Have your patients ever told you they sometimes feel overwhelmed or stressed out by all the day-to-day activities that are necessary to take care of diabetes? It is not hard to imagine how frustrating it must be to always have to count carbohydrates, take a daily walk or do some type of activity, take diabetes medications regularly, and monitor blood glucose. Sometimes the weight of this unrelenting process takes a toll and ultimately results in negative emotions. This is referred to as diabetes distress.

The medical profession is just starting to understand the difference between diabetes distress and depression, as well as the impact distress can have on overall health. Diabetes distress is not a major depressive disorder; rather, it is characterized by the often hidden emotional burdens, worry, and stress that are experienced by patients when managing a severe, demanding chronic disease. Patients may perceive they are "sick" and worry about developing complications, perhaps because they feel they are failing at their diabetes routine. Some express frustration with lack of support from family, friends, or even their doctors. They may believe others just don't understand how difficult living with diabetes can be (Gonzalez et al., 2011).

Although an occasional bout of distress is considered normal, something that people who live with chronic disease have from time to time (Gebel, 2013), prolonged diabetes distress requires attention because it can impact glycemic control, self-efficacy, self-care, and overall diabetes management. If this is the case with any of your patients, talk to them about how they are feeling. This will help you gain an understanding of the intensity and type of feelings your patients are experiencing and may help you and your patients determine what is the next best step (Fisher, 2006).

For example, perhaps your patient is experiencing distress because he/she never started the exercise program they planned and never started checking their blood glucose. They want to make changes, but just hasn't been successful. In this circumstance, it may be beneficial to help patients develop a plan to manage their diabetes. Trying to tackle both of these at the same time may just be too much. Instead, suggest they prioritize the changes they want to make and then focus on making one change at a time. Another important way to help your patients is to work with them to develop personalized goals they can achieve. Over time, these combined small successes can help improve self-efficacy. The key is to focus on small steps with realistic, achievable goals because it lessens anxiety and stress and can lead to improved outcomes.

Finally, ask your patients about other stressors that may be impacting their lives. A personal loss or significant change in life can impact coping and ultimately impact one's ability to maintain diabetes control. Although this would not be the time to encourage patients to introduce something new to their daily routine, you could encourage them to talk to you or others they trust about how they feel. Let them know you are there for emotional support. Recognizing other stressors in your patients' lives will help you understand all the factors impacting your patients' health and ultimately helps bring patients to the center of the decision-making process (Fisher, 2006).

It is important to recognize that diabetes distress may come and go throughout a person's lifespan. Therefore, it is important that you talk to your patients from time to time about the emotional strain associated with managing this disease.

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