Anxiety can be a perfectly natural response to a stressful situation. It can serve as a valuable survival mechanism in a dangerous situation by making you more cautious. That is normal behavior and everyone experiences anxiety from time to time. When the boss invites you into her office, for example, or you are about to begin taking a test you didn’t study for, you may feel worried.
But anxiety can be a problem when it affects you at inappropriate times or when it is so intense and long lasting that it interferes with daily living. When this happens, you may have what is called an anxiety disorder. Anxiety disorders can be so distressing to some people that they lead to depression. Some people experience depression and anxiety at the same time. The signs and symptoms of anxiety and depression sometimes overlap, and they may also be caused by the same problems.
Life is stressful and can trigger anxiety in anyone at one time or another. But if you have diabetes, you face more stress than most people, day in and day out. Many people with diabetes learn to cope with this without too much of a problem. But for others, especially those with other stresses in their lives, diabetes can contribute to or even trigger anxiety. It’s not enough that you have to face a deadline crunch, then come home to a house of screaming kids who need help with homework, but you also have to cook dinner and somewhere in there test your blood glucose and give yourself an insulin shot. That kind of stress can wear on you, and eventually, even little things make you feel anxious.
The key to dealing with anxiety, as is the case with most emotional problems, is to acknowledge the problem, identify the things that trigger undesirable behavior, try to alleviate the triggers, and find better ways to cope with the situation.
Symptoms of anxiety include restlessness, feeling tired or easily fatigued all the time, difficulty concentrating, irritability, disturbed sleep, muscle tension, and a tendency to be overly worried or overly concerned. You may worry about work, school, money, your diabetes or general state of health, or relationship. You may also worry about more mundane things, such as getting the chores done or the car repaired. It is not a matter of these worries being unfounded, but usually the severity, duration, or frequency of these bouts of worrying is disproportionately greater than the situation calls for. The symptoms are the worst during times of great stress.
What You Should Do
If you think you worry too much or have been told you worry too much, and find that you have more than two of the symptoms above, you may have anxiety disorder. This is especially true if you cannot see beyond your current concerns to enjoy things you once found pleasurable.
The first thing to do is talk to your doctor. Many medical conditions can trigger symptoms of anxiety and your doctor will first want to rule out any possible physical cause. Your doctor will also want to review your medications, because some medications can cause symptoms of anxiety. Your doctor will also want to check your records of your blood glucose levels over the past month, to see if extremes in your blood glucose levels might be triggering your feelings of anxiety. Anxiety itself, or the reaction to a stressful situation, can also alter blood glucose levels. As is the case with depression, this can lead to a cycle that needs to be broken.
Once any physical causes of anxiety are ruled out, your doctor will probably refer you to a mental health care professional. This could be a psychiatrist, psychologist, psychiatric nurse, or licensed social worker. You may already have one of these professionals on your health care team. Your mental health counselor will help you work through your problem. This can be accomplished through counselling or psychotherapy, medication, or a combination of counselling and drug therapy.
The exact course of treatment for any anxiety disorder depends on the nature of the problems and what sorts of things trigger anxiety. This may be related to the physical stress or emotional burden of dealing with diabetes, or it could be completely unrelated. In some cases, underlying insecurities and inner conflicts may be a major factor in anxiety. Getting to the bottom of those feelings through counselling and psychotherapy may be of help. Trying to identify and understand those situations that provoke anxiety may also help.
However, frequently there is no clear-cut reason why a person experiences inappropriate anxiety. In these situations, drug therapy may help relieve the symptoms. Antianxiety drugs must be prescribed by a psychiatrist or other medical doctor and should be given with great care. Make sure your regular doctor and your psychiatrist are in contact with each other. Ask whether any medication will affect your blood glucose control. Some antianxiety drugs, such as benzodiazepines, can led to physical dependence. If you discontinue such a drug, it must be done gradually. As with many drugs used to treat emotional disorders, they are usually more effective if used in conjunction with counselling. Talk to your doctor about what will work best for you.
One of the most difficult aspects of diabetes is the fact that it is a chronic condition. It never goes away. You may be able to manage it well and feel no ill effects. But in order for that to occur, you have to work at it. Sometimes you don’t mind. It can almost be like a second career for some people as they learn the ins and outs and ups and downs of controlling blood glucose levels.
Maybe you initially attack your diabetes care plan with gusto, carefully adhering to the prescribed meal plan, dutifully checking blood glucose and injecting insulin on schedule. But at some point, you may very well just get tired of it. You want to take a break, take a day off perhaps. It’s just too hard keeping on top of things, never getting a chance to rest—or feeling guilty if you do. Just how do you stay motivated to keep up the good work day in and day out, 24 hours a day, 365 days a year?
There are no easy answers. Everyone is motivated by different things. For some people it helps to have a partner, supporting and encouraging them. Other people prefer to go it alone, do their own way. Whatever your style, it is important to figure out what works for you. You may not be able to keep up with a plan developed with someone else in mind. You may need meals that take your likes and dislikes into account and a schedule that fits in with your lifestyle. It will be easier to be motivated if your plan lets you live life the way you like to live.
What You Should Do
First, evaluate where you are. If you have already written down a list of goals, dig them out and look them over. If you have never written out your goals, this may be a good time do it. Next, evaluate where you are. Are your blood glucose levels where you want them to be? Are you at your ideal weight? Do you feel good about your progress? If so, you are probably right on track and have been able to motivate yourself.
It is not unusual to have a day every now and then when you just don’t feel like doing everything you should. That is probably okay just as long as you don’t slack off entirely and let your blood glucose levels get too high or too low.
If however, you are not anywhere near reaching your goals, it is time to take a closer look and figure out why. Where are you falling short? Not sticking to your meal plan? Not always taking your insulin or monitoring blood glucose? Do you exercise? If there are one or more aspects of your diabetes care plan that you tend to neglect, ask yourself why. Chances are, if you are not doing what you want to be doing or feel you should be doing, you may have a motivation problem.
If you are having a difficult time motivating yourself to follow your plan, it may be because your plan does not suit you. Do your meals take into account your likes and dislikes? Does your insulin schedule allow you enough flexibility? Are you trying to do exercises that you don’t like to do? If your diabetes care plan does not take into account your needs, it is time to talk to your doctor or diabetes educator about your diabetes care plan. You may be due for an overhaul.
Make sure your health care providers know what your schedule is like, whether you follow the same pattern every day, or if your hours and activities change all the time. Do you like to cook or eat out? Which foods do you like? Which foods do you hate? What kinds of activities do you like to do? Ask your doctor of diabetes educator to help you design a plan that suits your living style. Once you have something that you can live with, you might find that you are more motivated.
You may find it easier to become motivated by talking to other people with diabetes. Join a diabetes support group. By talking to others about what helps them to feel motivated, you may feel more like making an extra effort yourself and may get some good tips. Investigate the internet and join in a chat session with other people with diabetes.
Another way to get motivated might be to team up with a friend. This could be someone with diabetes or someone without diabetes who just wants support in reaching his or her goals. Maybe you have a friend who wants to start exercising or lose weight. Try meeting for workouts or sharing recipes. Set goals that are realistic, not something you can never hope to attain. Track your progress and reward yourself when you succeed.
Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Anxiety and Diabetes: Innovative Approaches to Management in Primary Care by Allison Bickett and Hazel Tapp
Association of Diabetes with Anxiety: A Systematic Review and Meta-Analysis by K Smith, N Schmitz et al