An ‘insider’s’
perspective on living
with diabetes
Dr Lesley-Anne MacRae
[email protected]
Outline
 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
 Can
of metabolic control (A+B=D)
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, WittrupJensen, 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 selfmanagement 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.