We like to feature a different aspect of D every day. Mondays have been designated as Mental Health Mondays.
Ironically, I think I’m suffering from some D burnout of my own. So, I went to google and found a great article written by our friends at the Joslin Diabetes Center. It’s helping me get through my “rut”. Hopefully this will resonate with some of you.
Please share your tips and tricks for battling the burnout monster. I’d love to read them.
Is Diabetes Amnesia related to Diabetes Burnout? Around 10:00 this morning, after finishing my rather carby latte, I realized that I was getting rather fuzzy-headed. Then I realized that I hadn’t monitored when I got up or bolused for my latte. A whole morning without Diabetes! (Actually, I’ve had LADA Type 1 for over 22 years.) Burnout, Amnesia, I’m going to blame it all on Daylight Saving’s Time.
Things that helped me beat diabetes burnout
Sorry for the repetition for those familiar with my story. My diabetes burnout came on slowly over the years and I finally beat it at year 28. That was four years ago. I have some conclusions that helped me a lot but may not apply equally to everyone else.
My insulin philosophy, developed early in my diabetes career, was to remain vigilant with my BG levels, testing 10-15 times per day, and responding with lots of corrections and vigorous exercise. My insulin dosing included lots of “swagging.” I generally used insulin to carb ratios and knew my correction factor. I was sloppy, however, and always erred on over-dosing.
That worked OK while I exercised hard, mostly extended bicycle rides. Over time, as I became less active, I gained about 25 pounds over 5-10 years. That led to insulin resistance and an increasing pants size. I felt fat and my blood sugar swung wildly as I constantly fought off plunging lows. I succeeded in catching almost every low but missed one significant one that landed me in the ER.
Four years ago, thoroughly dissatisfied with the quality of my life, I made major changes that taught me important life lessons.
Here’s what I Iearned about diabetes burnout that may or may not apply to you:
Doctors don’t have the answer. I went through three endos in five years thinking that they would discover what lay at the root of my loss of BG control problem and how to fix it. None of them had a clue. I realized that none of these “wizards” had the answer. Like Dorothy in the Wizard of Oz, the answer lay within me.
Better blood sugar numbers lay the foundation for better mental health. It’s a simple enough truth: when you feel better, you feel better! Bringing my blood glucose numbers into a tighter range, with fewer lows, and much less variability brightened my disposition and created a new wellspring of hope in me. One that did not fade in the face of the next crisis.
Diabetes is a disease of carbohydrate intolerance. Everyone of us has a threshold of daily carb consumption that, when exceeded, causes a dramatic loss of control. That threshold does vary from person to person but denying that it doesn’t exist is a primary threat to your health. For some the daily carb limit is 30 grams, for me it’s about 50 grams, while others can eat a 100 grams or more. The variance of this threshold from person to person is not evidence that it doesn’t exist.
You gotta move! I know we’ve been told this from day one but it’s worth repeating since it’s easy to lose sight of this truth. I walk 2-5 miles every day. It’s the magic catalyst that makes all other efforts work. Remove daily exercise and your blood sugar management will suffer. Feel like you need a pity party? When you’re done with that, get moving!
Actively watch your numbers; it makes a difference. Some people track stock prices every business day. Some people follow the latest scores of their sports heroes. For me, the simple act of uploading all my D-tech and looking at charts, subconsciously engages me and boosts my motivation. When I watch my numbers, they usually get better.
None of us like to participate in anything if we simply suck at it. When you adopt habits that drive better blood sugar number, you’ll discover a natural inclination to want to monitor you most current chart. In other words we, as humans, much prefer winning over losing. When the stock market drops, I don’t like to look up my current stock holding prices. When the market goes up, I look up the new higher price eagerly. Get better at your blood glucose numbers, you’ll want to follow it and that leads to greater interest and and a virtuous healthy cycle.
Help someone, anyone, now. When we focus on another’s needs, we feed a basic need to help others. It makes us feel good, emotionally and physically. Help someone today. While driving let someone in. Stop for pedestrians in the crosswalk and smile at them. Help out an elderly neighbor or relative. There are countless way to do this and your opinion of yourself, along with your sense of hope, will go up.
Be kind to yourself and accept when you miss the mark. Many of us would naturally encourage a friend or relative when they face failure. Extend to yourself that much deserved courtesy. Rise up, dust yourself off, and begin again. You deserve a second, or third, or fourth chance.
Don’t ever stop learning about diabetes. The more you know, the better you’ll do. It’s a simple truth.
Terry, thank you so much for your advice. Now that I’ve had the please to talk to you in person, this means so much more to me. I can picture your soothing voice in my mind and it’s definitely putting me in a brighter place.
Trudy, I feel your pain sister. Some of us like to blame D and it’s misbehavior on farting butterflies in the Amazon. It’s as good an excuse as any.
Sarag
I frequently had a version of this problem when I was on MDI. Always took my morning Lantus and breakfast bolus shots first thing after hauling myself out of bed, sitting in the bathroom, that is to say BC: Before Coffee, and it became such a thoughtless routine that a lot of times I had no specific memory of doing it when the caffeine did kick in and my brain started to function again. And then the panic of wondering did I or didn’t I? Should I shoot up (again?) now? Or wait until later to see what my BG is doing…?
One nice thing about the pump is you can actually check…
DrBB, I used to wear a pump, but I ran out of real estate as I grew older. I do miss it and for many reasons; for one, my A1C was a whole lot better. This morning I forgot my Levemir as well as everything else; I’m seriously thinking of getting a Timesulin for my Levemir pen. My During Coffee is the best ten minutes of my day, and indeed, no brain functioning until afterwards.
Yeah that one worries me too. I’m T1 32 years and counting but I only started pumping 3 years ago, so I’m hoping I still have a ways to go. I’ve always rotated my injections all over the place but there are so many spots that are much harder or impossible to use with a pump, and scarring seems like a bigger problem. I actually did have trouble with occlusions from scarring when I switched to an Assante Snap pump last year, but the sensor on those pumps were light-based and just too darn sensitive, I’m pretty sure. About the only thing I didn’t like with that pump.
@DrBB. The real estate problem is individual like everything else about Diabetes. I burned my entire left thigh as a child, and so the scar has eliminated using it. And I just have less tissue overall–I’m 85 years old. My belly has become quite bruised from the MDI, so it’s time to start using my right thigh more. I really regret not being able to use a cgm, but oh well, my Apidra and Levemir sure beat the Regular and NPR that I started with those 22 years ago.
@Terry4. Number 8 resonates with me today–paraphrasing–Be kind to yourself despite missing the mark. Tomorrow’s another day.
I was on that stuff for 20 years. Still makes me shudder.
I think the article´s last point, keeping in mind the things that good D management brings me in the now instead of worrying about long term complications makes me want to stay focused! Being able to do mountain races and finish in good time is way more motivating than playing “What if…”!
All the fun stuff that we can have going on is going to be way better with good control!
In my experience, no, not at all, amnesia like this is really more influenced by everything ELSE going on in my life. Not remembering if you did something is much, much different than just not bothering to do something - the intent and the care to do so are both there, which wouldn’t really be the case in a burnout situation.
Great post, Terry
An amnesiac goes into a bar. The bartender asks, “What’ll you have?” The amnesiac responds, “I’m not sure. I forget a lot of things.” The bartender says, “Like what?”
Thanks, @David_dns. Once I started and maintained the points I listed, it seemed easy to me. But I know how easy it is to get lost on the road we travel. I woke up today to an overnight line on my CGM ranging from 120-150 mg/dl. Not a bad line but off the mark for me. Then I remembered that I decided to forgo my usual walking yesterday in favor of some other tasks. I’ll get in two walks today, for sure!
@Trudy1, I recently enlisted the daily alarm feature on my cell phone to remind me to take and record my once per day basal injection. Now if I forget what the alarm is for, then I’ll start to worry!
Seriously, I’ve often wondered about the effects of diabetes on my memory. I would forget the names of people that I worked with every day, not my immediate work group, but others that I’d see in passing several times each week. I’ve had many people, without diabetes, tell me they have the same problem. I think losing sleep, stress, and emotional upset all work against everyone’s mental capacity.
@Trudy1, I have issues with remembering to do things like basal shots on time. I think it’s just because I’m multitasking beyond the level that my brain can effectively track. Don’t know whether this is an option for you, but one thing that helps me quite a bit is setting timer alarms on my phone to remind me. In fact, one is sounding off right now . . . . LOL
I have been prescribed a new med that I must take at night. It’s throwing a huge curve ball into my routine because I take all of my meds in the morning. So, I also set my alarm on my phone. So far so good.
@Terry4, @David_dns, @curlysarah–the idea of my cell phone alarm is really good; thanks.
Technically, I believe this would be any multitasking, since the brain isn’t designed to multitask. 
When you think you’re multitasking, you’re really just switching rapidly between two tasks. I suspect multitasking has a lot to do with why we forget so easily.
Having said that, I’ve resorted to using a weekly pill container with one box per day. I hate it (I’m only 34!), but without it I forget to take medications, or else I couldn’t remember if I’d taken them. This way, I can look and if there are no pills, it means I’ve taken them (I take them at different times of day, but can remember which are morning and which are night). It doesn’t help for other medications that don’t fit in the box, though; those I just have to remember.
Actually, that’s precisely what multitasking is. The term originated in computer science; it referred to a single processor working on several tasks so rapidly that to one functioning at mere human speed, the machine appears to be doing several things simultaneously. What it’s actually doing is servicing your request for a tiny fraction of a second, then servicing someone else’s, then someone else’s, then yours again. Only, it switches back and forth so fast that the tasks appear to be being served simultaneously. The old fashioned and now little used term for it was “timesharing”.
One of the interesting things about human beings is how widely their capacity to do this varies. Exceptions always exist, of course, but there is increasing evidence that as a class, women are better at it than men. That’s one reason why they tend to make good pilots. Among other things.
I find that what really helps me is to develop a “routine.” A series of connected actions that all need to take place together. In the morning it is often, measure blood sugar, take pills, take correction, take basal. You could do the same thing at night, brush teeth, take pill, gargle with mouthwash.
If you can make elements of good self-care things that you don’t have to think about all the time then diabetes is just a bit less of a burden.