Caring for the Caregiver

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

Living with diabetes is a full time job for the patient, but what about their loved ones and family members? How do they cope with this disease and all of its implications? I would like to address the concerns of the caregivers today and how everyone can work together successfully.

Many people living with diabetes are perfectly able to care for all parts of their disease independently. However people who are visually impaired, have arthritis (particularly if their hands are involved), the elderly, and people with impaired mental functioning may require assistance in managing their diabetes. Their caregivers may include family members with whom they live or people who come to their homes as needed. The patient may work with just one person or there may be a team of caregivers available to assist.

Allow yourself to think for a minute about all that goes into daily self-care for a person living with diabetes. There are glucometer checks, medications and possibly self-titrating of insulin, meal adjustments, and the chance of unforeseen complications like hypoglycemia or an illness. Now think how stressful and difficult these responsibilities may be for a caregiver, especially for someone requiring a high level of assistance. Just as the person with diabetes can get overwhelmed and fatigued by their daily care, so too can the caregiver. That is when the caregiver needs the care.

Hopefully, if there is a team of people pitching in, no one will feel overburdened. However, many times there is just one person closely involved with the patient and it may be more difficult to realize the caregiver is suffering. It’s important that all involved in the patient’s care, including the health care team, check in with each other to see how things are going. Try to pick up on subtle clues such as off handed comments by the caregiver(s) like “I don’t always have time to get everything done, there is so much to do” or “I’m so tired all the time.” Also try to be aware of any changes in demeanor such as being impatient or more withdrawn, possible signs of fatigue or depression.

Schedules are important as well, not just for the patient but for the caregiver. It helps to still do the things that are important in their daily life so that their health and well-being are maintained. It’s important for caregivers to know that it‘s perfectly fine to ask for help. It doesn’t mean that they’re doing a bad job or can’t handle the tasks — just the opposite. Providing the best care possible really does begin with a mentally and emotionally healthy caretaker. Having responsibility in someone else’s care is a difficult and stressful job. It’s important for all involved to realize this. Caretakers should feel able to discuss their feelings with the health care team. Referral to social services may be in order to assist with identifying what other community services may be available. Support groups in the area may also be a good outlet to help to cope with the situation.

Everybody needs a little help sometime. A clear channel of communication between all the parties involved will hopefully ensure a caring environment is in place for all.


Diabetes Burnout

By Eileen B. Wyner, NP
Bulfinch Medical GroupStress

“I give up”. “I’m tired of doing this every day.” How many times have any of us uttered these words? This seemingly never ending winter has certainly made me feel this way, especially on the many days that the Needham commuter rail line came late, or more often, not at all. The choices facing me at that point included going home, (not really an option) or trudging to the Orange Line (along with all my other train friends). Whichever option I chose would cause an inconvenience, either to my co-workers and patients or to me, but not a potentially life threatening consequence.

When you have Diabetes and feel like giving up, the potential repercussions are much more serious and can include new or worsening complications like heart disease, stroke, blindness and kidney disease. People who feel this way about their Diabetes are frequently experiencing something called Diabetes burnout (DB). This means that you are just overwhelmed or exhausted with taking care of yourself. This feeling may last days or weeks or be intermittent. However, the longer it goes on without any intervention, the greater the possibility of a worsening in your Diabetes control.

I want to make it really clear: it is totally understandable that you may feel like giving up on your Diabetes self care sometimes. Almost everyone who has Diabetes feels frustrated and distressed from time to time, and some more than others. Taking care of yourself and your Diabetes is a fulltime plus job, and that is on top of everything else going on in your life. Your daily self care includes things like checking your blood sugar, taking your medications, watching your carbohydrate intake, and exercising. Sometimes you just don’t have the energy or motivation to do all of these things all of the time.

Helping hands

Here’s the key: the most important thing to realize when you are feeling this way is to acknowledge the feelings and know that there are people and strategies available to help you deal with them. It’s also important to be aware of some cues that may mean you’re experiencing DB. You may not be aware of anything different, but the people in your life may notice things have changed. It may be you aren’t checking your blood sugar as often as usual, you’re more careless with your diet choices, or you may even be less precise with the timing and taking of your pills or your insulin injections. In the most serious instances you may even neglect to do these things all together.

Now that you are aware of these behaviors, you can work on improving the situation. Here are a few strategies to implement when you feel worn out:

1. Admit to yourself how you feel. Don’t be ashamed of these feelings. Keep a journal to help you gain perspective.

2. Talk to your health care provider. They will help you to manage these feelings.

3. Get support. Let your family and friends know that you are struggling and let them help you—they care about you and want to be there for you. You may want to join and work with a Diabetes support group, too.

4. Identify roadblocks. Realize that sometimes things happen that you can’t control. You may have blood sugar fluctuations or not be able to eat exactly as you would prefer. You just need to do the best that you can and keep going forward

5. Make a schedule of all that you have to do to self manage your Diabetes to help you to stay focused.

Once you are diagnosed with Diabetes, it doesn’t go away. You can close your eyes and click your heels 3 times, but when you open your eyes you will still have Diabetes. It’s the job that you can’t resign from. My hope for you is that you always reach out to those in your life to help you through the rough patches.