Wil Dubois

Happy Saturday, and welcome back to our weekly advice column, Ask D’Mine, hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil responds to a scared mom's concerns about her teen daughter's mutliple health conditions on top of diabetes. It's a delicate conversation and Wil does what he can to help assure this mom that all will be OK.

Read on…


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Anne, D-Mom from North Carolina, writes: Hi Wil, my T1 daughter is 14, in ninth grade, and was diagnosed at 12. She also has dyslexia, ADHD and anxiety, caught early by amazing teachers. Rounding out the labels, she also found out she has celiac disease when she was diagnosed with diabetes and, as she always wanted to be a pastry chef, her celiac was the insult on top of the injury. 

She is a great person, warm, kind and super smart. And she is struggling. Her diabetes and celiac self-management are amazing but her results are not. Her numbers have been crazy, to say the least. As you know, hyperglycemia makes it almost impossible for someone with learning disabilities to function in school. She has missed a ton of school but works hard to keep her honors.

 She is so strong but I am afraid the next step is total burnout. All she does is make up work or deal with the disappointment of missing yet another test or quiz because of her BG. I just found your column and get the feeling you would have good ideas for my sweet girl. 

Oh, but on the plus side, she has taken up fencing and is the only girl on the high school team. She seems to have an uncanny ability to jab other people with a sharp object before they jab her, and she wants to be a state champ if we could get her feeling better. (I would strongly suggest fencing to any diabetic -- catharsis out the wazoo.) 

[email protected] D’Mine answers: Hold on a second, Anne, I’m Googling to see if there is a Fencing Academy anywhere near me. I’m all about catharsis and can’t believe I never thought of fencing before. Let’s see here: Barbed wire fences, wildlife fences, fences and gates, chain-link fences, picket fences, electric fences… Damn! No fencing with swords to be found. Now I really need some catharsis for my frustration in not finding a Fencing School! But in the meantime, I think we can all agree we need an all-diabetic fencing team for the Summer Olympics next time around. That should be our first Olympic Team once we get nation-hood. I bet we could mop up the floor with the competition! 

But your poor kid! She has a lot on her plate. And I think you are correct to worry about burnout, or, as you termed it: Total Burnout.

For what it’s worth, I’ve noticed one interesting thing over the years that I really want you to know: Without exception, type 1s are the strongest people I know. I don’t know if, like steel forged in fire, the disease makes us so, or if the mysterious tangled DNA that gives us our crappy immune systems that wipe out our beta cells also grants us stronger personalities. But either way—trust me on this—your warm, kind, super smart offspring has a soul stronger than a diamond.

Of course, that doesn’t make her immune from burnout, total or otherwise.

So let’s talk about burnout. Diabetes burnout tends to happen when the level of effort put forward does not produce the expected benefits. Or in plain English, you find yourself working your ass off for no reward. As she tries hard and still fails, she’s ripe for burnout. 

All people with diabetes are susceptible to this, we T1s are especially so. Think about it. If you have type 1 you have to pay attention to everything in your universe. Things most people do without thinking, like eating and moving, require pre-planning for us. Things that have no impact on most people can kill us, like minor illnesses, lapses in judgment (a math error on your insulin can do it), or even a big snowstorm that blocks the road to the pharmacy at a bad moment.

On top of that, our diabetes is unrelenting, 24-7-365. Diabetes, like the diamonds that make up our souls, is forever.

But here’s a darker secret: Even if her efforts at control succeeded, she’d still be at risk for burnout. Why? Because there’s no real reward in the traditional sense. Success in diabetes means being able to feel like “normal” people do. Or, as my good friend Bill Polonsky likes to say, the reward for all our hard work in diabetes is that, “ Nothing bad happens.

Given all of that, it’s hard not to burn out. Hell, I’m getting burned out just thinking about it and writing about it.

So what to do? How do we cure burnout? Well, like the flu, hepatitis B, meningitis, and tetanus, the best “cure” for burnout is not to get burned out in the first place. So like flu, hepatitis B, meningitis, and tetanus, it’s a good idea to get a burnout vaccine to prevent it.

Really? There’s a shot for that? Sure.

Well, sort of. The best vaccination to prevent burnout is a change of pace, a vacation, if you will. So how do you take vacation from diabetes? Well, for type 2s on orals, sometimes just not checking blood sugar for a week or two will do the trick. Of course, that’s not an option for type 1s. Likewise, you can’t take a pastry vacation if you have celiac; nor is it realistic that she could just light an aroma therapy candle and take a break from her anxiety, or just pay more attention to avoid that ADHD.

But while she can’t safely take a break from all her health challenges, she could take a break from the other challenges in her life to take a load off of her soul. For instance, she could take a vacation from schoolwork.

If she were a couple of years older, I’d make the radical suggestion that she give up on school and all its added stresses, just take the GED test to complete high school early, and then take a year off to re-charge her batteries. During that year she could focus all her available attention on diabetes control without the other stresses and distractions, and then get on with life (defined by me in this day and age as getting a college degree). But I think she’s too young for that prescription.

You say the teachers at her school are amazing. What about the administrators? Are they equally amazing? I’m wondering if a scheduled respite routine might help your kiddo. I guess what I’m envisioning is a way for her to leap-frog ahead of her schoolwork rather than always playing catch up.

Maybe she could attend school four days a week instead of five. Or maybe Tuesday and Thursdays could be half days. Or maybe she could take off one full week a month -- something that could give her a predictable island of sanity where there are fewer things to focus on at once. Not only could this help her keep her head above water, it would give her something to grab onto when things starting getting to be too much. OK, it sucks right now, but in three days I’ll be on my sunny little island with less to worry about…

So those are my ideas for your sweet girl. I hope you find them good. For the rest of you suffering burnout, total or merely eclipsing, here are some other vaccines you can try:

* Celebrate little victories. OK, so that last A1C was an epic disaster and the endo, in a misguided attempt to motivate you, made you cry by telling you that you are going to go blind. But, you bolused the hell out of the tiramisu at the Olive Garden, flat lining your blood sugar. Let the big one go and pat yourself on the back for the little job well done.

* Limit priorities. A good way to avoid burnout is not to put too much on your plate at once. Blood sugar too high? Blood pressure too high? Cholesterol too high? Weight too high? No wonder your stress is too high! Maybe the weight loss can wait until some of the other numbers look a little better.

* Get a DBF. No, not a Data Base File or a Divorced Black Female. I’m talking about a Diabetes Best Friend. OK, well, come to think of it, there’s no reason at all why your DBF can’t be a Divorced Black Female. Look, sometimes the best medicine is just sharing your burdens with another human being, and who more qualified than someone who not only understands, but also walks in your same shoes? Hey, and once you and your DBF vaccinate each other for burnout, you can take fencing lessons together.

Because we need to get ready for the Olympics.

Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.