I have Type 1 Diabetes and Borderline Personality Disorder

Welcome to an exclusive club: In 2012, between 1.6%-5.9% of the US population was estimated to have BPD. Meanwhile roughly 0.4% of the population had diagnosed Type 1 Diabetes (using 2012 total population). That number is actually higher when accounting for undiagnosed cases.

Having Type 1 Diabetes is easier if your mental health is in order. Likewise, as difficult as BPD is, having good physical health improves treatment outcomes.

Both at the same time? Well, now you have an epic silent struggle on your hands.

While the stigma of Type 1 Diabetes is decreasing, it is still quite high for those with BPD. Having BPD is hell on earth. Suicide rates approach 10%. Few people will care to help you. Like Type 1, it is a self-managed condition, in conjunction with a superb therapist. Marsha Linehan’s DBT (Dialectical Behavioral Therapy) is noted as efficacious psychotherapy, while some meds can decrease comorbid feelings of anxiety, depression and poor mood regulation.

Is Mental Illness Common with Type 1 Diabetes?

First, it’s important to note many Type 1 diabetics will experience depression and anxiety in their lives. That doesn’t mean they have BPD. Rather, it is collateral damage from the stress and demands of managing chronic illness. Incidence of depression, in particular, is more common among those with poor glucose control. That said, these conditions are fully treatable and beatable.

Throwing BPD into the mix complicates things: the sadness, rage and emptiness of BPD make managing Type 1 a herculean task. Why bother pricking fingers, taking insulin and eating healthily if your world is falling apart? If you just want to die? If you feel misunderstood, alone, dejected and miserable?

In 18 years with Type 1 and 14 years with BPD, I will admit it: I pondered overdosing on insulin just to end it. And who would know? At least I went out due to physical illness, not some perceived character defect. People would feel bad: “He had diabetes…”. Opposed to angry: “He was a manipulative, awful piece of sh!t…”.

These feelings have dissipated as both my Type 1 and BPD management improved. Both conditions require taking immense responsibility for your life, relationships and health. You don’t have to “get there” on day 1, just realize that’s where you’re eventually headed.

Type 1 is best treated one finger stick at a time. When your numbers approach normal, you will experience mood improvements. If my BG is 51, I’m irritable and incoherent. If I’m 251, I feel depressed and miserable.

But at 101, my body is back in the game. I don’t feel physically stressed, only my BPD remains.

How Does My BPD and Type 1 Diabetes Present Itself?

At present, my Type 1 is in good control, my overall physical health is excellent and I continue treatment for BPD.

The cost of taking greater responsibility for myself, however, has been increased sensitivity to healthcare providers offering constructive criticism, making objective observations or pushing me to improve.

BPDs can be thin skinned, and I’m no exception. This is compounded when a physician makes the *slightest* offhand remark, like “you’re too low at 2 PM”, “you take too much insulin at dinner”, or “your A1C is only above-average, we have some patients with better control”. ENOUGH! It’s like I’m being burned alive!

Here’s a good example in dialogue. I use an insulin pump, so “bolus” means taking a fast acting insulin dose.

Doctor: “You’re bolusing 26 times a day, that’s a lot higher than average…”

Me: [immediately taking offense inside, because it felt like an attack] “Well, I should talk to my shrink about that, I might have an OCD problem. I’m on that thing more than my cellphone.” [smirk, snide joke intended]

Doctor: [awkward grin] “I’m concerned you’re stacking your insulin, producing lows later on in the day. Fast-acting insulin lasts up to 4 hours in your system. Frequent boluses might lead to up-and-down glucose readings. Your CGM shows some swings.”

The doctor wasn’t outwardly upset at my remark, but I realize it was out of line. She was only trying to help me, but my emotional sensitivity got in the way.

A week later I went to individual therapy. I caught myself doing another BPD tactic: pitting healthcare providers against each other.

I recounted the same dialogue to my therapist. At first he asked if I should apologize. I didn’t feel my doctor took much offense. Even after my odd remark, our appointment was routine and cordial. Eventually I confessed I felt maligned, that her comment was unempathetic. Now I was playing victim, when nothing had happened. After a few minutes my therapist was still trying to make sense of it, questioning what I got out of going to the diabetes clinic. Voila! BPD manipulation, victimhood and projective identification in less than 10 minutes!

Therapy has taught me most physicians mean well. It is my BPD that conjures these dramatic emotional reactions. Had I raged, insulted the doctor or burst into tears, I would have made an apology.

This is BPD small ball, an improvement over many years of therapy and introspection. For some, the same comment would have sparked a much different reaction.

How Do Others With Type 1 Diabetes and BPD Present Themselves?

I’ve never met anyone else with Type 1 and BPD, so the following are from various medical journals. In general, the authors paint a gloomy picture of the Type 1 Diabetic BPD patient.

1. She doesn’t take care of her diabetes and blames others for it. Codependent spouses might be blamed for not taking care of the Type 1’s prescriptions, glucose meters, etc.

2. A1Cs are out of control. Metabolic Panels, Cholesterol tests, etc. out of normal ranges.

3. Patients refuse to follow medical advice, not because it is bad advice, but because they’re having a personality conflict with the provider.

4. Appointments are frequently missed and canceled. Office staff spend inordinate time taking care of BPD patients, coordinating and enforcing office policies.

5. Patients jump from clinic-to-clinic after a blowup or feeling offended. Arriving at a new clinic, she states, “I know you’ll be the best doctor I’ve ever had.” (Victim-Rescuer Dynamic)

6. BPD patients do not follow rules and expect special treatment. Full medical records are requested “STAT”, opposed to a 3-7 day wait most people experience.

7. Nasty complaint letters or phone calls will be made against the physician’s office.

8. Healthcare providers are pitted against themselves. The psychiatrist will get one story about the Endocrinologist; the Endocrinologist will get another story about the psychiatrist. The therapist is stuck in the middle. 🙁

Some diabetes clinics will actually “tag” a BPD patient’s file, so they know to be prepared when he/she arrives for treatment. This is for their own sanity, because they know the interaction will be more emotionally charged than normal.

Read more:

1. Borderline Personality Disorder and Diabetes: A Potentially Ominous Mix
2. Treating Patients with Borderline Personality Disorder in the Medical Office

Is there hope for people with Diabetes and Borderline Personality Disorder?

Yes. I sincerely believe there is hope and improvement for anyone battling both of these conditions.

I started this blog calling it an exclusive club. That was an objective compliment, because it is a rare combination. Of course, I’d rather be rare for different reasons than my health problems. But give yourself a break: these challenges are well beyond what most people face.

If you’re worn out from both conditions, start working on one first. Personally, I think diabetes is easier and more approachable. It sows seeds of structure, responsibility and management necessary for BPD treatment. With better BG numbers, your physical health, energy levels and mood will improve. Next, sit down with a skilled psychiatrist and therapist for the tough work coping with BPD entails. DBT groups, psycho-analytical group therapy and applicable meds for depression and anxiety will help.

Realize your rarity means most people will never understand your struggles. Furthermore, that few doctors will have experience with both conditions at once. Accept – for now – that progress will be slow and hard fought; but it will be worthwhile.

Finally, don’t let the perfect be the enemy of the good. Set reasonable diabetic and therapeutic goals. Anyone who is telling you to “snap out of it and eat better” is grossly misinformed and ignorant. This all takes immense time and energy. Don’t defeat yourself at the outset with the expectation of feeling great – physically and mentally – in a couple months.

Find qualified health professionals and cut them slack. They are doing their best. So are you. Sometimes emotions run high on both sides. Therapy will provide insight and coping mechanisms so that productive healthcare relationships aren’t ruined.

Feel free to ask questions in the comment section below. Good luck to everyone.

17 Replies to “I have Type 1 Diabetes and Borderline Personality Disorder”

    1. Hello,

      I live in the USA, working as a self-employed individual. I can buy insurance from the Federal Healthcare exchange, a state exchange or directly from a private insurance company.

      I fortunate enough that no subsidy is required. For those that require assistance, they must either use a state exchange or federal exchange with Medicare.

  1. I just wanted to say it is refreshing to hear from someone with Type 1 and BPD. It’s good to know I’m not alone…I am struggling massively with control but now I can see there’s some hope

  2. As the father of a daughter with T1D and BPD, I want to thank you for creating this blog and resource. Finally someone understands.

  3. Same, as the mother of a Type 1 and BPD 18 year old daughter, diagnosed after massive depression last year she dropped out of school, never tests her BG, sleeps all day, wakes up to lunch around 5 then binges all evening and night, only speaks to us if she wants food or clothes or money, is supposed to be on medication but only takes it erratically and won’t see a therapist except the psychiatrist for the medication. It is a living hell for her and for us but thanks so much for your blog and giving some insight and tiny bit of hope.

  4. Did you know BPD was invented by a woman who had been hospitalized for a year during high school and who was constantly suicidal including after she created the treatment? According to her very public life story a few years ago it was only after she had a religious experience that she got better.

    She is also super clear that the main reason the treatment works is the skills training but also mostly because it gives the therapists the support they need to work with “demanding difficult” clients. Thankfully most people with BPD eventually out-grow it and DBT actually can help as well

  5. I’m both a type 1 and a borderline.
    60 years old now…excellent A1C of 6.0
    no known complications…never been a difficult patient in therapy or endos office.

    I’ve been through DBT…but just getting older is mellowing me out. Stay strong! artificial pancreas is on its way!!!!!

    1. Hi Anonymous,

      Thank you for your comment. That’s a superb A1C. I imagine you’re an old pro at this point. It does get easier with age.

      Stay strong!

  6. Hi! I am a 50 year old female . Been type 1 for 40 years & was diagnosed Borderline 35 years ago. Have been involved in intense therapy for years along with DBT. Honestly & sadly enough I am sick of it all.Type one 24/7 has put a strain big time on me! Being Borderline does not help.Amazingly so I am a healthy diabetic! I take insulin daily. I only test occasionally right now. I just don’t care. It’s all just seems like way too much work! Am I slowly trying to kill myself? I don’t really care. When I go I go and that is okay with me. My family will be fine. I have given them my best & they have a firm foundation. They will survive. If they truly new the depression/anxiety I have & do face they would understand where I am coming from. Can anyone relate?

    1. Hi Michelle, thanks for your comment and I’ve been there myself.

      Honestly, if I had to choose, I’d rather have T1D than BPD. The ups and downs of BPD make managing T1D nearly impossible. In other words, if I was generally happy, not depressed and anxious, the daily grind of T1D wouldn’t be so bad. Lump in BPD and I truly just want to give up.

      I get really angry because it seems like everyone else has it so easy: get up when you want, eat what you want, life is happy, loving, fun and without worry. BPD and T1D waste my time and energy. I’d much rather have that time back to have fun, feel happy and most of all, FEEL FREE.

      I would start with getting therapy for your BPD first. Try group therapy when you are ready. You might find dealing with T1D will be easier when you feel better inside. Then, make every effort possible to get a CGM (Continuous Glucose Monitor) and insulin pump. They are very helpful for treating diabetes and have proven effective in improving patient outcomes long term.

      Tackling both buys you more time and energy for the good things in life.

  7. I realise this is an old post and probably won’t get a reply but just searching for someone who knows the difficulty of having T1D and BPD. I am at the end of my tether and horrifically anxious about the damage I’m doing with poor control. Reading this post made me feel much less alone. Thanks.

    1. Hi Katie, I’m glad you found it helpful.

      I sincerely hope you’re in some form of therapy for BPD. Also, that you’re seeing an endocrinologist to monitor your diabetes. As I said, start with managing the diabetes first. It’s much easier than BPD once you get into a predictable routine.

      However I also understand that the ups and downs of BPD erode any motivation to take care of one’s diabetes. This is where DBT (Dialectical Behavioral Therapy) and other modes can assist you. One of the first acronyms you’ll learn is “PLEASE”. PL = Treat physical illness, E = balance eating, A = avoid substances, S = balance sleep and E = get exercise.

      PL is where you’ll start first.

      Also, consider trimming all the excess stress from your life until both the diabetes and BPD are more manageable. That might mean stepping away from any chores, favors or care taking you do for others. It might also mean your significant other or spouse takes over some things you used to do; if only for a while. It’s ok to put yourself first.

      Good luck, I hope you feel better. I can’t emphasize enough how good normal blood sugars feel. It’s almost like you’re a different person compared to when your numbers are too high or too low.

  8. I’ve been a type 1 for 28 years and diagnosed BPD about 10 years after I became diabetic. I find managing the two nearly impossible. It’s good to hear there are others out there. I have strong suicidal tendencies and thoughts and have been hospitalised following overdoses of insulin a number of times. They remove my pump and then I fight them by manipulating my eating as I don’t like the diabetic control taken from me even though it was my own decisions that resulted in that. Occassionally I will decide to control the diabetes and do really well for a month or two (the problem is I aim for perfection and then cannot maintain it so just give up). I have had a two year period of really good control at one point getting to an hba1c of 6.4 and that was also the time when I was doing best emotionally. Staying in the present and just dealing with today or sometimes the next few hours works best for me. I have had stable relationships with care providers and have only switched when I have moved. I live by myself which means there is no one to take over or help and which is quite dangerous when I am low frequently. My therapists are trying to get me to lower my expectations regarding other areas of my life to try to decrease stress however I swing wildly from feeling I can cope to feeling quite hopeless. Anyway, its good to hear from others with both conditions.

  9. I don’t know if I’ll get a reply back but I truly do hope so. I’m, well I was in a relationship till a couple days ago. I had to break it off with her.

    She’s an amazing lady. I know she means well and has a heart. But I feel with her ways of thinking and being it gets in the way of herself and us as a relationship.

    She gets agitated fast, always thinks something is wrong, always over thinking things and believing what she’s thinking and then constant argues over it. She’ll reply with quick smart attitude like response when I’m trying to be calm and nice about things. She can’t take jokes that well, she’s always serious and so forth. Always thinking I’m trying to cheat on her or think I’m doing something and she starts believing what she’s thinking.

    It’s very stressful. So I had to call if off the other night. I was mad and just had enough of it. It’s been like this for 4 years. But she doesn’t go around telling her family and friends how she is with me or how she is as a person or admits to them that the cause of our disagreements or at times heated arguments is because of her. She tends to lie to cover for herself.

    I swear, I think if she were to get on medications and or see a therapist to tak things out. Maybe just her or for the both of us to talk thinks out she’d be the WORLDS GREATEST STRONGEST LADY ON THIS EARTH.

    She has Type 1 and is always putting herself down for it. I try to help her and tell her that’s not a sign of weakness it’s a sign of strength to be Type 1 and 43(we met when she was 39) good healthy body and somewhat active and very attractive lady. She should look at it the other way but at times she doesn’t and beats herself up for it.

    But with her mood swings and attitude like I mentioned above. I know some can be from the Type 1 but I’m doing more research and I’m seeing that she may have Type 1 and BPD. It truly sucks because I didn’t want to break it off with her. I just couldn’t take it anymore 2-3 times a week mad and arguing about stuff that’s not even worth it or not even there just in her head. I couldn’t take it anymore. My 7 year old said he’s afraid of her and she’s always arguing. So I just had to do what’s best for my son and I. But I truly do miss her already and truly wish she’d get help for what she needs. She has a lot of the BPD symptoms. So I’m like 100% sure she’s Type 1 & BPD.

    I’d love to go back to her and just work things out BUT she’s not the type to be able to confront about medical issues. I’ve told her she needs to see a doctor for bipolar or mood swings and that caused a huge argument.

    Now she’s playing victim to everyone around her that I get mad and so forth. But she doesn’t explain to people how she is 2-3 times a week hours at a time every week. After a while anyone will flip out and just get mad and walk out.

    I mean I work from home(day trade stocks) I cook, I clean, I do laundry, I help around the house, she doesn’t have to work. I give her my E*TRADE debit card to go shopping whenever she wants. I spoil her to the best I can. I try my hardest to give her the best life and the rest of her lasting life but she’s always finding a way to argue and fight and be aggressive. She has swung at me once.

    As for the Type 1, I just found out 5 months ago she had Type 1. She’s kept it from me all this time. And I would tell her she needs to go get her blood test and so forth and get check ups but she doesn’t do any of that.. She replies I’ve been dealing with this way before you, I’m older then you(I’m 10 years younger 32 she’s 43), please don’t tell me how to manage my diabetes. I know what the fuck I’m doing. I don’t need no test to tell me something I know. I’ve been doing this since I was 17 years old. So I couldn’t talk to her about anything with Type 1 or suggest a doctor or anything. Let alone I can’t even mention what I found these past couple days with BPD. She’d flip out and make it seem like I’m the crazy one.

    Soooo after all this. What I’m reaching out for is. I don’t know maybe some help or how to guide me through this to get her the right help. And or how to present it to her. I know I broke it off and we’re not together anymore for good. But I truly wish to see her happy and feeling good. I was reading the comments of people just wanting to give up and or commit suicide and I truly did feel sad and hurt reading that. I truly hope she doesn’t feel that way or try’s to do it or think that life is just “bla” type. I don’t want her to think she’s alone or to even think that dark. Hope those with this reading this don’t think that either. Stay strong to those reading this. People are out there that loves you and wants you, you just gotta make the effort to see that we do exist and we do love you.

    Thanks and sorry for the long long message. Holy crap I sure did write a lot here.

    1. Hi Santos, thanks for your comment and sorry for the long delay in response. I stopped monitoring this blog during an extremely difficult year (2020) for everyone, myself included.

      You’re correct, there seems to be more going on than just Type 1 Diabetes.

      Type 1 Diabetes is a physical illness. The pancreas produces little to no insulin, resulting from an autoimmune response. There are other possible causes and explanations. Any mental health symptoms would arise from blood sugar swings, stress and unpredictability of living with Type 1 Diabetes. It can be quite upsetting at times, especially when simple things like eating, sleeping and relaxing are disrupted by diabetes.

      This can exacerbate people’s need to control their surroundings and others. A controlling person before diabetes will often become more controlling afterwards. This can make blood sugar management easier, but in extremes it causes others a lot of grief. The need to control often comes from intense anxiety (conscious or unconscious) and some personality disorders like BPD, NPD or OCPD.

      I can’t say whether she is BPD or not. It’s obvious she’s managed her diabetes well enough if she’s made it to 43 after a diagnosis at 17.

      I would suggest YOU sit down with a therapist and talk about your concerns, feelings and the state of your relationship with her. It sounds like you’re really at your wits end. There seems to be a lot of conflict.

      And she seems to push you away when you rightly acknowledge what she has done well, which is another troubling dynamic. She may not have ever felt true, nurturing love before. Having someone tell her she’s amazing for surviving what she’s been through feels foreign.

      Definitely talk to someone yourself first. Seek couples therapy afterwards. Good luck!

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