Burnout

1

I don't know exactly what caused this.

It could've been the higher Met dose--the third new dose I've had in the past four months.

Maybe it's the knowledge that the higher Met dose won't help, just like all the others.

Maybe it was the nasty comment someone made a couple of weeks ago about how evaporated cane juice is only sugar if you're diabetic. (It wasn't what she said--even though she was wrong. It was the tone of the comment--you know, the tone that says that you brought this on yourself.)

Maybe it was my sister's question "are you T1 or T2?" this weekend.

Maybe it's my father's continued comments about how if he doesn't eat for two hours his 110 will become a 70 and then he'll die.

Maybe it's my father's continued comments that if he keeps testing so much he'll be like me. (Again, not what he said but how he said it.)

Maybe it's the fact that I'm SO SICK of being different all the freaking time, that I'm sick of being treated differently, looked at differently, judged, for THINGS I DIDN'T DO. I'm especially sick of people assuming I'm T1 and then getting the "but you don't look so fat" comment.

Maybe it's the fact that I'm studying so much I'm hardly sleeping (which stops this week, because I'm NOT taking the MCAT on a week of 4 hour nights).

Maybe it's that I'm sick of the same three things I bring for lunch because nothing else is low enough carb or convenient enough to bring.

Maybe it's that I'm sick of being 160 after a meal with 20g of whole grain and fruit carbs.

Maybe it's that I'm sick of none of this making any sense, and the knowledge that if I'm not T1 then I have to be MODY, because, for crying out loud, how the hell am I T2 at 20 years old??? And how have I been T2 since I was 16???

Maybe it's that I'm finally thinking of how impossible it will be to manage all three impossible conditions while in medical school and residency. I will NOT allow any of my health issues to keep me from realizing my dream, but the thought itself scares me.

Maybe it's because I can't help but think "that could be me in 20 years" every time I see a patient on dialysis with no legs.

This isn't the first time I've felt like this and it certainly won't be the last, but for the moment, I've had enough of everything diabetes-related.

2

Hmmm,it seems like you're doing a pretty good job and that your stress may be sort of family related? Perhaps you should take a break from them for a while? I bring the same stuff for lunch all the time but occasionally mix it up between peanut butter on LC bread and current fave tuna/ avocado/ sriracha salad. It's sort of good that your family are talking to you about stuff. I don't share any tactical or strategic details with my wife, much less parents, sibling, etc. I wouldn't ask them how to clean up one of my "messes" (except were I to pass out, when they'd have to call 911...) and just sort of do my own thing. I'd get pretty testy if anyone questioned me. If that's bugging you, you have a lot on your plate and taking a break might help?

3

How do I take a break from them when I live with them? As it is I've been ignoring them because I've been studying.

No one seems to be interested in tactical details--my sister "learned" about diabetes in biology class. (She learned that T2 is your fault because you're fat, and that T1 is an autoimmune disease. I'm happy she learned that there's a difference, but, of course, it must be my fault. I finally got her to stop calling me a druggie every time I take my Met dose by telling her that if I stopped taking it, I'd end up getting my legs amputated, I'd go blind, and I'd go on dialysis, and then I'd die. Now she only calls me a druggie when I take my vitamins, supplements, and Zyrtec.)

Maybe people annoy me...but how can I stay away from all people?...Hmm....A question to be pondered after the MCAT...

4

I hate to say it but if your current condition on a fixed and regular dose of metformin and a totally normal A1c stresses you out to the point it clearly does-- then I’m pretty concerned as to how well you will fare with full blown insulin dependent diabetes if it ever progresses to that point… Hopefully that day will never come but if it does I hope you aren’t so stressed.

5

AR, I have to ask: why don't you share tactical or strategic details with your wife? I totally get parents and sibs, but my husband is my anchor. He has been involved for nearly 40 years and can often help me make the right decision. I find him invaluable as a support.

6

Burnout is part of the deal with diabetes. It is a lot of work, and the best laid plans often do not work as they should. It is what it is....

I had a real bad spell about 10 years ago. The local CDE gave me a name for a psychologist who specialized in helping people deal with a chronic illness. Happened that she was T1 and on the same pump, but her help was invaluable. Sometimes you just need someone who will listen without judgment, point out things you may be overlooking, and help you come to terms with being diabetic.

I truly found it helpful and it still helps me today.

7

I don't really share them with anyone, except you guys. I tell her "I need to eat something..." or "I'm going to wait a while to eat" although regarding that, I'm generally the cook so I don't have any need to tell her, I just arrange things to suit my schedule without an explanation. She's a great deal of assistance and will do anything I ask but I'm sort of disinclined to ask for assistance. When I was a kid my dad got up and made his breakfast and that's what I did by second grade or so and I've always done things that way, including diabetes. There's so much information rattling around between my head and my pump that, by the time I explained things to anyone else, the conditions would change and I'd have to explain the new reality. About the limit is that I'll tell her "I'm still kicking ■■■..." after doctor appointments. This is, of course, offset by my penchant for bicycle accidents, other odd sports injuries, this armpit thing, etc. which I will explain what's going on to her. "hey, I crathed my bike and knocked my teeth out and need a lift..."

8

Hmmm, that would make it tough. I presume from the medical school trajectory you've described that you are "successful." Your sister's comments about being a "druggie" sound like really immature sibling rivalry material perhaps fueled by jealousy? I dunno if you can take her but maybe give her noogies or lock her in the closet or some other fourth-grade response would be appropriate.

9

There are several T2s in my extended family and we all treat it differently and criticize each other for doing the wrong thing. That's just family. What I hope is that you'll stick with your medical school goals because after all you will have gone through by then, and all you will have learned from personal experience, you'll make an awesome doctor. When you're out on your own (and it WILL happen eventually) you'll be able to snicker about your family issues. In mine, if it wasn't diabetes, someone would be arguing with me about politics or religion or if cousin Ken's girlfriend is a dud.

10

Sorry to read about your burnout. Writing about it is a healthy response. For me, when I write about something troubling, even if I don't post it somewhere, gets it out of my head where it persistently travels in a damaging circular pattern.

You have a lot of things going on and you've receive some good comments already. You ultimate solution will be multi-faceted. The only thing that I would recommend is that, to the extent possible, try to get a good night's sleep. I've had times when I was very upset at night and the thing that was emotionally trying the night before seems smaller and much more manageable the next morning. I know your problems exceed my narrow suggestion, but I know it will help.

Your ambitious goals compete for those hours that you could be sleeping but perhaps you bump sleep up into a higher prority, because your health and sanity depend on it!

11

I'm sorry you're having a hard time right now. One of the ways that you can help yourself is to stop catastrophizing. There is no reason to think that within 20 years you'll suffer blindness, amputation, kidney failure, stroke or cardiac arrest. You're probably more likely to be hit by a car. As everyone has said, you have a lot on your plate right now. The only way to manage all that stress is to treat yourself with kindness and that may mean letting an occasional 160 go with a shrug and ignoring things friends and relatives say that have been setting you off. Maybe your new mantra should be "whatever" - said quietly to yourself.

Maurie

12

Yes! And that's part of why I refuse to take the MCAT after not sleeping for a whole week. I don't handle stress as well when I'm sleep-deprived. Often when I'm in a really bad mood, I go to sleep early and wake up the next morning and wonder what my problem was.

13

Ha! I don't tell anyone anything ever, unless I absolutely must. It's disconcerting when someone sitting next to me asks if I'm okay when I test--unless it's one specific friend I have. I don't hide anything about my health problems, but I don't like feeling like I'm dependent on other people.

14

I can totally take her! Maybe I'll lock her in the closet next time...

15

I mean, if she's playing on that level, it's not inappropriate to compete on that level. Nothing's over until WE decide it is!!

16

You've got that right! :-)

17

It isn't taking pills and seeing my A1c or even meal planning that bothers me.

Imagine you took three units of insulin for 20g of carbs. And you were high after. So you up the dose to six units for 20g of carbs. And not only are you high after, but you're just as high as you were when you took three units. So you double the dose again to twelve units and the same thing happens. You'd be frustrated, right? Especially if you weren't even sure you needed insulin in the first place. What's the point of trying so hard if you don't even see a difference?

The Met takes the edge off, which means that I don't spend all day sick and exhausted from being high. It doesn't do much other than that, which is a trend I've noticed with each increasing dose. I'd be less frustrated if I were seeing some results. But every day I'm exhausted after lunch from 160's, which appear no matter what I do.

Tell me, how much sense does it make that I need 1500mg of Met per day, which still is barely helping despite the fact that I seemingly have no reason to have insulin resistance? It would make sense if it weren't helping if I were inactive, eating junk all the time, carried 100 extra pounds. Why do I have it "so bad" if I have no reason to have insulin resistance? THAT's what bothers me, not the involvement in the day to day taking care of myself.

Wouldn't you be stressed out then, too?

18

Maybe it's a basal deficit or something like that? It seems odd that doubling the dose would have no effect. I'm inclined to be dismissive about a lot of the phenomena that affect BG as when I break stuff down, a little more (or less...) insulin always works and I just turn up my pump until my BG stops going up. I don't worry about "resistance", if I need more insulin, I need more insulin. I think that the balance between basal and bolus insulin can be important as it's always possible to have a little more of one or the other and then change the other type of dose to be more or less involved and then, if stuff gets off, I can "chase the dragon" the wrong way for a while before I try the other one. I keep on adjusting the insulin and it sort of destresses me but I haven't run into a situation where my "tricks" didn't work.

19

guitarnut - I'm a T1D and was surprised to learn a few years back that I developed insulin resistance. I can remember taking boluses that had no effect on my BGs whatsoever. I may as well have just bolused with a syringe into mid-air! I know the frustration. I remember taking "rage boluses" and then thinking, "I've gone too far with that last dose, I better watch out." Then it seems to have no effect.

I read the results of one study recently that documented the good effect on BGs for T2Ds when taking a well-timed brisk walk starting one half hour after eating. The walks weren't long, I think 20-30 minutes. Exercise can't fix everything but it can make insulin work better.

And to answer your question: Yes, I would be stressed out!

20

I'm late to this discussion, but for whatever it's worth (or not), here's my $0.02.

First, it's been my observation that we all -- or very nearly all -- have periods of burnout. When it happens to me, I try to cope as well as I can in my mentally weakened state, remember that it will eventually pass (it always has), and refuse to beat myself up while it's going on. Easier said than done, I know -- like most things diabetic, it both takes practice, and improves with practice.

Second, I am T2 and took metformin for years (still do) and had the same difficulties you describe, in varying degree at different times. Eventually I concluded that I would never achieve the control I wanted without insulin, so I went to my doc and asked for it. It has been life changing. My control is orders of magnitude better than at any time since dx, and that is no exaggeration. I would not go back for anything.

As a footnote to that, insulin does not behave like metformin. If you double the amount of insulin, believe me you will see a substantial effect! Metformin acts to dampen IR and liver dumps. It doesn't directly reduce the level of glucose in circulation. Insulin does -- with a vengeance if you're not careful.

Third, on the rare occasions that someone makes one of those intensely annoying remarks, I usually stomp on them pretty hard, with information, a sharp rebuke, or both, as circumstances warrant. Fortunately, those remarks don't come from relatives I live with, so admittedly it's much easier to do.

Hang in there and keep your head down as well as you can. There really is light at the end of this tunnel. Honest!

:)