Do you feel overwhelmed or defeated by the responsibilities of self-care? Do you worry incessantly about your poor care, but still feel unmotivated to do something about it?

William Polonsky, PhD, CDE, says you're not alone. You may suffer from what he calls "diabetes burnout."

In a talk for the American Association of Diabetes Educators, Polonsky, a professor at the University of California San Diego, spoke about the syndrome and offered some examples of people who are simply "fed up with diabetes."

Problems With Self-Management

Polonsky spoke of one woman who binges on chocolate almost daily, and then reverts back to perfect self-care, only to feel overwhelmed and start the cycle again. Another woman tests her blood glucose only once a week. "Why bother?" she says. She feels constrained by her rigid meal plan, and feels she has failed if she is not absolutely perfect. One teen Polonsky knows has the same problems with self-management, and is obese as well as bulimic. Her fear is that she will gain even more weight from good glycemic control.

These examples are not unusual ones. Diabetes burnout is suspected to be very common. "There are so many frustrations involved with the chronic disease," Polonsky says. These include financial difficulties and weight gain in addition to simply feeling overwhelmed by the huge amount of effort involved in staying well. "Burnout follows the common experience of doing everything right and still failing," Polonsky says.

Black and White Thinking

People who suffer from diabetes burnout often view life in "black and white" terms. They feel either perfection or failure, with no in between. This view leads to feelings of depression, anger, frustration, fear, and guilt. Consequently, people avoid all diabetes issues, tests, and even doctors' visits. This continues in a vicious cycle, until their mental and physical health begins to deteriorate.

These reactions should not be confused with apathy, the doctor says. "People who are burned out are very concerned about their situations. They are angry and frightened, and they are conflicted about their concern. Their ambivalence lies in the fact that they know they need to manage their diabetes, but they don't want to."

What Doctors Can Do

Polonsky offers both doctors and patients strategies for dealing with diabetes burnout. Doctors must make a sound assessment of a burnout patient. "Ask questions of your patients," he says. "Are they overwhelmed? Does diabetes control their lives? Do they have strong negative feelings about diabetes? Is there ambivalence about treatment?"

If so, the first line of defense is the doctor's office. "A strong collaborative relationship between doctor and patient is crucial," he says. "Doctors should respect the struggle, and make their role a non-policing one. Let the patient know what he or she is feeling is normal." Polonsky says that just talking about the dilemma and giving positive, encouraging feedback can help tremendously.

Hold My Hand While I Test My Blood Sugar

The patient's job starts with a commitment to keeping doctor's appointments. A collaborative relationship can help patients feel allied with their doctor.

Also, a patient should try to get away from "black and white" thinking, and set reasonable, "do-able" goals. Know that lapses will happen, and that everyone makes mistakes. Finding compromise, Polonsky says, is the key. "A child, for example, is happy to test her blood sugar if she can have Sundays off."

Patients should also do all they can to maximize social support. After all, friends and family are invaluable to burnout sufferers. It's important to clarify responsibilities among family members. "It's okay to say to a loved one, 'Hold my hand while I test my blood sugar," Polonsky says. This kind of support can lead to more consistent self-care as well as a stronger, more-bonded family unit.

One Task at a Time

Most of all, Polonsky says, "Take one task at a time. Don't worry about exercise while you're worrying about chocolate binges." Instead of trying to rely on willpower, simply make environmental changes, such as not having ice cream in the house.

"Everyone's point of balance is unique," Polonsky says. "Finding that compromise is the key."

Learning to travel in the gray area can keep people with diabetes burnout from feeling overwhelmed. A positive attitude and a sense of personal control can pave the way to excellent diabetes self-management.