Dr Enslin Uys, an ophthalmologist, unpacks the symptoms, causes, and treatment for diabetic macular oedema.

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Diabetic macular oedema (DMO) is one of the leading, preventable causes of central vision loss. It’s a complication of diabetes that causes fluid build-up in the macula (the part of the eye responsible for the central, detailed vision). This can lead to blurred vision, double vision, and even total loss of vision.

What is the cause?

The retina is the thin nerve layer in the back your eye, like the film in a camera, that receives the image in your eye and sends it to your brain allowing you to see. High blood glucose levels cause damage to the small blood vessels in the retina, leading to fluid leakage and swelling (oedema).

What do you experience?

There are a variety of symptoms, most commonly blurred vision.  You can also have double vision, distorted colours, and blind spots.

How is it diagnosis?

You will need a comprehensive eye examination by an ophthalmologist. Your visual acuity (vision) will be recorded and your eye examined from the front to the back. Your pupils will be dilated, by inserting drops, to give the ophthalmologist a better view of the back of your eyes. Special lenses are used to look at the back of your eyes; this is called a fundoscopy or fundus examination. Special tests or investigations are also performed to assist in the diagnosis, for documentation and monitoring. These tests include:

1. Colour fundus photos

Image: Left colour photo – DMO circled

2. Optical Coherence Tomography (OCT)

This is a non-invasive detailed scan of the back of the eye, the retina, almost like a CT scan of the retina.

Image: OCT right – normal.

Image: OCT left – CMO.

3. Optical coherence tomography angiography (OCTA)

This is also a non-invasive medical imaging technique used to visualise the blood vessels (microvasculature) in the retina.

4. Fluorescein angiography

This is similar to doing an angiogram of the heart. A drip is inserted in your hand and a dye (fluorescein) is injected into the vein that travels very quickly through the body and gets to your eye within 20 to 30 seconds.

Numerous pictures are taken over a 10-minute period to see if there are areas of ischemia (poor blood supply), or leakage of the dye (as it is not supposed to escape the blood vessels) and where it’s leaking from.

Image: Left fluorescein angiography with leakage circled.

 Risk factors

• Duration of diabetes: The longer you have had diabetes, the higher the risk of developing DMO.
• Poorly controlled blood glucose levels: Inadequate control of blood glucose levels over time can increase the risk of diabetic retinopathy and DMO.
• High blood pressure: Hypertension can exacerbate the damage to blood vessels in the retina, increasing the risk of DMO.
• High cholesterol levels: Elevated cholesterol levels can contribute to the development and progression of DMO.
• Pregnancy: Pregnant women with diabetes may be at increased risk of developing DMO due to hormonal changes and fluctuations in blood glucose levels during pregnancy.
• Other factors: Factors such as smoking, obesity, and genetic predisposition may also play a role in the development of DMO.

Regular eye examinations are important for early detection and treatment to preserve your vision.

How is DMO treated?

Once the diagnosis has been made, a treatment plan will be discussed by your ophthalmologist. The current, most common, form of treatment is anti-vascular endothelial growth factor (VEGF) injections.

Anti-VEGF injections

• These injections have become the gold standard for treatment of many retinal diseases of which DMO is one of them.
• Anti-VEGF treatment is given as an injection into the white part of your eye (sclera). The drug is injected directly into the vitreous, the jelly that fills your eye. This is called an intravitreal injection. Your eye is numbed with drops prior to the injection and betadine is inserted to prevent an infection. Although it sounds terrible, the procedure is generally straightforward, quick, and not painful.
• Initially these injections are repeated every four weeks. This is called the loading dose. The vision and OCT scan are then repeated and the response to the injections evaluated.
  • If a good response was obtained: the interval between injection can then be increased.
  • If a poor response was obtained: you might be switched to a second-line treatment option.
• For DMO, these injections are usually ongoing over a two to three year-period. All depending on the response.
• The current anti-VEGFs available in South Africa are bevacizumab, aflibercept, ranibizumab and faricimab-svoa.
• Although bevacizumab is not registered (used off label), it’s ten times cheaper than the registered drugs and is used as first-line treatment. It has been used for more than 15 years worldwide and has an excellent track record with multiple studies to prove this.
• Second-line treatment is introduced only when bevacizumab failure has been shown.

Other treatment options include corticosteroid injections, implant or triamcinolone injections, focal laser photocoagulation, or vitrectomy surgery.

Prevention

Manage your diabetes through:

• Lifestyle changes (see a dietitian, follow a healthy eating plan and exercise three to four times per week).
• Medication to control your glucose levels.
• Regular eye examinations.
• Early treatment of DMO.

If you are experiencing symptoms or have concerns, consult an eye specialist or healthcare professional for personalised advice.

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Monique Marais, a social worker, highlights the power of community support when living with diabetes.

Listen to this article below or wherever you get your podcasts or visit our playlist.

Living with diabetes can be challenging, but you don’t have to do it alone. Community support plays a vital role in effectively managing diabetes. By tapping into the strength of community connections, you can find not just emotional support but also practical strategies to manage your condition better.

Three main forms of support

There are three main forms of support: behavioural, educational and psychological.

The benefits

Final thought

In conclusion, the benefits of support groups and community resources for patients with diabetes can’t be overstated. These resources provide emotional support, shared knowledge, motivation, and practical assistance that is vital for effectively managing this chronic condition. By embracing a holistic approach to diabetes management that includes both medical care and community support, people living with diabetes can lead healthier, happier lives despite the challenges of diabetes.

References

• Home – CDE | Centre for Development and Enterprise
• Home – South Africans with Diabetes (sweetlife.org.za)
• Diabetes Focus | Reclaim your winter comfort (diabetessa.org.za)
• Benefits of Support Groups & Community for Patients with Diabetes (mdforlives.com)
• Why social support is important in diabetes care (diabetesadvocacy.com)
• Understand the Power of Community Support for Diabetes (mindfuldiabetes.org)
• building-social-connections-and-family-508.pdf (cdc.gov)
• The Role of the Community Environment in Managing Diabetes Risk – Blog – NIDDK (nih.gov)
• https://cdn.slidesharecdn.com/ss_thumbnails/rnhealthcarediabetesfactsheetwebfinalwcpyrt-131106122756-phpapp02-thumbnail-4.jpg?cb=1383741647

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By fostering a language of support, empathy, and clarity, we can contribute to a more positive and effective diabetes experience for everyone involved. Kate Bristow expands on this.

Listen to this article below or wherever you get your podcasts.
Visit our channel mypod.zone/diabetessa

“Words stick in our minds and our hearts.”

Remember the saying, “Sticks and stones may break my bones, but words will never hurt me?” We were taught this growing up and we believed it – it made us brave – or did it?

We were not taught that words do damage, often deeper and for longer. Sticks and stones do hurt, for sure. They leave scars, sometimes big ones and the wound left can be cared for and treated because we can see it.

The trouble with words is that they leave no visible scar, nothing to show for the hurt caused. Words dig deep inside of us and can whisper back to us over time eroding confidence and extending the hurt. Words stick in our minds and our hearts.

How does this relate to diabetes?

Diabetes Australia has this to say about the language of diabetes, “Our language matters. The words we choose, and the way we use them, influence, persuade and affect how people view the world. Words do more than reflect reality: they create reality.”

Words make people feel valued, understood, and supported but they can also show bias, whether it be conscious or unconscious.

Sometimes we don’t realise the effect that our words and how we say things have on people. Language is crucial in shaping perception, our behaviour, and health outcomes. Diabetes management is no exception.

Diabetes management is a multi-faceted journey involving medical, lifestyle, and emotional components. One often overlooked yet profoundly impactful aspect of this journey is language. The way we talk about diabetes—whether in clinical settings, personal conversations, or public discourse—can significantly influence outcomes, attitudes, and overall quality of life for people living with the condition.

The International Diabetes Federation (IDF) as well as other diabetes organisations around the world have started the #LanguageMatters movement, encouraging us to think about how we communicate with people, and specifically with people with diabetes.

Let’s dig deeper

How we approach what we say affects those of us in healthcare as well as those who have diabetes. Language shapes how people understand and manage their condition. Terms and phrases used by healthcare professionals, support networks, and even the person with diabetes (PWD) themselves, can impact self-perception and emotional well-being.

For example, labelling diabetes as a “battle” or a “struggle” might contribute to a feeling of constant conflict, potentially leading to burnout and frustration. Conversely, framing it as a “journey” or “part of life” might foster a more positive and resilient mindset.

We (the public and healthcare) put stigma into our interpretation of the challenges faced by those with diabetes. For example, “Diabetes is a result of poor lifestyle choices” or “just control your sugar” can also lead to feelings of shame and guilt. Comments like this show lack of understanding of the complex condition which is diabetes, and how genetics, environment, and other aspects of life may influence diabetes.

Unfortunately, comments like this will affect a person’s self-esteem and discourage them from asking for help, or perhaps even sticking to a treatment plan.

As a diabetes educator I’ve often heard, “I got diabetes from eating too much sugar” or “He got diabetes because he eats too much.” We need to change the mindset in the public space and take away stigma and blame; it’s destructive and doesn’t help someone who is coming to terms with and trying to manage a chronic condition.

Supportive and empathetic approach

In healthcare, we need to have a supportive and empathetic approach to increase trust and engagement in the process. For example, managing diabetes as opposed to controlling diabetes gives a better sense of teamwork and partnership instead of an approach which is strict or punitive.

Be aware of body language, tone, and attitude

It’s also not just about the words we use, but our body language, tone, and attitude. A good example for body language is sitting behind a desk which gives a position of authority and control. This may be intimidating for the person with diabetes, especially a child or young person. A better approach may be to remove the barrier completely and create the impression of a safe space. Our whole persona needs to be non-judgemental and welcoming.

Avoid medical jargon

If we look at our diabetes definitions, often those of us in healthcare use medical terminology, such as hyperglycaemia and insulin resistance versus high blood glucose and difficulty in managing diabetes. Effective education for people with diabetes relies on clear and accessible language. Medical jargon can be confusing, leading to misunderstandings and less compliance with treatment.

Simplification of medical terms and providing clear, easy language will help people understand their condition and the steps they need to take for better self-management.

Think also about the word testing – I test, I’m testing, I’m being tested – it sounds like an exam or something to stress about. Replace that with the word check – how different does that feel?

Choose a positive approach

Diabetes burnout is real, and people with diabetes have so much to manage their condition already. All of us involved in their lives (healthcare team, family and friends) need to try to choose our words to impact them in a positive and encouraging manner to reduce diabetes distress.

Diabetes Australia suggest that we change the conversation around diabetes – be aware of how you say things and how they may be interpreted and approach every interaction consciously and without any bias. We are encouraged to challenge inappropriate words and change the thinking. Words have power and although it may take time for habits to change, it’s not rocket science. We just need to practise the new language of diabetes.

Words need to be:

• Curious – Show care and interest in how the person is doing.
• Be accurate – Use plain language that encourages change without judgement.
• Be respectful – Provide information in a way that the person can understand with respect for cultural practices and values.
• Acknowledge that they are doing the best they can.
• Empathic – Show understanding of the person and their circumstances.

Words need to take away:

• Blame – Prevents a person from doing their best or accessing care for fear of blame or shame.
• Irreverence – Using diabetes as a punchline in jokes is offensive and insensitive and shows lack of respect.
• Authority – Words such as should, must or allowed aren’t going to make people change. Instead, they make the person with diabetes feel like they are failing.
• Stigma – People with diabetes often feel judged, criticised and misunderstood so they hide their condition and how they manage it. This is negative from an emotional and physical perspective.

A few examples of how we as carers, family, and friends of someone can change our language.

Survey results

A 2019 survey found that the following words were deemed negative to many people with diabetes. The % of PWD found these words unacceptable.

• Victim – 99%
• Sufferer – 96%
• Consumer – 95%
• Normal – 84%
• Cheating – 95%
• Uncontrolled – 75%

Language is more than just a means of communication; it’s a powerful tool that shapes our understanding, emotions, and actions. In the context of diabetes, choosing words carefully can make a profound difference in outcomes, emotional well-being, and the overall management of the condition. By fostering a language of support, empathy, and clarity, we can contribute to a more positive and effective diabetes experience for everyone involved.

I found a lovely article about the damage words can do and I loved the conclusion they wrote: “And so tread carefully with the words you speak on others. You know not the damage you cause. Speak only good things into the universe. About yourself and about others.”

We need to choose our words with care, however we are involved with a person living with diabetes.

“Be sure to taste your words before you spit them out.”

References

https://anonymouslyafroirish.wordpress.com/2019/04/17/sticks-and-stones-

https://diabetesjournals.org/care/article/40/12/1790/36977/The-Use-of-Language-in-Diabetes-Care-and-Education

https://www.england.nhs.uk/long-read/language-matters-language-and-diabetes

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Being newly diagnosed with diabetes is overwhelming. Lynette Lacock advises on questions to ask your doctor, as well as explains facts to help understand this chronic condition.

Listen to this article below or wherever you get your podcasts or visit our playlist.

If you or someone you know has recently been diagnosed with diabetes, it’s a good idea to have a list of questions ready to ask the doctor or healthcare provider.

Here are important questions to ask along with facts to help you better understand and manage your condition.

Questions to ask your healthcare provider

Which type of diabetes do I have?

There are different types of diabetes and they are managed differently so knowing which one you have helps you manage it.

Why is the HbA1c test important and what does it tell you?

The HbA1c test shows the doctor what your average blood glucose has been for the past two to three months. It can be used to help manage your diabetes and to diagnose Type 2 and prediabetes.

What is my target range?

You need to know where your target range is to manage you blood glucose. This will guide your exercise, diet, and medication to help you stay within that range. Your doctor will discuss your target range with you.

Do I need to check my blood glucose levels? If so, how often?

Yes, you do, and your doctor will guide you on how often. Your diabetes nurse educator will show you how to use a glucometer. Knowing your levels is essential to manage your diabetes. For example, your blood glucose levels may fluctuate when you’re ill or require a change in dosage.

Do I need tablets or insulin?

Controlling your blood glucose can be daunting at first. Therefore, you need to know about the medications you will be using. This includes how and when to take them as well as all possible side effects.

What do I need to change in my daily life to help manage diabetes?

Ask for information on exercise routines, dietary changes and other ways you can keep your diabetes in check. Your healthcare provider can also give you information on support groups in your area and online education about diabetes. 

Where can I meet other people in my area with diabetes?

Your healthcare provider can give you information about support groups in your area. There are also many support groups that you can find online. Reaching out to people going through the same thing can decrease feelings of isolation and help you feel supported.

How do I prevent the long-term complications of diabetes?

Complications happen when glucose levels fluctuate and are uncontrolled. This can lead to nerve damage known as neuropathy and cardiovascular problems, amongst others. Most importantly, learn how to keep your blood glucose in your target range and learn about strategies to avoid complications like nerve damage and kidney disease.

Important facts about diabetes

The three types of diabetes

1. Type 1 diabetes

This is an autoimmune disease where the body attacks insulin producing cells in the pancreas. This may be caused by genetic or environmental factors, such as an illness from a virus. It usually occurs in childhood or early adulthood. This type of diabetes requires insulin because the body is unable to produce its own.

2. Type 2 diabetes

This type of diabetes occurs when the body becomes resistant to insulin or the body stops producing enough insulin. It usually starts in adulthood but is seen in younger people that are overweight and follow an unhealthy diet.

3. Gestational diabetes

This diabetes develops during pregnancy and usually goes away after birth. When a woman has gestational diabetes, she usually has a higher risk of developing Type 2 diabetes.

Early symptoms of diabetes

Thirsty, frequent urination, feeling extremely tired, blurred vision, and slow-healing wounds. 

Consequence of a healthy diet

Adopting a balanced diet that is low in carbohydrates is crucial for managing diabetes. Consume more unprocessed foods, such as vegetables, lean proteins, and whole grains, and limit foods high in sugar and carbohydrates.

Poor mental health can alter blood glucose

Managing diabetes can be stressful. It’s important to pay attention to your mental health and seek support when needed. Being under stress will increase your cortisol level which in turn will increase your blood glucose. It’s important to keep your stress levels low to manage your diabetes.

Make exercise your friend

Activity helps lower blood glucose and improve insulin absorption.  Aim to exercise 2,5 hours moderately every week. Exercise can also lead to weight reduction which will in turn help lower your glucose levels.

Monitoring target blood glucose levels

Consistent monitoring will enable you to see how food, activity, and medication affect your blood glucose levels, allowing for better management.

Preventing complications of diabetes

Having uncontrolled diabetes long-term can affect major organs. Early detection of any complication can help prevent or delay these complications from getting worse.

Regular check-ups with your doctor

The amount of exercise you do, if you are under stress or ill can affect your blood glucose levels. Regular appointments with your healthcare provider can help monitor any changes in your condition and allow them to adjust your treatment plan.

Regulating your diabetes incorporates a combination of lifestyle changes, education and medical care. Stay knowledgeable and take charge of your diabetes in order to lead a healthy long and healthy life.

References

https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/resources-to-answer-common-questions-from-patients-with-diabetes

https://www.healthpartners.com/blog/questions-about-diabetes/

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We hear from experts the foreseen problems if public sector patients living with diabetes have to use syringes and vials to inject insulin due to the alleged insulin pen shortage.

In June, an article published in The New York Times raised concern over an expected shortage of insulin pens in SA, specifically in the public healthcare sector. This is due to a pharmaceutical company, the sole provider, not opting to tender again for The Department of Health’s business.

It was also reported that the reason was that this pharmaceutical company wanted to rather focus on manufacturing new weight loss drug pens that are more profitable.

Since then two South African articles have also circulated, one article from News24 and another article from IOL shedding more light on the situation. Thankfully, it has been reported that another pharmaceutical company is willing to assist in solving what could be a serious problem for South Africans living with diabetes.

We requested comment from The National Department of Health and received the following comment from Foster Mohale, Director: Media Relations at National Department of Health:

“The National Department of Health (NDoH) is committed to ensuring equitable access to quality healthcare for diabetic patients through ensuring the availability of safe, effective, and cost-effective medicines, in the appropriate dosage form at the appropriate level of care.

Over the last few months, concerns have been raised about the availability of insulin pen sets in general, including premixed insulin pen sets in the public sector, amid fears of a shift towards an exclusive insulin vial use strategy.

The National Contract, which includes the supply of small volume parenterals (injections), including insulin, to the NDoH, was awarded in January 2024 and took effect from May 1, 2024.

The bid advertised included a comprehensive list of insulins required by the public sector in line with the Standard Treatment Guidelines and the Essential Medicines List. The insulin specifications advertised included both pen sets and vials.

Responsive bids were only received for the vials of isophane insulin, soluble insulin, and biphasic insulin, as well as for analogue insulin pen sets (ultrafast-acting and long-acting).

• Novo Nordisk (Pty) Ltd was awarded contracts for both short and long-acting human insulin vials.
• Sanofi-Aventis (Pty) Ltd was awarded the contract for short and long-acting analogue insulin pen sets.
• No responsive bids were received for isophane, soluble, and biphasic human insulin pen sets.
• No responsive bids were received for analogue insulin vials.

A supplementary tender is currently in progress to address items with no responsive bids, undergoing evaluation. In the interim, efforts are underway to obtain quotations to support the supply of pen sets, to bridge the supply gap and ensure patients have access to insulin formulations that best meet their needs.

It is important to highlight the global shortage of insulin pen sets, likely due to in an increased demand of more profitable products and manufacturers prioritising their production over insulin pen sets.”

Image supplied by NDoH

Other comments

Margot Mc Cumisky, National Manager Diabetes South Africa and Vice President of Southern Africa Region of International Diabetes Federation, comments, “Diabetes South Africa and NCD Alliance will bring this matter up with the International Diabetes Federation as it will not only affect patients in South Africa, but patients in countries all over Africa.”

Dr Louise Johnson, a specialist physician, comments, “It was with shock that we heard about the terminating of insulin pens at a diabetes congress. Insulin pens are easy to use with accurate dosing of small units such as 2 or 3. In cases where patients are insulin sensitive, such as with kidney failure, very lean patients and children, small amounts of insulin are used. One extra unit more or less can be very detrimental causing hypoglycaemia or hyperglycaemia.”

Dr Johnson continues, “Pens are also very comfortable for use in people with poor eyesight or arthritis; clicks can be counted to get to the correct dosage. It’s a very sad day when a weight lost drug is considered more important than insulin. Insulin has been a life-saving drug in Type 1 diabetes since 1914. The impact of changing to old-fashioned syringes and needles is a huge step backwards for diabetes treatment. The cost will be high in human lifespan due to unnecessary complications that could be prevented.”

The people who it affects

We asked on the Diabetes Facebook page if anyone has been affected by the shortage. A Facebook user, commented, “Being using vials intermittently when pens are not available but still get the required amount of insulin.”

Cain Tibbs, DSA Western Cape Branch Manager, has Type 1 diabetes and gets his insulin from Groote Schuur Hospital. He told us that he still has been getting insulin pens, just not as many as he normally would get.

He adds, “There is a certain social stigma when a person with diabetes uses a vial and syringe in public places…in that they get looked at in an unaccepting way as if they are using some type of illegal drug. I have experienced this as originally I started out using vials when first diagnosed some 40 years ago. It can be very awkward for a person with diabetes to inject in a public place. Hence, the pens are much more discreet or inconspicuous to use.

Why are insulin pens so important?

Margot Mc Cumisky explains below why insulin pens are needed in South Africa.

A person with Type 1 Diabetes (usually under 30 years) depends on insulin injections to live. Without daily and sometimes multiple daily injections of insulin, they will die.

A person with Type 2 Diabetes is often prescribed insulin injections to manage their diabetes and avoid serious diabetes complications (blindness, amputations, heart attacks, strokes and kidney failure), which can also lead to premature death.

Over the last 30 years with the new technology, people living with diabetes were prescribed insulin pens which are much easier to use, as you dial up your dosage with a number of clicks for each increase in dose. The needles used with the pens are short, so not invasive.

Going back in years before insulin pens were available, patients had to use syringes (up to twice as long as pen needles) and glass vials of insulin (which were fragile). This involved drawing up your dosage and injecting with a long syringe. These were also awkward to carry around with you. The pens are much easier to carry around as you can put it in your pocket, like a normal pen, with no danger of injecting yourself accidentally.

The foreseeable problems that could arise if vials and syringes are used:

Dosage errors

• Drawing up can easily happen which could be fatal.
• Poor eyesight – affecting older patients as syringes have tiny lines indicating the dosage.
• Load shedding and poor light leading to incorrect dosages.
• More chance of double dosing when drawing with a syringe, which could be fatal.

Other foreseen problems

• Needle phobia (syringes are much longer than pen needles).
• Syringes are more likely to get damaged and blunt, whereas with pens, the needles come in a sealed pod and have a cap to protect them.
• Mistaking the long-acting and short-acting when drawing up (pens are different colours for long- and short-acting which help to alleviate mistakes).
• With a syringe, you can accidently draw up too much and can be more prone to insulin spillages.
• A syringe to young children is threatening and scary, and it would take longer for the child to do their own injections.
• Syringes are longer and therefore more painful and cause bruising.

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Daniel Sher addresses the overlooked connection of trauma therapy and diabetes and how trauma therapy should be integrated into diabetes care with a holistic and patient-centred approach.

Listen to this article below or wherever you get your podcasts or visit our playlist.

As people with diabetes, we often tend to focus on the physical aspects of this condition. Food, insulin, blood glucose testing, and exercise, for example. However, often the psychological side of diabetes gets overlooked. The intersection of trauma and diabetes is important to understand, as unaddressed trauma can significantly impact the ability to manage diabetes effectively.

What is psychological trauma?

Trauma can be broadly defined as the emotional and psychological response to an event or series of events that are overwhelmingly stressful or life-threatening.

Examples of trauma outside of diabetes might include experiences like being in a car accident, enduring physical or emotional abuse, or surviving a natural disaster. These events can leave lasting emotional scars and may trigger the development of post-traumatic stress disorder (PTSD).

PTSD is a specific type of trauma response that occurs when the brain struggles to process the traumatic event, leading to symptoms like flashbacks, nightmares, hypervigilance, and avoidance of anything that reminds the person of the trauma. Unlike normal trauma responses, which may fade over time, PTSD symptoms are persistent and can significantly interfere with a person’s daily life.

For people with diabetes, trauma can include the shock of diagnosis, difficult circumstances around being in hospital, insensitive disclosure of diagnosis, or traumatising processes related to finger-pricks and injections. Especially if the diagnosis occurs at a young age, all of the above can represent acute traumas.

On the other hand, the experience of living with diabetes can itself be traumatic. The constant need for vigilance, the fear of complications, and the potential for life-threatening events (including severe lows or diabetic ketoacidosis) can lead to chronic stress and anxiety. This stress can be compounded if the individual has a history of trauma, creating a cycle of fear and distress that makes diabetes management even more challenging.

The impact of trauma on diabetes management

Trauma, especially when unrecognised or untreated, can significantly hinder diabetes management. It often leads to psychological conditions, such as PTSD, depression, and anxiety, which can severely impair an individual’s ability to adhere to their diabetes care regimen.

For instance, someone with a history of trauma may struggle with flashbacks, nightmares, or intrusive thoughts, making it difficult to concentrate on daily tasks like blood glucose monitoring or medication adherence.

Additionally, trauma can alter how individuals perceive their bodies and their relationship with food; both crucial aspects of diabetes management. Survivors of trauma may develop disordered eating behaviours, such as binge eating, restrictive eating, or emotional eating, as coping mechanisms for overwhelming emotions. These behaviours can disrupt blood glucose levels and overall diabetes control.

Recent research¹ underscores the significant impact of PTSD on diabetes management, particularly among younger patients with Type 1 diabetes (T1D). The study, published in Scientific Reports, found that T1D patients under 25 with comorbid PTSD experience worse glycaemic control, higher rates of diabetic ketoacidosis, and more frequent hospitalisations compared to those without PTSD. This highlights the critical need for integrated psychological support in diabetes care, especially for vulnerable groups facing PTSD.

Moreover, the stress associated with trauma can lead to diabetes distress, a term that describes the emotional burden and anxiety specific to living with diabetes. Diabetes distress or burnout occurs when the demands of managing diabetes become overwhelming, leading to neglect of care. This creates a dangerous cycle where poor diabetes management leads to health complications, which in turn exacerbates the individual’s stress and trauma.

The role of trauma therapy in diabetes care

Given the significant impact that trauma can have on diabetes management, it’s important to incorporate trauma-informed care into diabetes treatment. Psychological therapy, which focuses on recognising and addressing the effects of trauma, can be a vital component of a comprehensive diabetes care plan.

Trauma therapy can take many forms, including cognitive-behavioural therapy (CBT), eye movement desensitisation and reprocessing (EMDR), and somatic experiencing. These therapies aim to help individuals process their trauma, reduce symptoms of PTSD, anxiety, or depression, and develop healthier coping mechanisms.

For example, a person with diabetes who struggles with emotional eating due to past trauma may benefit from CBT to challenge and change their thoughts and behaviours around food.

EMDR might help someone process traumatic memories that trigger anxiety and lead to diabetes burnout. By reducing the psychological burden of trauma, these therapies can make it easier for people to recover and learn to thrive with this condition.

Integrating trauma therapy into diabetes care

For healthcare providers, integrating trauma therapy into diabetes care requires a holistic and patient-centred approach. This means recognising the signs of trauma, understanding its impact on diabetes management, and referring patients to appropriate mental health services when needed. It also means creating a safe and supportive environment where patients feel comfortable discussing their emotional and psychological challenges.

In practice, this could involve routine screening for trauma and mental health conditions in patients with diabetes, providing education on the link between trauma and diabetes management, and collaborating with mental health professionals to provide integrated care. It’s also essential to educate patients about the connection between their mental and physical health and to empower them to seek help for both.

Summing up

The connection between trauma and diabetes is a critical but often overlooked aspect of diabetes care. By recognising and addressing trauma through specialised therapy, healthcare providers can help individuals with diabetes improve not only their mental health but also their ability to manage their condition effectively.

As our understanding of this connection grows, it becomes increasingly clear that a holistic approach to diabetes care—one that integrates trauma therapy—can lead to better outcomes and improved quality of life for those living with this challenging condition.

References

1. Lunkenheimer, F., Eckert, A. J., Hilgard, D., et al. (2023). Posttraumatic stress disorder and diabetes-related outcomes in patients with type 1 diabetes. Scientific Reports, 13, 1556. https://doi.org/10.1038/s41598-023-28373-x

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