Share on Pinterest
PopTika/Shutterstock

A decade has passed since my darkest days with diabetes when mental health struggles made everything feel like an infinite tunnel of hopelessness without a light shining at the end.

A lot has changed since then. I’m fortunate that I’ve had a lot of good luck and help in dealing with these challenges.

Yes, I came out victorious in most of my battles for the past decade. But no, I still haven’t “won.” The war wages on. A new explosion could erupt at any moment, knocking me down suddenly or just smoking me out of the safe sanctuary I found.

This is life with type 1 diabetes (T1D). According to the Centers for Disease Control and Prevention, T1D generally makes us two or three times more likely to experience depression than people living without this condition. The org notes that at best, only half of people with diabetes (PWDs) are likely to be diagnosed and treated, and it’s likely to get worse if not dealt with.

This past year of pandemic life escalated mental health conditions for the population at large, including PWDs who have three times the risk of developing more severe effects of COVID-19 should they contract it.

Those stats are not in our favor, but I am optimistic because I’ve dealt with mental health demons first-hand. Know that we can keep them at bay. It takes a village — including support from family, friends, healthcare professionals, and sometimes even medication — but we can successfully curtail the downward spiral. I like to think that my own T1D story helps show how that’s possible.

For me, everything came crashing down in 2001 (ironically, the year of the national tragedy 9/11). At that time, I was in my early 30s and living with T1D for nearly three decades.

A few mild diabetes complications materialized for me in the years before that, but mostly it was financial challenges and work stresses that ultimately pushed me over the edge. I realized that I was simply unhappy, and that my ups and downs with diabetes through the decades culminated in a sense of hopelessness that I just couldn’t overcome on my own.

Depression became my reality. And to be clear, this wasn’t just a case of diabetes distress or burnout that can sometimes happen to us PWDs when we get stuck in routines or overwhelmed. No, this was full-on depression. I probably didn’t realize it at the time, but only years later after reflecting and talking with diabetes mental health experts Dr. Bill Polonsky, Dr. Jill Weissberg-Benchell, and Dr. Larry Fisher.

At the time, reading general articles about mental health conditions and diabetes was not helpful to me because I simply wasn’t in a place to absorb what was probably good guidance and tips.

In fact, I didn’t even realize how much help I needed until it was almost too late.

A friend in the Diabetes Online Community (DOC) wrote about his own mental health challenges, and in talking with him and some other friends, I connected the dots that I, too, experienced quite a lot and needed help. Not only peer support, but professional help from a therapist.

Conversations with my endocrinologist at the time and a diabetes educator weren’t particularly helpful, but there were other options. As luck would have it, I found someone who was quite qualified in this area of mental health — and importantly, was a fellow PWD living with type 2 herself.

This gave her an insight that I very much needed in those private conversations, and I dubbed her “Mind Ninja” for all the skill she brought in digging into my mental health woes.

This therapist helped me see clearly that I focused too much on the negative side of things — often unconsciously — and sometimes, I experienced imposter syndrome. Here I was, an editor writing about diabetes and an active patient advocate, while in the background, I felt I was “failing” at my own diabetes control.

She helped me step back from the toxic internal thoughts and look more actively at the glass being half-full, rather than half-empty. I had a good job, a wonderful wife and family, solid insurance and diabetes care, and by God, I did my best every day not to let T1D slow me down or stop me in my tracks.

We also talked about how to find a balance between thinking about diabetes and all of life’s other stresses. Importantly, this diabetes-savvy therapist helped me realize that I needed to tackle negative thoughts immediately rather than allow them to fester and eventually reach a boiling point.

The therapist helped me see the diabetes and broader life concerns that might spark distress, burnout, and eventually depression.

Specifically, she helped me identify and tackle three scenarios:

Getting into a rut

This materialized slowly for me, with a gradual sinking feeling of being stuck in a diabetes management hole. There was device fatigue, where I didn’t want to rotate my insulin pump infusion sites as often as required. I would also slack on counting my carbs and dosing insulin accurately, and that all led to higher blood sugars, which just fueled my feelings of inadequacy and stress.

My solution: Changing up my management routines on a periodic basis. That meant disconnecting from my diabetes devices and going back to multiple daily injections (MDI) or doing fingersticks instead of always connecting to my continuous glucose monitor (CGM). Instead of using a mobile app to log my diabetes data, I went back to pen and paper to mix things up and nudge myself back into engaging more with my routine.

Tip: Try taking a brief “diabetes vacation.” This is also a long-advised tip from Dr. Polonsky, author of “Diabetes Burnout” and founder of the Diabetes Behavioral Institute in San Diego, California. Personally, this trick allowed me to step back from my routine, not connect to CGM or any diabetes device, and give the reigns to my wife for a brief amount of time. There’s no clear timeline recommended, but try being “off the usual grid” for whatever period fits best with your life and safe diabetes care.

Feelings of isolation amid too much noise

I found that the busier I was and the more that was going on around me, the more isolated I felt. My therapist helped me realize that I needed to mute the noise as best I could, and reground myself in my home, and with my loved ones and friends.

My solution: Balancing social media as well as in-person peer support and individual connections. While being online can be a great way to connect with others, it can also be very draining at times. I found that it was a good idea for me to disconnect at regular intervals, and turn to in-person gatherings or more 1-to-1 chats with friends.

Tip: Try writing in a private journal. Writing publicly or posting on Facebook and social media only goes so far. I found that keeping a private journal, one that I didn’t share with anyone other than myself and my wife, helped me catalog certain feelings and mindsets. And later on, I revisited those notes to better understand what I went through.

Losing sight of the good

When diabetes burnout became overwhelming, I tended to see only the hopelessness ahead. That tendency created a vicious cycle, where out-of-range blood sugars and fatigue led to more stress and that just fueled even more diabetes chaos.

As it does for many of us, diabetes often feels unsurmountable to me — a part of my life that trumps everything else and seems as though it will ruin everything good that’s possible. Simple as it sounds, a key action that helps me is focusing on the good rather than the bad.

My solution: Time off work twice a year. I specifically started scheduling time away from work to disconnect from social media and do as much as possible to step away from my “must be on 24/7” mindset.

Tip: Snap photos. This may seem a bit superficial and a social media-driven, but photography simply helped me appreciate my vacations long after they ended. Today, vacations and time off often feel too short, of course. But capturing some key moments in pictures helps me keep “seeing” and reflecting on those much-need breaks and the good they do.

Before seeing a diabetes behavioral health expert, I had a preconceived notion that depression medications just weren’t going to be for me. I subconsciously held on to stigmas about taking medication for depression, feeling as though it would be a sign of defeat or a route to “just take the easy way out.”

My therapist helped me recognize that medication was a tool that could help me at my lowest points to get to a better place to cope and move forward. My doctor prescribed a medication known as Lexapro. It works by increasing the amount of serotonin in your brain, which helps decrease the symptoms of depression and anxiety.

That helped me greatly for several months until I eventually phased it out slowly. I “cleared my head” and felt empowered to battle my mental health demons more effectively.

Depression medication may not be the best answer for everyone, but it’s certainly worth exploring, and it should not be seen as “the loser option” as I once believed it to be. Remember to always talk with your doctor before taking any medication.

Those simple lessons stayed with me since, even when the COVID-19 pandemic began in 2020 and put all of us into a tailspin of emotions and uncertainty.

Many turned to counselors and therapists during the past year to deal with pandemic-time stress and mental wellness. I applaud that. For me, spending time with a professional who helped me analyze my feelings and develop strategies to stay happy had a lasting effect.


Mike Hoskins is managing editor of DiabetesMine. He was diagnosed with type 1 diabetes at age 5 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. He lives in Southeast Michigan with his wife, Suzi.