An ‘insider’s’ perspective on living with diabetes Dr Lesley-Anne MacRae L.MacRae@gcu.ac.uk

Outline Fear of hypoglycaemia Anxiety and stress Assume presence of type 1 diabetes. Incidence of type 1 and type 2 diabetes. Gathering background data. Focus on some everyday factors associated with diabetes, looking more closely at: Fear of hypoglycaemia Anxiety and stress

Some facts There were 258,570 people diagnosed with diabetes in Scotland recorded on local diabetes registers at the end of 2012. 4.9% of the population. 88.2% of all people registered with diabetes had type 2 diabetes (T2). 11.2% had type1 diabetes (T1 (Scottish Diabetes Survey, 2012).

Incidence of T1 in Scottish children There has been a steady increase in the incidence of T1 diabetes in Scottish children over the last 40 years. Patterson et al., (2009) predict a European increase of 70% in the under 15’s by 2020. For the under 5’s, the rate is expected to double. (Scottish Diabetes Survey, 2012).

A Little Bit of Background Symptoms at diagnosis? Cause? Treatment? For both types. Implications of having diabetes?

Overview of Treatment for T1 Main goal of medical intervention is improving metabolic control while balancing this against quality of life. Important psychosocial factors. Unpredictability of metabolic control (A+B=D) Can lead to anxiety, fear and depression.

Psychosocial factors associated with T1 Diabetes doesn’t occur in isolation-families and relationships. Significant anxiety about hypoglycemia and future complications and sources of conflict that may increase relationship stress. (Trief, Sandberg, Dimmock, Forken and Weinstock, 2013).

Hypoglycaemia Impacts heavily on the psychological health, work-related and personal quality of life of people with diabetes. It is important to try to reduce the incidence of hypoglycaemia, while maintaining good glycaemic control. (Davis, Morrisey, Wittrup-Jensen, Kennedy-Martin and Currie, 2005). Intensively managed T1 brings with it a four-fold increase in susceptibility to hypoglycaemia. How does this fit with improved metabolic control afforded by intensive therapy? 

Hypoglycaemia Has been described as being, ‘‘the single greatest barrier to achieving and maintaining good glycaemic control’ (Frier, 2008, p. 87). Why might that be?

Stress & Anxiety Special relevance to those who have T1 in that the foundations of this fear can be ubiquitous. Concern over hypoglycaemia, hyperglycaemia and both short and long-term complications are commonplace (Welch, Jacobson and Polonsky, 2002).

Stress & Anxiety cont’d Grigsby, Anderson, Freedland, Clouse and Lustman (2002) found elevated anxiety symptoms in 40% of participants, with no reported difference between diabetes type. It may compromise metabolic control at a behavioural level by interfering with self-management behaviours.

Stress & Anxiety cont’d BUT stress itself can elicit a hormonal response that is counter-regulatory and energy mobilising. This can, for the person with diabetes, lead to an increase in blood glucose levels (Hermanns, Kulzer, Krichbaum, Kubiak & Haak, 2005). However it may be that the symptoms of hypoglycaemia (sweating, increased heartbeat, inability to concentrate, slurred speech and confusion) are confused with stress and anxiety (Gonder-Frederick, Cox and Ritterband, 2006).

I’ll leave you with…….. An appreciation for some of the psychological and social aspects of diabetes. An awareness of how these often compound the difficulties of living with diabetes. Knowledge of how these may impact on metabolic control-directly and indirectly.

References Davis, R.E., Morrissey, M, Peters, J.R., Wittrup-Jensen, K., Kennedy-Martin, T. and Currie, C.J. (2005). Impact of hypoglycaemia on quality of life and productivity in type 1 and type 2 diabetes. Medical Research and Opinion, 21 (9) 1477-83. Frier B.M. (2008). How hypoglycaemia can affect the life of a person with diabetes. Diabetes/metabolism Research and Reviews, 24, 87-92. Gonder-Frederick L, Cox D, Ritterband L. (2006). Diabetes and behavioural medicine: The second decade. Journal of Consulting and Clinical Psychology, 70, 611–25. Grigsby A.B., Anderson R.J., Freedland, K.E., Clouse, R.E. and Lustman, P.J. (2002). Prevalence of anxiety in adults with diabetes. A systematic review. Journal of Psychosomatic Research, 53, 1053-60. Hermanns N., Kulzer B., Krichbaum M., Kubiak T. And Haak T. (2005). Affective and anxiety disorders in a German sample of diabetic patients: prevalence, comorbidity and risk factors. Diabetic Medicine, 22, 293-300. Scottish Diabetes Survey (2012). http://diabetesinscotland.org.uk/Publications/SDS%202012.pdf Trief, P.A., Sandberg, J.G., Dimmock, J.A., Forken, P.J. and Weinstock, R.S. (2013). Personal and Relationship Challenges of Adults With Type 1 Diabetes. A qualitative focus group study. Diabetes Care, 36 (9) 2483-8. Welch G.W., Jacobson A.M. and Polonsky W. H. (1997). The Problem Areas in Diabetes Scale. An evaluation of its clinical utility. Diabetes Care, 20 (5) 760-6.