Long story short: my immune system killed my pancreas for absolutely no good reason.
When I was 10 years old, I was diagnosed with type-1 diabetes, which is often referred to as juvenile diabetes because it is most often developed in children and adolescents. It is an autoimmune disorder in which the pancreas no longer produces insulin because it views its insulin-producing cells as bad guys. Because our immune systems are awesome, mine fought off these bad guys in attempt to keep me healthy. However, my immune system made a mistake because my insulin-producing cells were not bad guys at all; I actually need them to live. In order to live, I am required to take multiple insulin injections per day (sometimes up to 10).
Type-1 diabetes is known in the medical community to greatly affect mental health, particularly illnesses such as depression and anxiety. While the severity of the illness can exacerbate symptoms of mental illness, mental illnesses also exacerbate the symptoms of diabetes. Because I have found that most people do not understand this relationship, I am reflecting on my personal experience with both types of conditions in order to raise awareness.
Below are 7 ways my diabetes and mental health conditions affect one another:
- Having diabetes is exhausting and frightening. When my blood sugar is low, I literally feel like I’m dying. I start to blackout, have difficulty breathing, become physically weak, can’t think or speak clearly, and begin shaking violently. This is because my body does not have enough glucose to operate my body’s organs and my body is slowly shutting down. If I do not put sugar into my system immediately, I will have a seizure or slip into a coma. I will sometimes avoid taking insulin in fear of dying from a low blood sugar. While having a high blood sugar level is less of an acute health risk, it causes me to be significantly less functional. I feel overwhelmingly exhausted physically and cognitively, lack concentration, consistently yawn, am overly thirsty, nauseous, and irritable. It is important to note that I also feel these symptoms anytime my blood sugar is fluctuating, which is pretty consistently throughout each day. Experiencing these symptoms makes it feel nearly impossible to complete everyday tasks and activities. It is absolutely exhausting experiencing this constant whiplash of biological and cognitive functions.
- My blood sugar levels make my anxiety worse. Whether my blood sugar is high, low, or in the process of fluctuating, this makes my anxiety peek due to biological reasons. I have been known to snap at people or have panic attacks during these times because my body is just not functioning the way it is supposed to. Diabetes also increases my anxiety because it is a life-threatening condition that I have to worry about. Therapists will often tell me that my anxiety about my diabetes is irrational, but that is not true. I worry about the long-term effects of diabetes, including blindness, limb amputations, strokes, heart disease, nerve damage, kidney disease, etc. With the current political climate and potential ACA repeal, I have additional factors to worry about: it is possible that I will be denied health insurance for a pre-existing condition in the future and the cost of insulin is impossible to pay for without excellent health insurance. I have to worry about this because lack of healthcare will put me at a higher risk for these complications and will limit my treatment options if I do develop them. I also worry about the short-term dangers of diabetes, especially low blood sugar levels. It is possible that I could just not wake up one morning because my blood sugar got extremely low during the night.
- Diabetes has trained me to operate with a sense of helplessness. If you don’t know already, managing diabetes is extremely difficult. It seems like no matter how hard I try to stabilize my blood sugars through exercise, healthy eating, and insulin treatment, I just can’t seem to get a handle over them. Even when I do everything perfectly right, it feels like my blood sugars are doing the exact opposite of what I want them to do: dropping deadly low or staying steadily high. This often hinders me from doing the things I want to do, even exercising. Experiencing this for 13+ years without any sense of mastery has made me develop an apathetic attitude towards my chronic illness. Bothering to care just leads to constant disappointment and feelings of misery, so why become emotionally invested in my treatment? This is an attitude that I generalize to many aspects of my life because ultimately, what control do I have over anything? This results in me being less compliant with my medication regimen, which in turn leads to poorer physical and mental health.
- Diabetes lowers my feelings of competency and self-esteem. Having diabetes makes even the simplest tasks overwhelmingly difficult because there is so much to consider regarding your safety. Do you want start a fitness plan? Well, you won’t be able to follow through half of the days because your blood sugar will be too high or low to engage in physical activity. Do you need to make it to court for work by 9am? Well, you’ll have to be late because your blood sugar is too low to drive, since driving with a low blood sugar is basically the same as driving inebriated. People are going to think you’re an unprofessional social worker and the foster child you’re representing will think you abandoned them. Do you need to work on a paper for class? Well, your blood sugar is too high and you can’t put your thoughts together. It will take you ten times as long to complete this task than if your blood sugar was within normal range. Are you ready to lead that team meeting? Well, you’re going to be extremely anxious, stutter, and have difficulty processing questions because your blood sugar is high. You will sound unprepared and unqualified. Do you want to go on this date? Well, your blood sugar has been fluctuating all day so you don’t feel up to trying to impress someone new because you’re exhausted and irritable. What if your blood sugar drops or gets dangerously high while you’re with them? Being out of it will sure make a good impression… Do you want to go to the bar with some friends? Make sure you have your insulin pens, pen needles, dexcom meter, blood sugar monitor, lancets, strips, syringes, two juice boxes, and extra money. Check your blood sugar every hour or so. Make sure the friends you are going with are trustworthy and have a basic idea about what to do if you start showing signs of a diabetic seizure. Don’t forget to write “type 1 diabetic” on the inside of your arm. Don’t lose your dexcom like you did that one time, because it cost you a lot of money to get that replaced. Diabetes is something I have to thoroughly think about before planning to go to sleep. My blood sugar is fine… should I have a snack before bed just in case it drops? What if I get low in the middle of the night? I’ll put a juice box right next to my bed. What if I get low again and can’t make it to the kitchen? I’ll put three juice boxes in case I wake up low multiple times. I hope I wake up. Don’t even get me started on how difficult it is to lose weight while having diabetes.
- Anxiety raises my blood sugars. As I explained earlier, I often feel anxious when my blood sugars are off. However, having anxiety due to my anxiety disorders can actually raise my blood sugars. This is because the stress hormone, cortisol, makes one’s blood sugar rise so that they have the energy to fight or flee. On days when my anxiety is very high, my blood sugars will remain elevated no matter how many insulin shots I get. However, then the insulin catches up to me hours later, typically causing me get low several times that night, thereby putting my life at risk. Consequently, I’m getting a poor night’s sleep, which exacerbates my anxiety and depression.
- Some medications that help diabetes harm mental health. I was recently taking a medication for my diabetes called Trulicity. In addition to my insulin regimen, this medication makes it so that your body does not absorb as much glucose as you ingest. Because of this, my blood sugars became more stabilized. However, the medication caused several terrible side effects: lack of appetite, nausea, diarrhea, partial-seizures, and severe episodes of anxiety. My blood sugars were better managed, but I had been missing days of work and school because of the anxiety and other symptoms this medication caused.
- Being noncompliant is my way of being suicidal. I will be the first to admit that I do not always take my insulin the way I am supposed to. While part of this is because of the learned helplessness (see number 3) it is also my way of expressing passive suicidality. Because of this, I am significantly more likely to be noncompliant while in a depressive episode because I see the future as bleak and any years taken off of my life is a positive thing.
Why is this important?
To this day, it has been impossible for me to find a therapist who understands the effects of diabetes on my mental health and to find an endocrinologist who understands the effects of my mental illnesses on my diabetes management. This is common with not only people who suffer from diabetes, but anyone who struggles with any sort of chronic illness. Mental health and physical health affect one another so intimately, yet the mental health and physical health fields are so segregated in our society. This is an incredible wrongdoing because it hinders people from getting the holistic treatment they need to become healthier physically and mentally.