Juggling Exhaustion: When Diabetes Becomes Too Hard

By Owen C. Franklin

There are simply too many factors to coordinate, too many priorities to meet. And, on top of all this, there's that whole "life" thing.

One or two times a month, 21-year-old Brandon Fuhrer carries out a dreaded ritual.

"I just sit in my room and I get into these terrible moods," said the Lakewood, Calif. resident. "I think: Am I going to die soon?"

During those hours, the frustrating obligations of managing diabetes become too much to bear.

"Basically, it sucks," said Fuhrer. "You see those candy bars, but you can't have them anymore. You want to go hiking, but you have to remember to bring sugar tablets. You talk about getting married, and you think about your kids getting it."

Each issue related to diabetes, from the relatively trivial to the "big-picture," can pile into an intangible list of worries and chores. For many people, working through this list becomes a chaotic, exhausting and seemingly fruitless task.

This nebulous burden has a name: diabetes burnout. While neither word is all that inspiring, together they can offer a first step to recovery.

In many cases, the glucose tests and dietary vigilance aren't the enemy. Instead, a person's own emotional exhaustion poses the greatest threat.

Here, those two uninspiring words come into play.

"Once you give a name to something, you can really claim some control," said William H. Polonsky, Ph.D, assistant professor of Psychiatry at the University of California at San Diego and a diabetes educator. "Then, you have the beginning of some semblance of hope."

Dr. Polonsky wrote the book on diabetes burnout — literally. It's called Diabetes Burnout: What to Do When You Can't Take it Anymore.

The term "burnout" requires little explanation. Most everyone feels exasperated from such daily drains as a long commute, a trying relationship or a demanding job.

According to Dr. Polonsky, the universality of the term is exactly what makes it so helpful.

"It really normalizes the condition," said Dr. Polonsky. "It reminds you that this happens to a lot of people."

The normalization of diabetes burnout takes on a major role in Dr. Polonsky's book. Through conversational writing, slice-of-life anecdotes and realistic suggestions, Dr. Polonsky breaks down the ethereal mass of diabetes burnout into its everyday forms.

Some of you may be saying "Do I really need another person telling me how to manage my illness?" People with diabetes are virtually flogged with the reams of publications that remind them why tight glucose control is so important.

But Diabetes Burnout doesn't preach the typical "dos and don'ts" gospel. Instead, the book takes on an empathetic mission. Entire chapters clarify the uphill fights of diabetes management.

Sections entitled Ten Good Reasons Why It’s Impossible to Follow a Healthy Meal Plan, Ten Good Reasons to Hate Blood Glucose Monitoring and Ten Good Reasons to Avoid Exercise all tilt their proverbial hats to the reader's daily struggles.

"I'm assuming that if my reader is burned out, s/he is sick of reading articles that say 'gee, here are all the wonderful reasons you should be taking care of your glucose,'" said Dr. Polonsky. "They could be saying 'big deal!'"

However, following each title of Ten Good Reasons reads the parenthetical (and What to Do about Them).

"Once we go over the obstacles, then we can go over the good news," said Dr. Polonsky. "There really are some wonderful things you can do."

Various obstacles obstruct the diabetic day. Some come and go, such as dietary frustrations and bouts with abnormal glucose levels. Other complications, however, linger as subtle but powerful influences that can drastically change a person’s state of mind. In Diabetes Burnout, Polonsky names three: fear, denial and depression.

Brandon Fuhrer knows all about fear.

"I know that I can have a lot of complications when I get older," said Fuhrer. "My cousin has diabetes and her foot had to be amputated and I keep thinking that that could happen to me."

According to Polonsky, these feelings are typical of people with diabetes burnout. Most people with diabetes know (and some have seen) the "worst case scenarios." While fear can, in many ways, motivate people to avoid disaster, it can quickly escalate into a crippling way of thinking.

"A little bit of fear is probably a good idea," said Polonsky. "But some people just feel doomed. When you feel like that, you feel like there's nothing you can do. We've found that our patients who had the worst self care were also the patients who were the most scared."

The flip side of fear, however, can be just as damaging. A person who decides to ignore the illness completely could simply "forget" to take an insulin shot or check for developing complications.

"A little bit of denial is reasonable, you don't want to be thinking about diabetes day in and day out," said Polonsky. "But if you put it aside completely and go on a diabetes vacation, you could be setting yourself up for serious trouble."

Fear versus denial, obsession versus ignorance — where's the safe middle ground? For many people with diabetes, there are simply too many hazy, but critical, systems to figure out. Even with the most diligent attention, things still fall apart. At times, keeping a positive outlook becomes the greatest challenge.

"Depression may be the very biggest problem for people with diabetes," said Polonsky. "If you're depressed, it just sucks the 'oomph' right out of you, and you might not even want to bother anymore."

Diabetes Burnout offers more than a "legend" of diabetic trauma. Various tips, worksheets and "to-do" lists show the reader good places to begin the recovery process.

"These lessons are my attempted 'virtual interactivity,'" said Polonsky. "I really want to get people connected to the material and show people ways they can use what they've learned."

There may be no such thing as the "perfect diabetic." There are simply too many factors to coordinate, too many priorities to meet. And, on top of all this, there's that whole "life" thing.

"Keeping good glucose control all the time, in my mind, is basically impossible," said Fuhrer. "I play sports, I go to work, I go to church. I have so much going on that I don't have the time to do everything that I need to do to stay healthy."

According to Dr. Polonsky, the attempt to manage everything perfectly is often the catalyst of diabetes burnout. The solution, in turn, may come when a reasonable "workload" is identified.

"People may know how to eat well and know how to check glucose, but they also have a life," said Dr. Polonsky. "Life gets in the way for all of us, so how are you going to take these ideas and fit them into your day. You can't do everything, so lets figure out where you can begin. Let's find what's reasonable."

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