How can I manage my chronic anxiety, stress, elevated WBC count, type 2 diabetes, and hidradenitis suppurativa?

Managing Chronic Anxiety and Stress in the Context of Multiple Comorbidities

You should be screened for anxiety symptoms and referred to a qualified behavioral health professional for evidence-based psychological interventions, particularly cognitive behavioral therapy (CBT) or mindfulness-based interventions, which have demonstrated benefits for anxiety, diabetes distress, and glycemic control in patients with type 2 diabetes. 1

Immediate Screening and Assessment

• Screen for anxiety symptoms using validated tools at your next diabetes visit, as the American Diabetes Association recommends screening all people with diabetes for anxiety symptoms or diabetes-related worries 1
• Your chronic anxiety may be compounded by diabetes-related fears (hypoglycemia, complications, blood glucose targets) and the psychological burden of hidradenitis suppurativa, which independently increases anxiety risk by 48-97% 2, 3, 4
• Screen concurrently for depression, as 41-47% of patients with hidradenitis suppurativa have depressive symptoms, and these conditions frequently co-occur 5, 6

Evidence-Based Psychological Interventions (First-Line)

Cognitive Behavioral Therapy

• CBT is the strongest evidence-based intervention for your situation, demonstrating benefits for anxiety symptoms, diabetes distress, A1C reduction, and depressive symptoms sustained up to 1 year in adults with type 2 diabetes 1
• CBT specifically reduced health anxiety by 77% at 16 weeks in patients with type 2 diabetes while also improving diabetes distress and depression 1

Mindfulness-Based Interventions

• Mindfulness integrated into diabetes self-management education (DSMES) showed the strongest effects on diabetes distress when delivered as a single session plus booster session with 24 weeks of mobile app-based practice 1
• Mindful self-compassion training reduced both depression and diabetes distress while improving A1C in patients with diabetes 1
• Mindfulness-based interventions have strong evidence for reducing anxiety across various populations 7

Additional Behavioral Approaches

• Collaborative care models (integrating mental health with diabetes care) demonstrated sustained anxiety reduction for up to 1 year in adults with type 2 diabetes 1
• Motivational interviewing combined with emotion regulation skills showed large improvements in diabetes distress 1

Referral Pathway

Refer to a qualified behavioral health professional with diabetes expertise if your anxiety symptoms interfere with diabetes self-management behaviors or quality of life 1

Specific Indications for Referral:

• Anxiety interfering with insulin dosing, glucose monitoring, or other diabetes self-care 1
• Fear of hypoglycemia leading to avoidance of glucose-lowering behaviors 1
• Excessive diabetes self-management behaviors beyond what's prescribed (possible obsessive-compulsive features) 1
• Elevated WBC count causing health anxiety about complications 1
• Psychological distress from hidradenitis suppurativa, which affects 40-41% of patients 5

Integrative Approaches with Evidence

While awaiting or complementing psychological therapy:

• Yoga shows effectiveness for anxiety and depression management 7
• Tai chi and qigong may help improve depression symptoms and stress 7
• Relaxation techniques have demonstrated benefits for stress management 7

Critical Considerations for Your Complex Case

Hidradenitis Suppurativa-Specific Factors:

• HS independently increases anxiety risk (adjusted hazard ratio 1.11-1.48), with highest absolute rates in younger adults, females, and those with depression 2, 4
• The association between HS and anxiety persists across all disease severity levels, so psychiatric assessment is warranted regardless of your HS severity 4
• Risk factors for incident anxiety in HS patients include female sex, younger age, tobacco smoking, and depression 2

Diabetes-Specific Anxiety Sources:

• Common diabetes-related anxiety includes fears about blood glucose targets, insulin injections, hypoglycemia, and complications 1
• General anxiety predicts injection-related anxiety and fear of hypoglycemia 1
• Your elevated WBC count may be triggering health anxiety about infection risk or complications 1

Integration with Diabetes Care:

• DSMES combined with psychological interventions reduces diabetes distress and may improve A1C when combined with peer support 1
• Counseling about expected diabetes-related emotional distress should occur at diagnosis and when disease state or treatment changes 1

Common Pitfalls to Avoid

• Do not delay referral to behavioral health if anxiety interferes with self-management—early intervention prevents worsening glycemic control 1
• Do not assume anxiety is solely diabetes-related—screen for generalized anxiety disorder, which has 19.5% lifetime prevalence in people with diabetes 1
• Do not overlook the HS contribution—patients with HS managed by dermatologists have 2.43 times the risk of anxiety compared to dermatology controls 2
• Avoid recommending unproven supplements like Moringa for stress management due to insufficient clinical evidence 7

Monitoring and Follow-Up

• Screen for anxiety at least annually and more frequently given your multiple comorbidities 1
• Reassess when there are significant changes in medical status, such as new diabetes complications or HS flares 1
• Monitor for depression concurrently, as it co-occurs frequently with anxiety in both diabetes and HS 5, 6, 3