December 8, 2005

Diabetes Burnout

by

Thursday, December 8 9PM est.
Dr. William H. Polonsky, PhD, CDE
Topic: Diabetes Burnout
Author of “Diabetes Burnout: What to Do When You Can’t Take it Anymore”

Dr. William H. Polonsky, Ph.D., CDE is a licensed clinical psychologist, and the Behavioral Diabetes Institute’s Founder and Director. He is also an Assistant Clinical Professor in Psychiatry at the University of California San Diego. Dr. Polonsky has and served as a behavioral consultant in diabetes to several multi-site clinical research trials, and is an active researcher in behavioral medicine and a licensed clinical psychologist specializing in psychosocial issues related to diabetes.

William H. Polonsky, PhD, CDE
PO Box 2148
Del Mar, CA 92014
e-mail: [email protected]
<a href=”http://www.behavioraldiabetes.org/”>http://www.behavioraldiabetes.org/</a>

Welcome! You have entered [The DTF Lounge] at 7:31 pm
[Scheduled Chat Room]: Dr. Polonsky has entered at 9:02 pm
[
Dr. Polonsky] 9:02 pm: Hello all. I believe I am in the right place, aren’t I? [Gina – Type 1 dxd Nov 2000] 9:03 pm: Welcome to our very first Guest Chat

[Gina – Type 1 dxd Nov 2000] 9:03 pm: and thank you all for coming!!

[Scott] 9:04 pm: It is with great pleasure that I introduce Dr. William Polonsky. Dr. Polonsky is President and Founder of the Behavioral Diabetes Institute, the world’s first organization dedicated to tackling the unmet psychological needs of people with diabetes. A licensed clinical psychologist, certified diabetes educator and Assistant Clinical Professor in Psychiatry at the University of California San Diego, he has been studying the psychological and behavioral aspects of diabetes for over 20 years.

[karen] 9:04 pm: Dr. Polonsky do you have any relatives that are diabetic?

[Dr. Polonsky] 9:05 pm: Yes, Karen, I do have relatives with diabetes! You?
[karen] 9:05 pm: no dr. P I do not

[rjommp] 9:07 pm: Dr I’ve had Type One 40 years and sometimes it seems like there has not been enough with treating complications and also a true cure

[rjommp] 9:08 pm: This is frustrating

[Dr. Polonsky] 9:08 pm: The Guardian is sure to be very, very cool. And possibly a good remedy for burnout (though maybe not sarabean’s)…. but anyway…

[bjkiah] 9:08 pm: 46 years T1

[Dr. Polonsky] 9:08 pm: rj, what do you mean? not enough research?

[karen] 9:09 pm: sara i had to split my dosage when i was on lantus to get good bgs or i was sky high after dinner on one shot

[Scott] 9:09 pm: Dr. Polonsky, what prompted you to start the Behavioral Diabetes Institute? Can you tell us a little bit about it?

[Dr. Polonsky] 9:09 pm: oh good, i’ll start with scott’s questions

[rjommp] 9:10 pm: there is research just not enough concrete happenings with cures and treatment of complications technology is awesome now

[jim] 9:10 pm: i work in a busy hospital and wanted to know if it is possible to have a dubble burn out from healthcare and diabetes

[Dr. Polonsky] 9:10 pm: the BDI is, as you know, the first of its kind. we do a whole variety of workshops for folks with diabetes, focusing on burnout, depression, etc.

[Dr. Polonsky] 9:10 pm: unfortunately, so far, all of them are in San Diego!

[Scott] 9:11 pm: Dr. Polonsky, your latest BDI newsletter indicates you are planning to take them elsewhere soon!
[sarabear63] 9:11 pm: whose next ?

[karen] 9:11 pm: what kind of things do you use mostly to treat burnout/depression, etc, any one thing that works the best

[Dr. Polonsky] 9:11 pm: what prompted me? so much burnout and stress, and very few who can be of any help. finding a way to do this in groups, and as cheaply as possible (we are a nonprofit) seems an important solution….

[Dr. Polonsky] 9:12 pm: yes, we do have hopes to take our programs on the road. hopefully, sometime later in 2006.

[Dr. Polonsky] 9:13 pm: to answer karen, there isn’t a single thing that helps with burnout, so we have a menu.

[Dr. Polonsky] 9:13 pm: for example, the most import answer seems to be “controllability”. you get burned out when you feel that diabetes is out of control…

[Dr. Polonsky] 9:14 pm: so by looking at every thing bout your diabetes, we try to tackle one things at a time– the diabetes police in your life, the fact that your best efforts don’t seem to lead to better BG’s, etc.

[sarabear63 QUESTION] I have been T1 for 29 years no major complications is memory loss a possible complication and I have had depression for years and cant shake it no matter what kind of anti depressant i have tried.

[Dr. Polonsky] 9:16 pm: sara has 2 good questions. let me answer both, one at a time

[Dr. Polonsky] 9:17 pm: first, memory loss. even if you have had many severe low blood sugars, the evidence suggest that most people do not suffer any serious cognitive problems. good news. and not memory problems.

[Dr. Polonsky] 9:18 pm: memory problems ARE associated with depression. people with diabetes are at double the risk of depression

[Dr. Polonsky] 9:18 pm: antidepressants help a lot of people, but not everyone. if you’ve tried a bunch and nothing works….consider the following…

[Dr. Polonsky] 9:19 pm: first, we know that cognitive-behavioral therapy (brief, structure, focusing on the present and helping to problem solve issues in your current life, and talking about how you think about thins) help depression as well as medications! the combination works best.

[printcrafter QUESTION] IS burn out more a problem with t1 or t2

[Dr. Polonsky] 9:20 pm: other things that help– regular exercise, a decent sleep pattern, feeling successful with your diabetes, etc. I’d recommend find a good skilled psychologist!

[Dr. Polonsky] 9:20 pm: G the second question is about burnout, type 1 vs. type 2
[Gina – Type 1 dxd Nov 2000] 9:21 pm: YES

[Dr. Polonsky] 9:21 pm: no one knows for sure, but I’d wager that it is much more common in type 1., where it is much harder to ignore diabetes completely!

[Heidyn QUESTION ] 9:14 pm: Dr. P- at what blood glucose level is there a significant rise in depression? Does it vary by the individual?

[Dr. Polonsky] 9:22 pm: but again the common issue is– feeling out of control with diabetes. so it can affect anybody living with this tough disease

[Dr. Polonsky] 9:22 pm: good question, heidyn.

[Dr. Polonsky] 9:23 pm: there is NO BG level where you see a rise in depression. I’m not sure exactly what you mean.

[Heidyn] 9:24 pm: when I’m in the 200’s-I get depressed easier

[Dr. Polonsky] 9:24 pm: you can certainly feel lethargic and crummy when your BG’s get high and stay high, but depression is a more chronic, serious problem.

[Dr. Polonsky] 9:25 pm: I see what you mean, H. elevated BG’s, because they can make you feel more tired and out of sorts, can EXACERBATE depression, but they don’t really cause it. know what i mean?

[AllisonBlass] 9:25 pm: Heidyn, I think you’re talking more simply about moods… Depression is chronic problem that doesn’t go away.

[karen] 9:25 pm: I understand Heidyn question, our emotions change with bgs changes and we do feel differently at low and highs

[Gina – Type 1 dxd Nov 2000] 9:25 pm: yes i think i am more depressed when my sugars are high also

[Dr. Polonsky] 9:25 pm: yep, karen. and that is probably much more noticeable for someone with type 1 than type 2

[Scott] 9:26 pm: Dr. Polonsky, what the signs are for depression that require seeking counseling and/or medication?

[Heidyn] 9:26 pm: yeah, I guess its a mood thing-but it is depression, because depression you don’t want to do anything about it anyway..

[Dr. Polonsky] 9:27 pm: scott, signs for depression include: depressed mood (DUH!), loss of pleasure in daily activities (nothing is fun any more), sleep problems, change in appetite, problems concentrating, etc.

[Gina – Type 1 dxd Nov 2000] 9:28 pm: [The LIVabetes Glucose Goddess] 9:16
pm: How can we work through the guilt/shame part

[Dr. Polonsky] 9:28 pm: Hi LGG. Depends which kind of guilt you mean. For example…

[Dr. Polonsky] 9:29 pm: some people guilty whenever their BG gets out of whack or they eat one wrong morsel. often the solution here is to think about expectations. is it reasonable to think i will always eat perfectly, or that i will never have a bg above 150? thank goodness for a1c testing. know what i mean?

[Dr. Polonsky] 9:30 pm: some people feel guilty (more likely to be type 2) that they gave themselves diabetes.

[The LIVabetes Glucose Goddess] 9:30 pm: I am okay it is the wrath from the diabetes police

[Dr. Polonsky] 9:31 pm: OH, so its dealing with the comments/nods from others!

[The LIVabetes Glucose Goddess] 9:31 pm: Yes! What would be some good way to handle

[Dr. Polonsky] 9:31 pm: i just wrote something for Diabetes Forecast about the need for “diabetes etiquette” wallet cards, which should be available so you could hand them out to threes…. for example

[Scott] 9:31 pm: or is it the wrath of The Blood Sugar Fairy??

[The LIVabetes Glucose Goddess] 9:32 pm: It is the standard you cant’s or you shouldn’t

[Dr. Polonsky] 9:32 pm: i always suggest finding a nice calm moment to talk with your loved ones who are acting like Police, and….

[Dr. Polonsky] 9:33 pm: first remember, because they care, they will never, ever stop…

[Dr. Polonsky] 9:33 pm: so you must DISTRACT them…

[Heidyn] 9:33 pm: smack them upside the head?(just kidding…)

[AllisonBlass] 9:33 pm: I try to use the opportunity to educate them. To tell them why I can do it even though I have diabetes. Most people are just confused….

[Gina – Type 1 dxd Nov 2000] 9:34 pm: I sat my friends down when they were trying to be the police and explained everything to them in a calm manner and they appreciated it in the end

[Dr. Polonsky] 9:34 pm: tell them exactly how they COULD be of help. give them something to do. AND let them that their comments, even when they are right, just aren’t helpful. also, like allison said, educating them can work..

[The LIVabetes Glucose Goddess] 9:34 pm: I find that I constantly try to educate my family and friends and sometimes just choos to withdraw instead.

[Dr. Polonsky] 9:34 pm: thanks for that comment, gina. perfect.

[Gina – Type 1 dxd Nov 2000] 9:35 pm: i think that a lot of people just don’t understand
[AllisonBlass] 9:35 pm: Well, here’s another little secret: Ignore them!

[Gina – Type 1 dxd Nov 2000] 9:35 pm: back in the day people were told not to have things but these days you can have everything in moderation

[Dr. Polonsky] 9:35 pm: not to toot my own horn, but let them read the chapter in my book (Diabetes Burnout) about the diabetes police. sometimes that can help to start a nice conversation… and change!

[AllisonBlass] 9:35 pm: Sometimes when they say “Can you eat that?” I just say “Yes” and then take a big bite of whatever it is.

[Scott] 9:35 pm: It seems like the media doesn’t really help … I see mis-information in news articles re: diabetes every week!

[The LIVabetes Glucose Goddess] 9:36 pm: yes it is true… Thanks Doc…I love the work you do and your book

[Dr. Polonsky] 9:36 pm: scott, the media clearly doesn’t help!

[onepfalzer] 9:16 pm: what of i do if i think 1 of my meds is making high BS – Zetia, I’m type 1.5 for 8yrs on insulin, + metformin

[Dr. Polonsky] 9:37 pm: well gosh, onepfalzer, you may be right! why not talk to your doc or pharmacist ASAP! there certainly are meds that can do that.

[onepfalzer] 9:38 pm: my docs said ………..not supposed to!!

[Dr. Polonsky] 9:38 pm: however, I’m certain that neither insulin or metformin is not raising your bg’s. which med?

[onepfalzer] 9:39 pm: Zetia……..its has changed the absorption I think

[onepfalzer] 9:40 pm: my doc it trying to raise my HDL’s

[Dr. Polonsky] 9:41 pm: you can always try, with your doc’s collaboration, an experiment. stop zetia for x period of time and see if bg’s change. but do it with your doc please!

[onepfalzer] 9:41 pm: thanks

[rjommp] 9:18 pm: Have some major life effecting complications that can’t all see
m to be documented with tests but they appear to be neurological and am frustrated by not knowing exactly what is causing the problem

[Dr. Polonsky] 9:42 pm: rj, well that sucks. have you seen specialists? another thought….

[rjommp] 9:43 pm: Yes i have been to a Neurologist

[Dr. Polonsky] 9:43 pm: I am a big fan of Joslin’s DOIT program (diabetes outpatient and intensive treatment), a 3 1/2 day intensive program, very personalized, that can help you to get to the bottom of probs like this…. know about it?

[rjommp] 9:44 pm: No haven’t but thanks for the suggestion.

[rjommp] 9:44 pm: just getting there with limited finances

[Dr. Polonsky] 9:44 pm: what i like about very specialized programs like this is that they can hook you up with diabetes-knowledgeable neurologists, who’ve seen it all.

[rjommp] 9:45 pm: Are there any in Michigan

[Dr. Polonsky] 9:45 pm: the $$$ issue isn’t an easy one. sometime insurance covers. check it out at the website, <a href=”http://www.joslin.org”>www.joslin.org</a>.

[rjommp] 9:45 pm: thanks again Dr

[Dr. Polonsky] 9:46 pm: in Michigan? i don’t know. i know that they have an awesome diabetes program at the U of Michigan. contact Martha Funnell there for guidance and advice re availability of the right stuff at U of M….

[trish] 9:38 pm: Does clinical intervention/counseling at an early age help at all?
With coping skills? Any research on this?

[Dr. Polonsky] 9:47 pm: not sure i understand the question, but i won’t let that stop me….

[Dr. Polonsky] 9:48 pm: it seems likely that when you grow up with diabetes in the “right way”, its easier to deal with as an adult. for example…

[trish] 9:48 pm: Me neither…can seeing a counselor to deal with small issues help to prevent bigger ones later?

[Dr. Polonsky] 9:48 pm: Yes, trish. absolutely. what are you thinking of?

[trish] 9:49 pm: I’m thinking that, while I cannot “prevent” burnout in my 8 yr old, can seeing a counselor significantly help?

[trish] 9:49 pm: Before the issues fester? Have there been any studies on this?

[Dr. Polonsky] 9:50 pm: good question. perhaps it would help, depends on the counselor of course. but there may be other things to do. things we do know about. for example, is everyone eating the same way as your daughter?

[trish] 9:50 pm: Yes. One for all…

[Dr. Polonsky] 9:50 pm: your daughter shouldn’t be restricted to “special meals”, while everyone else eats “real food”

[Dr. Polonsky] 9:50 pm: great!

[Dr. Polonsky] 9:51 pm: a second issue is making sure you share all diabetes tasks..

[Dr. Polonsky] 9:51 pm: she shouldn’t have to do it all, or nothing.

[trish] 9:51 pm: OK…

[Dr. Polonsky] 9:51 pm: your daughter needs to know she doesn’t have to be alone with this crumby disease. and that it doesn’t have to be horrible

[trish] 9:52 pm: Gotcha. I hope I am doing that.

[Dr. Polonsky] 9:52 pm: its tough being a parent with a kid with diabetes. talk about stress and guilt
[Dr. Polonsky] 9:52 pm: 1 hang in there

[trish] 9:52 pm: Thank you for your advice tonight.

[Scott] 9:18 pm: How about asking Dr.
Polonsky what the signs are for depression
that require seeking counseling and/or
medication.
[Scott] 9:20 pm: How are you doing?
[Scott] 9:24 pm: Dr. Polonsky, how much
is the BDI doing as far as working to help
diabetes educators, endocrinologists, etc.
recognize and properly address issues
related to depression

[Dr. Polonsky] 9:53 pm: scott, we do have a depression program, and we do travel around the country lecturing and training providers about depression and burnout in diabetes. our very formal programs should start in the Fall for providers.

[Dr. Polonsky] 9:54 pm: I’m still amazed that providers are surprised by the strong link between depression and diabetes. they love to hear about this!

[AllisonBlass] 9:47 pm: “I do a lot of mentoring with teens with diabetes, and I’ve found that even those most of these kids haven’t had diabetes for that long, they burnout so fast (mostly because of being “different” from their peers. Even though I’m 20 and have had diabetes since I was 8, I don’t always know how to address their issues of denial and depression. Any pearls of wisdom you could offer?”

[Dr. Polonsky] 9:55 pm: oh goodness, I’m no expert when it comes to teens, but…..

[Dr. Polonsky] 9:56 pm: i know that teens get a lot of pressure to be more motivated by parents and to take this diabetes more seriously, but….

[Dr. Polonsky] 9:56 pm: that’s tough when you’re a teen and feel immortal. AND

[Dr. Polonsky] 9:56 pm: as you mentioned, the not wanting to be different is REALLY tough.

[Dr. Polonsky] 9:57 pm: when i work with teens, i like to work with whole families. making sure we know who is responsible for exactly what. trying to get kids to be at least a little more responsible, while helping parents to back off (at least a little)…

[Dr. Polonsky] 9:58 pm: so what do i recommend? probably what you’re doing with those teens, just being a good listener. Diabetes IS tough, especially for them..

[Gina – Type 1 dxd Nov 2000] 10:00 pm: Doc, i was diagnosed with type 1 when i turned 25 yrs old and i have noticed i get down a lot because i feel as though my life is always turned upside down and always have a feeling of diabetes, i also have the feeling of I HATE DIABETES ALL THE TIME. is there a way to calm down without going to a therapist and do you feel a lot of older adults diagnosed with type 1 have this problem

[Dr. Polonsky] 10:01 pm: Shocking? You don’t love your diabetes?

[Gina – Type 1 dxd Nov 2000] 10:01 pm: haha

[Dr. Polonsky] 10:02 pm: In truth, few people are thrilled about it. what I’d recommend is take it part. what are the top 3 things you hate about it? yes, i know there are a million, but…
[Gina – Type 1 dxd Nov 2000] 10:02 pm: that’s easy

[Scott] 10:01 pm: Everyone, I’d like to share with you something from Dr. Polonsky’s BDI website you may find useful. The following pages describe 10 important tips for mastering the emotional side of diabetes. You may also click here ( <a href=”http://www.behavioraldiabetes.org/downloads/Diabetes-10-things-brochure.pdf”>http://www.behavioraldiabetes.org/downloads/Diabetes-10-things-brochure.pdf</a>) to download the PDF brochure version of this booklet.
[Scott] 10:02 pm: Sorry, once again 10 important tips for mastering the emotional side of diabetes. You may also click here <a href=”http://www.behavioraldiabetes.org/downloads/Diabetes-10-things-brochure.pdf”>http://www.behavioraldiabetes.org/downloads/Diabetes-10-things-brochure.pdf</a> to download the PDF brochure version of this booklet

[Dr. Polonsky] 10:02 pm: once we know those top 3, we can begin to problem solve. is there something even small we can do to address even one of those issues?

[Gina – Type 1 dxd Nov 2000] 10:02 pm: checking my sugars, counting carbs and giving myself a shot

[Dr. Polonsky] 10:03 pm: so we might start with checking sugars. what’s tough? doing it, seeing the results, not sure what to do next, etc. we take it apart, and figure out what to do! for example…

[Gina – Type 1 dxd Nov 2000] 10:03 pm: seeing the results mostly
[Dr. Polonsky] 10:04 pm: i don’t know your situation exactly, but many people get terribly upset about the numbers they see and forget– ITS JUST A NUMBER! not a statement of self-esteem..

[Gina – Type 1 dxd Nov 2000] 10:04 pm: doing everything i am supposed to and still seeing a high sugar

[Gina – Type 1 dxd Nov 2000] 10:04 pm: it makes me crazy

[Gina – Type 1 dxd Nov 2000] 10:04 pm: you feel like giving up

[Dr. Polonsky] 10:05 pm: so we cant solve it all right now, but that’s right– it feels like too many straws on the camel’s back. the solution. one straw at a time. as scott mentioned, you might want to read my chapter about the “blood sugar fairy”. you’ll see.

[Gina – Type 1 dxd Nov 2000] 10:06 pm: ok i will

[Dr. Polonsky] 10:06 pm: also, we have been suggesting that you take a piece of making tape, put it under the window on your meter, and write– its just a number!

[Gina – Type 1 dxd Nov 2000] 10:06 pm: ha

[Dr. Polonsky] 10:06 pm: another step would be to make sure you have VERY clear goals. At what number should you decide that this is just terrible and must do something.

[The LIVabetes Glucose Goddess] 10:07 pm: Hey Gina…Have to share a thought. I I try to think of your BG meter as a compass to a mountain climber…just give you information on your current status so you can determine what action you need to take in order to reach your goal…it helps me to think of it this way.

[Scott] 10:07 pm: Dr. Polonsky, I hate the term “control” for blood sugar management. We do not control everything, only a handful of elements in the grand scheme of everything, yet the medical profession loves using the term “control” instead of manage.

[Gina – Type 1 dxd Nov 2000] 10:07 pm: ha that’s a good way to think of it

[Dr. Polonsky] 10:07 pm: right, scott. i hate the term control as well. its just good BG management, not control.

[AllisonBlass] 10:07 pm: Dr. Polonsky, you sound like my dad… He’s been telling me for years that “It’s just a number!” and that he thinks the greatest fault of people with diabetes or caring for the disease is getting emotionally bent because of a BG reading… which really is just counterproductive…

[Dr. Polonsky] 10:08 pm: uh oh, sounding like your dad. that worries me!

[AllisonBlass] 10:08 pm: no no, my dad’s cool!

[Gina – Type 1 dxd Nov 2000] 10:08 pm: DR. DAD lol

[Dr. Polonsky] 10:08 pm: thx allison!

[AllisonBlass] 10:08 pm: lol.

[Dr. Polonsky] 10:10 pm: Heyy LLG, like the compass idea!!

[Dr. Polonsky] 10:10 pm: I mean LGG

[Dr. Polonsky-&gt;Gina – Type 1 dxd Nov 2000] 10:10 pm: how bout one more…

[The LIVabetes Glucose Goddess] 10:11 pm: Thanks it works for me…I found i needed to re-establish my relationship with my meter

[Dr. Polonsky] 10:11 pm: I’ve got time for one more. gina?

[printcrafter] 9:19 pm: D people 2x at risk of depression. ‘Cause it is hard or bio-medical reason?

[Dr. Polonsky] 10:12 pm: Ah, why is depression elevated in people with diabetes, especially type 2?

[Dr. Polonsky] 10:12 pm: one reason is— all the other stuff. it turns out that depression is elevated especially high in people with diabetes who have OTHER disease problems (hypertension, arthritis, etc).

[Dr. Polonsky] 10:13 pm: if you have diabetes and no other disease problems, depression rates don’t seem to be that high

[printcrafter-&gt;Gina – Type 1 dxd Nov 2000] 10:13 pm: I’ll scroll back and get it….multi tasking!
[Dr. Polonsky] 10:14 pm: also, there is new evidence that depression may contribute to the development of type 2 diabetes, not type 1!

[Dr. Polonsky] 10:14 pm: this may be behavioral, depression leads to poor self-care, making diabetes more likely in those genetically predisposed. OR depression may contribute to insulin resistance directly, the core problem in type 2 , not type 1

[Dr. Polonsky] 10:15 pm: wild, huh?

[Gina – Type 1 dxd Nov 2000] 10:15 pm: that is

[Dr. Polonsky] 10:15 pm: of course, i also think that just the hassles of diabetes can also make depression more likely. the core feature of depression is a feeling of powerless ness…

[Gina – Type 1 dxd Nov 2000] 10:16 pm: wow you just summed me up

[Gina – Type 1 dxd Nov 2000] 10:16 pm: powerless

[Dr. Polonsky] 10:17 pm: I’m really enjoying this, but I need to sign off shortly and go grab some dinner. I hope you’ll invite me back sometime!

[Scott] 10:17 pm: we’d love to have you join us again in the future, Dr. Polonsky!

[Gina – Type 1 dxd Nov 2000] 10:17 pm: and thank you so much for doing this guest chat it was a great success

[rjommp] 10:17 pm: Good night Dr

[The LIVabetes Glucose Goddess] 10:17 pm: Thanks for sharing your wisdom Dr.P

[Gina – Type 1 dxd Nov 2000] 10:17 pm: nite doc and thanks again we will be contacting you

[Dr. Polonsky] 10:18 pm: I didn’t know I could type this fast (faster than my brain)…… Thanks again, and see you all again soon!

[Jon] 10:19 pm: Thanks Dr. Polonsky!

[Scott] 10:19 pm: Please visit the Dr. Polonsky’s Behavioral Diabetes Institute’s website at <a href=”http://www.behavioraldiabetes.org/”>http://www.behavioraldiabetes.org/</a> for newsletters and updates on scheduled events in the future