Melanie Cole, MS (Host): Welcome to Bryan Health Podcast. I'm Melanie Cole and joining me today to tell us about diabetes distress is Annalisa Briggs. She's an outpatient diabetes educator with Bryan Diabetes Center. Annalisa, thank you so much for joining us today. I'd like you to tell us a little bit about what you do for Bryan and your experience with diabetes and specifically diabetes distress.

Annalisa Briggs, BSN, RN, CDCES: Well, thank you so much for having me, Melanie. I feel very privileged to be here today. So, I'm a registered nurse and a certified diabetes care and education specialist working with Bryan Diabetes Center. And I've been working with people with diabetes off and on since 2018. I also have several family members with Type 2 diabetes. So this is a very personal topic for me as well.

Host: Well, then since our topic is diabetes distress, tell us what that is.

Annalisa Briggs, BSN, RN, CDCES: Yes. Thanks for asking. Diabetes distress is not a new thing, but there are a lot of new things about it that have been learned in the last few decades about how we can help with distress.

And I think the first thing that people need to know is that diabetes distress is normal. It is common and expected. And so when we're talking about what diabetes distress is, it's the hard or tough emotions that come from the experience of living with and managing a complex chronic condition like diabetes.

It can be the burdens, worries, concerns, fears, and even threats associated with living with diabetes. And it's this like invisible burden that constantly managing diabetes is, on top of all the work of just being a human being. diabetes never takes a vacation. It never stops.

We used to think of diabetes distress as something that happens if diabetes isn't well managed, but actually this can happen no matter the results of your diabetes tests and goals. And it should be expected for people with diabetes to experience distress related to their diagnosis of diabetes and their relationship with diabetes throughout their life.

But how bothersome some of those feelings are varies over time. So it can be more bothersome at different times of life and more distressing at some times than others.

So times when diabetes distress may be higher for some is if you're first diagnosed with diabetes, it can be quite overwhelming. Or when you're experiencing a stressful time in your life or a life transition, graduating from high school or retirement or adding a new baby to your life. If you develop a diabetes complication or another health care problem that also complicates your diabetes, or when your diabetes care routine is changing, you know, new medications or new technology, or when you're changing health care providers; these can all be times when distress may be higher.

Host: So I'd like you to speak about some of the specific symptoms.

Annalisa Briggs, BSN, RN, CDCES: The symptoms may not be super specific where it's like if I have these symptoms, I know I have diabetes distress; because everybody's diabetes distress is unique. They have their own fingerprint for what it is about their diabetes or what's going on with their diabetes that causes this distress.

 Older studies showed that a lot of people with diabetes were at a two to three times higher risk for depression than people without diabetes. But we found that that's just not true, and that's good news. But as we've been investigating more about diabetes distress and the emotions that are expected to happen when we have diabetes, concern, fear, anxiety, stress, feeling overwhelmed, feeling fatigued; we're discovering that some of the screening tools for depression were actually picking up diabetes distress. It's really important to have depression assessed and, if it's there, addressed.

And so your doctor or your mental health professional can screen for depression, but they'll do a clinical interview to evaluate and determine if you actually have a diagnosis of depression. And that's really important. The biggest difference is depression is more widespread through your life than diabetes distress.

Feelings of overwhelming sadness, loss of interest in things that usually bring you pleasure, and feelings of hopelessness regarding all areas of life, and depression is serious, and if you're feeling this way, it's important to talk to your doctor or medical provider right away. But diabetes distress is more those same feelings of overwhelmed or maybe even loss of interest in taking care of your diabetes, but it all focuses on diabetes, managing diabetes or your feelings about diabetes. So maybe you're still gaining pleasure from spending time with your family or participating in the hobbies you love, but when you think about your diabetes, that's when the feelings get overwhelming. And so, of course, people with diabetes can have depression and other mental health conditions and have diabetes distress, but it's important to get care from your mental health professional and then address the diabetes distress with your practitioner managing your diabetes.

When we think of burnout, diabetes burnout is a term that we've often used, and it refers to the feelings of diabetes distress affecting your ability to do diabetes self care behaviors, like checking your blood sugar, or taking your medication, or eating healthy, or exercising. And, those kinds of things, when you start to feel so overwhelmed that you're not able to care for yourself regarding your diabetes, or you have that feeling, even if you continue doing those behaviors, you have that feeling of what's the point?

That's where diabetes distress can be leading to that diabetes burnout. And that's where it's just so important to get support.

Host: Well then let's talk about the support and I'd like you to speak about actions people can take because I can see how it'd be easy when you're living with a chronic condition to get burned out or to get that distress and to say, you know what, I just, I can't do this anymore. And I don't want to check my blood glucose anymore.

And I don't want to do all this, but it's so important that they maintain it. So what are some steps, some action steps that people can do to really help themselves? And when should they seek help?

Annalisa Briggs, BSN, RN, CDCES: So when you think about what leads to diabetes distress, it's literally just having diabetes. It doesn't mean something's wrong with you because you're feeling this distress. You know, diabetes is a lot to manage and most people with diabetes are never asked how they're doing emotionally with it all.

And we're trying to change that. We want people living with diabetes to have a support system and for it to be routine to talk about tough feelings and experiences about living with diabetes with their health care providers. Diabetes never takes a break. I can't stress that enough. It's chronic and lifelong.

And so even if it's well managed, that emotional and mental burden can be tough. And so we want to support you. So if you're listening to this and think, this applies to me or my loved one, what do I do? There are a few wonderful resources out there. So I would start by going to diabetesdistress.org. And And you can learn a little about diabetes distress there, read some information about it, or you can take a survey about your own diabetes distress. And there are several surveys available on that website, but I highly recommend taking the diabetes assessment system for whichever type of diabetes you have.

So one is called the T1DDAS, and it's 30 questions, and it's for people living with Type 1 diabetes. The other is called the T2DDAS. And it's 29 questions and is for people living with Type 2 diabetes. And they are available in both English and Spanish. , I would save it and print it and take it to your healthcare provider who helps manage your diabetes to start a discussion about it.

Host: Do you feel in your experience, Annalisa, that it's different if someone has Type 1 or Type 2, because Type 2 can start later in life? It can start certainly teens, twenties, thirties, anytime. Type 1 can start when someone is a child and be a lifelong condition and they kind of grow up with it. Do you see a difference in distress and or burnout when someone is dealing with Type 1 versus Type 2?

Annalisa Briggs, BSN, RN, CDCES: I think any person living with diabetes can and will experience distress in some form. But like you said, the challenges and experiences a person has with diabetes can be different depending on their type or when they were diagnosed or the manner in which they were diagnosed.

I was recently talking to some experts in the field about diabetes distress and, they mentioned often there can be a lot of trauma surrounding a person's diagnosis and how they receive that information and what other acute things are going on with them at that time. So, we consider each person's diabetes distress fingerprint sort of unique to them because their experience of living with diabetes is unique.

And so that's where these diabetes assessment system tests can really help, because they not only score the severity of your distress at the moment, but they also help us see what are some of those problem areas or what categories of dealing with your diabetes are bringing you the most distress.

Host: So speak about preventing it from happening. Is that possible? And briefly tell us, if we notice in a loved one that they are starting to suffer from depression, burnout, diabetes distress, what we can do to help them.

Annalisa Briggs, BSN, RN, CDCES: As with all challenges in life, I think one of the most important things is to build a really good support system and a team. Diabetes, so much of the burden of it falls on the person living with it.

And they deal with it day to day, and that's why it's important to have that support team to be able to go back to and troubleshoot with and share your experiences and feel like you're not in it alone because so much of it can feel very lonely. Also, it's valuable to continue growing your coping strategies for managing stress.

You know, that can really help build your resiliency and ability to bounce back when problems occur and, knowing who to reach out to when you are struggling. And if you're thinking about, how can I help a loved one who's struggling with this? I think three of the biggest things are offering your support, listening, and then helping them talk with a provider, a diabetes care and education specialist about some of this.

 part of it is just to ask your loved one, How are you feeling about your diabetes? So few people are asked that question. It's really important after that to listen without judgment. There's so much stigma and misconceptions about what causes diabetes or how best to manage it out there in society, and so it's really important when somebody opens up and shares their feelings about living with this, to listen and not trying to offer necessarily advice or to tell them whether there's a variety of support systems that you can kind of build from your friends and family to connecting with other people living with diabetes.

your health care providers or support groups in your community or online, and of course, your diabetes care and education specialist.. If you do get to talk with a provider or diabetes care and education specialist about this, there's actually training that some healthcare providers have received called Diabetes Distress Assist.

And many certified diabetes care and education specialists or other healthcare providers such as our providers here at Complete Endocrinology, have been trained specifically to help a person understand their diabetes distress survey results and take steps to help them with that distress.

Host: This has been such great information. Annalisa, as we wrap up, I'd like you to speak about the services that Bryan offers in terms of Diabetes Distress, offer the listeners your best advice if they are suffering from diabetes distress, or they know someone, they love someone who is,

Annalisa Briggs, BSN, RN, CDCES: one thing that I really want to stress is that it's okay to talk about your feelings with your health care provider who manages your diabetes. You can always ask for a referral to Diabetes Education.

So Bryan Diabetes Center offers comprehensive and tailored diabetes care and education, and we're equipped to help you with your distress. So this does require a referral from your health care provider who's managing your diabetes,

but once a referral is received, our team will reach out to get you scheduled.

There's also two great websites that give a lot of resources and information and one is the one I mentioned before, DiabetesDistress.org, and the other is BehavioralDiabetes.org. And both of these are developed by people who have been working for a long time with people with diabetes and they offer a lot of great tools and information as well as those surveys we talked about.

So I would definitely check out those websites, especially at BehavioralDiabetes.org, they have a lot of resources for family members of people with diabetes. And that can be really helpful in learning how to support and encourage your loved one who's living with diabetes. I just want to end on a note of encouragement for those out there living with diabetes themselves or with loved ones living with diabetes. It's just important to remember that you're not alone and that here at Bryan Diabetes Center we've dedicated our work to empowering people living with diabetes to thrive.

So we're here to support you and even though diabetes can be challenging, you're so much more than your diabetes and we want to equip you with the knowledge, tools, and skills to thrive.

Host: Thank you so much, Annalisa. This was so informative and educational and I can hear the compassion in your voice for people living with diabetes. Thank you so much for joining us. to listen to more podcasts from our experts, please visit bryanhealth.org/podcasts.

Melanie Cole, MS (Host): And Bryan offers several physician clinics that provide comprehensive diabetes care for patients. At these clinics, patients receive coordinated care important to diabetes management that includes their provider as well as certified diabetes educators, registered dieticians, social workers, care navigators, and pharmacists.

To learn more, please visit bryanhealth. org slash diabetes. And that concludes this episode of Bryan Health Podcast. Please always remember to subscribe, rate, and review Bryan Health Podcast on Apple Podcasts, Spotify, iHeart, and Pandora. I'm Melanie Cole.