Living with Diabetes: Managing Distress
A handout on diabetes distress: the frustration, worry and burnout that come with managing a demanding, lifelong condition. Explains how distress differs from depression, why avoidance makes it worse, and how acceptance and small, values-led steps help.
About this resource
Diabetes distress is the term used for the emotional burden of living with and managing diabetes: worry about complications, frustration with blood glucose that does not respond to effort, feeling judged by clinicians or family, and the sheer relentlessness of a condition that requires attention every day with no time off. It is distinct from depression, though the two overlap, and it is common; Polonsky and Fisher's work has shown that it is strongly related to self-management and glycaemic outcomes and that it responds to targeted intervention. Clinicians treating people with diabetes should assess for it rather than assuming that low mood in this population is always depression.
The psychological mechanism this handout targets is experiential avoidance. When checking glucose, attending appointments or thinking about the future reliably produces anxiety, guilt or shame, people understandably start to avoid them, and the avoidance then produces worse control, more guilt, and a sense of burnout in which the whole condition is pushed out of mind. Acceptance and commitment therapy has been applied to diabetes with this in mind, helping people make room for the difficult feelings that come with the condition so that those feelings no longer dictate self-care, and reconnecting self-care with what the person values. Gregg and colleagues' trial found an ACT-based intervention improved self-management and glycaemic control compared with education alone.
This handout explains diabetes distress in plain language, describes the avoidance cycle, and introduces three ideas the client can start with: naming the distress without judgement, making room for the feelings rather than fighting them, and choosing one small self-care action that connects to something they care about. The professional version notes the value of a brief screening tool for diabetes distress, the importance of liaising with the diabetes care team, and that the handout contains no medical advice about medication, diet or targets, which belong with the treating team.
How to use it
- Use when a client with diabetes reports frustration, guilt, burnout or avoidance of self-care. Distinguish diabetes distress from depression in your assessment; both may be present.
- Read the avoidance cycle section together and ask the client to identify their own version: which part of management they avoid and what feeling drives the avoidance.
- Introduce willingness as an alternative to fighting or avoiding the feeling, and link it to values: what does keeping well allow them to do or be?
- Help the client pick one small, specific self-care action for the week and treat it as an experiment in acting alongside the discomfort rather than waiting for it to go.
- Coordinate with the diabetes team where the client consents. Do not advise on medication, insulin, diet or glucose targets; keep the psychological work in its lane.
References
- Polonsky, W. H. (1999). Diabetes Burnout: What to Do When You Can't Take It Anymore. American Diabetes Association.
- Fisher, L., Polonsky, W. H., & Hessler, D. (2019). Addressing diabetes distress in clinical care: A practical guide. Diabetic Medicine, 36(7), 803-812.
- Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 75(2), 336-343.
