According to the dictionary ‘alone’, when used as an adjective, is a word that describes someone or something as being in isolation, or as being unique. Alone can also be used as an adverb, meaning something was done by a single individual.

People living with diabetes can either be alone or can feel alone. If you are alone you would literally be the only person in a particular place. This is neither good nor bad, but can be experienced as either positive or negative, depending on the situation. If you feel all alone, it implies a sense of sadness or loneliness, as you find yourself existing apart from all others. Let’s take a look at ways to live safely alone with diabetes.

Living with type 1 diabetes

Many people with type 1 diabetes can feel alone with their condition. In particular, children may be singled out by their peers because they are ‘different’ and often are the only person with diabetes in their school. The diagnosis of type 1 diabetes can put families under significant stress as they do everything they can to keep their child safe and healthy, especially when they go to school.

For many adults with type 1 diabetes, the main concerns about living on their own are often around what happens if they get hypoglycaemia (a low blood glucose level) or ketoacidosis, a serious condition related to illness or very high blood glucose levels. Nocturnal hypoglycaemia (low glucose levels overnight) can cause anxiety for people with type 1 diabetes, especially when living alone. To reduce this worry, you should:

• Check your blood glucose level before going to bed and as soon as you wake up
• Consider setting an alarm and checking your level through the night, particularly if you exercised or drank alcohol earlier in the day or if you wake up with unexpected blood glucose levels and if you have symptoms such as headaches on waking
• Always have hypo treatment besides your bed
• Keep a regular schedule of when you eat, when you take your long-acting (basal) insulin and when you go to bed
• Consider using a flash or continuous glucose monitoring system which alarms when your glucose goes outside your target range.

If you frequently experience hypos, if you experience severe hypos (ones that require help from someone else) or if your awareness of hypos is decreased you should consult your diabetes health professional as they can help make sure you have the right insulin doses or types.

To prevent ketoacidosis, make sure you don’t miss or delay insulin injections, check your blood glucose levels regularly and follow your sick day management plan. Contact your diabetes health professional for further personalised recommendations.

Type 2 diabetes

Many people feel a range of emotions when first diagnosed, including fear, anger, grief, denial and loss. You may also feel a sense of relief at finally knowing what you are dealing with. These are all normal responses.

People with type 2 diabetes can also feel alone with their condition and misconceptions from those around us can contribute to feeling alone, misunderstood and isolated.

Diabetes is not caused by eating too much sugar – type 1 diabetes is an auto-immune condition and type 2 diabetes is caused by genetics and lifestyle factors. However, while sugar does not cause diabetes, it can contribute to overweight, which is a major risk factor for developing type 2 diabetes. Similarly, diabetes cannot be cured by avoiding carbohydrates. Research has shown that it is possible to go into remission in the first five years or so after diagnosis of type 2 diabetes by achieving significant weight loss. However, remission does not guarantee that diabetes does not return. Not achieving diabetes remission does not mean you have failed at managing your condition.

You can find more information on remission by reading our type 2 diabetes remission position statement.

Managing diabetes as you age

Diabetes care is generally the same no matter how old you are. However, some things change as you get older and these changes can affect your diabetes. If you live alone you may need to be more aware of how ageing affects how you look after your diabetes.

As you grow older, physical changes can affect your ability to manage your diabetes independently. For example, failing eyesight and reduced mobility may lead to a reduced level of daily foot care, which means that early warning signs of damage to your feet may be missed. It can be more challenging to stay nourished and maintain healthy eating habits as your appetite can change with age.

It can sometimes be difficult to tell the difference between symptoms and signs caused by diabetes and those that are a part of the ageing process but not necessarily related to diabetes. It is important to seek medical advice for any new symptoms.

The target range for blood glucose levels may need to be increased if you become frail, if you are at risk of falls, if you take certain types of medicines for your diabetes or if you have other health problems. Your doctor or diabetes health professional should review your target blood glucose range regularly and help you decide what target is best for you.

Managing diabetes as you age is a guide for older people living with diabetes. It is available through the NDSS website and is a great resource for anyone with diabetes as you grow older.

Hypoglycaemia

If you have diabetes, a little worry about the possibility of hypoglycaemia is normal. Growing older can increase the risk factors for hypoglycaemia, such as having a poor appetite, being on multiple medications or having kidney disease.

Experiencing hypoglycaemia can be frightening, so it is not surprising that recurrent hypos can lead to anxiety. If anxiety about hypoglycaemia is affecting your day-to-day life, talk to your doctor or diabetes educator about it.

A good tool for preventing hypoglycaemia is doing regular blood glucose checks. By checking your levels at different times of the day you will get a more complete picture of how your levels go up and down naturally. Having regular meals and snacks can also help in preventing hypos.

Eating alone

Eating healthily can become a challenge if you do not like preparing meals for one. There is also the issue of food going bad before it all gets eaten.

If you are buying larger amounts of food, try cooking several portions at once and freezing the leftovers. This will give you some easy meals that can be quickly reheated when you are too busy or too tired to cook.

Buying individually portioned food is often more expensive, but may make more sense when you are buying foods that don’t last very long or don’t freeze well, such as fruit and vegetables, or if you don’t have the space for long-term freezing and quick reheating.

Exercising

Living alone does not mean you have to exercise alone.

Many people enjoy exercise more with a partner or in a group. There are many options available, our free Beat It program is one of them. Contact the NDSS Helpline on 1800 637 700 to speak to an exercise physiologist to find out more.

If you choose to exercise alone tell a friend about your plans so there is someone who knows where you are and when you are expected back.

Whether you exercise alone or in a group wear a visible medical identification such as a necklace or bracelet. This is useful in case you are unable to relay information during an emergency.

Living alone during illness

When you have diabetes and you live alone it is important to plan ahead. For example, when you are unwell you will probably not want to go shopping for supplies, so as well as stocking up your pantry it is also important to make sure you have adequate diabetes supplies such as blood glucose testing strips, lancets (finger prickers), and medications.

Make sure that your sick day management kit is well stocked and that you have a sick day management plan in place, including a list of important phone numbers. Your diabetes health professional can help you with this.

Remember, it is often better to get help early rather than waiting. So, make sure to let someone know when you are unwell. If you are not sure if you need an ambulance it is better to be safe and check. Ring 000 and talk to the operator so they can help you decide whether you need an ambulance or some other service.

Alone and lonely?

Living alone does not mean that you have to be lonely. Many people are quite happy living alone, but if you live alone and are unhappy about it seek support.

We can feel lonely or isolated for many reasons, even when other people are around. Feeling connected is important for our mental health and physical well-being. Feeling connected can protect against developing anxiety and depression.

If you feel alone or socially isolated, talk to a friend or family member, join a club, organisation or online community, and try to get out of the house as often as you can. You may find it helpful to talk to one of our Diabetes Australia counsellors, to make an appointment call 1800 155 177. Your doctor can also refer you to a counsellor or help you access a Mental Health Care Plan that gives you subsidised access to up to 10 individual and 10 group appointments with eligible health services per year. This includes visits to a psychologist, occupational therapist or social worker.

Loneliness increases the risk of type 2 diabetes

Research has shown that loneliness and an absence of quality connections with people can predict the onset of type 2 diabetes. This suggests that helping people form positive relationships could be a useful too in prevention strategies for type 2 diabetes.

However, there is a clear distinction between loneliness and social isolation. Living alone does not predict the development of type 2 diabetes.

It is believed that the chronic feeling of loneliness increases stress levels, which in turn increases the risk of developing diabetes. So, if you are feeling lonely, reach out and make a connection.

One option is to join our online community forum where you can talk to and ask questions of others living with diabetes. Email [email protected] to find out more. Or you may just like to speak to one of our experienced healthcare professionals who can be contacted through the NDSS helpline on 1800 637 700.

Another option is to attend one of the many free NDSS diabetes self-management education and support programs. NDSS events include short webinars, face-to-face workshops and comprehensive education programs. Check out the events website events.ndss.com.au/ or call 1800 177 055 to find out more.

By Credentialled diabetes educator and somatic psychotherapist Carolien Koreneff