← Taking Control Of Your Diabetes® - The Podcast!
Taking Control Of Your Diabetes® - The Podcast!
The Emotional Side of Diabetes with Clinical Psychologist Dr. Bill Polonsky
00:35:42
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- [00:20]
A
Do you ever feel burnt out from your diabetes? Of course you do. Well, we are going to talk today about some coping mechanisms to help you survive and even thrive with your diabetes on this edition of the Taking Control of youf Diabetes podcast. I am one of your hosts, Dr. Jeremy Pettis, joined as always by my good friend and colleague, Dr. Steve Edelman. So, Steve, have you ever felt burnt out from your diabetes?
- [00:47]
B
You got me speechless. Absolutely. I don't know how I can capitalize my verb. Yes, I have.
- [00:53]
A
Yeah, I mean, literally, we all have. I mean, diabetes is extremely frustrating. I don't care if you have type one, type two, what kind of diabetes you have. I mean, I always say this, I'm biased, but I just don't think there's any other disease like it. The minute to minute kind of judging. Is your blood sugar high, is it low? If you don't get your medications, your insulin right, you go high and that has long term complications. You can go blind and lose your feet. But if you take too much and you go low and, well, gosh, that feels awful, and you have to eat, drink, you get confused, you can pass out. I mean, I always say we don't have people wake up and check their cholesterol in the morning and then take their medicine and check their cholesterol again in 10 minutes and see if they got it right and then check it again. I mean, like, it's just unreal what we ask people to do.
- [01:41]
B
What do you do when you take Cialis? What do you check? Jeremy, I was being serious. It's relentless. It's always there. And even though you and I, we have the best technology, I don't think there's a day goes by when we don't think about, am I going to go high, am I going to go low? It's just, it's the nature of the beast, unfortunately.
- [02:03]
A
And yeah, Steve and I, thankfully, we have each other. And I've gotten a number of texts and calls from you about just a rough night you had. You had one of those roller coaster nights. You went low, you ate everything in sight, you went to 300, you wake up feeling crappy. I mean, the list goes on and on, but these are things that not everybody knows. If you're living with diabetes, it's so ingrained in who you are, what you do, but it can be foreign and there can be a lack of sympathy from family members and doctors, and it can kind of contribute to this. So the whole podcast today is about diabetes burnout, diabetes distress, particularly. We all face this. But when maybe does this become a problem that you need to be addressed? How can you address it? What help is there? I mean, we could talk about this for hours and hours and hours, but thankfully we have a very special unique guest to talk this through with us. And who is that, Steve?
- [03:01]
B
That is the world renowned Dr. William. We'll call him Bill Polonski, who is on a late term, touchy feely guy, but a extremely focused clinical psychologist on the emotional and behavioral issues with diabetes. Has trained in some of the best institutions like Yale, the Joslin Diabetes center, went to undergrad at Santa Cruz, and he dated a friend of mine from medical school, which I found out later. And I'll tell you more about that if we have time. But without putting all joking aside, you know, Bill has really focused his whole career on the emotional and behavioral issues of diabetes, has hundreds of publications and we're lucky to have him here. And I should say that Bill was on the faculty of our very first face to face TCOID conference in September of 1995 at the San Diego convention. Sir.
- [04:00]
A
Wow. You keep inviting him back. He keeps coming back. So thanks for joining us, Bill. Say hi.
- [04:04]
C
Thanks. I'm really glad to be with you guys.
- [04:07]
A
Yeah. And I'll just add to that that we are here in San Diego and Bill, we're very thankful lives here locally. But don't get the impression that there's 1,000 bills in the world. There's probably two or three. I mean, this is a very kind of unique niche that you have of focusing specifically on the behavioral aspects and mental health issues that come along with diabetes. So maybe tell us a little bit of backgr on maybe about how you got into this first of all and then what your day to day is kind of now.
- [04:39]
C
Well, I stumbled into a job at the Joslin Diabetes center in the late 19, I want to say 1880s, because I feel so long actually 1980s. And I've been very delighted and happy to be working in this field ever since. And I think what really shifted for me very quickly, even after a few days at the Joslin, I kept getting referrals from all of the endocrinologists and the healthcare providers at the Joslin. And the referrals all said the same thing. Could you please help this person? He or she is in denial. I said, okay. And I would interview each of these individuals and it turns out no one was in denial. They all knew they had diabetes, but they were pissed or freaked out or overwhelmed. So they were full of feelings about their diabetes. And no one had really paid any attention to that or didn't try and certainly didn't think it was important to address. But it turns out what we realized just through my opportunity to have met now many, many thousands of folks and work with them and also do, as Steve mentioned, a ton of research on this subject to really understand better this whole problem of the emotional side of diabetes and why makes it sort of an anchor, an anchor in a bad way that can make it hard for people to be successful putting up with this day to day. Just like you mentioned, Jeremy.
- [06:06]
A
So, all right, so we all get mad about having diabetes or frustrated. The things that Steve and I kind of mentioned at the top. Is there a spectrum? Is that different than diabetes burnout or just frank depression? Diabetes distress? Do these things have specific meanings, labels?
- [06:25]
C
Yeah, I'll try to be as clear as I can about it. And brief. So it used to be people thought, oh, well, if you're overwhelmed with diabetes or you're crying in your doctor's office or you're upset in any way, the typical thing to say was, oh, you're depressed. And it turns out that's just not true. I mean, we used to think, in fact, I was responsible for some of these studies, that people with diabetes, type 1 or type 2, maybe 40% of them, were suffering from significant depression. Turns out that wasn't even remotely true. We were just using the wrong ways to try to assess depression. And depression is really about. I mean, there's a biological side of depression, but there's a psychological or cognitive side of depression. And depression is about feeling powerless. And everyone understands this. It's when something bad's going on in your life and you feel like there's nothing you can do about it. And that's the sort of kernel around which people can get significantly depressed. But what was happening to all the people I was meeting was, well, sometimes depression, but not that often is they were feeling powerless and overwhelmed about diabetes. And we called that, initially we were calling that diabetes distress. Where. And again, you already mentioned some of these things. Feeling hopeless, that I'm doomed by this disease, or despite my best efforts, these glucose levels go up, down and sideways, or. Well, I mean, we can. We'll probably come up with thousands of examples we can talk about. But we realized that this was really the core of what was going on. And diabetes distress is again, about feeling powerless, but not about everything. It's about diabetes. And that distinction is very, very important because you don't try and help someone with diabetes distress by giving them an antidepressant medication that accomplishes nothing, or sending them to a counselor who knows about depression, that's not going to help either. This is someone who is wrestling with depression, wrestling with their diabetes. And we have to have ways to, as we've developed over the course of years, ways of addressing that. I'm going to say one more thing, but we started by talking about diabetes burnout. I wrote a whole book about diabetes burnout.
- [08:33]
A
What was the name of that book?
- [08:34]
C
I think it was called Diabetes Burnout.
- [08:36]
B
Actually what to do when you can't take it anymore.
- [08:39]
C
Thank you. That's right, the subtitle.
- [08:41]
B
Yeah.
- [08:42]
C
And Diabetes burnout is sort of the end of the road for diabetes distress. It's when diabetes distress gets so bad and so high and you're so fed up and overwhelmed that you disengage from diabetes. I've seen you, Jeremy, use a particular phrase to describe that that I don't know if I should repeat on this podcast, so I won't. But it's just when you say, I've had enough, I'm out of here. It's really when you say that's I'm not going to participate anymore. And so people say, I'm going to stop. And it can get extreme. I'm not going to bother checking my glucose. I'm going to rip off my cgm. I'm going to drown my pump in a bathtub. I'm not going to bother seeing my healthcare providers anymore. I'm going to keep diabetes pretty quiet for everybody else, and I'm going to do my best not to think about it at all. So that's sort of the extreme end. And that's what we think about, is you're disengaged. That's really diabetes burnout. And that's scary for folks because odds are good you're going to. Bad things are gonna happen.
- [09:38]
B
You know, like anything else, I think I get the impression there's a continuum. You know, there's people who diabetes never bothered them one minute in their life, and then people who totally disengage, and then there's all in between, you know, And Jeremy always says the word angry. And I've. We've talked about this. I don't get angry. You know, I get frustrated. I get frustrated is probably the best word.
- [10:00]
A
That's another term for anger, in my opinion. I don't know. Maybe you're just in denial. You should go see Bill.
- [10:08]
B
But what I was just gonna finish saying is that we all have our own emotional issues. With diabetes, and some of us handle it better than others. I'm not saying that's me, but there's a wide range. And then I've heard you speak many times on people who have hypoglycemia, fear syndrome, and then, you know, their blood sugars are A1, C is 12, and you can't get them down. So there's a whole bunch of issues within the area of diabetes that I've heard you speak about. And I'm sure every person with diabetes listening is thinking about their own situation right now.
- [10:43]
C
Yeah.
- [10:43]
A
Well, let me ask you, Bill. So it sounds like if I'm understanding this diabetes distress can lead to diabetes burnout and, like, the extreme situation. And then over in kind of a separate column is clinical depression that we use antidepressants for. And they're very separate. So then if I'm listening, I'm wondering, how do I know when my usual frustrations are tipping over into distress or potentially burnout? When do I need to be concerned? Or what are the signs and symptoms, I suppose, huh?
- [11:17]
C
Well, it may be hard for me to answer that, and I'll tell you why. It. Our best evidence suggests that problematic diabetes distress, elevated levels of diabetes distress occur in maybe three quarters of people with type 1 and type 2 diabetes. And what that means is if you aren't going through time, if you aren't going through what you guys are talking about, if you aren't getting frustrated and upset and overwhelmed and aggravated, you get mad, too. Yeah. I mean, if you don't have that. Actually, that's weird. It's normal to be annoyed for all the things, Jeremy, that you talked about. Right. You know, diabetes is a job you didn't volunteer for. There's no pay, there's no vacations. You get to do it forever. And that degree of attention you have to pay, where it can be really frustrating, too, can get to everybody. I always like to say that. If you. I can say this. For me, I think this is true for most of the healthcare providers I know. If you ask the next 20 patients you see, Mrs. Smith's, nice to see you. Can you tell me one thing about diabetes that's driving you crazy? You're never gonna meet anybody who's gonna go, yeah, yeah, no, it's all good. Really can't think of a thing. So it's there to some degree for everybody. I think I lost my train of thought in terms of trying to answer.
- [12:40]
A
Your question, though, or just any advice of what you would give somebody of when this is becoming more than the typical amount or concerning that they should maybe seek help.
- [12:52]
C
You know, that's tough. I always worry about recommending people seek help because as you mentioned in the beginning, there's not a lot of people who do the kind of work that we do at the Behavioral Diabetes Institute. There just aren't a lot of people around the country. There are some, and there's a way I want to recommend people can find those folks, but it's not as common as you might think. And the most important thing is what you guys do for each other. So when people find themselves annoyed and aggravated, we find the most useful thing is don't do this alone. You know, if you can have there's someone in your life who is rooting for you, whether that means a good friend, someone who gets it, finding a support group online or in person. I mean, just someone who you can sort of let down your hair with and say, you know what? Today, diabetes profoundly sucks. Let me tell you why. And just sort of normalizing that by having someone to talk to is by far the most important thing.
- [13:52]
B
I was just gonna mention that for all the years we did face to face conferences and both of you were there so many times, you know, it was like a gathering of people living with the same condition, you know, and even our yearly face to face in San Diego called one at Paradise Point. I mean, it's an amazing event. I think it's. It addresses what you're just saying, Bill. It's other people that can empathize with your problems because they experience it themselves.
- [14:19]
A
You know, and I'm thinking too that, yeah, Steve and I have done all these challenge videos, like, you know, can we eat three pieces of pizza and stained range or three donuts or whatever. And generally it doesn't go well for us. And people love that. The exercise video, when things just go to hell. And it's not us like trying, we're actually trying quite hard to stay in range and things go out of whack. And it's not that people are hoping ill will on Steve and I, it's just that it happens to all of us, including endocrinologists and people that have spent their lives kind of dealing with this. So, yes, that connection, I always say when you see somebody out in the wild with a pump on that you don't know there's an immediate kind of connection there. And just, you know, that they get it. But let me ask you something else, Bill. So are there factors that make somebody more prone to developing diabetes distress? Burnout is it worse if you have type one or two. Is it older, younger, Is it certain ethnic groups, jobs, anything that you would see as kind of red flags that somebody might be at risk for this?
- [15:31]
C
Yeah, we've looked at that and we haven't really seen anything. I mean, it's probably true that you're going to see higher levels of diabetes distress and probably diabetes burnout in people with type 1 versus type 2. Probably it's going to attract younger rather than older, but all the data we've seen, nothing really has stood out, actually, which means it can affect just about everybody.
- [15:58]
A
I guess there's good news and bad news in that, right? It can't affect anybody, but. Yeah, well, I would.
- [16:03]
B
I would if I had to guess us type ones. We have a lot more stuff to worry about. We got technology we can get. We can go into ketoacidosis much more easily if your pump line comes out. And I think there's a lot more variability. But type 2s, on the other hand, there's a lot of shame and, you know, prejudice towards their weight and, you know, they cause diabetes themselves. So everyone has their own areas that cause some mental stress. You know, especially, let's say you're overweight. Type 2, it runs in the genes. You got central obesity and your family just stares down everything you eat. And so that's a whole different issue.
- [16:43]
C
Yeah. And when we've done studies and looked at what contributes to people's diabetes distress, you really see different things for people with type one and type two. I mean, there's some important overlaps. But you're right, the shaming and blaming, much more common for folks with type 2. Hey, by the way, I want to go back and answer one of your questions differently or not differently, better. Because you were saying, well, how do you know if it's a sizable enough problem that maybe I should seek help? I forget that I can actually make a very clear recommendation. So we have a website now called diabetesdistress.org diabetesdistress.org and you can go there and fill out one of our diabetes distress questionnaires.
- [17:29]
B
That's me, Jeremy.
- [17:30]
A
Okay. That's Steve's CGM going on.
- [17:32]
B
Sorry, Bill. Diabetesdistress.org Sorry.
- [17:35]
A
Blood sugar just all over the place. He's a nightmare.
- [17:38]
B
Those makes me so mad.
- [17:42]
C
It's perfect example. Anyway, so on diabetestress.org, you can. It's easy to fill out one of the diabetes distress questionnaires that's appropriate for you, and you'll. The site will Guide you to where you need to go, and it'll automatically score it for you and tell you whether your. Whether your level of distress is significant or not, and see if that fits for your experience. It's completely anonymous. None of the data gets saved, so you can go and play with it multiple times if you want and see if there's anything there that really strikes you. But it's a good way to. To get a sense. Is, wow, am I. Am I. Is what I'm experiencing really problematic?
- [18:21]
A
Yeah, we should take it after this. Yeah, I can be. You.
- [18:25]
B
You mentioned that you're gonna give people an idea of how to find someone. I know. Since you're talking about websites, is this the same sort of website or is that different?
- [18:33]
C
Well, it's a different website. I mean, what's really nice is that the American Diabetes association, in collaboration with the American Psychological association, has put together a mental health registry. And so if people are interested, you could just go to Google and put in American Diabetes association and Mental Health Registry, or go to the ADA's website, diabetes.org and in the mental health registry section, you could just put in your zip code and something about whether you're adult or a kid, I think. And it'll tell you within the area around you who are there, knowledgeable psychologists who are diabetes knowledgeable, that is in your area who might be able to be of assistance, which is nice. I'm really excited about that registry.
- [19:17]
A
Yeah, that's a great resource. Because it can be very difficult to find a bill or anybody that does what you do. So I want to start shifting towards what you do and how people might get better. And so I'm thinking about all the different people I've sent to you, and they generally have very specific issues at times. There's the patients that are fearful of hyperglycemia, so they want to be low all the time. They have an A1C of 5.5. There's the opposite, like you said, Steve. The people that I've had severe lows, and now they don't want to be anywhere south of 200. But I think for the purposes of this podcast, it's the patients that I see a lot that are coming to see me. Their A1Cs are elevated, but it's clear, like you said, that they're doing enough to kind of keep an eye on things, but it becomes overwhelming, and they can kind of shut down, and they're just so kind of burnt out with their disease with type one or type two that they kind of ignore it.
- [20:15]
C
But.
- [20:15]
A
But they still pay attention to it, and it still pisses them off. So it's this unfortunate place for people to be. So when someone comes to see you and you evaluate them, determine that they have a high level of diabetes distress or burnout, or however you call it, where do you start? What do you start working on with them?
- [20:34]
C
I start with my single question, and usually they filled out the Diabetes Distress Questionnaire, so we can use that. But I start with my question, which is, tell me about what's driving you crazy about diabetes.
- [20:46]
A
You set a timer for two hours or what?
- [20:49]
B
I think the difference between you and many other physicians is after you ask that question, you just listen, and there's a period of quiet time where you let them come out. And I would imagine more and more people open up to you in clinic. You know, we really don't have a lot of time. And I would say for me, six out of eight patients I refer to you do not call you. You know, And I know you'll talk about that.
- [21:16]
A
Yeah, maybe at the end, how to get people over that hump. But so, okay, so they open up about whatever's bothering them. And I bet you have categories in your mind of kind of where these things, like, fit into. And so, yeah, how do you do that assessment? And how do you come up with, I guess, a treatment plan?
- [21:33]
C
So one of the first things we do is talk about how what they're experiencing is normal. And that's the first thing that really surprises folks. Right? And it's like what you talk about, we used to have the giant tcoid events is what happens at the one event when you're with 500 or a thousand other people who you can complain with. It's enormous, right? You go, oh, my God. It's not just me who goes through times like this. It's fantastic. So finding ways to let people know how normal they are and do what you guys do so well to laugh with them. One of the things we do, by the way, is we show them your videos. I love showing them your pizza video or the exercise video. Let them know those kinds of aggravations are common. Trying to be perfect is impossible. All those things I can tell you, for most people, we start with two important pieces of information that we'll talk about. And one is about hopelessness. And you've heard me talk about this a million times. People are really surprised when you let them know that what we now understand in the 21st century, that with good effort and care, odds are pretty good. You could Live a long and healthy life with diabetes. And we're seeing that every day. We're overwhelmed with people who've had type one for more than 50 years now. Right. Those damn people with diabetes, they just go on and on and on.
- [22:50]
B
Right.
- [22:50]
C
I'm talking about type ones, of course, but, you know, people are doing or can do very well still. Horrible, tragic things happen to folks. But with good care and effort, we know that people can really benefit. And it's. I mean, you guys see this every day, but you'd be shocked, I think, to realize how rare that is that people actually ever hear that from anybody else. What they hear is the opposite. Now, if you don't listen to what I tell you and start behaving, let me tell you, all the bad things are going to happen to you. Sounds like it's the same thing, but it's not. So what we call this idea of evidence based hope is such an enormous relief for so many people. So we almost always start with that and we'll talk about that. It can take some time to convince people that's maybe possible for them.
- [23:36]
A
Yeah, well. And you know something that we talk about, Steve and I too, and try to relay to our patients, but we just don't have that much time. Sometimes I find that patients think that success in diabetes is binary. They're either good or bad. Your A1C is either less than 7 or it's not. And if it's not, you're going to die. And if it is, then you're a good person. For me, when I do have the time explaining to people that if your A1C is at 12, just getting it to 11 has massive benefits, or 10 to 9, or whatever it is, and every step away along the way is giving you benefit. And it's never too late. I think another thing that I hear a lot is, well, gosh, when I was first diagnosed for the first X number of years, 5 years, 10 years, I ignored it and I just, I know that my eyes are shot. So what's the point now? So do you deal with these same things or have these same conversations or.
- [24:33]
C
Yeah, well, you bring up two very important points, and as a second one, I usually get to very quickly, which is that, well, the way we say it is, you can't be perfect with your diabetes and you don't have to. Right. When we see people who are doing well, living long and healthy lives with diabetes, we know that, first of all, your A1C is not everything.
- [24:55]
B
Right?
- [24:56]
C
So we know that for many folks, blood Pressure, lipids and genetics are going to play a huge role. But, you know, there is a reason why there's this international consensus that says if you're wearing a CGM, if you. If you can reach 70% time in range, you're golden. Huh. That's funny. Not 100%, 70%.
- [25:13]
B
Yeah.
- [25:13]
C
And I think it was. I think you did an interview with Pratik Chowdhury once who said it so well. He says if you're 70% time in range, you're out of range six hours a day, and you're still gonna do really well. And people are blown away by that. So the message, Jeremy, that you're trying to give your patients, I completely agree with. And it really is such a weird idea for folks who have been propagandized for so many years about either you're good or bad that it's really hard to help people be convinced that maybe you're doing fine.
- [25:46]
A
Well, I say it a different way. It doesn't go over that well sometimes. I say the only time your blood sugar is completely flat is when you're dead. And otherwise everybody has some variability. Even people without diabetes are going up and down. So this idea of perfection is. It's just gonna make people go crazy and make them disengage.
- [26:06]
B
Once you say the word dead, they're not.
- [26:08]
A
Nobody ever laughs. But I keep saying it.
- [26:10]
B
What's my famous slide of the guards at Buckingham palace that stand perfectly still.
- [26:17]
A
That'S the only way to control your blood sugar is to stand perfectly still.
- [26:21]
B
Stand, don't eat a thing.
- [26:23]
C
But I do remember, I've seen another way that can happen, actually, and it's because I've been on these as you have, Jeremy. I've been on these international flights with Steve, and somewhere high over the Atlantic, he'll say, oh, my God, my blood sugars are freaking unbelievably flat. It's incredible. And he goes, I figured out the secret. Never move, never eat. This works amazingly well. I should just do this all the time.
- [26:46]
B
Well, you've been on enough bike rides with me to see awesome days and just horrendous, frustrating days that actually made me mad when my Omnipod came off. He's. He's working on me. You know what? It's. Yeah. And, Jeremy, you know what this reminds me of? When we were doing more videos and lecturing, we would show the data that showed that people with diabetes are living just as long as people without diabetes. And there's plenty of good data to show that, you know, in Your famous Sir William Osler quote, the way to live a long and healthy life is get a chronic disease and take care of it. That is so true.
- [27:27]
A
Now, Bill, this wasn't one of my written down questions. I'm going off script here, but how do you involve partners, family members or not? Do you have them come to these meetings with you? I mean, obviously, that's such an important part of this. So how do you engage on that?
- [27:44]
C
Well, I'll tell you the truth, I don't make that decision for them. But in my experience, when people do bring a partner with them, that's wonderful. And it's either wonderful because there's already a great relationship going on, and it doesn't take much to simply. Well, usually my typical question is, how do you want your partner to be involved? You may want them to stop bugging you. The problem we call the diabetes police. But odds are pretty good they're bugging you because they care about you. So what do you need? What's the way in which they can really support you and help you? And if you can help that relationship do better and do well, that can be an extraordinary advantage. But I don't usually insist people bring a partner or spouse. I just say it's up to you. And it can be really helpful if you'd like. And in general, it's extremely helpful. Sometimes we gotta work out stuff, sometimes not.
- [28:32]
B
What a great answer. It's a good question, too.
- [28:36]
A
Yeah. I mean, we've done the Diabetes Newlywed game where we have couples come and they answer questions and they're generally kind of amazed how the other person answers, because I think we found that, let's just call it. Couples usually don't talk about diabetes unless it's like a code red. My blood sugar's low. Get me something. And you never care about me or my diabetes. But there's never a calm moment of, yeah, how would you like me to help you? How can I help? Or these things that I'm doing, are they helpful or not? Rather than what usually comes out as just nagging. Even though it does come from a place of love, it's freaking annoying. So how to address it?
- [29:15]
C
Well, you know, one of the things I think you guys have addressed as well, and I always think of it as a dirty little secret about diabetes that people who don't have diabetes don't recognize, is that, you know, sure, you'd like to live a long and healthy life, and you'd like to think about diabetes as little as humanly possible. So I don't really want to talk about it with anybody in my family, and I don't want to go see pulanscaring anybody else, because what I'd really rather do is just not be bothered and not think about it. But if I could do that and be successful, that'd be great. And what people deal with, you guys are dealing with all the time, is how do you find the balance between those things?
- [29:53]
A
Well, I want to kind of leave people with more specifics on kind of what to do. So you mentioned the ADA website, which would be a great place for them to find a therapist in their area. Maybe somebody's not ready to kind of, like, make that commitment yet. Are there books, are there online resources? Are there groups that you recommend? Anything else that you. Resources for people?
- [30:19]
C
Sure. Well, there's resources on our website. For example, this is behavioraldiabetes.org, behavioraldiabetes.org, and we have a bunch of things that we've tried to, as you guys have done, to try to make find things that are useful but still fun. So the thing we're probably most known about is a little accordion card you're familiar with called the Diabetes Etiquette Card, which is for people who don't have diabetes. So the idea is that if you're having an aggravation with your partner or someone, a coworker, instead of having just to punch them out or scream at them, you could just politely say, oh, you must not know the rules about how to behave, and simply hand them the 10 items Diabetes etiquette Card and talk about it. And each of them, each of the issues of the 10 issues, are supposed to be at least a little bit funny because they're designed to open a conversation.
- [31:13]
A
Give an example. One's like, don't freak out or lose your mind when my blood sugar's low, or something like that.
- [31:18]
B
Oh, yeah, My grandmother died of diabetes. So glad you told me.
- [31:22]
A
Don't tell me about your dead relative.
- [31:24]
C
You guys know it. Well, I can tell you, number one is don't offer unsolicited advice about my eating or any other aspect of my diabetes. It's not nice.
- [31:32]
A
Yeah, I mean, that is such. That's great. And if nothing else, maybe like a conversation starter, even for partners or things like that. So that is a fun resource.
- [31:41]
B
I think you just answered partly the last question. Create a conversation with someone that you care about or someone that cares about you, and it's all about communication. I've learned that from. From you through the years, and I Think that is therapy in and of itself, and I love that. Diabetesdistress.org, i'm gonna take that test. I'm gonna be under mad, sad, glad, or afraid for one of those.
- [32:05]
A
Is there a way to win?
- [32:06]
C
Can I beat Steve?
- [32:07]
B
That's all I care about. Yeah. Yeah.
- [32:09]
A
All right, well, those are some good resources. So then maybe actually the thing to leave people with is what do you see when people start getting better? Like, what are some things that improve? Obviously, you would hope that they're. Their diabetes management improves, but you'd have to imagine people start, their anxiety levels come down, they start sleeping better, they look better. I don't know what happens.
- [32:30]
C
Well, number one, they're going to score lower on the diabetes distress scale. And so if you give them a list of 15 things that can drive them crazy, and on each of those you're going to rate how big of a problem for you, they're going to start scoring that lower. We do see, not always. If that affects how engaged you are with your diabetes, then all sorts of things may change. That's when it really might affect your sleep. That's when it's really going to affect your overall well being. And we know, especially for people who are profoundly distressed, really burned out, that's how we know things are moving for them. When they're willing to make positive changes, when they're willing not just feeling better, but acting differently. Saying, you know, maybe seeing my doctor on a regular basis doesn't have to be such a terrible thing. I don't have to feel like he's going to judge me or shame me, or maybe I need to find another doctor, or maybe taking my medication on a more regular basis can really make a difference. Or maybe eating in a more healthful manner doesn't have to be. I don't have to think about it as just eating bird seed and cardboard, but it actually could be kind of fun experimenting. So engaging more towards trying to live a longer and healthier life is really what we see happening for folks just being willing to make first steps.
- [33:44]
A
Well, my concluding thoughts, Steve, and you can chime in here, is just, you know, it's been helpful. We know this, but to hear that this is common, that this is something that pretty much everybody with diabetes goes through and it is something that we have to deal with that most people don't. So there really is kind of some sympathy there, but that there is help. There are just ways to kind of improve this. And we all want to engage with our diabetes to live a long and healthy life. So also hearing that when we do that, guess what, you can live a long and healthy life and it's never too late to engage with your diabetes.
- [34:17]
C
And you can feel a lot better.
- [34:20]
A
And look sexier is what I heard you say earlier too, of course. Steve.
- [34:24]
B
Well, not much to add. Jeremy, you said it so well. I think self recognition, if diabetes is really causing you some mental angst is important. Talking to people, talking to a professional like Dr. William Polonsky is the key. I would just urge people not to ignore their feelings and seek help, seek guidance, seek communication and see if you can overcome some of the things that are really bothering you.
- [34:52]
A
Yeah. Well, with that, thank you everybody for listening. Thank you Bill, so much for joining us. It's always great having you and we very much look forward to seeing or hearing you hearing from us on the next podcast. Be sure to like subscribe, follow, check out our YouTube channel, online, our newsletter, all that stuff and hope you have a great rest of your day. Bye bye.
- [35:29]
C
SA.