s funny how one aspect improves and the other suffers.

What has worked for me:

  1. Cheat days. Somedays I just say the h$ll with it and eat pizza or ice cream with my daughter.
  2. Mindfulness meditation. I try to meditate every morning using the calm app.
  3. Reading. Sometimes you just need to turn off your phone/laptop and have a digital detox.

Adam

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Sounds like you’ve struck a nice balance.

Not sure I would agree with your characterization of frequent monitoring of your CGM number as obsessive. Glucose metabolism in the non-diabetic is exquisitely controlled in a very tight range-- it shows how important the human body has determined optimal glucose to be for overall well-being.

As people with diabetes, we do need to accept some less than optimal glucose excursions. I see “obsession” as a frequent behavior where the compulsive activity begins and ends with the actual behavior.

Overly frequent hand-washing or constant checking and rechecking to see if we’ve locked our doors is behavior I see as obsessive. Frequent monitoring of blood glucose levels and using that info to take action with timely and effective counter-measures is not obsessive from my point of view.

The charge of obsessiveness with this kind of behavior is often offered by people who enjoy the luxury of a working pancreas, someone who has never felt the visceral threat of a severe hypoglycemic incident.

If frequent CGM-monitoring is causing you to feel anxious, then I see that as a separate issue that should be explored and effective action taken.

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Especially when the “norm” is as distorted as it is on sites like this one. A 5% A1c is not the norm, but many times on this forum, it looks like it’s because such a high percentage of members are able to achieve it. So some of us find ourselves striving for goals that are based on the top 1-2% of achievers rather than the true norm.

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I just lost 21 pounds using NutriSystem, but after spending $300 per month for 3 months, I stopped. I didn’t have any mental health issues—actually, I feel very happy and great relief — from being able to get that initial weight loss done successfully! I find that, after 48 years of diabetes, it is still hard, though! I think I need an emotional support team. Doctors, great! But taking care of your diabetes is a MARATHON!! I think that after writing to you today, I’m going to gather a team—I’m going to ask friends and family to be on my support team! When I recruit them, I’ll ask them to think of ways they can encourage me on a weekly basis. And, “Can I reach out to you when I’m frustrated or sad?” I hope they’re good cheerleaders and get their pom poms out!!:smiley: