Diabetic Burnout
Been there, doesn't work!
Remember that YMMV (your mileage may vary) concept we stress so much? Well it applies here too.
Some people follow the classic 5 stages pathway, either on their own or with the aid of professional help, and do finally reach acceptance but there are others for whom this does not appear to work.
There are people out there beating themselves up because they just cannot seem to reach the stage of acceptance and I can totally empathise with them as I was/am (the jury is still out on that one) amongst their number.
If you are now asking yourself whether you should continue reading an article by someone who hasn't got it right for themselves yet, remember that I never said I had all the answers, just that I wanted to share with you the information about emotions and coping mechanisms I had gleaned, from the experiences of myself and others, in the hope that they would be of some small help.
Good as the five stages are, I have come to the personal conclusion that they were originally conceived for terminally ill patients and, callous though this may sound, these patients have a finite time in which they have to deal with their disease and know that nothing they do is going to change the end result.
Having diabetes is somewhat different.
Yeah, we are all going to die sometime, that happens at some stage to every living thing on earth, but what we do and how we choose to deal with the disease does affect our 'end point'.
I was scratching my head (also stamping my feet and crying bucket loads) trying to find out why I and others felt the way we did when a phrase in an article jumped out at me - DIABETIC BURNOUT. This was what has been termed an 'aha moment' or, as they say, I heard the penny drop.
We hear a lot about burnout, but tend to associate it with over-stressed people in the workplace. Though this group certainly do suffer from burnout they are by no means the only ones.
Burnout can be experienced by anyone, in any walk of life, with the right personality traits and under the right set of circumstances.
The man who originally came up with the term 'burnout' was a New York psychologist, Herbert J. Freudenberger, PhD, and if you look at his definition you will understand why this concept impressed me so much.
He said burnout was "A state of fatigue or frustration brought about by devotion to a cause, way of life, or relationship that failed to produce the expected reward."
How many of you reading this are yourselves, or know someone who is, fatigued and frustrated by the endless daily devotion to the diabetic way of life which gives you so little in the way of reward? Makes you think doesn't it?
There is yet another definition, just as thought provoking, that one finds if you read a book 'Career Burnout: Causes and Cures by Ayala Malakh-Pines & Elliott Aronson.
They claim burnout is "A state of physical, emotional and mental exhaustion caused by long term involvement in emotionally demanding situations."
If you are thinking "Yes, yes, yes" or "But they are describing me to a T" then you are very probably suffering from diabetic burnout. Welcome to the club.
Do all diabetics get burnout?
No, certainly not. Remember I said it required a particular type of personality and the right circumstances.
This has been found to apply to non-diabetics when dealing with career burnout and I suspect is just as valid for us.
Do any, or all, of the following fit you?
1. You are often called a perfectionist. You may admit to this, or feel that it is a bit extreme, but you do like things to be 'just so' and are pretty highly motivated to get them that way.
2. You feel a deep need to succeed in everything you do, you are highly committed to that goal and if you do not achieve that success you feel inadequate and see yourself as a failure.
3. You need to have control over all aspects of your life. You want to make the choices, not have situations thrust upon you.
4. You find change, with it's related unpredictability, stressful.
5. You have extremely high personal expectations and tend to be very critical of yourself if you do not meet your own standards.
6. You have a tendency to take things personally.
Though by no means all, these are some of the main personality traits of the person likely to suffer from burnout.
They set unrealistic goals for themselves and go into meltdown when they cannot meet them.
A person who is able to accept that it is okay to fail occasionally without beating themselves up about it, who can look at unwanted results and shrug them off with a laugh or a cynical comment is not going to get burnout.
Knowing the tendency of folk who fit the above criteria (and I have to admit to being such a one) to see themselves as 'bad' or 'wrong' I want to say here that there is no such thing as a 'bad' or 'wrong' personality.
We are, thankfully, all different and the world needs that diversification. While you may now be wishing for a calm, accepting nature remember that there is a calm accepting person out there longing for your drive and motivation.
We are seldom happy with what we have. Think about it - go into any electrical appliance shop and look at the shelves. You are sure to see the very latest in hair straightening tongs sitting right next to the very latest in heated hair curlers - get my point?!
What is it about diabetes that causes burnout?
We hear again and again the term 'chronic' in association with diabetes but most of the time we do not really take on board what that means.
Chronic means 'something that persists for a long time'.
Therein lies the problem. We cannot just take a pill and get better.
Diabetes is an endless daily grind of hard work with unpredictable results and little satisfaction.
"But many folk have that sort of repeated boring grind in their daily job" you might say. "What about the woman who stays at home and takes care of the kids and house. The food she cooks is soon eaten and more food will have to be made tomorrow, while that spotless floor never stays that way and will soon need to washed again. Why does she not suffer from burnout?".
Good question -
The answer lies in what she gets back for her hard work.
It is amazing just how much one can cope with if one sees some reward for ones efforts.
That reward can be from such things as good results, a feeling of satisfaction at a job well done, commendation or appreciation from those around one etc.
If the housewife sees people enjoying the food she has prepared she gets the reward of appreciation, while a gleaming floor is a source of satisfaction in itself. And remember that the reward is more or less instant, unlike that in diabetes.
We are conditioned to the equation:-
Following the correct procedures = Good end results.
So taking that into account our equation should look like this:-
Eat right, exercise right, take meds, check BG = Consistently good BG results.
Diabetes just doesn't seem able to do the maths.
For most of us, no matter how hard we follow this tedious and restricting daily regime our BG readings refuse to fall into line.
We get days of perfection when we think "Hey, I've got it right at last" and then bam!!!, they soar off the top for no reason that we can find. When this takes place week after week, year after year, burnout can occur.
Burnout does not have a time limit, it can occur a few months after diagnosis or years later.
It is prevalent in Type 1 diabetic teenagers who have been fighting this disease from early childhood.
I cannot even imagine what it must be like to have done so and take my hat off to any who come through without some form of depression or burnout.
How do I know if I am suffering from diabetic burnout?
For once the answer is very simple -
Are you so sick and tired of being a diabetic and having to manage your disease that you have lost the motivation to do so and have just given up?
If the answer is yes then you are already suffering from burnout.
However if you have not quite got to the stage of no longer managing your diabetes but have any of the symptoms listed below you are well on the way to burnout and need help.
1. Are you frustration and anger at poor results despite all your efforts?
2. Are you worn down with the day to day management of your disease?
3. Were you highly committed but now have lost all motivation?
4. Are you depressed - does life seem to have lost all meaning?
Lets explore these feelings a little further.
We are exhausted from all our efforts.
To the outsider it may seem a simple thing to keep up a diabetic regime but it dashed well isn't and with no visible good results to keep us feeling 'chirpy' we become physically, mentally and emotionally drained. We tend to let things 'slip' as we are too tired to be bothered to do such a difficult regime for so few results.
The feelings of helplessness and frustration don't do anything to improve this either. There just seems to be no way out of ones situation. We often feel weepy or just apathetic and what I call the 'I can't' gremlin takes up residence in ones mind.
You have probably met him - he is a really negative little chap and causes thought of "I can't take this any more; I can't drum up enough energy to care anymore; I can't stand this anymore; I can't think straight; I can't, I can't, I can't......And don't let anyone, on pain of death, tell you there is no such word as "Can't".
We've become disillusioned. We have done our level best and what reward have we got - nada, zilch, nothing! We have put more concentration and effort into this one area than into anything before yet all our best efforts appear worthless - how can one help but feel bitter about that?
Along with the disillusionment come feelings of resentment and anger, anger against our bodies, the medical profession, God or the world in general, in fact anyone or anything who we can blame for our situation.
The danger here is that we now get to the 'Don't care, to much trouble, will never work' stage and we decide to just ignore the disease and stop all routine care.
We may even go into total denial, convincing ourselves that in actual fact we do not have a disease at all.
There are folk out there who are so exhausted and disillusioned that they have bought into a story that goes around periodically - this is the tale of a conspiracy between the drug companies and the doctors. They are supposed to have created this mythical disease called diabetes so as to make more money on visits and medications.
If the 'burnt out' diabetic can believe that, it absolves them from any responsibility or feelings of guilt in the scrapping of their diabetic management - after all, they cannot have a disease that does not exist!
We would all like to have some reason for doing exactly as we please although we know only to well we shouldn't and this is as good as any.
It is possible that they are making a fortune out of our misfortune but I feel they are going to make a darn sight more out of kidney dialysis, amputations and triple bypasses if we do not take control of our disease now so as to prevent these!
If you think belief in this conspiracy theory sounds a tad crazy then think of the weird things you sometimes do when you are very tired. Exhaustion leads to a sort of mental fatigue where you just cannot think straight.
Even pre-diabetes days, after 36 hours with no sleep, I remember searching the kitchen for the kettle which I had, with grievous intent, placed in the fridge. Well, it seemed logical at the time!
We can also become increasingly irritable with those around us. I always felt rather sorry for Pinocchio, having Jiminy Cricket always sitting on his shoulder acting as his conscience and that is often how we view the folk around us when we are on the way to diabetic burnout, and sometimes not without reason.
I appreciate how frightening it must be to family and friends to see us toss all, or part, of our diabetic regime in the trashcan but constantly acting as our conscience is not going to help. It may well turn a mild problem into a major one.
Remember how I said earlier that one of the personality traits in someone possibly subject to burnout was the desire to have control over their own lives, to make their own choices?
If those around you are constantly trying to 'supervise' you then you get the feeling that they think you are incapable.
Resentment builds, you feel they are trying to take control of your life and are treating you like a child or a congenital idiot.
What may have been just 'a few days off to recoup' may become a serious issue in a risky 'tit for tat' retaliation against this.
On the opposite end of the spectrum from this overdose of care are the diabetics who feel no-one cares or truly understands what living with diabetes is like. They feel lonely and isolated and due to lack of support or encouragement stop managing their diabetes.
This can occur in diabetics who truly have no family or friends nearby but it can also occur in diabetics living within a family circle if the people concerned have not taken the time to educate themselves about the complexities of managing diabetes and feel the diabetic is making a big fuss about nothing.
So where do you go from here?
You must feel I have told you a lot about what to expect but nothing about what to do about it, and you would be right.
Remember at the very beginning of this article I said "I am not a doctor, even less am I a psychiatrist, psychologist or even a councillor" and it would be remiss of me to assume to advise you on how to treat the psychological aspects of this disease.
If you are suffering from emotional problems connected to your diabetes the first thing you should do is consult with your doctor, diabetic nurse or whoever you deal with in connection with your disease.
Although I try very hard on this website not to appear as an advert for a particular product there are some instances when it is difficult not to do so. In this instance there is such a product.
When I considered trying to write some advice for you as to what to do about burnout I realised that everything I wanted to say came from this product and my trying to replicate it would be plagiarism (for the uninformed that means taking the work and ideas of someone else and passing them off as your own).
It is a book, written by William H Polonsky, PhD, CDE. The book is entitled 'Diabetes Burnout - What to Do When You Can't Take It Anymore'.
This book came into my life at just the right time and was, and still is, or tremendous help.
So much so that I am breaking my self imposed rule and suggesting that anyone who feels they or a loved one is on the way to diabetic burnout buys this book as soon as possible.
It is easy to read, humorous in places and, best of all, offers practical solutions.