Living with diabetes, whether it’s type 1 or type 2, isn’t just about managing blood sugar levels or counting carbs—it’s an unrelenting emotional and mental challenge. The constant vigilance can leave you feeling like there’s no off switch, and then, even if you ‘do everything right’, there’s still no guarantee that you’ll even achieve the stable blood glucose levels you’re after.

Managing diabetes demands constant attention—24 hours a day, 7 days a week, 365 days a year.

There are so many variables that can impact blood glucose that it can end up feeling like a hopeless game of whack-a-mole, and this can weigh heavily, adding a significant contribution to your cognitive load.

The Emotional Toll No-one Sees

The impact of this emotional burden isn’t just incidental—it’s a central consideration in diabetes care.

Studies show that one in six people with non-insulin-treated type 2 diabetes experience severe diabetes distress.

This rises to one in five people with insulin-treated type 2 diabetes, and still further to one in four people with type 1 diabetes.

If it is unaddressed, then diabetes distress can evolve into diabetic burnout which leads some people to ‘chuck in the towel’, and disengage completely from their diabetes care because it simply becomes too overwhelming to manage.

This puts them at risk of complications and potential progression of the condition, so addressing diabetes distress, and preventing it from becoming burnout, is absolutely crucial…not just for mental and emotional well-being, but also for physical health.

What’s the weather forecast?

So if you notice that you are starting to feel frustrated and hopeless about your diabetes management, possibly skipping medications, not bothering with monitoring blood glucose levels, being less careful about what you’re eating, or missing check-up appointments take a moment to check in with yourself and ask:

“Do I feel like I’m at war with my diabetes and losing the battle?”

If the answer is yes, then it’s important to start tuning into your inner weather:

• are storm clouds of demotivation gathering with thoughts like, ‘I can’t be bothered with this anymore’?
• perhaps a gust of hopelessness is blowing in, carried by thoughts like, ‘I’ve tried all the advice, and nothing works’;
• or maybe there’s a biting cold front of resentment sweeping in with, ‘It’s just not fair!’

The first thing to do is be kind to yourself – acknowledge what a tough and demanding commitment it is to care for yourself.

Understanding Diabetes Distress and Burnout

Diabetes burnout can develop from diabetes distress and comes about when the relentless demands of managing the condition—monitoring blood sugar, taking medications, and/or making lifestyle adjustments—become emotionally overwhelming.

You become both mentally and physically exhausted and your self-care can feel like it’s become an impossible burden.

Your frustration can mean you start to neglect your self-care and eventually, you might even completely disengage from your treatment.

Recognising the signs of burnout as early as possible is crucial to preventing the long-term impacts on both your emotional and physical well-being.

Practical Steps to Manage Burnout

Acknowledge the Feeling

Naming your feelings and recognising that you may be in burnout, but without judging yourself, is an important step. Burnout thrives in silence and denial, so by naming and recognising it, you are taking the first step towards addressing it.

In some ways, this step is the hardest because you can’t do something about something unless you know what that something is. So even if you’re feeling good about things and it seems like all is going well, it’s valuable to still check in with yourself regularly so that you have a really good sense of your ‘baseline’ and are more likely to recognise when something shifts in the wrong direction.

Practical steps to take:

• Name your feelings—”I feel overwhelmed” or “I feel frustrated.” If this feels hard, try using an emotions wheel or a feelings app (such as How We Feel) to help you identify what’s coming up for you;
• Journal about your challenges: reflect on questions such as ‘What’s been hardest for me lately?’ or ‘Am I avoiding parts of my self-care?’ These reflections can help you uncover and bring forwards hidden thoughts and emotions to work on;
• Check in with yourself regularly (daily or weekly) to monitor your internal weather, as this helps to establish your baseline and recognise shifts before the burnout can get a hold. Using a mood tracker app (such as Daylio) or a notebook to keep track over time will reveal patterns that may not be immediately obvious to you.

Mindfulness Practices

When we’re feeling burnt out it’s very easy to get caught up in our heads. The mind is a great time traveller; it can take us back to all the occasions when things went wrong, or it can travel forwards to predictions of worst-case scenarios – both things can reinforce our difficult and challenging feelings, trapping us in a vicious cycle. Using mindfulness practices, such as contact with the present moment, we can interrupt this cycle of rumination and self-criticism, which often exacerbates burnout.

Practical steps to take:

• Take five deep breaths, focusing on the sensation of air moving in and out (short breathing exercises);
• Lie down or sit comfortably, and mentally scan each part of your body to notice where you hold tension (body scan meditation);
• Slow down while eating, notice flavours and textures, or when walking the dog, notice the small details in the environment around you, all without judgement (mindful activities);
• Use a mindfulness app (e.g. Smiling Mind) or YouTube videos (guided practice).

Start with just a few minutes a day and gradually build up to make it a habit that sticks.

Clarify Your Values

Burnout can make diabetes care feel purposeless, but connecting with your ‘WHY’ can help you re-find your motivation and sense of direction.

Our values are like a compass point; they can give us a direction at times when we’re feeling ‘all at sea’. Consider what matters most to you and what personal qualities you would want to imbue, and connect this with your diabetes management.

What is your ‘WHY’?

It could be enjoying time with your kids, supporting your partner, or pursuing your passions in activities that bring joy into your life. All of these things require both physical and mental energy which can drain away when we lose sight of our sense of purpose.

Practical steps to take:

• Reflective journaling can be helpful for this too – asking yourself questions such as: ‘What matters most to me?’ and ‘What do I want my health to allow me to do?’;
• Once you’ve identified what’s important to you, connect those things to daily actions, for example:
  Value – being present for my family.
  Action – prioritising blood sugar monitoring so I have the energy for family outings;
• Create a visual reminder of your values, such as a list or vision board, and put it somewhere prominent so that you’ll see it on a daily basis (e.g. fridge, phone wallpaper, etc).

When you notice that you’re starting to feel overwhelmed, revisit your values as a “compass” to guide your next steps, which are…

Set Small, Achievable Goals

Once you’ve reconnected with your values, link them to things you can do. Large goals can feel overwhelming, playing into avoidance because when you can’t see where to start it’s easier not to start at all.

A goal such as “being there for my family” might seem overwhelming, as there are so many different ways that you could do this, but breaking it down into small achievable actions and focusing on just one thing at a time can help you gain momentum and grow your confidence.

And it really doesn’t matter how small the goals are – it could be as simple as watching a movie with the kids at the weekend.

There’s a saying – ‘a journey of a thousand miles starts with a single step’ – focus on the step in front of you rather than the total distance…it will be a whole lot less overwhelming that way.

Practical steps to take:

• Use the SMART goal framework: make your goals Specific, Measurable, Achievable, Relevant, and Time-bound – e.g. instead of ‘get my diabetes under control’, start with ‘check my blood sugar once each morning this week’;
• Acknowledge every success, no matter how minor – celebrate even the smallest of wins. This is really important: studies have shown that attaching a positive emotion to the habit makes it far more likely that you will repeat it!
• Write down your goals and track them visually, such as crossing them off a list or using a habit tracker app. This will reinforce your progress and keep you motivated.

Build a Support Network

Diabetes management can feel like a lonely journey sometimes, especially if those around you don’t really understand what’s involved in managing this condition.

Well-meaning family members and friends can inadvertently say and do things that reinforce some of the difficult thoughts and feelings that you’re having about your diabetes management – Great Aunty Gert turns up with a chocolate cake that she made especially for you and can’t understand why you’re not diving in!

There is a lot to be said for being able to speak with people who are on a similar journey, and connecting with others not only helps to reduce loneliness, but you will hopefully be able to provide encouragement and even share practical tips acquired through the benefit of your collective experiences.

The power of the internet for research means that these days it’s never been easier to connect with peers and share experiences.

Practical steps to take:

• Join local or online groups for people with diabetes to share experiences and coping strategies. A platform like Diabetes.co.uk, which has a forum for both Type 1 and Type 2, is a great starting point;
• Get your family involved and don’t be afraid to communicate your needs to them – guide them on how to support you. E.g. explain how unhelpful offering unsolicited advice can be, or how creating situations like Great Aunty Gert’s cake scenario can feel unsupportive and upsetting;
• Reach out to your diabetes care team to discuss your distress – not only can they lend you a supportive ear and give you practical advice, but they can also help you tap into the support offered by therapists trained in managing chronic illness.

Self-Compassion and Diabetes Management

Managing diabetes is a demanding, lifelong task, and perfection isn’t a realistic goal. Everyone faces setbacks, and it’s important to replace self-criticism with kindness. If you wouldn’t say harsh things to a friend, why say them to yourself?

Celebrate small wins, and focus on:

PROGRESS, NOT PERFECTION

Every small effort counts and every setback is a step in learning – give yourself the grace to keep trying.

Remember, you are not alone on this journey and you deserve to have a rich and meaningful life – diabetes does not have to steal that from you!

If you are struggling, then speak with the clinicians who are managing your care – they may be able to put you in touch with local peer support groups. In addition, you may consider working with a therapist who specialises in supporting people who experience long-term physical health conditions.

Ref: Speight, J., Holmes-Truscott, E., Hendrieckx, C., Pouwer, F., & Hagger, V. (2015). Diabetes MILES-2 2015 Survey Report. Diabetes Victoria, Melbourne.

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If you’d like to explore how therapy can support your relationship with diabetes, The Remote Therapy Space offers remote consultations tailored to chronic illness. Book a free 15-minute consultation to see if working together might help.

This post was written by Sarah Cosway, BSc, a BABCP-accredited CBT therapist who works online with people across the UK. You can find out more about her work at Cosway CBT.