For the past several months, I’ve had a (yet another) case of diabetes burnout. It’s been a semi-constant itch that I ignored and tried not to scratch for a while, but eventually it became unavoidable.
This is probably a byproduct of dealing with diabetes on both the personal and professional front. To me, the balance is always a challenge. When I’m at the top of my game professionally, my own D-management isn’t great, and vice versa. When I'm thriving on both ends, that only lasts so long before it's too much "diabetes all the time" and eventally there comes a boiling point.
I imagine that for all of us, no matter what job or study course or set of responsibilities we're dealing with, there can come a time when we feel like the diabetes is "spilling over the wall" and drowning us.
So it's certainly a fitting time to address the psychosocial state I’ve been spinning around in, and how I’ve begun addressing it. I'm working on some specific tactics to for navigating work/life -- or rather professional/diabetes -- balance, including stepping away from social media and non-critical deadlines when possible to improve my mental state. And I'm re-evaluating the diabetes tech tools I use as well.
As someone living with T1D for 35 years and counting, this is not a new phenom for me. It's been a back-and-forth cycle for much of my adult life. Now at age 40, I wonder sometimes if my diabetes burnout is part of becoming curmudgeonly and not wanting to change or try new things. But if I let it slide for too long, eventually that D-burnout builds up and reaches a dangerous explosion threshold.
This time, I'm not going to let that happen.
Confronting my diabetes burnout
After my last endo visit in early August in particular, I realized I need to get a better handle on my D-burnout. I've been taking steps like consulting with friends from the Diabetes Community for peer support, reviewing great tips and tricks by wise professionals like Dr. William Polonsky, head of the Behavioral Diabetes Institute in San Diego (and author of the amazing Diabetes Burnout book), and also refreshing my own mindset on personal vs. professional diabetes.
That latter part is huge for me -- because I so often let my personal diabetes management slide when the professional side of life heats up. In fact, that usually happens over summer when there are so many diabetes conferences and events. But it also sets in as the weather cools, and typical winter blues start appearing. So if I'm honest with myself, it adds up to most of the year! Recognizing that, I talked with my endo about addressing these issues up front.
What have I done?
- Sprinkled small mini-vacations into my schedule. Even if it’s just a single PTO day, or an effort to not be plugged into work over the weekend, these have been helping me keep my mind more clear and focused.
- Set my insulin pens and a pen needle out on top of my work calendar, as a daily reminder to take my Tresiba insulin. I’ve also opened up my meter/Afrezza inhaled insulin case on my desk so that it’s always visible when I glance in that direction and reminds me to test (if I’m not wearing my CGM) or to take Afrezza as necessary.
- Stepped away from social media at times. While I love the Diabetes Online Community (DOC), I’ve stopped tweeting and posting diabetes-related stuff as much on my personal accounts. This is specifically because it can be such a time-suck and also, over the years, it’s become a much more volatile environment. Moreso, posting all the time about diabetes just drains my energy and contributes to my personal D-management going to the back-burner.
- Attempted to get more sleep. This is a work in progress, as I’ve been trying to go to bed at a more decent hour. Solid sleep has clear benefits for diabetes, and overall for improved focus and health. Diabetes tech expert and author Adam Brown of DiaTribe writes that "sleep is the most destructive diabetes landmine." I certainly find that sleeplessness or an uncertain routine has a direct impact messing with my blood sugars.
- Revisited resources in the DOC, including our own very helpful article on mental health and diabetes by Greg Brown published earlier this year, that includes a lot of great advice on dealing with diabetes distress, burnout and mental health overall.
Refreshing my diabetes tech
I'm also changing up my diabetes tech tools. As some readers may recall, I’ve been disconnected from any insulin pump since May 2016 and have been using multiple daily injections (MDI) and Afrezza inhaled insulin. That works well for me (at least when I’m taking my Tresiba basal insulin and managing as I should be).
But I do get bored easily and diabetes apathy sets in, and as a result I’ve been watching my Time in Range (TIR) decrease, my glucose variability go bonkers, and my A1C creep higher since the start of the year. With my retinopathy progression and first-ever laser treatment earlier this year adding to the mental load, it’s become clear that I need to mix things up by trying something new.
I’ve decided to test out the t:slim X2 insulin pump with Basal-IQ feature from Tandem Diabetes Care. This is the system that works with the Dexcom G6 CGM (continuous glucose monitor) and automatically tweaks your background basal rates if it predicts you’re going too go Low within the next half-hour. Users have given it high marks so far.
This system constitutes a partial Closed Loop, dealing only with the hypo (low blood sugar) side of the equation, while Tandem's next product under development, the Control-IQ system, will allow for correction boluses to address High blood sugars as well. Control-IQ is currently before FDA regulators and expected to be approved and launched by year’s end.
I had used the original Tandem pump several years ago before opting to stay with Medtronic, but since then they’ve released a newer version that you can update remotely from home without needing to order a whole new device. Back then in 2015, I had some concerns about Tandem’s t:slim and decided not to buy it. But now, years later with the tech’s evolution, I’m keen to give it a try.
Even though insulin pens and Afrezza have worked well for me, my discipline has circled the drain and needs a refresh. So here we go.
It’s an ongoing struggle for all of us to do better, but I’ve noticed that my mood has lifted just knowing that I'm making these efforts to embrace change. Now with my new pump on the way, I can look forward to improving my diabetes life even more.
I realize that I'm privileged to have access to these cutting-edge tools, because I have good insurance and in part due to my work here at DiabetesMine (for review purposes).
But as an average guy with T1D, I feel that any way we can "shake it up" by trying a new routine can be critical to fighting off diabetes burnout.
Mike Hoskins is Managing Editor of DiabetesMine. He was diagnosed with type 1 diabetes at age five in 1984, and his mom was also diagnosed with T1D at the same young age. He wrote for various daily, weekly and specialty publications before joining DiabetesMine. You can also find Mike on his personal blog, The Diabetic's Corner Booth. He lives in Southeast Michigan with his wife Suzi and their black lab, Riley.