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As we enter into the third COVID-19 winter, during the worst surge in the pandemic’s history, more and more people are asking themselves: Will this ever end? With the Omicron variant of the coronavirus racing across our country in January 2022, more people are sick, hospitalized, and dying from the disease than ever before.

The United States actually set the record for the highest single-day, new case count in the entire world on Jan. 10, 2022, with 1,364,418 diagnoses (and that does not include at-home antigen testing, just PCR test results from state-recognized testing sites).

All of this has been nearly 1 year after the first batches of the COVID-19 vaccine were starting to be administered to healthcare professionals.

So how do we take care of our mental health during this trying time? Especially given the additional health concerns and mental burden that people with type 1 diabetes (T1D) deal with on a daily basis?

This article will dig into the current state of the pandemic, how people with T1D are taking care of their mental health, what professionals have to say, and how you can better equip yourself for the road ahead.

The emotional and mental health burdens of living with a chronic disease like diabetes are more and more often being discussed in the open. Studies have shown that while one condition doesn’t necessarily cause the other, diabetes and depression occur together (in the same person) approximately twice as frequently as it would be predicted to occur by random chance alone.

More studies have shown that the occurrence of insulin resistance alone can nearly double the risk of major depressive disorder.

Young people with diabetes are also more likely to suffer from eating disorders and other forms of anxiety, with rates hovering around 13 to 17 percent, and children with diabetes are twice as likely to receive a psychiatric diagnosis by age 18 as children without diabetes.

The risks are high, and the stress, anxiety, and fear have only increased as we experience our third COVID-19 winter.

A lot has changed since March 2020: As of this writing, there have been nearly 500 million reported diagnoses of COVID-19 and over 5 million deaths, with the United States reporting nearly 1 million deaths alone (with only 4 percent of the world’s population, 20 percent of all deaths have occurred in the United States).

What once appeared to be a 2-month quarantine for the country is now entering its third year, having completely turned people’s lives upside down.

Extreme and extended social distancing has made many feel anxious and isolated, the constant vigilance and adhering to handwashing and mask protocols can feel overwhelming, and lockdowns, schools being shuttered, and places of employment becoming permanently work from home can be a lot to handle.

In addition, the news media can spark fear and stress responses, as well as stoke fears over getting sick yourself, spreading a (sometimes) asymptomatic virus to others, and financial insecurity from the widespread economic fallout from the pandemic and what the future holds.

It’s no wonder that America is facing a mental health crisis. The pandemic has spiked rates of depression in the country, with 1 in 3 Americans showing signs of clinical depression and anxiety.

The rates of suicide are spiking for People of Color, and rates of depression and anxiety in children and youth have doubled since the start of the pandemic, according to a review published in JAMA Pediatrics in August 2021.

The researchers looked at 29 general population studies and found depression and anxiety rates of 25.2 percent and 20.5 percent, respectively.

Vanderbilt University researchers reported in a 2020 study published in the American Journal of Pediatrics that disrupted, unpredictable, and changing routines and schedules can be hard on young children. In the study, 48 percent of families reported losing their normal childcare.

That same study showed that of 1,000 U.S. parents, 27 percent said their mental health had worsened since March 2020, and 14 percent said their children’s behavior problems had gotten worse. Families with younger children reported worse mental health than those with older children.

In another study out of China published in JAMA Pediatrics in 2020, researchers in Hubei province examined 2,330 school-aged children for signs of emotional distress, anxiety, and depression.

The children studied had been in quarantine for an average of 34 days. Even after only 1 month, 22.6 percent of children reported depressive symptoms and 18.9 percent were experiencing anxiety.

These reported rates of anxiety and depression are probably conservative, due to the lack of universal healthcare and telemedicine in the United States, with many cases most likely going unreported and undiagnosed.

All of this compounds when you’re also juggling a life with T1D.

Living with T1D under normal circumstances is hard work and requires a lot of resilience. Research has shown that managing this autoimmune type of diabetes requires at least 180 extra decisions every single day. That, on top of living during this unprecedented pandemic (that has now killed more Americans than the 1918 flu pandemic did) is a recipe for a mental health breakdown.

Experts tell us that people with diabetes, especially once they hit 40 years old, are more likely to be hospitalized if they get COVID-19, and 40 percent of people who’ve died from COVID-19 had either type 1 or type 2 diabetes.

And the risk runs both ways: Children who have had a previous diagnosis of COVID-19 are at higher risk of a type 1 diabetes diagnosis, based on emerging data.

There are only so many times people living with chronic conditions like diabetes can be told that we’re more likely to die (even while vaccinated), and that was supposed to be “encouraging,” according to Rochelle Walensky, director of the Centers for Disease Control and Prevention (CDC).

Dr. Walensky has since apologized for her comments.

Telehealth and telemedicine, where you connect with a provider either over the phone or through an online video chat, can be helpful, but it lacks a certain “humanness.” There’s no way to check a patient for foot neuropathy or palpate their stomach or look into their ears from over the phone. In a country without universal healthcare, or universal broadband internet access, many people have simply gone without care.

For example, more than 41 percent of Medicare patients don’t even have a desktop or laptop computer with high speed internet at home, 41 percent don’t own a smartphone with internet access, and nearly 1 in 4 don’t have access to either.

Diabetes market research firm dQ&A and the American Diabetes Association recently published a comprehensive report quantifying “the extraordinary challenges faced by Americans with diabetes during the pandemic.” Their findings show that people with diabetes have been more negatively affected by job and subsequent health insurance as well. In June 2020, 18 percent of people with diabetes were either unemployed or furloughed, compared to 12 percent nationally.

Nearly 30 percent of employed people with diabetes at the start of the pandemic have lost some or all of their income, and for lower income Americans with diabetes, the hit has been even harder, with 50 percent having lost some or all of their income since the start of the pandemic.

These numbers are problematic but show a harsher truth: As of 2020, almost half of all working people with diabetes were employed in jobs that could not be done from home, putting them in more precarious, public settings that often have no indoor mask mandates.

The data shows that 60 percent of these workers are performing “essential” duties, like working in healthcare, mail distribution, sanitation services, or in grocery stores.

Additional data shows that the pandemic has resulted not only in poor mental health outcomes, but in poor physical health outcomes as well. In 2018, a Yale University study found that 1 in 4 people with diabetes were rationing their insulin, which has only inevitably increased since the start of the pandemic.

All of this, not to mention worries over supply-chain issues and nearly a complete loss of community with in-person everything postponed or canceled, has left people with diabetes feeling isolated, lost, scared, and sad.

Merely managing T1D during a pandemic isn’t easy, either. Many clinics stopped taking appointments for regular check-ups and elective surgeries during the height of the pandemic, leaving people with T1D to delay care — or to forgo it completely.

Emily Hooven, from the Brewerytown neighborhood of Philadelphia, who has lived with diabetes for 20 years, has found the pandemic especially draining on her mental health. She tells DiabetesMine, “I cannot recommend therapy enough. Therapy, therapy, therapy!” She continues, “Have your therapist ask at the beginning of each session, ‘how has it been managing your diabetes recently? ‘How have your sugars been?’ Just having someone checking in on you can help a lot.”

Dr. Allyson Hughes, a health researcher from Athens, Ohio, who has lived with diabetes for 26 years, tells DiabetesMine: “My biggest act of self-care has been giving myself grace and letting myself off the hook. I realized that with all the other stressors going on that the last thing I needed to do was stress myself out [over my diabetes management] even more.”

Elizabeth Peroski, who has lived with T1D the majority of her life and is a film student at The New School in New York City, tells DiabetesMine, “The past few years have been extremely isolating, with virtual school and nearly all in-person interactions postponed or canceled indefinitely. Finding a community has been hard.”

All is not lost, however. There are many ways that you can prioritize your mental health during this uncertain time. Try implementing these strategies to improve your mental health.

Keep in touch, albeit virtually, with others

Staying connected with loved ones is important to prevent isolation, even if you can’t get together in person. Prioritize a weekly phone or video call, start a text message thread, or start a pen-pal writing circle to keep in touch with others.

Reach out to friends to let them know you’re thinking about them and ask that they check in on you occasionally, too. Keeping in touch with those that matter most is crucial during this time.

Stay physically active

The mind-body connection is strong.

The CDC recommends moving your body for 30 minutes a day, most days of the week. This will not only keep you physically fit, but it will release endorphins that can help improve your mood as well (it can also help you manage your blood sugars!).

Even something as simple as taking a walk or vacuuming counts. Turn on some music, get out in the sunshine, and move a little. Watch your mood improve.

Haley Burnside, a social media manager and T1D living in Salt Lake City, Utah, tells DiabetesMine, “I’ve taken to running outside since I no longer feel safe going to my boxing gym in a pandemic.”

Get enough sleep

Getting enough sleep is critical if we want to maintain good mental health. Start by cultivating an evening routine: a bath after dinner, meditation or yoga before bed, or even journaling or reading before you close your eyes can help settle the mind and ready the body for sleep.

Once an evening routine becomes a habit, it will signal the brain that it’s time for bed, which can make falling asleep easier.

Remember to limit caffeine in the afternoon. Eating foods that naturally contain melatonin in the evenings, like cherries, walnuts, grapes, peanuts, or sunflower seeds, can be a great snack that will also encourage sleep. For more suggestions, see our DiabetesMine guide to T1D and sleep.

Practice mindfulness

Incorporating gentle yoga and meditation into your life can bring peace, especially during stressful times in life. It can calm the immune response and bring quiet to your mind.

Repeating a mantra, such as, “I am strong, I am worthy, I am healthy, I am at peace,” can be helpful when you are stressed out and need something to focus on to calm down.

Practicing yoga, meditation, or even simple breathing exercises right before bed can also help you sleep more soundly, helping to mitigate stress into the next day.

Abby Bayer-Pratt, a T1D and registered nurse from New York state tells DiabetesMine that mindfulness can extend past simply doing yoga or meditating. “I changed my Time in Range (TIR) goal on all of my devices and reporting tools from my pre-pandemic tight range to something a bit more loose, but still clinically safe, to avoid the extra stresses that can bring.”

For more suggestions on the mindfulness front, see our DiabetesMine guide to embracing spirituality in your diabetes care routine.

Maintain a healthy diet

Even when you don’t feel like it, maintaining a healthy diet, with plenty of fruits and vegetables, is crucial for prioritizing your mental health. Stressful situations can exacerbate disordered eating, which is common in the diabetes community, so making sure you’re filling up on nutritious foods is vital.

The vitamins, minerals, and antioxidants found in plant-based foods can calm the immune response, keeping you healthy as you age. Experts say to aim for 5 to 9 servings of fruits and vegetables per day.

Haley Burnside, a T1D in Salt Lake City, Utah, tells DiabetesMine, “I’ve also gotten more into cooking recently, once it got too cold for patio dining at restaurants. It’s really helped me discover easy, low carbohydrate recipes that I wouldn’t have tried otherwise!”

Know when you need professional help

Sometimes prioritizing mental health means that we need to know when to seek professional help. Diabetes and depression are both serious conditions that can be fatal if not managed properly.

If you are not feeling better after incorporating all the above strategies, or are having thoughts of suicide or self-harm, get help right away. Call the National Suicide Prevention Lifeline at 800-273-8255.

Speak with your doctor about treatment options. They may refer you to a therapist or prescribe medication to help manage your condition. There is no shame in seeking help. More resources for diabetes and mental health can be found here.

The COVID-19 pandemic has been an extremely stressful time for everyone but especially people living with preexisting conditions, like T1D.

Managing our stress and prioritizing our mental health is of utmost importance to make sure we’re living our healthiest lives.

Incorporate self-care strategies to help you and don’t hesitate to reach out for professional help if you are experiencing symptoms of depression, or if you feel your mental health is suffering and it does not improve.

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