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The US healthcare system makes it difficult, expensive, and often impossible for people with T1D to access the care, education, and support they need to live. Around the Circle: Living Well with T1D brings together voices from across the type 1 diabetes community to share real stories, expert insight, and practical support for living well with T1D.
Hosted by the team at Blue Circle Health, a U.S.-based program transforming type 1 care, this podcast helps people go from just surviving to truly living well with type 1 diabetes.
Learn more at BlueCircleHealth.org
You've probably known for a long time
that living with type one diabetes
isn't just a medical condition.
It's an emotional one too.
But even after decades of research,
many people with diabetes feel like
that part of the conversation hasn't
fully caught up with their reality.
My name is Scott Johnson, and
today we're talking with Dr.
Bill Polonsky a diabetes psychologist
who has spent his entire career studying
the emotional burden of diabetes.
In this conversation, we're exploring
what we've learned over the years and
what conversations still need to happen.
But before we continue, I do
need to remind you that we're
not providing medical advice.
For personalized guidance.
we'll always encourage you to talk
with your personal healthcare team.
Additionally, Blue Circle Health does not
endorse any specific product brands and
encourages you to discuss those details
with your personal healthcare team.
I'm excited to welcome Dr.
Bill Polonsky to the show.
Dr. Polonsky is a clinical psychologist
who's spent his career helping the
diabetes world better understand the
emotional side of this condition.
He's the co-founder of the Behavioral
Diabetes Institute and a pioneer in
research on diabetes distress and burnout.
Dr. Polonsky thank you
so much for being here.
I'm really looking forward
to this conversation.
Thanks Scott, I'm glad to be here.
Being a pioneer, ugh, that just
means I'm really freaking old,
but okay, we'll, to go with that.
Fair enough.
A pioneer for sure, and you'll
be forever young in my eyes.
Now, you've been talking about the
emotional side of diabetes for a long
time now, and that's exactly where I
wanna start for a few minutes, especially
for those who maybe are not as familiar
with you and your work as I am.
if I asked you to.
Summarize the messages that you've
been sharing about the emotional side
of diabetes throughout your career.
What would your response be?
I feel like I'm preaching
to the choir here.
It seems so ridiculous to have to tell
your audience, it's mostly people with
type one diabetes, that guess what guys?
There's an emotional side to diabetes.
But it has been remarkable over
all the years I've been working in
this field, which is getting pretty
close to 40, how few healthcare
providers recognize, and address that.
At all, but probably that's the most
important thing that we've spent,
I've spent all these years learning,
quite humbly from all the many
thousands of people with diabetes I've
met over the course of the years to
understand the degree to which there
is this very, important emotional,
behavioral side of diabetes That's.
An enormous contributor that what can
make people feel so miserable, but also
really can provide such umph and impetus
to help people manage diabetes effectively
and successfully, and to not to have to
feel so overwhelmed and so burdened by it.
So there's opportunities, and it's
just really just the recognition that,
this whole touchy feely side is a
really big deal and we want, for people
with diabetes to know if you've ever
getting ever feeling like overwhelmed
and freaked out, man, you are not alone.
Yeah, that's great.
you've done a lot of research and clinical
work around things like you've mentioned
the diabetes distress and burnout.
Can you talk a little bit about
some of the early things that you
discovered that, surprised you?
I guess I should start by talking
about where did this whole idea of
diabetes distress ever come from?
Many, years ago, as I used to work at
the Joslin Diabetes Center in Boston and.
the, healthcare providers there would
send me lots and lots of patients to see,
and they, and the, consult form would
always say, please see this patient.
this patient is in
denial or non-compliant.
Okay.
And that was usually about it.
And I, what was really striking in
those early days, every single person
I met, I went, this person doesn't
really seem into denial and I.
Don't think calling them noncompliant
is particularly very nice and
actually not very accurate at all.
But there was something else going on.
people were just, freaked
out, overwhelmed, et cetera.
And so with my colleagues, we began
to think, what do we call this?
And really this idea of calling it
diabetes distress is really what.
Came together.
And so we began to do a lot of work,
not just to learn from our patients,
but to do research to understand this
and find different ways to assess it.
So it was really, again, the surprising
thing, I guess you could say, or what we
learned was how important this issue was.
Yeah.
I can tell you more about what.
Really most surprising though about
them.
Yeah, please do.
Yeah.
We'll, come back to, we're gonna dig
into diabetes distress in a little more
detail in the next question actually.
Okay.
So let's, follow that other train
of thought that you had too.
The other direction.
it was, I.
If you work in this field and you're
open-minded, you have to be surprised
every day, and I'm thinking very
early on, we were just starting to
formulate this idea and realize,
wow, people are really fed up with
their diabetes and freak freaked out
and burdened, et cetera, et cetera.
Yeah.
I said, let's bring together
people in a group and see if
we could really help them.
This was really primarily my idea.
So I take full credit for the
incredibly stupid thing that we did.
I, we said, ah, let's see.
I'm a psychologist.
We know a lot about stress management,
so we'll teach people relaxation
exercises and we'll talk about how
to reframe things so that you don't
have to feel overwhelmed by life.
very traditional stress
management kind of interventions.
And to my surprise, everyone in this
group just got really mad at me.
and luckily listened to them.
And what they were telling me is, what
are we doing this stress management for?
This is not what I'm here for.
I'm not stressed out about life.
I'm stressed out about fricking diabetes.
Let's talk about that.
I went, oh, no.
We're gonna all practice just relaxing.
And they're going, screw you.
This is ridiculous.
And, luckily I listened enough
to them to say, oh, okay.
Wrong idea.
We really have to stick with.
What's really going on with them?
Throw away all of our preconceived notions
about what's important and how to address
this and have them teach us what they need
and what really can make a difference.
So I'm.
I guess I'm happy and proud to say
on my clinical side as well as my
research side that I feel like I'm still
surprised every day, but that's one of
my earliest memory of being surprised.
Let's dig into diabetes distress a
little bit more for, someone who is
listening who may not necessarily be
familiar with the term, can you tell
us what exactly is diabetes distress?
diabetes distress is.
it's em emblematic in the name.
It's this very, common feeling.
Most people with diabetes experience,
both and that includes type two diabetes
as well as type one where you just can
feel this sense of pressure and burden
of living with diabetes every day.
And it's important to say
this is not pathology.
This is not like a
mental health diagnosis.
oh, if you have diabetes
stress, you're messed up.
It's to be expected and it's to be
expected of What we understand, which
is everyone, I'm sure you understand,
is the day you develop diabetes, the
universe said, Hey, congratulations.
I have a job for you to do.
You get to do forever.
Congratulations.
Can't say no.
there's no pay, there's no vacation.
hey, good for you.
And anybody who's had, would ever have
that kind of experience about having
this extra job with no pay and no
vacations that you have to do, man.
Who wouldn't get sick and tired of that.
And then you add this other element of how
is this gonna affect my life and my life?
Could it be shortened?
And how is this gonna affect me
and what about people around me?
And all the huge permutations, and
ways in which we understand that
diabetes can just really annoy
you and really make things tough.
And we've continued to learn
about new ways in which
diabetes can drive you crazy.
over the years.
I don't know if I can be more
formal about it, but that really
is what diabetes distress is all
about.
Why?
Why is it so important to accurately
diagnose diabetes distress or,
talk about diabetes distress?
And a related question to that is,
is it true that diabetes distress can
sometimes masquerade as depression?
Yeah, good question.
first of all, I'll put on my
research hat to answer that.
one of the things we know
about diabetes distress.
First of all, diabetes stress is very
common that, our best evidence suggests
that maybe 75 to 80% of people with
type one diabetes experience some
significant diabetes distress right now.
Yeah.
then there's what we call really
chronically elevated distress.
People are just really fed up
and overwhelmed most of the
time at very, high levels.
And one of the things we know,
especially as diabetes, distress
gets bigger and overwhelming in your
life, one of the reasons why it's so
important to talk about it is it's
a ball and chain around your leg.
And it definitely makes
it harder to put up.
And manage diabetes day to day.
So we have lots of scientific evidence
to show that people who score high
in diabetes distress tend to have,
higher blood sugars tend to have poor
a, or I hate to use the word poor,
but tend to have higher A one Cs.
If they have cgm, they
have less time in range.
Yeah,
that diabetes stress
just makes it tougher.
and that's not true for everybody.
There are people who in fact have,
fairly tight control of their blood
sugars and have what looks to be
like great quote, unquote, A one
Cs, and they're still miserable.
That'd be miserable because
they're putting too much time
and effort in their diabetes.
They're being dragged down by that.
So it's not a perfect correlation,
but one of the big reasons we
talk about it is here's this huge.
Burden that makes it harder for people
to be successful, to manage diabetes
effectively in a way that they'd wanna do.
Yeah.
And, tell me a little bit about
the danger of it masquerading as
depression and, what that can lead to.
And where I'm going with this
question is being able to, to.
To give help and proper help.
So if I'm dealing with diabetes
distress, taking an antidepressant
isn't necessarily going to help me much.
With that problem.
Yeah, and that, that's a good point.
We talk to clinicians about this a lot
because that gets confusing to them.
And so oftentimes they'll assess,
they'll give you a questionnaire if
you see your doctor often a depression
questionnaire and and say, ah, look,
you score high in this questionnaire.
You probably significantly depressed
for, gonna refer you for treatment that
you're gonna probably not wanna do.
Or there's medication
you're not gonna wanna take.
And there's a huge problem with that.
First of all, we used to think.
We used to think that depression was
extremely common in people with type
one diabetes, and I was unfortunately
part of some of those studies.
So we would say, people with type one,
there's 30, 40% of more who have really
chronically elevated levels of depression.
and what we now realize is that was wrong.
people were scoring high on these
depression questionnaires, but it
turns out those questionnaires weren't.
Exactly measuring depression, they
were really picking up something else.
What they were picking up was how
fed up and overwhelmed and distressed
people were about their diabetes.
And as you mentioned, giving someone
an antidepressant pill for diabetes
distress doesn't accomplish anything.
Yeah,
and by the way, we also have pretty
good evidence that high levels of
depression, which still surprises me.
Isn't really that strongly related to how
well you're doing with your blood sugars.
It's really diabetes
distress is the issue.
Now, where's the confusion?
And the confusion is because
of what they have in common.
So if you've ever been
significantly depressed.
What that means from a psychological
or cognitive point of view for most
people is it feels like things are bad.
Bad things are happening around
you, and you feel powerless.
You feel like there's nothing you
can do about it, and does that.
Grows.
That's really the cognitive nut, the
core of what depression is about.
Although there are can be biological
aspects of that and really the core
of diabetes distress is similar.
It's feeling powerless and outta
control with diabetes and that's
why there's often this confusion.
But, we've been, it was part of a big
international study a couple years ago
to suggest in type one you might have.
What, 10, 15% of people who would
meet criteria for having a clinical
depression disorder, 10 to 15%
where diabetes stress is gonna be.
50, 60, 70, 80% of people.
what do you think we should focus on?
So that's really the big issue.
And by the way, if you're seriously
depressed, that's really terrible.
we know that can really be an
awful thing to have to deal with.
And we have lots of
ways of helping people.
So I don't mean to say it's not important,
I'm just saying it's not prevalent.
Yeah.
And it's really not the most, I think the
most important thing we need to focus on.
and you bring up a great point there
because it is possible to have both,
clinically diagnosed, depression and be
significantly distressed about diabetes.
And that needs to be handled,
appropriately as well.
We are.
We are great.
We are, humans are amazing.
We have wonderful ways of
driving ourselves crazy.
We can be depressed, we
can have diabetes, stress.
We get all sorts of awful things happen.
It all is in combinations.
You've been sharing
these ideas for decades.
What parts of the message do you feel
like the world hasn't fully heard yet?
Which world You mean healthcare providers?
You mean people with diabetes, you mean?
Depends who you mean.
if you, if we talk about healthcare
providers, I think there has been
a slow growing recognition that.
The emotional side of diabetes is
important, but certainly there has
not been a recognition appreciation
that healthcare providers can and
should do anything about that.
and it's not because they're
bad people, it's because usually
they're just so overwhelmed with
dumb other stuff they have to do.
Yeah.
And their appointment time with you,
people with diabetes is so limited.
Now they may also not have the
skills to do that either, to do
something other than treating.
People with diabetes as their numbers
is really what this is all about.
And why?
And why That's so absolutely key.
I think for folks with diabetes.
I still don't believe that most people
with diabetes recognize that when as
they're feeling overwhelmed at times, or
scared or pissed off, I don't know if they
recognize how normal they are and that.
It would be almost weird if
they didn't feel that way,
that when you're having a tough time
managing diabetes and you're just
feeling sick and you wanna take a
break and you hate it and it's driving
you crazy or whatever that emotion
is, there's an enormous number of
other people feeling that way and.
That in and of itself is so important
and so healing, and I think it's just
because people with diabetes can still
get so isolated, which is one reason I'm
glad you're doing this podcast and I'm,
glad that Blue Circle Health exists.
It's easy just to feel like
you're the only one in this boat.
so for me the most important message that
most people still don't hear is if you are
ever getting burned out and overwhelmed
by your diabetes, that's normal.
It's super common.
It doesn't mean we can't do anything
about it, but just know that we're all,
I'm reaching out to you with a big old
hug and to go welcome to a big club.
it's okay.
And it's understandable how this happens
given that you're trying to put up
with this tough job you've been given.
Yeah.
Thank you for that.
Can you maybe.
Explain or describe some
signs that someone might be
dealing with diabetes distress.
I, wanna help the listeners recognize
if they might be experiencing this
themselves and are there any tools
that, that, that might help them
in terms of what you might recognize?
Probably the most important thing,
as you recognize that dealing
with diet diabetes every day is
just seeming harder and harder.
it's hard to find the
oomph you need to put up.
With this idea that you should
be mobilizing for a meal or just
feeling angry from time to time
about feeling you don't wanna do this
anymore, this need to take a break.
I say all that and again, wanna
emphasize how normal this is.
Yeah.
but it's a sense of being worn down.
it'd be just like having a job.
Any job where you're working 15 hours
a day every single day and within
a week or two you're gonna go, I'm
not sure I wanna keep doing this.
Yeah.
And you also begin to, at the
extreme, begin to depersonalize.
So you begin to distance yourself from it.
It's this isn't even me,
something I have to do.
But, maybe I'll just stop
thinking about it for a while.
I'm being a little vague because it's
so hard to capture, but I wanna answer
the second part of your question.
There's some very easy ways to begin
to assess and measure and decide
how distress you are, because we
made up most of those measures.
Great.
and, the easiest way is to go to
this website, diabetes distress.org.
Diabetes distress.org.
And at that site you could.
fill out one of a number of
our different questionnaires.
I, would recommend you, probably
take the most, recent one and
the best one, which is called
the Type one Diabetes Assessment.
Diabetes Distress
Assessment Scale, T 1D DAS.
And you'll see it there.
You can fill it out as
completely anonymous.
No one's ever gonna see
the results except you.
You fill out this questionnaire,
I think it's 29 items.
It's automatically scored.
It'll show you what your score
is, it'll tell you what it means.
unfortunately this current version, I
won't tell you a lot about what to do
about it, but it at least give you a sense
of how big of an issue is this for me.
And because it has a whole
bunch of subscales, because we
know there's different things
you can be distressed about.
It can help you pinpoint the
sources of your diabetes distress.
is it really the fact that I'm
feeling hopeless about my future,
that diabetes means I'm doomed?
Does it mean that I'm just having
trouble affording to affording diabetes?
Is I feel, my family members don't care.
There's different things that
can contribute to this, and by
helping you figure out what's the.
The source or sources that are
most important, it can then
open up what to do about that.
So that's, I highly recommend that site.
It's completely free.
It's totally anonymous.
Go for it.
Diabetes and
is
it.org?
Diabetes distress.org.
We'll be sure to get
that in the show notes.
and is it something that once they've
gone through it, they can maybe
print it out, and bring it to their
healthcare professional to, to start
having some of those discussions?
Yeah, I should, have mentioned that.
Thank you.
Because it's anonymous.
The system is anonymous.
It doesn't, can't save anything.
Yeah.
So the, so if you do wanna save it,
you do need to scan it into a PDF or
you can print it out directly from that
site and take it to your healthcare
provider and wave it in front of your
healthcare provider's face and say, I
got a couple extra things to talk about.
that's what, that's can be very
worthwhile say ideas is where, areas
where I need to, this is what's driving
me crazy and I could use some help.
This is a great.
Place to take a quick break.
When we come back, we're gonna talk
a little bit more about what actually
helps and, what people with diabetes
can do when the emotional side of
this condition starts to feel heavy.
One of our favorite things is sharing
stories from people who've participated
in the program, and I'd like to share a
story I have here from Rachel in Florida.
She's been living with type one diabetes
since 2024 and participated in the
Blue Circle Health Program recently.
I got diagnosed when I was 26.
It was so much to try to understand.
I really felt knocked down and I
think that was because I didn't
have the knowledge that I do
now about just what it's like to
live with, this kind of disease.
And I'd get some very like
surface level answers when I
knew that there was more to it.
Like a circle of.
Just questions, despair her a
little bit and just frustration.
It didn't seem like there was
an end in sight, and I felt very
alone when I started Blue Circle.
I felt like I was in a hurricane.
I didn't know how to help myself.
I didn't know how to help my parents.
I didn't know what power I had.
I felt like I was just this lost, confused
patient, but really just talking to.
Lenni, Rita, Catherine Z. Like I can't
say enough good things about them.
I would have them like above,
like on my wall, honestly.
they took the time to not only help
me and answer my questions and help
me inform myself, but help me inform
and educate my parents and everyone
else in like in my life, in my circle.
And it was such a great experience of just
reframing how I think about end disease.
Then how everyone else
thinks about it, right?
One of the best things that I
got out of the program was my
sense of advocacy for myself.
Just speaking with Eleni as much as I
did and, Catherine and everyone, they
really gave me a sense of courage.
I feel so much less alone.
I feel so much more empowered.
And my management has improved so much.
And honestly, part of that has
just been the mindset shift that
comes with the, like all this
empowerment, all the information
that was, it was just incredible.
I know that there's so many
people out there like me that
need you, that need blue circle.
Wow, Rachel, what a moving example
of what we hope to do here.
Thank you.
Now, before we dive back in, I wanna make
sure you know about a helpful resource.
And listen, this is not an ad.
There's no sponsorship involved.
In fact, they don't even know
that I'm doing this Today.
I'm talking about the mental health
professional directory from the
American Diabetes Association.
This directory is a quick way
to search for mental health
professionals in your area.
You can search and sort by distance.
Ages seen languages and
even special interests.
You can find the directory@diabetes.org
and then click into the tools and
resources menu, and you'll see
mental health provider directory
in the list that drops down.
So if you're looking for help with
the mental and emotional side of T 1D.
This might be a great place to start.
It's also a great idea to talk
to your healthcare team and see
if they have any recommendations.
Welcome back.
We've been talking about the emotional
burden that can come with living with
type one diabetes, but there are also
ways to navigate that experience in
maybe healthier and more supportive way.
So Dr. Polonsky when someone
realizes they might be struggling
emotionally with diabetes.
What are some helpful first steps?
again, wearing, putting on my
clinical hat, I can tell you, the
majority of people who come to see
me because they're burned out or
overwhelmed about their diabetes
probably don't really need to see me.
let me say.
Actually, they probably do need to see
me, but what's even better than seeing me
they could see in place is if I could have
the opportunity simply to introduce them
to a whole lot of other people, like them
living with type one diabetes every day.
That, again, people end up
feeling so isolated and.
As as well as I do, when you help
to bring people together, where that
means of, local meetups like as we have
here in San Diego, and you're aware
of the various ways we can do that.
A lot of that's going on nationally.
Now.
We know our friends are taking a 12 year
diabetes, have a program once a year.
Other organizations as well.
You can help people just hang out
and meet each other and re and be
in a big room to gather together
and realize everybody's beeping.
There's something so
amazing about that, right?
it's weird if you don't have
diabetes in that room and.
That's by far the most remarkable
thing I think I've ever seen.
It seems to make a difference.
I've, I know I've told you the
story long ago that when we used to
do a lot of, before the pandemic,
lots of group programs for people
With diabetes, especially type
one, and we bring people together
in groups of 10, 12, 15 people.
We'd meet once a week for maybe.
6, 8, 10, 12 weeks.
And at the end of every program, I would
usually go around the room and say,
Hey, you've been coming here every week.
What have you found, if anything, of
any value about being in our program?
And to tell you the truth, when
I first started doing that, I
was fishing for compliments.
And so you can imagine
my disappointment when.
The first response I heard was Harry
over here would say, you know what
I really liked, I got to meet Bob.
Bob really gets it.
He knows where I'm coming from.
I went, yeah, okay.
That's nice.
yeah.
and Sally would say, it's been great.
I got to meet Barbara.
She really gets it.
She like knows what's going on.
I'm like, okay, wait a minute here.
What's happening here?
and I began to realize that.
Here.
I thought I had given such wisdom
and helped all these people so much,
but really I was just the host of
the party and by helping people
meet each other and brainstorm and
listen to each other and realize.
Just take a deep breath and go, oh gosh,
someone else gets this and understands
this and put up with the same stuff.
And maybe as a solution, maybe not.
That was by far the best thing.
So any creative ways we can
help to bring people together.
Ideally in person, I think not
as good, but sometimes online if
it's in some moderated fashion.
So we force people to
be nice to each other.
really is by far the most important thing.
I'll stop for a minute 'cause
I can talk about a lot of other
things, but that's the biggie.
I love that I community has been such
a big part of me and, me feeling like
I'm living well with, Type one diabetes.
What are maybe some small
mindset shifts that.
People with diabetes can strive for that
might make feeling, make living with
diabetes feel a little more manageable.
the, I would say the, other biggies
that we talk about a lot, one has to
do with what we call evidence-based
hope that even here in 2026, we
know that so many people feel.
Doomed that diabetes is gonna get you,
that your life is gonna be shortened.
You're gonna end up with horrible
complications, you're gonna have your
legs cut off and you're gonna be blind.
You've heard all these awful, things
and people rarely hear the good news.
What doesn't get told enough, which
is what the evidence tells us, is
that with good, and I'm gonna say
this broadly, good with good care.
Odds are pretty good.
You're gonna live a long and healthy
life with diabetes and as you know
so well, Scott, we have been spent a
couple decades simply accumulating all
the evidence to document how true that
is, that we can't make any guarantees.
But it's the opposite of what we
typically tell folks, which is, if
you don't behave, here's the opposite.
Here's where the bad things
are gonna happen to you.
But we know for a fact, especially here
in the US, that we have more and more
people living long, long, healthy lives.
In fact, it's turning
into a problem, right?
So we have our friend, Joanne
Milo, who started this new
group by two one T one to 100.
Yeah.
Where now we have this problem of.
These damn people with type one are
get, they're not dying, they're getting
older, and now they're freaking out
about, what happens when they get so old?
I'm not gonna lose my marbles and
not be able to use my technology well
enough and it's gonna take care of me.
Like whoever knew we'd
have problems like this.
and it's a problem, but it's wonderful.
It's a
great problem.
Yeah, absolutely.
If someone listening today takes just
one thing from this conversation,
what do you hope that is?
First of all, if you're going through
times when diabetes is driving you crazy
in any way, you are freaking normal.
Okay?
It is understandable that's happening.
Number two, you wanna
know what to do about it.
The most important thing
is don't do diabetes alone.
You need people in your life who are
rooting for you, whether that means
getting your family and friends on board.
Whether it means having a healthcare
provider who really cares about
you, whether it means reaching out
to finding, meetups or groups of
people with type one diabetes in
your area, region, or even online.
If there's any way, anything you could
do so that you don't have to be alone,
that you can meet others who are maybe
doing better than you, maybe doing worse
than you, but who have also dealt with.
can I be stressed over the years?
You can laugh, you can cry.
By far.
It's the most important thing to do.
That's what I'd say.
Very well said.
Dr. Polonsky thank you so much
for talking with me today.
I'm eternally grateful for the benefits
of your work in the diabetes field, and
I feel like I've personally benefited
from much of your work over many years.
So I just really appreciate
you taking the time today.
That's
really my pleasure.
Thanks so much.
Thanks so much for listening today.
If this conversation resonated with
you, I hope it helps you remember
that the emotional side of living
with type one diabetes is real.
And you're very much
not alone in feeling it.
If you're looking for support, you can
visit Blue Circle health.org to see
if our program is available in your
state, or talk with your healthcare
team about getting help with the
emotional side of diabetes, and I hope
you'll tune in for our next episode.
Until next time, keep
living well with T 1D.