It's time to be well with your health. I'm Shanna.

And I'm Nimeet.

We're your hosts for the Adventist HealthCare and You podcast. We're back and we have a excellent topic today. One that isn't often addressed and it's about managing diabetes and your mental health. Right, Nimeet?

I think it's an exciting topic. You know, when people think about diabetes, they think about the physical aspect of And, you know, it's so beneficial to talk about the emotional and the social pressures around it. So I'm very excited about today's topic.

Yes. It's just not something that really is ever addressed that I've seen. So I'm excited.

And also according to the CDC, people with diabetes are two to three times more likely to have depression than people without diabetes. And only twenty five to fifty percent of those people with diabetes who have depression get diagnosed and treated. Underdiagnosed, not talked about enough. And we have two fantastic guests today that I'm privileged to introduce. We have Laura Previte, who is our diabetes nurse educator here at Adventist HealthCare. Welcome, Laura.

Thank you very much. Pleasure to be here again.

And Mary Lynn Price, who is a social worker with Adventist HealthCare Shady Grove Medical Center Outpatient Wellness Clinic. Welcome, Mary Lynn.

Really glad to be here. Thank you.

And Laura, you work directly with people that have diabetes, correct?

I do.

And Mary Lynn, you work directly with patients who have mental health concerns or conditions. Do you see some overlap with chronic conditions like diabetes? Yeah, absolutely. And, you know, there's even psychotherapists who really specialize with chronic illness. Okay. But in addition to that, just in the work that I do, there's people that have chronic conditions and have diabetes.

Okay.

What are some of the mental health challenges currently with patients with diabetes?

Well, and I'm sure Laura will, you know, talk about this because she sees lots and lots of people with diabetes. But you know, that you mentioned in the statistic there about the, you know, the issues with depression and there's issues with overwhelm. There's issues with stress. There's issues with anxiety.

All of those factors come into play and just the chronicity is can be taxing.

It can be really taxing.

Yeah. The mental toll of constantly tracking your numbers and, the ups and downs of your blood sugar or your numbers, medication management can be, that's a, that's a toll.

I think unfortunately it's the vicious cycle because the more you stress, the more your sugar levels could go up as That's true. It could be impacted as well.

So I think that, you know, the emotional pressure is, emotional stress is significant.

What do you see Laura?

Oh, I see a lot of diabetes distress is what we call it. Okay. And that's that emotional burden, right? That relentlessness, that twenty four hours a day, seven days a week, you can't get away from it.

You know, it's overwhelming. Mary Lynn said, right, it's overwhelming. And sometimes people get to the point where that distress gets kind of chronic and it builds and it turns into a burnout where people get to the point where they're just so exhausted and they feel powerless and they just kinda throw it out the window. And they're like, I'm not taking my medicine. I don't care what I eat. Right? I'm just giving up because I just can't do this anymore.

And it's of note, there is a difference between depression and this distress that we feel because depression is like a biological, I don't wanna say phenomenon, but a biological, it's like pathophysiological. It's something that we can actually diagnose and treat. You can give somebody antidepressants, and they're gonna feel better in like two weeks. Right? They're gonna start noticing a difference.

Distress is this emotional burden. It's not anything biological. It's literally just the stress of dealing with diabetes. And it's a documented thing, right? It's not something we just made up. There's been a lot of research done over the last couple of decades.

Bill Polonsky, and he runs the Behavioral Diabetes Institute in San Diego. And they have been focusing for the last like forty years. He's done a ton of research. He's known internationally in this field of diabetes distress. And it's just like amazing information. That was one of my resources that I would recommend that people check out if they're feeling distressed because he's got some really good tools on that website.

Well, Mary Lynn, what is your advice for people that begin to feel that, that burnout and distress?

So I think one of the things is to really validate for somebody that how much sense that makes, right?

Just to really have affirmed for them. You know, a lot of times when people like people in someone's life, they, they may start to present that they're having the burnout and, and from a good place in people's hearts. So try to talk them out of it, right? Wow, it's not that bad, or you can do this, or, you know, things like that.

They're just trying to encourage the person. And I think initially just really being validated at how difficult this is, is not going to make somebody be like, Oh, great. I don't have to take care of it anymore. A lot of times that can have a little bit of a re energizing effect for somebody.

So that's one place. And, you know, maybe I'll just say this right now. So I do a mindful eating workshop and Laura and I have been together for several times doing a mindful eating for prediabetes and diabetes. And I call it a workshop.

I keep saying sometimes I'm going to change it to workshop and support group because when we do this, it's online. When we do it, you know, the people that are there not only are interacting with Laura and me, but also with each other. And so having support around that. Yeah, they're not alone.

No, they're not alone.

They're not alone.

Yeah. And a little bit later, I'll probably get into more about how mindful eating can have positive effect for somebody dealing with some something like this. Yeah, we'll get into that.

I do want to ask though about your first point about validating someone's feelings, families and caregivers play a big part in anybody's health, specifically for diabetes as well. So how does this affect families and caregivers and how can they help their loved one as well?

So I'll take this one just because I deal with this on a regular You know, there's kind of, I feel like there's two families, right? You've got the family that's supportive, right? The one that's, you know, mom, dad, brother, sister, whatever it is, husband, wife, they're there to support them. What can I do? I want to learn all I can and I want to be there with them. And it can be a really healthy relationship.

On the other hand, there's that family or a friend or whatever that support system is that's maybe guilt shaming, being the diabetes police, right? You shouldn't be eating that, making people feel guilty or, you know, shame about, you know, oh, you caused this. What did you do? You know?

Oh, look at all that junk that you ate over the last, you know, when you were a kid and now look at you. And it's really not helpful, obviously, to anybody to have that kind of negative reinforcement and that pressure. And it just builds into that diabetes distress that these people feel, this constant need to like be perfect or to kind of master it, to control it. It's just so overwhelming.

So one of the things that I've been trying to do when we've, when I have these caregivers or support people in a call with me and like a one on one situation with a patient is to try to give them, you know, the tools and the support like, hey, this is probably a better way or just communicate, like ask the person with diabetes, what can I do that's going to help you? Instead of just kind of assuming a role and thinking like, you know, I'm going to be good cop, bad cop kind of thing. Does that make sense?

Yeah.

You know, we have to be kind to each other, validating.

Scrutiny they go through. The Eating every chocolate or whatever, you know, instead of a person without diabetes, you know, doing that.

So I think they're allowed to do that though.

You know, they're allowed to make their Every moderation is appropriate, right?

And having that regular, having that discipline is important. I think, you know, that's what you both help our patients work with.

Speaking of that sort of stigma, do you guys come across people that feel, do you feel guilt or shame about your blood sugar highs and lows and the control and how do we manage that?

I'll jump in here.

So, you know, in the mindful eating group, tell the folks that are there, I have a tagline, which is that mindful eating is a journey of curiosity and discovery back to yourself.

And the significance of that is being curious instead of being judgmental, right? And then discovering about yourself. And so when I talk about it in mindful, in the mindful eating group, just in general, that's about the choices that people make, the things that happen and how they view them. You have the same opportunity with diabetes.

In other words, starting to shift the thought from my number is bad to what is my number? What did I eat? What happened in my body? Oh, okay.

Without judgment, I know that one doesn't work for me. And then it brings in choice. So that's what you were, you know, you're talking about how to choice.

It doesn't have to be, I'm, I have to make this awful choice. It means, oh, I can make a choice that works for me. So I found out that two cups of popcorn raises my blood sugar such and such, but one cup doesn't. Okay. Okay. That might be something that you discover. And when you discover that without anxiety and without judgment, you learn it.

You know, said we have to be kind to each other, but we have to be kind to ourselves.

That sounds, And you don't have to make a significant change, or you can make a small change by, you know, reducing the number of popcorns you have.

Yeah, Going down from two bags to one bag. Know, making small steps like to be cognizant about it is the right steps to take. Yeah.

Right. And a lot of times too, patients feel like they're doing all the right things.

Yeah.

Right? They feel like I'm eating better. I'm exercising. I'm taking my medicine. And then they go to the doctor and they get their A1C and they let that number judge them.

Right? It's like getting your, you studied for the exam and you got your grade, and then you're like, oh, right. I did all the right things. It's very frustrating.

So, you know, that plays a huge role in, you know, how people manage their blood sugars because they start feeling like they're powerless. Right? They're losing control. I ask people a lot of times, know, tell me the one thing that kind of like drives you nuts about diabetes, right, that's really stressing you out.

And the majority of the time they say, after they ponder for a couple minutes, right? They're like, I feel like I don't have control. I don't know. I don't understand.

Right?

That's a big deal.

So in those instances, how do you work with patients to keep them motivated? I'm sure they're getting questions and information from all different angles, you know, their scores, their blood sugar levels, what they're eating, and they may just feel defeated. So what are some tips and strategies that they could work on to stay motivated?

From my perspective, from what I do is that I usually say, let's pick one thing, right? One thing, let's make that a goal. What do we want to work on? What's important to you?

And we go from there. And then just kind of mapping out, okay, we're going to work on this. And after that, what do you want to work on? So we kind of have a plan.

But it's always, it's like flexible, right? We're not like locked in, oh, no, we said today we're going to do this. Something else may have popped up in their life, right? A death in the family, another diagnosis, you know, some other struggle, maybe they've had COVID, you know, something along those lines that pops up that's unexpected and derails them.

And that's usually pretty significant, right? Because they feel like I can't deal with my diabetes and something else. Right?

And so they kind of got to make a choice between what they're going to deal with. So trying to just kind of, you know, talk people through that, give them that support, validate what they're feeling and what they're going through.

And I think like the mindful eating workshop, I have to admit, it is kind of a support group setting, you know, because people feel very open to sharing with everybody and understanding like, hey, I'm in this group and I'm not alone in how I feel. And we're doing the same thing now with diabetes. We've started a support group for that as well. Hopefully that will help address some of this diabetes distress that people are experiencing.

Let's talk a little bit about the effects that that stress, that distress, depression, you know, anxiety, stressful times in life. How does that affect somebody's diabetes? It can actually affect the numbers too. So you kind of get in this cycle.

You do. It's a vicious cycle. Yeah. So there's stress hormones. So when we're stressed, our body releases cortisol.

It releases adrenaline. There are inflammatory hormones, right? So that makes insulin resistance worse. And then that means it's harder to keep your blood sugars under control.

Your blood sugars are going to be higher. Those stress hormones stimulate a release of extra sugar out of your liver to fuel that response, which, again, feeds into that vicious cycle because now it's just giving you like that extra energy to be extra stressed, right? So it's, you get stuck in those vicious cycles of stress. And in addition to all the other things that stress can do to our bodies, it definitely.

Finding those coping strategies that help is really important. Absolutely.

Yeah. I like to talk about the model of the brain and the structure that we have that's called the amygdala. It's the fight or flight part of us. And there's scientific evidence that in mammals, that structure, when we get stressed, there's an adverse event or we're overwhelmed, etcetera, there are actually cells that trigger high calorie, high density, high fat food seeking.

That that's a survival mechanism for animals, but it's also then when people are stressed, they're drawn to that in addition to having their liver dump the extra glucose, right?

So it's more than a double whammy. It's a triple whammy. And the thing is, and maybe you were going to go in this direction now is the ability for us to be mindful, to ground ourselves, to calm ourselves, to bring those kinds of signals into that same brain structure, offer the opportunity to bring back choice, bring down the system from the, so the stress hormones aren't being dumped, things like that. So maybe you were going to ask what are some of the things that you can do?

Yes. Let's go there.

And then I have another question, but let's, let's talk about some of that.

Yeah.

Mindfulness, you know, a lot of times people think that means I have to sit and meditate and that's, that's not really what it means. It means more, there's an official definition I'm not going to go into now, but the idea of, of being in somewhat of a moment by moment space and looking at things through a kind nurturing lens, being kind to ourselves, right?

And regulating our nervous system, bringing our system back into balance. So we do some mindfulness grounding techniques in this workshop. There's other workshops. There's a mindfulness workshop coming up purely focused on that. Some examples would be patterned breathing, being aware, doing a five, four, three, two, one, that's of your five senses and looking for five things you can see, four things you can touch, etcetera, to bring yourself back into the present moment.

Then it takes you out of the overwhelm where you're like, I got to get away from this. I can't think about this and allows you to start focusing on what you want to do and what you need to do.

I love that.

Yeah. One of my favorite things, which your department taught me a couple of years ago, was the circles of control. And I pay that forward to everybody because you can use that. You know, it's focusing on kind of taking that situation that's stressing you out And what do you have control over in that situation?

And then teasing out what do you maybe just have influence over? What do you have no control over? And then focusing on what you actually do have control over because otherwise, you're wasting your energy, which just increases your stress level if you do that. So focusing on what you can control and with diabetes, it's so relevant.

People love that. I share that with people all the time. So thank you to the outpatient.

Yeah, that's awesome. You know what?

Did an endocrinologist I one time heard say, and it was about somebody judging their numbers. And the endocrinologist said, diabetes has a hundred things that affect it. Like your glucose is affected by a hundred things and you have some control over like three of them, what you eat, your insulin and your activity, but there's lots of other things that affect it. And I think for somebody, you know, to be able to say, okay, there's a hundred things. How many of our are in that outer circle that I can't really do anything about? Right.

And then also what that offers the opportunity is to decrease the shame.

So around getting that glucose report card or the A1C Absolutely decreases the shame, you're right.

Because you only have control over a certain amount of things and the remainder is just a mystery for lack of a better term.

Yeah.

Mary Lynn, my question for you was, know, given that stat that I had earlier that those with diabetes may not actually be getting the treatment, the mental health help that they might need.

So what are some things that people can do when they're talking with their primary care doctor or their endocrinologist or their diabetes nurse educator? What should they be doing when they're with their doctor?

You know, I think one of the things is, and at least this is more standard practice now that people are being given that PHQ-two, which is a couple of questions asking about, you know, geared towards depression.

I think probably one of the big things before was it was just overlooked. I mean, you're, you know, you're coming in, you have medical diagnosis, you have the physical things that you're dealing with, and that sort of takes precedence over it. I think another thing that happens for people is they don't realize the stress or the depressed sense that they're under because they're just in that keeping on with keeping on with life. This is just how it is and I have to have it be this way.

Right? And so I think Laura is way up on this and checks in with people on that, but maybe others don't. And so for someone with diabetes to go in and say, you know, I don't know if I'm in the right range here. I think maybe I am depressed or I I'm not sure what's going Can you help me assess that?

Or can you assess that for me? And asking their practitioner for a referral for mental health.

You know And that's a good thing.

Exactly. Talk to the doctor. Ask for it. It's good. It'll help you. Exactly.

And there's tools out there to make their subjective feeling too objective, you know, with the questionnaire that they could use or point system that you're saying that, hey, here's what your answers are and this is how you could quantify what you're feeling.

So, you know, it kind of validates what you were saying earlier that, hey, this is what we're going through, and these are the numbers that show And to that point, there has actually been created by that Doctor.

Polonsky, a diabetes distress scale that is a series of, I think it's like seventeen or twenty questions. And it goes through all these, like kind of the big topics of dealing with diabetes on a daily basis, and you score it. And then at the end, it gives you, you know, kind of the score of where you are lying on this spectrum of distress so that you can take it to your doctor and say, hey, I did this scoring and look, I'm really distressed about my diabetes. I need help. You know, figure out how to help me.

And I think for, you know, maybe to make a reach out to the medical practitioners that are working with people with diabetes, you know, not necessarily a diabetes nurse educator, you, I'm not making my plea to you because you already know it. Right. But to other practitioners that may not be as aware of it for them to really almost when the diagnosis is made for them to know this person is going into something that is going to really change their life from the way that they've known it so far. And there really is the potential for a lot of stress to becoming that way. Think to kind of just know that at the beginning and to be watching for that and to be encouraging people, like you said, therapy is not a bad thing. It's a good thing. And we, you know, we have that remnant, those remnants of stigma.

Yeah.

Right. And shame around that.

Well, so you talked about when somebody's newly diagnosed, what are some good resources for someone newly diagnosed or who's feeling overwhelmed that they can go?

Laura, you mentioned the physician out in San Diego had some good resources. What are some other ones?

I would say checking out any kind of reputable site, Right? So I'm not talking about I I feel like every time I'm in here, I say don't use, you know, TikTok and Instagram for your health information. Make sure you go to, you know, reputable sources. So I will tell you that any of the national diabetes foundations, so like the American Diabetes Association, the CDC, you know, the UK, Canada, Australia, like everybody's got some kind of diabetes information that we all know is going to be evidence based, right?

They're not going to just put anything on those websites. And there's information on all those websites about any topic that you need, including diabetes, distress, and depression and burnout. There's a lot of information and resources. But I would say, you know, on a more like, I actually need help.

I don't just want to read something. There are support groups. So there are online support groups. Here at Adventist HealthCare, we've started a community diabetes support group for people with type two diabetes.

And other local resources, Mary Lynn, I know we have some support groups here at Adventist HealthCare, specifically at the Outpatient Wellness Clinic as well.

What other resources would you suggest?

Yeah. So we have the Mindful Eating Workshop slash support group. Like I said, periodically Laura and I run one together. One of our other therapists is going to be doing just a mindfulness. So hers is not going to be particularly related to eating issues.

And, another therapist who, periodically runs a workshop dealing with chronic illness. Okay. Coping with chronic. Coping with chronic illness. Okay.

So there are local, there are local, resources for people. There's the national resources. So they're not alone. There's help and support.

Yeah. And I say the biggest thing, right, is to not let the stigma of having diabetes or having those feelings. Yeah. Those feelings are normal.

You are dealing with something that most people that don't have diabetes can never comprehend. That just constantly, every time you go to do anything, you're thinking about your blood sugars. Right? You go to eat.

We're humans. We have to eat. Every time you eat, you're thinking about your blood sugars. You know, if you're feeling stressed, you're thinking about what does that do into my blood sugars when you're sick?

I mean, it's twenty four seven. So, you know, finding even the support person that you can talk to about these, even if it's not in a support group setting. Support groups aren't for everyone, but at least finding that person, whether it's a healthcare provider, a friend, a family member, a member of the clergy, right? Somebody that you feel comfortable talking with about it.

Excellent.

All right.

We ask all our listeners, you know, if you have any one happy tip for people to stay healthy in general. So she shared a lot of healthy tips. Is there anything that stuck out to you or specifically you would mention for a healthy living?

I'll go.

Mary Lynn, you go first.

Yeah. I was thinking about you asking that question and what I thought was to be truly curious and to turn that curiosity towards yourself and discover about yourself.

I love that.

Love that too.

Investing in your body. Yeah.

Yeah.

What I was thinking, Shanna kind of stole earlier, but you know, it's basically like be kind to yourself, right?

Stop using words to describe, especially your, you know, your relationship with diabetes is like good and bad. Right? Kind of get rid of that, that naming those behaviors like that.

And that can go for anyone. It's true. We all suffer from, you know, I, I get down on myself if I don't walk or if I, well, I had, I had those Swedish fish last night and I shouldn't have.

Yeah. So, you know, they just have to remember, right? They don't have to be perfect. They just need to do the best they can do.

Yeah.

And just remember that it's like there's this great analogy. The Association of Diabetes Care and Education Specialists has a great handout on diabetes distress. And it starts out with this analogy of juggling and having four balls. And having diabetes is like juggling these four balls.

But in addition to juggling those four balls, you have to do everything else in your life. Right? So you're you're juggling your diet, your medicine, your lifestyle, your stress, Right? And you gotta do this all the time.

But at the same time, you know, you have to go to work or you have kids or whatever else is going on. Right? You're caring for your parents, things like that or other stress or other health issues that might be going on in your life. And so, you know, what happens when you drop one of the balls?

What do people say? Well, just pick it up and start juggling again. Right? It's not a big deal.

And, and that's kind of I I love that analogy because that's really what it is. You know? It's just just nonstop balancing or juggling. Right?

You're just kinda trying to do it all, And it can get overwhelming. And it's normal. That's the big point with diabetes distress is that you're not abnormal. There's not anything wrong with you.

You're dealing with a lot. And that's okay.

But just try to find the resources, the help, the support. Don't be hesitant to ask for it.

Love Thank you for sharing that.

Well, thank you. Thank you both. Thank you, Mary Lynn. Thank you, Laura, for coming. This was such a great conversation and something that we just don't talk about. And I've been doing this for a really long time and just have never really even thought about it. So this was enlightening for me.

Absolutely.

Well, we hope our listeners enjoyed it as well. Adventist HealthCare offers a variety of classes, workshops, and support groups to help you manage different conditions. We'll actually put a lot of those in our show notes for today, but you can also go find a class at AdventistHealthCare.com and click on Classes and Events to search. We'd also love to hear from you.

You can let us know if you like the podcast by leaving a review, or you can email podcastadventishealthcare.com and let us know what healthcare topics you want to know more about. Thank you, Laura. Thank you, Mary Lynn, again. Nimeet, as always, it's wonderful.

As is always a pleasure.

Don't forget to subscribe to the podcast so you get new episodes. Thank you and be well.