DIABETES SUPPORT GROUP SESSION TACKLES DIABETIC “BURNOUT” AND MENTAL HEALTH ISSUES
Effective diabetes care requires that a person’s emotional needs are taken into account alongside their physical care needs according to Counselor at Independence Surgery, Betsho MokgatlheDinonyane.
People with diabetes have high blood glucose levels caused by a problem with the hormone insulin. The two main types of diabetes are type one (insulin dependent) and type two (noninsulin dependent). In Botswana 80 000 people (about 4 percent of the population) suffer from diabetes and there are many more who are undiagnosed. There is no cure, but symptoms can be controlled with diet, exercise and medication. If untreated, high blood glucose levels can result in serious complications. It can lead to organ damage, eyesight problems and in extreme cases limb amputation. But for many there is also a significant psychological impact of learning to manage the condition.
Anita Kebadilwe was diagnosed with Type 1 diabetes in 2007 when she was 11 years old. From learning to manage her eating habits and weight from scratch, she ended up suffering from depression as a result of her diabetes for many years. “The pressure and fatigue of managing the disease did get to
me and fortunately I started seeing a therapist in 2017 who has helped me a lot to manage my emotions when I get off balance.
She said: “When I was diagnosed, diabetes was seen as a medical condition but there was little understanding of the effect it has on mental health, so psychological support was not readily available. It still isn’t because the waiting period to see a psychologist is too long and many patients don’t have medical aid to see independent psychologists. Therefore many of us only ever to hospital to review our blood glucose control”.
Kebadilwe now spends her time volunteering, raising awareness about diabetes. She gives and gets support talking to others who live with diabetes and struggle with their food especially young people, teaching them about carb counting, exercise and diabetes, injection techniques as well as how to deal with stigma and bullying.
“Diabetes is a lot of work. The day someone is diagnosed, they have just been given a new job for the rest of their life,” that doesn’t pay and has “no days off,” Dinonyane stated.
Recently giving a talk during a virtual support group meeting titled, “Diabetes and Mental Health”,Dinonyane noted that living with any kind of chronic condition was a huge challenge and diabetes, in particular was not only a medical condition that damages the body, but it also crushed the spirit of those who have it. “A lifetime of following diets, counting carbohydrates, sticking with medication schedules, managing insulin injections, and visiting a fleet of doctors can wear diabetics down, even if they are doing everything right,” she said.
“People living with diabetes are often worried about developing complications, they are worried about the future impact of having diabetes and there’s the constant burden of diabetes management,” shared Dinonyane. Adding, “Many patients I see also worry about other people’s attitudes and the stereotypes about diabetes, which further impacts on their mental health.”
Common issues to look out for she said, include but not limited to a persistent feeling of sadness and loss of interest in usually pleasurable things that interferes with the person’s ability to function, insomnia or over sleeping, change in appetite and sex drive.
Depression and diabetes often occur together. This puts huge strain on both patients and the healthcare system. Depression in patients who have diabetes is associated with poor selfmanagement and treatment adherence, reduced treatment response and higher morbidity. The World Health Organisation advocates for the integration of mental health care into primary care as a way of improving access to mental health services.
Depression screening for example, Dinonyane said, must happen as one way of reducing the treatment gap in the chronic care clinics. Therefore clinicians should consider using validated screening tools to identify depression among patients with diabetes. To provide a continuum of care, depression screening and treatment into diabetes care must be integrated and enforced through policy.
“Yes, most health professionals kind of wing it when giving patients psycho-social support. They need to have an approach that is more open-ended, ask more questions and pay attention on whether what the patient says and describes gels.
“We should try to get more insight from clients about their experience and not see them just as numbers,” she added.
Meanwhile, Chairman of Diabetes Association of Botswana (DAB), Dr Gontle Moleele stressed the importance of education, not just at diagnosis level but as an ongoing process to equip both patients and clinicians with tools and skills to screen and manage depression and other mental health issues experienced by diabetic patients.
“Once you have diabetes, knowledge is a great protector,” she said. “Good information is readily available. Take advantage of that. The more you know, the better off you are.”