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Everything discussed in this section so far has been building up to this theoretical model, the Brainbox.

Remember the initial model introduction:

• We have a “Brainbox” of a particular size: CAPACITY
• We carry our “stuff” around in it: STRESSORS

Now let’s imagine that the largest box in the world is size 10 and the smallest is size 1, therefore, everyone has a box rated at a size graded between 1 and 10.

And the same story for the stuff. The maximum stuff that anyone has to carry is 10, and the minimum is 1, so everyone can grade their stuff between 1 and 10.

Let’s look at some examples.

• An average non diabetic adult has a box of size 7 and carries around stuff of size 4, including, work, health, children, relationships, finance and so on. The stressors are difficult to carry, they weigh quite heavy on the mind, but the capacity of the box is good enough to contain it.
• Another non diabetic person has a capacity of 6 and stressors of 6. The box is just big enough to contain with the stuff, but it is hard! A week later, there is a bereavement in their family, stressors increase to 7. The box is no longer fit for purpose, it is overflowing. In this model, this is when depression occurs.
• A person with long term mental health issues might suffer from them because their capacity is very low. They might have a box of only size 2 but a life with very few stressors, only 3. However, this explains how, for some people depression can be a huge internal battle despite the exterior perception that their life is relatively good.

In essence the brainbox model is that:

• BRAINBOX DEFICIT: If the value of stressors is greater than the value of capacity, depression is the result.
• BRAINBOX EQUILIBRIUM: where capacity is equal to stressors. This is not a good state to be in. It leaves you sailing too close to the edge of depression
• BRAINBOX CREDIT: The ideal brainbox situation is to have a gap of where capacity is greater than stressors.

If in deficit or even equilibrium, a person should try to create a gap and there are two ways to do this:

• Increase the size of the box: The best way to do this is to take antidepressant medication.
• Decrease the value of the stuff: Counselling and cognitive behavior therapy can be used to change the perception of the stressors to reduce them.

Implications with T1D

T1Ds are 4 times more prone to experiencing depression because:

• T1D increases our stressors: All of the unique anxieties and disorders discussed in this series increase the value of the stuff!
• T1D reduces our capacity: The serotonin imbalance caused by T1D decreases the size of the box

It should be no surprise that so many suffer, I reiterate, it is normal and to be expected.

Consider an average adult diagnosed with T1D, walking around with a box of size 7, filled with stuff of size 4. The immediate greif and short term anxiety increases the stressors to 6, but still in credit. After a period of diagnosis the box decreases to 6 and now they are in equilibrium, a short time later, there is a stressful incident at work and then they are in equilibrium. Without the T1D, the credit state could deal with a few extra stressors, but the combination of the increase stuff and decreased box caused by T1D results in it being in equilibrium.

Resolving diabetic depression

If depression is caused by having too much stuff in too small a box, the solution is to reverse one or both:

Increase mental capacity

As with a non diabetic sufferer, the best way to increase the capacity of the box is to take antidepressant medication. Antidepressant medication forces the use of serotonin to repair the insufficiency, thus restoring normal chemistry and increasing brainbox size.

Decrease stressors

In a non diabetic patient, stressors are decreased by counselling to understanding them, modifying the perception of how they think about them. Cognitive Behaiour Therapy is essentially the skill of placing a positive spin on negative feelings, improving our perception of them to decrease their weight.

In my opinion, the unique stressors related to T1D play such a large role in the amount that we have to carry, that I believe that if you can significantly reduce the diabetic stressors, by improving the way you feel about T1D, you can significantly reduce your stuff.

Where do you think your Brainbox is? Credit, equilibrium or deficit?

Understanding it and understanding why empowers you to fix it.

Today I am sure that my Brainbox is comfortably in credit. To flip from a deficit requires a combination of two solutions.

We have a box that is too small and with too much stuff in it, so i needed to:

• Increase the size of the box AND/OR
• Decrease the size of the stuff.

Increasing the Box

This is done through antidepressant medication, I was originally on Citalopram, but when my neuropathy became worse, this was switched to Duloxatene, which has a dual benefit of being an antidepressant by nerve suppressant, so is beneficial to neuropathy also. There is no shame attached to taking antidepressants. All it is doing is replacing something that our body is insufficient in, serotonin. Isn’t that the same reasoning as to why we take insulin?

Decreasing the Stuff

Hypo, hyper and complication anxieties are reduced, mainly through knowledge, education, acceptance of perception of perfection. Perfection is impossible to achieve, accepting this was key and redefining my interpretation of perfection was crucial.

Diabulimia, I struggle to assess, I do not referee anymore, due to my eyes but I do trust myself, that if this was not the case, I would not revert to previous behaviours, because my knowledge would preclude me.

I do suffer burnouts, but as said, my high bar, gives me a buffer zone to fall down.

 

Statistics suggest that 25% of all T1Ds have had incidences of diabulimia, 40% of females and 10% of males.

Diabulimia is the deliberate act of avoiding, reducing or omitting insulin injections with a specific intention to lose or control weight. The mechanism for diabulimia is that failure to take sufficient insulin prevents the efficient absorption of food nutrients. This is the same mechanism that means that many people suffer from severe weight loss prior to diagnosis.

• Insulin delivers glucose to the muscles where it is used. Any surplus not used is converted to fat stores. Hence, weight gain.
• The insufficient amount of insulin (pre diagnosis or diabulimia) results in the muscles receiving no energy, therefore, they will convert the fat previously stored into energy.
• However, the conversion process releases creates a chemical reaction as it does so and releases large amounts of ketones into your blood. This places you at serious risk of the short term health complication, DKA
• Furthermore, the insufficient insulin also results in the glucose remaining in the blood and increases blood sugar levels and Hba1c. This puts you at significantly increased risk of all the long term complications.

I believe that diabulimia can be separated into two sub categories.

Outcome based diabulimia   

In many cases, it is outcome based and short term. For me, it was a sporting outcome, for others, it is “to fit in that dress for that wedding”.

I would hypothesise that the vast majority of the 25% fall into this category.

In my case, it was not compulsive, it was not even subconscious. I was choosing to do it. I turned it on and off like a switch as and when needed. It is my belief that this is not uncommon behaviour.

Compulsion based diabulimia

For many, diabetic or non diabetic, what starts out as an outcome based activity, becomes a compulsion and a habitual behaviour, and often related to a body image disorder, for example, body dysmorphia. It is at this point it becomes like a stereotypical perception of an eating disorder, requiring serious medical intervention.

Diabulimia was described in a recent BBC documentary as: The most dangerous eating disorder, you’ve never heard of.

Why does diabulimia affect so many T1Ds?

As with depression, the amount of us that succumb to diabulimia is no surprise to me, it is not a weakness, it is completely to be expected! Refusing to succumb to it shows massive mental strength, but the opposite is not true. Consider the following analogy:

The Magic Pill

Dietting and weight control is a massive commercial industry that we are all subjected to. I have massive issues with the body image debate and the media portrayal of what is healthy, but that is a debate for another day. However, very few people find weight loss, easy!

I want you to imagine what would happen if the following weight loss product was introduced on to the market place for use by all:

Introducing the new magic pill.

• Take this pill every day with meals and the weight will just drop off!
• There is no need to reduce your eating (in fact, it works better, if you increase your food intake!)
• No additional need to exercise
• It really is that easy!

But here is the small print:

• Possible long term side effects include
  • Blindness
  • Heart failure
  • Kidney failure
  • Circulation problems
  • Amputations
• Possible Short term side effects may include
  • Death

But, who ever reads the small print on anything?

I challenge you, the next time you are with a group of non diabetic friends, discuss this, ask them if they would take this magic pill? How many do you think would say yes? How many would say no? How many would be lying and actually would take it.

As a T1D, we are biologically unfortunate, that this magic pill is available to us, simply by omitting insulin. We either ignore the small print or are not made aware of it!

My hypothesis is that, of your friend survey, it would be a large percentage maybe 40% of females, 10% of males? The exact same ratios of T1Ds that do actually succumb to it

How can we reduce this percentage?

Social Media

There are many diabetic community groups in which any conversation on diabulimia and eating disorders is deleted. Part of the reason is fear of triggering, which will be explained next, another part of the reason is the monosyllabic nature of social media communication. Many people try to summarise their feelings or opinion in as few words (or symbols) as possible.

A discussion on diabetic eating disorders deserves a full explanation as you are getting here. But a common conversation I see is as follows:

Q: Does insulin make you fat?

A: Yes its a growth hormone.

Although the answer is factually true but it does no justice to the full details. I will be answering this exact question in a later post and I guarantee my answer will be longer than 5 words long.

Triggering

As mentioned above, diabulimia is a bit like “Fight Club”.

The first rule of diabulimia is: You do not talk about diabulimia

The second rule of diabulimia: You DO NOT talk about diabulimia

We, as a community, also, do not talk about diabulimia enough, because we fear that if people are made aware of their biological magic pill, they will utilise it, but if they don’t know about it, they won’t.

For that reason, I believe the majority of diabulimia occurs by osmosis, mine did, I had one year when my control was particularly awful and i lost weight and consequently performed well in my fitness test. Because I perceived a favourable experience, I repeated it in subsequent years.

The big paradox is though:

The reason we don’t talk about it, is because we don’t want people to be tempted to try it!

BUT

The reason I tried it was because it was never talked about!

My mantra is to tell you the truth, the whole truth and nothing but the truth, there should be no taboos. Knowledge empowers avoidance. If it does become a behaviour, knowledge will allow you to identify it early and ask for help. Abusing your insulin for short term gain, may seem like a good idea but the dangers far, far, far, far, far outweigh any outcome. Never ignore the small print.

If you are T1D for 50 years you are likely to test and inject yourself well over 50,000 times (assuming 3 a day, 365 and a quarter days, 50 years)! It is a tiring and frustrating process. Unlike your job, you cannot take a day off or a vacation. No matter where life takes you, T1D will always follow. Exhaustion and exasperation are inevitable.

I had a decade wher my pattern was probably:

• 1 month trying to resolve my diabetes health
• 5 months of burnout
• Repeat

Seeing numbers that seemingly made no sense and were completely random was so demoralizing to me, even though at these times I was motivated and was trying my hardest. However, the main reason why the results were unpredictable was because, without the knowledge, I was not able to evaluate and interpret them.

There is a massive difference between: knowledge of what you want to achieve and knowledge of how to achieve it. Yoyo management was the result of my lack of knowledge, guesswork dosing for meals and corrections.

EITHER

• Too much insulin
• Go severe hypo
• Overeat the hypo
• Go hyper
• Overcorrect the hyper
• Go hypo………

OR

• Insufficient insulin
• Go hyper
• Overcorrect the hyper
• Go hypo…….
• As above…..

Resolving burnout

The key to not suffering burnout, I beleive, is the knowledge and expectation. Know your body, know what to expect, know your rules, but dont always expect them to work. Understanmding how unpredictable T1d can be is a key to accepting it as such.

Have realistic and acheivable “big picture” control goals. Burnout is like falling off the bicycle. Dont expect that you can be a champion racer, be happy with a leisurely pedal and aim to speed up constantly, eventually, you’ll be a champion. And if you fall off, get back on and slow down a bit!

Meeting my personal goals feels great, I call it the success cycle, I enjoy riding it and i dont want to get off!

Another trick that works for me is to have high and aspirational “finer detail” compliance goals. If I could rate my compliance on a daily basis on:

• Procedural correctness – pen priming, fresh needles and post meal blood tests.
• Recording and calculating – writing details on app and doing an accurate calculation, writing in my book, observations post meal.
• Food timing and discipline – waiting a calculated time before eating and choosing not to eat food that makes control more difficult

If i gave it a score out of 10, it might be 9. (because no matter how aspirational i am, i will never change my lancet every time!)

I find that a burnout period reduces that by an amount. In my case, I might say 4. So in my burnout periods, I maybe comply at 5 out of 10.

• I drop the recording and calculating (although I would still do a mental calculation),
• procedural correctness (reusing needles and so on),
• Food discipline and timing (I might choose to eat my nemesis food, chips!!).

The net result is that my numbers although higher than desired, are relatively ok, and not catastrophic. This might last a few days or until I do have a bad event and I realise, I am much better at the 9 out of 10.

The contrast to that is that if I complied every day at 5 out of 10 and burnout caused me to drop by 4, I would drop to a 1 and virtually be doing nothing.

My last post discussed anxieties all related to fear of hypos but there are other anxieties that can cause insulin manipulation.

Peer isolation anxiety

As a T1D we need to adapt our lives and that, by implication, means we are different to our non diabetic friends. We can either:

1. Embrace these differences: Be the “I am T1D, deal with it” kind of person!
2. Minimise their impacts: Carefully plan and strategise behaviours to be a good T1D but having it not affect a “normal” existence , or
3. Ignore them: Pretend not to be T1D!

Option 3 can obviously lead to insulin manipulation.

Imagine a T1D teenager at a party, they know they should be careful with food, but the fun atmosphere leads to them not caring and observing that, in order to fit in.

Similarly, an adult at a function, there might be a perceived pressure to not be “that person” who has to leave the table to test, inject and manage. Furthermore, the T1D doesn’t want to have a hypo at the table, drawing attention to themselves and their condition.

Weight or body image anxiety/PTSD

This is particularly related to eating disorders and will be discussed in it’s own blog.

Diabetic Non insulin manipulation anxieties

There are also anxieties related to T1D that have nothing to do with insulin manipulation, although, incorrect administering of insulin occur as a result.

Needle anxiety

Needle anxiety is when there is a fear of needles, either as an irrational fear, or a PTSD fear based on previous pain or an infection. There are many products available to alleviate needle fear, eg Buzzy and Tickleflex.

I have never had any needle anxiety, and yet, I went months at a time, not testing my blood sugars. For me, this was a different anxiety altogether

Numbers anxiety

My issue with not testing my blood was actually numbers anxiety, fear of seeing numbers that confirmed how bad I was. Contradictorily, though, it was also, I knew how bad I was and didn’t need to see the numbers to confirm it. I felt that high numbers were a judgement on me, my meter was a permanent reminder to me of how much of a failure I was.

I recently spoke with a man who had no issue with injections (because he knew he would die if he didn’t take them) but was not able to do his blood readings because, he believed, needle fear. We spoke at length, and the mental block was absolutely real, but I do believe it was a numbers anxiety rather than needles. Evaluate yourself, if you think you have needle fear, analyse it and check if it is not the numbers.

Relationship anxiety

Relationship anxiety can occur in at least two forms depending on age and time of diagnosis.

If you are a child, or a single adult, you may have the following feelings:

• Will my T1d make my chances of finding a partner more difficult?
• When I start a relationship, at what point do I disclose my T1D? How will they react?
• Will they worry about whether we could have a family or not?
• Will I be a burden?
• Will I suffer from vicarious grief?

If you are diagnosed as an adult and already in a steady relationship or marriage, you may have the following feelings:

• Will our relationship change? Will s/he still see me as a lover, or as a carer?
• Will I become a burden if I get more ill or complications?
• Will it change our future plans for children?
• Will I die before him/her?

Of course, many of those fears are not unique to T1D and it can be difficult in this (and, in fact, all) anxieties to isolate were T1D starts and ends.

Responsibility anxiety

Unique to younger diagnosises and their parents, responsibility anxiety is the worry of when vicarious care stops and personal care starts, and the transition phase in between. Parents might not want to trust their children and the children may not feel ready for the responsibility. Its a fine balance and an emotional process.

Financial anxiety

As a UK resident and writing this blog primarily from a UK perspective, I am so glad that we do not have to deal with this anxiety. It is a fact, that in many countries, insulin and medication and technology cost extortionate amounts of money, and T1Ds need to make financial decisions as to what they can afford or not. That is not to say that the NHS is a complete bed of roses. It comes with some of its own anxieties and problems, but nothing compared to the scale of financial worries.

Just as T1Ds can suffer from hypo anxiety, we can also suffer from hyper anxiety. This can be related to short term consequence as in Diabetic ketoacidosis (DKA) or long term consequences, complications.

DKA Anxiety

DKA anxiety can be either PTSD or anxiety itself. If you have suffered a DKA or regular suffer them, you might actively try to avoid them and panic when numbers are high. Conversely, if you have never suffered one, but have read of others experiences or created a perception in your mind about how bad they are, you might also fear them.

In my case, I only ever suffered one DKA and I do beleive that my body used to be resistant to them, as it became so used to being high.

My personal theory on DKA is that what the body actually hates the most, is a rapid change from its modus state, it gets used to how it is asked to run and becomes resistant. For me, there was no fear of the short term consequence of high blood sugars, but all the time i was there, I was doing long term damage.

Complications anxiety

Every T1D is told and scared at diagnosis and thereafter that poorly controlled numbers will lead to, blindness, amputation kidney damage, ect.

In particular, our eyes and legs are so important to us, obviously. Both are connected to working, driving, hobbies, everything percieved to be crucial to a fulfilling life, and the fear of losing either or both of them creates panic.

The Consequenses

If you suffer from hyper anxiety, your behaviour might manifest as follows:

• Deliberately over dose pre meal insulin.
• Over react to higher numbers and overdose corrections.
• Stack correction doses too soon.

None are effective solutions as all place you in a much higher risk of hypoglycemia, which, as discussed, creates its own anxieties.

My unfortunate truth was that I could function reasonably normally running in hyperglycaemic range, I did for about a decade. I don’t believe I am alone in this truth. I was so terrified of the short-term vulnerability of hypoglycaemia, that I manipulated insulin to never put myself at risk of it. Here I analyse why this was the case.

Driving anxiety

In the UK, there are special conditions to your driving license as a diabetic. The guidance is known as ‘five to drive’.

• You must not drive if your blood sugar is below 5.
• You must take a break every 2 hours to recheck.
• If your blood sugar is below 5, prior to driving or during a break, you must treat it and get it above 5.
• Once above 5, you must wait 45 minutes before starting or resuming your journey.

I do have to tell you at this point and not to trigger further anxiety that:

• If you were involved in an accident due to a hypo, the law would treat you in the same legal category as a drink driver (although with mitigated punishments.)
• There would also be breaches of insurance policy in these circumstances.

The most oxymoronic factor of our driving conditions is that there is no maximum restriction. You are, apparently no danger to anyone if you blood sugar is 30mmol!

I avoided hypos whilst driving, for fear of crashing and fear of breaking the law.

Work anxiety

Whether you work with people, machinery or both, hypos can put you in vulnerable situations. Your employer does have to be understanding, diabetes is covered by the disability and discriminations act so you do need to have an assessment at work. If you work in the public sector, this would be in the form of an occupational health report. In the private sector it can vary. Large companies may have an occupational health department, in medium sized companies it may be an agreement with Human resources and in small companies, it may be just having a good relationship with your boss.

However, even if your assessment does say, lateness may occasionally occur, you will get in trouble if you are regularly late. If you are hypoing everyday, expect a call for a meeting!

Don’t kid yourself, if your T1D gets in the way of your job and forces your employer too much hassle and money, they will find a way to get rid of you in a way that you could never prove was in breach of the law.

I avoided hypos at work, for fear of losing that job.

Sleep anxiety

Sleeping is, technically, the only time when you are not in control and you potentially have to trust your insulin to work for 6-9 hours without the ability to correct.

Many diabetics suffer sleep anxiety, insomnia, avoiding going to sleep, for fear of not waking up, setting alarms for every other hour to check, light and therefore broken sleep. My unhealthy resolution to this anxiety was making sure I had high blood sugars before sleeping.

Death anxiety

The ultimate fear of all the above anxieties is death!

A hypo does leave you in immediate medical danger that needs to be acted upon there and then, that is a fact! Therefore, the ultimate anxiety related to all the specific examples above is death.

In my analysis, all these examples resulted in short termist decisions not to take, or to underdose my insulin.

Conclusion

If you wrote a list of the consequences of hypos and hypers and placed them side by side, what would you notice?

• The consequences of hypos are all short term vulnerability and death.
• The consequences of hypers are mostly long term consequences and medical debilitations.

It is not surprising therefore that many T1Ds fall into the trap of neglecting their control and subconsciously, or consciously, decide to test the probability of future complications in exchange for an uncomplicated life today. My experience says that you can live hyper and function reasonably well, however, the probability of complications is almost certain!

 

Diabetic post-traumatic stress disorders VS Diabetic Anxiety

Post-traumatic stress disorder is defined as an anxiety disorder caused by very stressful, frightening or distressing events. The person often relives the event in thoughts or in dreams. PTSD can lead to changes in behaviours to avoid such situations where a risk of the event repeating itself is possible. In T1D terms, PTSD can be caused by a traumatic hypoglycaemic attack where the T1D felt vulnerable and was unable to treat themselves, maybe causing a hospitalisation.

PTSD can be connected to any of the anxieties I will go on to list below. The difference would be:

• PTSD is the fear caused by suffering from an event and the fear of it reoccurring, whereas
• Anxiety is the fear of our perception of what the event would be like if it did occur.

In my case, it was never PTSD as I never suffered an adverse incident, my anxiety was always caused by trying to avoid what i perceived the fear to be.

 

 

Diabetic Grief, in terms of the T1D themselves, in my opinion, can take one of 2 forms.

• Past life grief – Grieving the life you had
• Potential life grief – Grieving the life you could have had

However, it is not only us who can suffer diabetic grief, our loved ones and/or parents can also suffer vicarious grief.

Past life grief

It is obviously true that an adult or teenager diagnosed T1D is more likely to suffer past life grief, than a younger diagnosis, simply because a younger diagnosis might not actually remember their life before T1D and they have got used to life as a T1D.

Feelings related to past life grief might be include:

•  I wish I could have one day where I could just eat spontaneously, without insulin or calculating.
• I wish I could sleep without worrying about numbers.
• I miss the care free, anxiety free days prior to being a T1D.

Potential life grief

The two forms of grief are connected, so it can be difficult to separate them. Older diagnosises can experience both, but a younger diagnosis can only feel the potential grief based on their non diabetic friends and family.

Feelings related to this, include

• Would I have been physically healthier, if I wasn’t a T1D?
• Would I be more successful in work?
• Would I be more successful in relationships?
• Would I have avoided the complications I now suffer from, if I’d have taken better care of myself?
• Would I have had children (or more children)?

Vicarious grief

Vicarious grief is most common in parents of younger T1Ds but can affect all of our love ones, but also ourselves.

In the case of parents, feelings might include:

• I am so sorry that my child has T1D.
• I wish that my child could go to sleepovers, without having to liaise with the hosts with a care plan.
• I wish my child wasn’t excluded from events, both at school and as friends.
• I wish my child had the spontaneity that all of his/her non-diabetic friends enjoy.
• I hope my child does not resent T1D for the choices it makes necessary for him/her.
• I hope my child enjoys a full life with no complications

In fact, due to the last feeling in that list, I actually believe that vicarious care is always much more stringent than personal care.

In the case of significant others there could be a difference in feeling depending on whether diagnosis happened prior to meeting, or after, but the feelings might include:

• Should we have children, if there is a chance that they could become a T1D?
• I wonder what my life would be like if I hadn’t fallen in love with a T1D.

We, T1Ds ourselves can also feel grief on behalf of others. Feelings related to this might include:

• I hope I outlive my parents
• I hope my children and significant other, see me grow old and I don’t leave them, before they are ready to let me go.
• I hope my significant other never sees me as a burden, or that I never become one.
• Will my significant other stick around with me if my health gets worse or I do become a burden.

The lists above are by no means exhaustive. Analyse your own feelings, see if you agree with many of the above, and contact me with others if you think of them.

If you are T1D, some studies have suggested that you are 4 times more likely to suffer from depression than a non diabetic.

This is because, Diabetes affects us by:

• Decreasing the size of our brainbox, and our mental capacity, and
• Increases the number of stressors we are required to carry in it.

It is no surprise that for many of us, the box becomes impossible to carry and depression occurs.

Mental Capacity Reduction.

Serotonin is the substance that is regarded to regulate brain chemistry and mood but is not only produced in the brain. It is also produced in the intestines and guess what system is responsible for its production? The very same system that is broken in us T1Ds: The endocrine system.

Furthermore, a recent article I read, discovered that serotonin is also, actually found in the beta cells of the pancreas of a non diabetic person and it has a link to insulin production. Another study suggests that serotonin is actually produced as part of the breaking down process of carbohydrates to glucose.

So, simply by being diabetic, we have greater potential to have less balanced brain chemistry, and therefore a lower capacity, a smaller box.

Increasing our Stressors

Stressors are the baggage we carry around.

Just as our non diabetic friends do, we carry around the stresses of everyday life:

• Work issues
• Relationship, marriages and divorces
• Financial obligations
• Moving house
• Families and children
• Your health and mortality
• Death of others and grief
• Mental Health disorders, anxieties, depression and self esteem

We also carry stressors specific diabetic stressors.

Psychologically, the stress of constantly monitoring your health, incessantly obsessing over food intake and levels is a large burden to carry. There has been a study released which estimated that a T1d makes an extra 320 decisions each day due to the condition.

There are also a number of additional stressors unique to us T1Ds.

• Diabetic Grief
• Diabetic Anxieties
• Diabetic Burnout
• Diabulimia

These will be discussed next in this series.

Diabetes and depression can actually be a vicious circle: Diabetes causes depression then depression affects diabetes and so on…. This was certainly true in my case.

Usual symptoms of depression include

• Low mood (to varying degrees of definition)
• Lethargy
• Failure to motivate yourself, even for things you enjoy

Depression in a T1D can also result in insulin manipulation in a number of ways:

Burnout

Depression can result in a lack of motivation for normal activities. Therefore, it is common for it to result in a lack of motivation for T1D care.

Lack of self care

In my case, my lack of self care and therefore diabetic care has heavily linked to my self esteem issues. In general, I just stopped caring about anything to do with myself.

Self harm

I did not discuss or talk of this at the time, but could my insulin omission during depression have been my way of self harming?

Not necessarily in my experience, but depressive insulin misuse could include:

• Denying insulin as a self punishment
• Overdosing insulin to instigate hypos
  • As a cry for help?
  • As an justification to satisfy a binge eating episode

Suicide

The saddest and most extreme example of depressive insulin misuse is when a T1D is suicidal and uses the insulin as the weapon. I do know of a few friends who did attempt to end their life by administering a huge dose.

Medical screening and personal evaluation of mental health is even more important to us T1ds for the added dangers above.

Use the knowledge here, to realise how depression can manifest itself. It is more vital for us to recognise it early before the viscous circle starts. It is not your fault, it is no reflection of you as a person, there is no shame.

It is not about “Get over it!” or “Pull yourself together!”. If you need help, you need to ask for it.

My mantra today is that is is not a weakness to succumb to mental health issues in diabetes, it is par for the course and normal, but conversely it is shows massive strength to refute them and that strength and weakness are not two sides of the same coin…..

My biggest rebuild of PROJECT ME was to repair my Mental Health. I had to understand why I did what I did in order to be able to accept it and not be ashamed or feel guilt over it.

I created a theoretical model to analyse my own mental health at various stages of my diabetic journey.

The Brain Box Model

I want you to imagine that we are all born carrying a box. In this box we carry around all of our mental stuff. This box is a particular size and all of our boxes are different. For each of us, the box is usually a fixed size for life, but there are circumstances when you box might grow or shrink throughout your life. The amount of stuff in your box is completely fluid and can change from day to day.

• The box size represents my “Mental Capacity”.
• The stuff inside represents my “Stressors”.

The more stressors I carry, the more difficult it is to fit them all into my mental capacity. It can even reach a point where the stressors are too much to fit in the box and it becomes impossible to carry. In this model, this represents depression.

As a Type 1 Diabetic, there are physical and psycological reasons why:

• Our Boxes are, on average, smaller thn our non diabetic counterparts.
• Our value of stressors is higher than our non diabetic counterparts.

This Blog series will outline these and also discuss strategies that have worked for me in both:

• Increasing the size of my box
• Decreasing the number of stressors