^{Today is R U OK? Day. It’s a day dedicated to encouraging us all to ask ‘are you OK?’. Not just today, but every day (rightly so). It is a day that has become such a big part of the social calendar for Australians. It’s great to see so much effort, advocacy and support going into trying to break down barriers and stigma in the mental health space, because it’s impossible to deny that there is still a huge amountof stigma associated with mental health.}

^{But what's diabetes got to do with it? A whole lot, actually!}      

• 41.6% of adult Australians with diabetes alsoreporting medium, high or very high levels of psychological distress (1)
• People with diabetes are two to three times morelikely than the general population to experience depression (2)
• People with depression are more likely to experiencetype 2 diabetes (3)
• Diabetes distress and depression are separate constructs, but they are risk factors for each other (4)

PDC Health Hub by Perth Diabetes Care is WA’s (if not Australia’s) largest private community-based diabetes clinic. And that’s a big part of exactly why we felt it was so important that we get behind RUOK? Day and show our support. Our clinicians see countless people with diabetes every single day, and so many of those people will be in need of someone to ask them ‘Are you ok?’ – not just today, but every day.

Diabetes is a somewhat ‘invisible illness.’ There’s nothing obviously wrong or broken. However, it’s very real. It’s very demanding and it’s very complex to manage.

Cue = diabetes mental load.

Our Health Promotion and Communications Manager, Lauren, shared some examples of this diabetes mental load:

There are insulin injections, carb counting, site changes (for those using an insulin pump), monitoring of blood sugar levels, administering more insulin if our levels are too high, or finding sugar to consume if we are low. We watch and wait to see if we’ve administered enough insulin, or if we need more. Some days we feel like we’re injecting water because it’s just.not.working. We have to make sure we’ve always got a hypo treatment nearby. We have to have insulin with us at all times. If we use an insulin pump, we have to make surewe have enough insulin in the pump to get us through the day. The same applies to using an insulin pen. Don’t forget the test strips, too! And make sure you’ve ordered your CGM supplies/pump supplies/insulin. Do you have a script for your insulin or do you need a new one? Do you need a new referral for your Endocrinologist? Have you used all of your care plan appointments? Has your insulin pump has enough battery left? Some types of exercise will make our blood sugar levels rise (without eating anything), while others will make us more likely to have a hypo. Carb counting isn’t as simple as x amount of carbs= x amount of insulin required. It sure sounds great in theory, but what if it’s a high protein meal, or a high fat meal? What if we’re already above target before the meal, or below target? What if we’ve exercised recently, or will be soon? Do we have time to ‘pre-bolus’? Should we pre-bolus? Do we have an appointment with our team coming up soon? Do we need to try get in sooner? Can we get in sooner? Does my partner know what to do if I have a severe hypo? Do my kids know? When should I tell them what to do if they can’t wake mum/dad, or they find mum/dad having a seizure? This is just SOME of the mental load wehave to consider and keep on top of. Every. Single. Day.

It is also known that there are a long list factors that influence blood sugar levels beyond what you're eating and how much insulin you are having. There is meal timing, hot weather, dehydration, activity levels, recent hypos, stress, menstruation, hormones, pain, medication, sleep, injection site, dawn phenomenon, alcohol intake – to name a few - to be considered.

To put it simply, a person living with diabetes will makeover 100 diabetes-related decisions every day. It is more than a full-time job. It’s 24/7, you can’t take leave and there are certainly no holidays.

There is no quick fix, there is no cure and there’s no way to prevent the disease. So we need to be proactive about supporting the mental health of all people with diabetes, and ensuring they have access to these supports. We also need to empower each other to seek out support if they need it.

It’s not just about the demands of diabetes (though this might be the key trigger). There is the constant worry about long-term complications, the stigma associated with diabetes, lack of awareness and understanding from those around us, the financial implications.

People with diabetes can experience diabetes distress, the emotional distress that can result from having diabetes and the pressure of relentless self-management of the condition, amongother mental health conditions including depression and anxiety. 

• 1 in 4 people living with T1D, and 1 in 5 insulin-treated people living with T2D will experience severe diabetes distress.
• 1 in 10 people living with non-insulin treated T2D will experience severe diabetes distress.
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• 1 in 6 people living with T1D, and 1 in 5 insulin-treated people living with T2D will experience moderate-to-severe symptoms of anxiety.
• 1 in 6 people living with non-insulin treated T2D will experience moderate-to-severe symptoms of anxiety.
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• 1 in 4 people living with T1D, and 1 in 3 insulin-treated people living with T2D will experience moderate-to-severe symptoms of depression.
• 1 in 5 people living with non-insulin treated T2D will experience moderate-to-severe symptoms of depression.

Source: Diabetes and emotional health, NDSS resource for healthcare professionals.
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With these stats in mind, we urge you to ask your patients how they are – R U OK? – at every consultation. If you spend the whole time discussing mental wellbeing, and nothing about diabetes – that’s OK. Because that’s obviously what they need.

Please ask the question today, tomorrow and every other day. Healthcare professionals: please ask it at every appointment. Diabetes is relentless, and the research shows that people with diabetes have double the risk of developing depression. It can feel like a burden and most people living with diabetes have, or will, experience diabetes burnout. Obviously, no one is expecting all healthcare professionals to have all the answers or to be able to offer full mental health support; but you can ask how your patients are coping/managing and listen. You can refer them on to other services if need be.