For this installation of the Ask-a-Scientist series, your friendly (virtual) neighborhood psychologist shines a spotlight on one of the many challenges that come with T1D: the constant daily decisions of T1D management and its impact on your mental and emotional well-being. 

What can a person do to relieve or manage the stress of constant daily T1D decisions? 

There are many people who can take on the burden of decision-making, but some are not built personality-wise for the excruciating number of decisions that must be madeis there anything science can do to relieve that burden of decision-making? 

Decision-making is a huge component of what makes living with T1D extra stressful. In fact, one study estimated that people with T1D make 120 or more additional decisions each day compared to people who don’t have T1D. 

Recent developments in making diabetes technology better (e.g., insulin pumps with automated delivery features, and better CGMs) have been shown to help reduce the burden of making so many decisions.  

Each year, there are new systems that hope to utilize automated algorithms to reduce the number of decisions people with T1D must make about their insulin doses and timing. Two devices that recently received FDA clearance are Medtronic’s 780G system and the iLet Bionic Pancreas system — both of which are closed-loop insulin pump/CGM systems that strive to lessen the burden of carb-counting while constantly adjusting insulin doses to help you stay in your goal blood glucose ranges.  

But technological advances don’t eliminate the need to make any T1D decisions. And technology comes with decision-making needs of its own, such as keeping track of your supplies, dealing with insurance challenges, infusion, and sensor changes, adjusting and pausing automated dosing, and more!  

Other factors that make T1D decision-making even more challenging 

Some people with T1D have other challenges that make the kind of decision-making necessary for T1D management especially hard. Attention-deficit disorder (ADHD) — a neurodevelopmental condition that leads to differences and challenges in attention — has been correlated with T1D, meaning there is a higher chance that someone with T1D also may be diagnosed with ADHD.  

In a sample of adolescents, one study suggested that struggling with blood glucose levels and T1D management may be one flag to assess for undiagnosed ADHD, especially in teen girls. People living with T1D and ADHD have been shown to have more difficulty meeting A1c targets compared to people without ADHD.  

Some research has even shown that the ability to make decisions and problem-solve may be negatively impacted simply by having T1D for a long period of time!  

Add into the mix the challenge of hypoglycemia unawareness or non-T1D stress, and these multiple, daily health decisions can become extremely challenging and complicated.  

So, it’s no wonder that many people with T1D — at least sometimes — feel burdened by T1D decision-making. 

Simplifying T1D decision-making isn’t simple! 

One way to ease this burden without technology is to simplify the decisions that need to be made by establishing habits around everyday T1D tasks. Establishing habits around T1D can alleviate some of the cognitive burdens of decision-making because it reduces the amount of effort spent thinking about how to do the task.  

For example, if you keep the same snacks on hand for a low and you already know the portion size and carbohydrate content, you don’t have to think too much further about calculating the amount of carbohydrates to raise your blood glucose. Routine — like eating the same thing for breakfast every day or taking your long-acting insulin dose at the exact same time every day — definitely lends itself to T1D management. 

In this case, it’s not that you are making fewer decisions, but you’re not putting extra effort into the decisions you need to make, because they are decisions you’re already very familiar with.  

Managing your mental health is part of managing your blood glucose 

In research circles, scientists and clinicians have a lot of terms to describe some of these common mental health or emotional experiences of living with T1D. There is diabetes distress, which refers to the negative impact T1D can have on a person’s emotional well-being, how they perceive their diabetes management (for example, feeling like what you’re doing to manage your T1D isn’t “good enough”), their social relationships, and their interactions with healthcare providers.  

Sometimes the distress of living with T1D can lead to diabetes burnout— which can include a broad range of symptoms. Your burnout might just mean you carry on with daily tasks but you’re mentally and emotionally exhausted. At the end of the spectrum, it might mean you’ve stopped checking your blood glucose levels and you’re taking just enough insulin to get by, putting yourself in danger.  

At the T1D Exchange, we try to highlight that mental health care should be a part of your regular T1D care. And we have contributed a lot of research towards understanding the types of psychosocial experiences that come along with managing T1D which can impact a person’s mental or emotional wellbeing.  

Anxiety and depression are common in T1D for a reason 

While the research is clear that T1D affects the entirety of a person’s life and can have a negative impact on mental health, it can feel less clear on what people with T1D can do to take care of their emotional well-being. And it often feels like the discussion around mental health focuses on the really big challenges that some people face, such as anxiety or depression. 

Our mental health can be affected by everyday challenges that don’t necessarily mean we reach the level of depression or a crisis. Still, these burdens can negatively impact people with T1D and it’s important to remember managing this type of burden is also part of taking care of your mental health. 

In one recent example from the T1D Exchange’s Outcomes Research team, we examined how young adults perceive severe hypoglycemic events (and the potential to have a severe hypoglycemic event). What we found serves as a reminder that the emotional toll of T1D is not just in the experiences people have: instead, even the perception of a potential severe hypoglycemic event can be distressing in itself. 

There are many reasons why the potential of a medical emergency like a severe hypoglycemic event may be perceived as distressing — but one consideration is the anticipation of severe lows often leads people with T1D to take up even more planning.

It’s not only that T1D management revolves around keeping Goldilocks-style (or ‘just right’) blood glucose levels, but that people with T1D must be prepared and prepare others on what to do if a diabetes-related emergency happens.

People living with T1D make many health-related decisions, health-related plans, and health-related contingency plans just to get through the day. And this level of planning and decision-making itself can be overwhelming. 

How mental health care professionals can help with decision fatigue 

For anyone who is struggling to manage the hundred-plus daily decisions in T1D or for anyone just wanting some additional support in how to streamline decision-making in their own life, a mental health care provider can be a great resource.

To find a mental health care provider, your existing health care team may be able to help.

Alternatively, you can find mental health care providers online. The American Diabetes Association has a Mental Health Directory which has a list of providers who have a specialized interest in working with people who have diabetes — and you can narrow down to providers who have interest and experience in working with people with T1D! 

Read more from this series: All About Autoimmunity & T1D

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