Written by: Ms Wong Soh San, Assistant Nurse Clinician/ Diabetes Educator & Dr. Tan Ming Yeong, Diabetes Nurse Specialist

Diabetes Mellitus is a life-long condition. Living with diabetes and its daily management often involves multiple physical and psychological challenges that can affect many aspects of the life of people with diabetes and their family/caregivers.^1,2 The caregiving demands increases if the person with diabetes are partially or fully dependent on their care from the caregivers such as the young, the old or those with diabetes complications. These demands leave caregivers vulnerable to physical and emotional distress that can affect their health and quality of life.³ Caregivers refer to anyone who provide care to another person.

Diabetes distress or burnout refers to the hidden emotional burdens and worries that developed when managing diabetes on a day-to-day basis. Diabetes care that contributes to distress or burnout include

1. Lack of knowledge and skills.

• Insulin injection administration
• Blood glucose monitoring
• Management of high and low blood glucose levels

2. The need for regular schedule in medication intake and meal time.

3. Changes in eating habits, meal choices and preparation.

4. Changes in lifestyle, emotional swing, frustration, anger shown by the person with diabetes.

5. Financial stress.

These roller coaster of emotional distress not only affect the person living with diabetes but the effect spreads throughout the family and caregivers.

Caregiving is often a long-term challenge with emotional impact that can be snowballing over time. When the stress of caregiving builds up and left unchecked, it can impact the caregivers’ health, relationships, and state of mind which can eventually lead to physical and emotional burnout. Studies reported caregiver burnout is associated with inadequate care provided by the caregivers that could impact the outcome of the person with diabetes they cared for.⁴ Below are information’s about how to detect caregivers’ stress and some suggestions on coping.⁵

• Feel life has no joy with little satisfaction.
• Often feel angry, worried or helpless.
• Get upset over little things.
• Constantly exhausted, even after sleeping or taking a break.
• Have trouble paying attention.
• Feel unwell more often than usual or worsening health problems.
• Change of eating habit such as eating more or less.
• Have trouble sleeping.
• Isolate from friends and family.
• Feel trapped and wanted to escape.
• Alcohol abuse and/or smoking.
• Neglect own needs.

• Build confidence by learning as much as you can about your loved one’s diabetes care.
• Embrace your caregiving choice by focus on the positive reasons behind that choice.
• Think about the ways caregiving has made you stronger.
• Engage in hobbies.
• Focus on the things you can control.
• Set aside some quiet time every day for yourself.
• Attend to your basic needs such as a good night’s sleep, eat well balance meals and exercise regularly.
• Set priority in each day’s tasks by focusing on the top most important first.
• Accept own limitation and seek help when needed.
• Take care of your other relationships with your spouse, children and friends.

• Malaysian Mental Health Association, https://mmha.org.my/find-help/caregiver-peer-support-service
• Caring for a loved one with diabetes, https://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/caring-for-a-loved-one-with-diabetes/faq-20424136
• American Diabetes Association – Healthy Living: Loved ones and caregivers, https://www.diabetes.org/healthy-living/loved-ones-caregivers
• National Diabetes Service Scheme, https://www.ndss.com.au/about-diabetes/resources/find-a-resource/caring-for-someone-with-diabetes-for-family-and-friends-fact-sheet/
• Family Caregiver Alliance, https://www.caregiver.org/resource/caregiver-relaxation-exercises-series-english/?via=caregiver-resources,caring-for-yourself,relaxation-and-meditation
• Elder Advisory Group, https://www.elderadvisorygroup.com/2015/11/04/caregiver/
• Anxiety Canada, https://www.anxietycanada.com/resources/mindshift-cbt

The demands of caregiving can be exhausting and overwhelming. The well-being of caregivers is important because the person with diabetes depend on them for care and support. Helping caregivers in managing stress, regain their sense of balance, joy, and hope in life will impact on the quality of life of people with diabetes and clinical outcomes. The best thing caregivers can do for the person they are caring is to ensure his/her own physically and psychological wellbeing.