Suicide and diabetes isn't something that's generally talked about. But we should be talking about it, says Simon O'Neill, our Director of Health Intelligence and Professional Liaison. Here he explains why and what to do if you need help or want to help a loved one.
Diabetes can be hard to live with. The daily grind of checking blood glucose levels, carb-counting, insulin adjustment and dealing with hypos and highs can take its toll. It’s relentless and there’s no day off. Unsurprisingly diabetes burnout, when you’ve just had enough, is common. We also know that depression is twice as likely if you have diabetes and that 60% of people with diabetes struggle with their mental wellbeing at some point.
So it isn’t that surprising that people with diabetes have double the risk of suicide or intentional self-injury compared with the general population. But that isn’t something that’s widely talked about.
The RESCUE collaborative community are trying to do just that – start talking about suicide and self-harm in diabetes – and to make sure that help and support are there if people need it. I’m part of that collaborative, to ensure that the voices of people with diabetes are right at the heart of the conversation.
The American Food and Drug Administration (FDA) were integral to setting up the community, which is chaired by Prof. Katharine Barnard-Kelly, a health psychologist from Bournemouth and Dr. Shideh Majidi, a paediatric endocrinologist from Colorado. Part of the FDA’s remit is to ensure the safe use of drugs and technology, and they wanted to ensure that people using insulin and insulin delivery devices were able to do this safely, without additional burden. They also wanted to make sure that we really understood how common suicide is in people with diabetes and what could be done to prevent that.
Why suicides go unreported
The fact is that many suicides or incidents of intentional self-injury go unreported for many reasons. We know that many healthcare professionals don’t like to record a code of a suicide attempt or self-harm because of possible stigma for the patient.
We also know that many people with diabetes won’t admit that they are feeling suicidal, particularly to their healthcare professionals, because of the fear of being detained for their own safety.
And we also know that many attempts at suicide might be mistaken for accidental hypo or DKA. One study of 160 cases of insulin overdose leading to severe hypo found that 90% were either suicidal or parasuicidal and only 5% were actually accidental. (Parasuicide is serious, deliberate self‐harm with or without suicide intent, that does not lead to death).
We also know that people struggle sometimes to tell family or friends about their feelings because of the fear that they will overwhelm or burden them.
So, the problem is probably under-reported but is definitely not talked about enough. RESCUE have just undertaken a survey of healthcare professionals working in diabetes to ask them about their experience and feelings about suicide. 95% of them believed it was their professional responsibility to ask about depression, self-harm, or suicide on at least an annual basis but only 35% of them felt very comfortable about having that conversation – with 24% being uncomfortable.
The main concern was that, if someone replied that they were feeling suicidal, the healthcare professional wouldn’t know what to do about it or how to get help for that individual. They were also concerned that by talking about it, they might put the idea into someone’s head, although the evidence shows that this isn’t the case at all.
So, what are we trying to do about it?
Well, the main thing is to start talking about it and to help people have those conversations. We know that healthcare professionals want more education about how to raise the issue and how to be more supportive to people with diabetes, and to have the resources to do that. We’re also now reaching out to people with diabetes through a survey to see what they feel about the issue and what support they want.
The collaborative has started raising the issue at diabetes conferences and plan to continue to do that over the coming years. We also want to start raising it with the diabetes community, through things like this blog. If you want to see who is involved and what’s happening, you can visit the RESCUE website.
And what can you do?
If you’re feeling that living with diabetes, or even just living, is getting too much, please talk to someone. You’re definitely not alone and people will be there to help and support you, whether that’s your friends and family, or your healthcare professionals, or someone anonymous like our helpline (0345 123 2399) or the Samaritans (116 123) or our online forum.
And if you’re reading this as a parent of a child or young person with diabetes, or as a carer of someone with diabetes, be open to having the conversation that starts ‘How are you really feeling today?’ and not being scared of what you might hear. Sometimes just talking about it can really help. And if they’re not open to talking to you, there’s no shame in seeking professional help – in fact one in five people living with diabetes use counselling from a trained professional to help them manage their diabetes.
It shouldn’t be the case that people living with diabetes have a greater risk of suicide and, working together, we believe we can reduce that risk and support people to really live well with their diabetes.
(Photo: Clique at Unsplash.com)