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Dr. Bill Polonsky on diabetes distress and the one big thing you can do

May 18, 2019 by Scott Johnson

Maybe you’ve heard that people diagnosed with diabetes are more likely to also suffer from depression. Do you sometimes feel like you are part of that statistic?

Today, I sit down for a conversation with Dr. Bill Polonsky, a psychologist who has spent years studying the mental and emotional side of diabetes. He has some great news for all of us!

Summary

  • Could the connection between diabetes and depression be a misconception?
  • Diabetes distress
  • The emotional side of dealing with diabetes
  • Dr. Polonsky’s one big thing that will help you

Resources

Video

Transcript

Scott Johnson: Has diabetes ever made your head spin or made you question which way was up? And I don’t mean literally, although that can happen too, right? But with all this stuff we have to deal with, I’m talking about simply keeping our heads on straight.

Scott Johnson: What’s up, monster tamers. Welcome to another episode of “Live, with Scott!” Thanks so much for tuning in. My name is Scott Johnson. I’ve been living with diabetes since I was five years old, and keeping my head on straight has been, by far, the most challenging part of diabetes.

Scott Johnson: As your host today, I’m excited to share a great conversation with Dr. Bill Polonsky about helpful strategies for living well with diabetes. He’s someone I enjoy listening to and talking with. I always learn so much, and I hope you will, too, but first, this week’s winner. Congratulations Aarondo Johnson, who just won some cool mySugr swag. Aarondo, we just sent you a Facebook message to coordinate details. Everyone else stayed tuned for your chance to win.

Scott Johnson: Today’s episode is sponsored by the mySugr Bundle. Get unlimited strips, automatic supply refills, personalized support, and more, all for just $49 per month. Learn more at mySugr.com/facebooklive.

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Scott Johnson: Now, for more on today’s guest, Dr Bill Polonsky, he is Associate Clinical Professor in psychiatry at the University of California San Diego. He received his PhD in clinical psychology from Yale University and has served as senior psychologist at the Joslin Diabetes Center in Boston, faculty member at Harvard Medical School, and Chairman of the National Certification Board for Diabetes Educators.

Scott Johnson: A licensed clinical psychologist and certified diabetes educator, Dr. Polonsky is a distinguished national and international lecturer on behavioral diabetes issues. An active researcher in the field of behavioral diabetes, he has served on the editorial boards of Diabetes Care, Diabetes Forecast, Clinical Diabetes, Diabetes Self-Management, and Diabetes Health, and his most recent research projects have focused on quality of life in diabetes, diabetes-related distress and depression, hypoglycemic fear, blood sugar monitoring behavior, and attitudes in people living with diabetes, physician and lay attitudes towards insulin and oral medication, group-based behavior change programs, the influence of continuous glucose monitoring on quality of life, and emotional and behavioral responses to the diagnosis of diabetes.

Scott Johnson: Whew. I need to just… I mean, of course, someone like Dr. Polonsky, his introduction and short bio is going to be a mouthful, right? Well-deserved and well-earned with all of that, of course, but as you can tell, to say that Dr. Polonsky is a busy guy is understatement of the decade, and when I caught up with him on Saturday, he was taking a short break between presenting at the TCOYD Conference and Health Fair in Raleigh, North Carolina, where we were as well. It was super generous of him to share a few minutes with me to chat, and I’m super excited to share that conversation with you as well. Let’s dive right in.

Scott Johnson: I’ve got the privilege today of joining my friend the esteemed Dr. Bill Polonsky, here at TCOYD, Raleigh, North Carolina, for a few minutes. I stole Bill away from important conference work, so thank you for taking a few minutes out of the conference.

Bill Polonsky: Ah, my pleasure. I’m glad to be here with the esteemed Scott Johnson, too.

Scott Johnson: Too kind, but I wanted to just chat for a bit about mental health and diabetes. Maybe we’ll just jump right into it, if that’s all right.

Bill Polonsky: Sure.

Scott Johnson: Why is it important for people to be aware of mental health and diabetes?

Bill Polonsky: Well, first of all, I want to be very clear with you and with everyone who is paying attention to this. Diabetes is not a mental health condition. There’s lots of people living life well without any particular major psychiatric issues, so let’s not get confused about that.

Bill Polonsky: There’s always an emotional side or a mental side to dealing with a tough disease like diabetes that is work, that requires effort, that can be frustrating, and it’s also true when you combine diabetes with a pronounced mental health problem, like depression or a frank eating disorder, something like that, the combination of those two things can be pretty tough, but the majority of people are going through these profound conditions. There’s more of a day-to-day emotional element to diabetes that can make it tough.

Bill Polonsky: So, the name for that we just refer to as diabetes distress, or diabetes emotional distress. It is true, I don’t have to tell you this, that there’s a lot of unique emotional issues associated with putting up with and trying to manage a disease. That’s the job, that the universe granted you this lovely job where there’s no pain, no vacations, and good luck. So, it’s understandable that people get fed up or burned out, that they get scared about what’s going to happen in the long term. You’re scared about hypoglycemia or aggravated by how they’re being treated by healthcare providers or by the well-intentioned loved ones.

Bill Polonsky: So, there are all sorts of emotional elements, but I just want to make sure we distinguish that from the bigger fish that can happen to people, like chronic depression or schizophrenia or things that are actually fairly unusual.
I’m just going keep talking now you’ve got me on a roll.

Scott Johnson: Please, yeah, yeah.

Bill Polonsky: I just want to say one thing about depression. There’s a lot of misunderstanding about depression in diabetes. Part of it is the fault of me and people like me where there was a lot of early research suggesting that people with diabetes are at much, much higher risk for running into a problem with serious diagnosable depression compared to people who don’t have diabetes, but as research has gotten better and better and better, we realize that the risk is not much greater than it would be for someone who doesn’t have diabetes.

Scott Johnson: Okay.

Bill Polonsky: But here’s the weird thing, people with diabetes score higher on these pencil and paper depression questionnaires. So, wait a minute. How can that be? How can I say people with diabetes are not at higher risk for depression much compared to people don’t have diabetes, but they score higher on these depression questionnaires?

Bill Polonsky: The reason is that what we believe they’re scoring higher on is not actual depression. It’s actual diabetes distress. It’s all this gunk of the fatigue and fear and despair and aggravation and anger and guilt and shame that can accumulate when you have diabetes, which doesn’t mean you should put up with that; doesn’t mean there are not solutions, but the solution is not taking an antidepressant pill.

Scott Johnson: Sure, yeah, yeah.

Bill Polonsky: All right. That’s all I have to say. You?

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Scott Johnson: I mean, that was amazing. Well, first of all, just the fact that… clarifying my statements about mental health and diabetes just to open things up, thank you for that. Second of all, providing a glimmer of hope, which you’re so good at, and I think you pride yourself in providing great health to many of us living with diabetes, so thank you for that because I was always under the impression that because I was living with diabetes that I was at a higher chance of dealing with depression. Can you talk to me a little bit about where this learning of diabetes distress came from? It sounds to me like this is evolving a bit.

Bill Polonsky: Sure, sure. By the way, I should mention not even all professionals will agree with me that people with diabetes are not at elevated risk for depression. That’s still, to some degree, a controversy, but I think the evidence is pretty clear, and thank you for what you said. So, for me, I do take great pride in wanting people to know the hopeful side of diabetes, that you’re not at high risk for depression. Odds are pretty good with good care you can live a long and healthy life, but it’s not just because I want to be positive. It’s because I’ve read the evidence, and the scientific evidence tells us this, and I think that evidence sometimes gets misinterpreted.

Bill Polonsky: So, when I am suggesting that one should be hopeful, it’s not just because I think so. It’s because I’ve got data, and that’s what, I guess, I want people to know.

Bill Polonsky: I think I just sidetracked whatever your question was.

Scott Johnson: No, no, that’s perfect. That’s great. I know that you have things that you need to get back to. If there were one or two or however many things you want people to know walking away from watching this video or reading this, what might those be?

Bill Polonsky: I’m going to answer that, but I remembered, I just forgot to answer your last question, which you forgot, which was how do this diabetes distress thing… Where did all that come from, anyway? So, I will tell you, I was hired by the Joslin Diabetes Center to be their first psych… I think I was the first psychologist back in the ’80s, and they hired me. I have no idea why they did that because I knew nothing about diabetes at all. I mean, nothing. It was unbelievable, but luckily I’m a psychologist. I’m pretty good at asking questions.

Bill Polonsky: So, the very first thing I did is I looked at this big waiting room of this huge diabetes center, and I would walk up to people and say… just sit down and introduce myself and say, “Could you tell me what’s living with diabetes like for you?” The first person I ever asked looked at me in surprise and said, “Thank you,” and I went, “What do you mean ‘thank you?'” She said, “Well, no one’s ever asked me that question before.” I said, “That is really messed up that no one’s ever asked you that,” but then she told me all this stuff she was going through and her concerns and her fears and her aggravations. I was blown away, and then I asked the next person sitting in the waiting room; said, “Can you tell me what living with diabetes is like for you?” and she told me the same story, or similar story.

Bill Polonsky: So, that was what I did for, well, I want to say months, but actually I’m still doing that, asking people what’s living with diabetes is like for you. So, just by listening, collecting stories over the course of years, we began to realize, “Oh, my God, this is not just about numbers. This is not just about simple things. There’s an emotional side to this disease that very, very few people were paying any attention to at all.” So, then I put on my scientific, my academic hat, and said we need to really study this, and see is this really just here at the Joslin? Is this really other places? Is this really for real? Is this really making it hard for people? So, we continue to study it ever since and studying it all over the world, and not just study it just for an academic purpose, but study it because people are hurting, and people are struggling, and I made it my life’s goal to see if we could understand it better and make a difference.

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Bill Polonsky: So, now your second question, if I could leave you with one thing, meaning if we could get to the point and get over, get this done, what would be the thing I would leave people with? Depends what’s going… I mean, to be really general, I would say the single thing that we’ve learned that really has made the biggest difference to help people be okay with and manage diabetes successfully, it’s if there’s any way humanly possible, don’t do diabetes alone, that if you have, or if you can find, somebody in your life who could be rooting for you, and that can be a good healthcare provider that treats you like a human being and not a number who you really feel is on your side.

Bill Polonsky: It could be a family member or a friend. It could be a support group. It could be someone online, someone you could meet who you feel like can understand what you’re going through or offer you a hug or an attaboy, or if it’s someone close to you, someone who wants to hang out with you and make healthy changes in their lives with you. It can be anybody, but the people I see who were in the most trouble and have the biggest problems are those people who get so ashamed of diabetes they keep it too private or end up, despite their best efforts, getting too isolated.

Bill Polonsky: So, reach out to other folks, and if it’s reaching out to other people with diabetes, you’re going to be doing them a favor, too, because we know it’s too isolating. So, I would say that’s the biggie.

Scott Johnson: That’s great. Thank you.

Bill Polonsky: Thank you.

Scott Johnson: My pleasure. With that, I will let you get back to helping all these amazing people in Raleigh-

Bill Polonsky: Thanks.

Scott Johnson:… live better with diabetes.

Bill Polonsky: Thank you, Scott. Thanks everybody. Bye.

Scott Johnson: All right, there you have it. What did you think about that chat with Dr. Polonsky? Let us know in the comments, and if you’re open to sharing, do you feel that you experience diabetes distress, or have you experienced diabetes distress? I know that I have, and if so, do you have people that you can lean on as Dr. Polonsky suggests? I agree 100% that that’s very important. I know I wouldn’t be living as well with diabetes as I am today if I were trying to do it alone.

Scott Johnson: So, thank you to my family. Thank you to all my friends with diabetes, many of whom are in the office behind me, and thank you, especially, to all of my amazing friends and all of you out there in the peer support diabetes online community. You’re amazing, and you help me a great deal. I can’t even put it into words, so thank you. Thank you.

Scott Johnson: As a special thanks to all of you watching, I have a fun mySugr tote bag with some goodies inside, like a pop socket, a few stickers, and I tracked down another autographed copy of Adam Brown’s Bright Spots & Landmines book that I want to give away. To enter, leave a comment below, and before next week’s show, I’ll randomly pick a lucky winner or two and announce them during the start of next week’s broadcast.

Scott Johnson: Once again, today’s episode is sponsored by the mySugr Bundle. Get unlimited strips, automatic supply refills, personalized support, and more, all for just $49 per month. Learn more at mySugr.com/facebooklive

Scott Johnson: And then be sure to tune in next week where I have a really fun episode for you with Mr. Bobby Turman, Jr., better known as the Hungry Hungry Hippie. He’s a popular food and history blogger who was diagnosed with type two diabetes about 10 months ago, and he’s using his platforms to share his story of living well with type two diabetes, and I can’t wait to connect with him, and I hope you’ll join us, too.

Scott Johnson: All right, and thank you so much for joining today. Please like this video. Share it with your friends, especially if you think there’s anyone out there that you know that could benefit from the wise words of Dr. Polonsky. I know I’ll probably watch that video again over and over again just because I always benefit so much from everything that he has to say. So, have another amazing day, and as always, I’ll see you next week.


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