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Dr. Jen's Diabetes Diary

The Diary of a Diabetes Psychologist

Emotions - StressLife with diabetes can be hard work. Diabetes has been likened to a job — not just any job, but one in which you have to work 24 hours a day, 7 days a week, 365 days a year, with no holiday, no praise, and no pay. I don’t know about you, but I wouldn’t stay working in a role like that for very long! However, individuals with diabetes don’t have the option of walking out or giving up; they have to keep ‘working’, day in and day out, for the rest of their lives.

None of us can do anything in life that requires effort over a sustained period without getting support and respite — and diabetes is exactly the same. There are wide ranges of emotional factors that can impact the well-being of someone with diabetes — some of which affect people with type 1 or type 2 only, but many of which affect individuals with either type.

Dealing with Diagnosis

The diagnosis of diabetes is a life event that has been likened to the experience of grief. In the same way as it is natural to grieve for a lost loved one, being given a diagnosis of diabetes can trigger a grieving for one’s lost health. It is common to live life as if we are invincible, rarely considering our health or mortality. This dramatically changes when you are diagnosed with diabetes: you are suddenly acutely aware your life is not without limits. You now have to rely on regular medication, frequent visits to a medical setting, and a team of doctors and nurses to keep yourself well. By becoming aware of the different stages of grief and recognising the stage of the process that you may be in, you can manage the potential challenges better.

Depression and Low Mood

Psychological research has demonstrated that low mood and depression are very prevalent among people with diabetes; in fact, studies have demonstrated that depression is approximately twice as common in people with diabetes as in people who are in good physical health. Life has its challenges for all of us, with or without diabetes, and experiencing the whole range of high and low moods is part of the human condition. However, coping with a demanding condition like diabetes is an extra stressor to contend with, and it is very common to struggle with low mood at times.

Guilt, Shame and Self-Blame

Feelings of guilt, shame, and self-blame can be experienced by people diagnosed with either type 1 or type 2 diabetes. For individuals with type 1 or 2 diabetes there can be the shame of being ‘different’ by virtue of having this health problem to contend with. For those with type 1, injecting and blood testing in public can be experienced as embarrassing and something they would rather hide than engage in openly. People with type 2 diabetes may experience these emotions because they may have been aware they needed to make changes to their health and lifestyle, and they feel regret they didn’t act on this awareness in time to prevent diagnosis.

Fear and Anxiety

Fear and anxiety affect many people with diabetes. They can be divided into two categories: fear about factors in the here and now, and fear of the future. Fear in the here and now may be anxiety over hypoglycaemia, fear of needles, or simply the daily anxiety about the changes that diabetes causes in life. In terms of fear of the future, many people worry about the long-term complications and how they may have an impact in the years to come.

Using Food to Cope with Emotions

For many people, both with and without diabetes, food can offer more than just fuel for the body. From birth, food is intimately linked to feeling safe and secure in the world, and in adulthood food can become a shortcut to dealing with difficult emotions. Many people go their whole lifetime using food in this way to a greater or lesser extent, and often without causing much harm. However, individuals with diabetes need to be more mindful of the role food plays in their lives, and that using food to cope with their emotions can cause problems.

Communicating with Health Professionals

Developing a good working relationship with your healthcare team can go a long way towards making you feeling supported in your journey of managing diabetes. However, it’s common for people to avoid going to their health appointments completely, or to feel a range of difficult emotions when they do go. Exploring the various ways you may be relating (or not) to your healthcare team can help you see these relationships in a more helpful light.

Family Relationships

Diabetes doesn’t only affect the person with the condition. It has the potential to affect the whole family. Just as the person with diabetes can struggle emotionally, those around them can too. Family members can express their concern and worry in a multitude of different ways. Some loved ones may have a tendency to be over-involved with the management of diabetes, which can feel suffocating to the person with the condition. The opposite can also happen, when family members withdraw and seemingly ignore what is going on, leaving the person with diabetes feeling lonely and isolated.

Sexual Difficulties

Difficulties with sexual response are a very common experience for people with diabetes and can affect men and women in differing ways. For individuals with diabetes this can be a further setback: not only do they need to deal with all the other challenges of managing diabetes, now the part of their identity that could be expressed through their sexual relationship is hindered. It can feel like there isn’t any part of life that isn’t affected by diabetes.

How Does Psychology Help?

So we can see that there are a variety of challenges that can affect the emotional wellbeing of the person with diabetes. Next time I’ll be explaining exactly how therapy can help. Look forward to connecting with you then!

You may use this article on your website, or for your own e-zine; however, there’s one thing you MUST include: Dr. Jen Nash is a Clinical Psychologist chartered with the British Psychological Society. Dr. Jen helps her clients find solutions with simple and highly-effective psychological strategies to gain freedom from the frustration and stress of living with diabetes. To sign up for her free Diabetes Diary, visit www.PositiveDiabetes.com.

Expert ButtonI’m not sure about you, but I don’t often feel like an expert of my diabetes. Certainly not when I think I’ve done everything ‘right’ and I still have a sky high blood glucose reading, or when I wake up with a hypo for the third night in a row, or when I’ve (yet again) missed an exercise session.

But what does this word ‘expert’ mean anyway? Typing ‘define expert’ into Google offers this definition: “A person who has a comprehensive and authoritative knowledge or skill in a particular area.” Now I have to admit that’s a little different. I know you do need to have a comprehensive knowledge of the ways you can handle your diabetes to get at least okay results. Just because it doesn’t go to plan every time, you cannot deny you have detailed knowledge of how certain things affect your body.

Of course, when something doesn’t go to plan, the human response is to get angry or frustrated, or think, “What’s the point?” Experts also feel this way. Like the scientist who is frustrated when the experiment doesn’t produce the expected results, but still returns to the lab the next day. Building up a tolerance to, and curiosity for, the variables that are less predictable, is a crucial part of being an expert.

The expert gets inquisitive and treats the curiosity like a scientific experiment. Okay, so I’ve woken up with a hypo (again) but what was different? Opening up that space allows something new to dawn.

Some of the tricks I’ve learnt over the years are:

  1. Keep a diary of hypos: This doesn’t have to be a daily diary of everything I do and eat, but just a short summary/a few bullet points of what happened when it went wrong, or as soon as possible afterwards.
  2. Reward myself when I’ve managed diabetes well for a certain period of time: Rewards don’t have to cost anything. They can be time spent in an enjoyable pastime, a relaxing bath, relishing a favourite hot drink, listening to favourite music — anything that is enjoyable for its own sake. Alternatively, you could design a ‘token system’ in return for rewards. Award yourself one token for each day you manage your diabetes well and after 5, 10, or 15 tokens (you decide), ‘exchange’ these tokens for a CD, a new item of clothing, some fresh flowers… again, it’s your choice!
  3. Share what I have learned with someone else: Not necessarily my diabetes doctor or nurse either, sometimes a partner or family member can have a fresh way of looking at the situation, which I hadn’t noticed (novices teach experts too!).

What are your tricks and tips for managing your diabetes? What has worked for you, even if that doesn’t mean it will work for others? I want to encourage you that you are an expert, an expert of you. That does not mean you get it right every time. Notice the definition above does not include the word perfect! In fact, any expert I know had to make many mistakes to acquire their expertise — a lot of getting it wrong, so they could get it a little more right. They became the expert because their peers decided to stop — stop learning, developing, trying, dedicating themselves to their skills. So don’t stop and own your expertise. And do share…

You may use this article on your website, or for your own e-zine; however, there’s one thing you MUST include: Dr. Jen Nash is a Clinical Psychologist chartered with the British Psychological Society. Dr. Jen helps her clients find solutions with simple and highly-effective psychological strategies to gain freedom from the frustration and stress of living with diabetes. To sign up for her free Diabetes Diary, visit www.PositiveDiabetes.com.

The theme of today’s article may not be relevant for you, but even if it’s not, I know it will be for someone you love. So I urge you to keep reading.

All of us know someone who is overweight and unhappy, with diabetes or without. Many of us will have heard this person (or ourselves) saying, “I haven’t got any motivation.” They are certain that if only they could summon up enough enthusiasm; they could make the changes they would like to their weight and health. However, in my experience the word ‘motivation’ is often a smoke screen for something else. Motivation actually comes easily when we really want something to change. In psychology, we call this “a secondary gain” — on the surface, the behaviour of overeating is unwanted, but it persists because it is serving a function. Those of you who have been part of my community for a while now will already know what this function is. Overeating works because it soothes some form of emotional upset.

So today, I have a gift for you. A short e-book that explains, simply and clearly, why you struggle, and more importantly why it’s okay to struggle. No telling off, guilt, or blame; just acceptance, hope, and action steps for change.

You can get your free e-book here: WorldWithoutObesity.com. (It’s as relevant for you even if your overeating means you can maintain a healthy weight).

I have a vision that by 2020, 20 million people will have gained a newfound control of their struggles with emotional eating and that worldwide we have a 20/20 vision of understanding the emotional context of our obesity crisis. This short guide is a part of making that vision a reality. My invitation to you is that you read it and if you find it useful, you pass it on to someone else you might know who needs it. Or, if emotional eating is not an area you struggle with, I invite you to pass it on to someone else you know who might benefit.

Get your free e-book here: WorldWithoutObesity.com

At the end of the guide, you’ll also learn about my commitment to getting even more of this important information to as many people as possible, including how to access the first part of the pilot version of my online programme, ‘Thrive’ — a video and workbook self-help programme for just £1 (approximately $1.50).

Here’s to changing the world as we know it: WorldWithoutObesity.com

 

You may use this article on your website, or for your own e-zine; however, there’s one thing you MUST include: Dr. Jen Nash is a Clinical Psychologist chartered with the British Psychological Society. Dr. Jen helps her clients find solutions with simple and highly-effective psychological strategies to gain freedom from the frustration and stress of living with diabetes. To sign up for her free Diabetes Diary, visit www.PositiveDiabetes.com.

  • “She says she wants to change but she always comes back and nothing is different.”
  • “Am I doing something wrong? No one seems to take any notice of my advice.”
  • “I always run out of time.”
  • “I’m stuck.”
  • “Some patients just make me feel like I’m rubbish at my job.”
  • “Why won’t he do what he needs to do to care for his health?.”

Have you ever had thoughts like these? You are not alone. Many clinicians struggle to feel they are good enough. The section that follows aims to help you think about your patients’ actions from a different perspective and introduces some strategies to help you.

Your Patient is Doing What is Right for Him or Her

You might not ‘get’ why your patient is not caring well for his or her health. People act in accordance with their feelings, beliefs, cultural norms and values, and your belief systems may be very different to your patient’s. Exploring the background to your patient’s beliefs can give both of you clarity. Behaviour that is difficult for you to understand usually stems from a person’s belief about its value, or is based in habits that might be difficult to alter. By asking questions in an open, enquiring way, you will get an insight into the beliefs that are driving the behaviours and actions.

How to Improve Your Relationship with Your Patient

Set an Agenda

Time in a consultation is short and you will both have an agenda to fulfil. It is good practice to set the frame of the space. For example:

  • “We have 15 minutes together today [point towards or indicate the clock]. I will be keeping an eye on the time for us. Let’s prioritize how we are going to spend this time, so we use it wisely. What would you most like to discuss?”
  • Make a note of the patient’s answers. If the patient starts going off at length, you could say, “Can I pause you for a moment? For now, I just want to get the main areas and then we can focus on each in turn. To recap, we’ve got [insert agenda items]. I would like to add one in too, which is [share agenda item]. We may not have time to cover them all today, in which case, I will keep a note and add them to the agenda for next time. So we can prioritize, which is the most important item to cover today?”
  • Keep track of time. When you notice you are in the final five minutes, let the patient know. “We’ve got five minutes left, so let’s make a plan to guide you between now and the next time we meet.”

Help the Patient Become Active

Invite the patient to be active within the session. You could give him or her a sheet of paper and a pen (and a surface to write on). Do be sensitive if the patient is not keen to write, or his or her literacy levels are low.

Empathy

Empathize, empathize, and empathize. Research into the efficacy of various forms of psychological therapy demonstrates the most important factor in any successful therapy intervention is the relationship. How are relationships developed? Through shared experience, being listened to, and accepted. Give permission for your patient to find things difficult.

Focus on the Issue the Patient is Concerned About

Often the patient will be most concerned about something completely unrelated to diabetes: financial worries, a sick relative, or a relationship breakdown. You do not have to be an expert in this or have a solution to it; simply acknowledging it and helping the person identify how to gain his or her own solution, or move forward, can be very helpful.

Be Curious About Successes

Be curious about any movement at all in a positive direction. Ask your patient, “What is going well with your diabetes?” (If patient replies, “nothing,” you can always let him or her know that coming to the appointment is a positive step!) “What was different on these days? What helped and what got in the way?”

Keep the Goals Very Small

Goals need to be small, in fact, the smaller the better. Success builds on success. Yes, your patient may need to lose three stone in weight. But being thoughtful about how to cut out the biscuit with the cup of tea is an important step towards an overall goal (the extra 100 or more calories, a few times a day, over a year, really adds up!). Do encourage and praise your patient, and notice times when he or she may be quick to discount success. Bring it out into the open and congratulate your patient for these with a simple, “Well done.” Be ready to encourage and praise.

Normalize

Let your patient know that he or she is not unusual. Tell your patient you have worked with lots of other people who have struggled with similar issues. Reassure your patient that his or her experience is “normal.”

Problem-Solve in the Context of Everyday Life

Behaviour change can be theory-driven, but it also needs to fit into everyday life. Think flexibly about how a goal might be implemented and the unspoken barriers that are really preventing change from being realized. Ask your patient, “What might get in the way of implementing this change?” Problem-solve with your patient. For example:

  • Does your patient forget to test his or her blood glucose? Could your patient move the kit somewhere it will be seen often, such as by the phone or on the kitchen counter?
  • Will your patient need to ask his or her partner to take on childcare responsibilities to allow some room for exercising a few times a week? When and how will your patient do this?
  • Look out for systemic issues that are obstacles to behaviour change. In the example above, is the real problem your patient does not have the skills to ask his or her partner for support? In that case, a valuable conversation could be had about how to equip the your patient with the communication skills needed to convey to his or her partner the importance of giving support.

As diabetes is woven so intricately into a person’s life, personal goals that are not obviously about a patient’s condition are still valid. They are likely also to have implications for health at some stage.

Be Comfortable with Being Silent

In “real” life, we usually have to feel comfortable with individuals before we can be comfortable with being silent with them. A healthcare appointment is not real life; of course, it is based in reality but it is not subject to the same customs as everyday interactions. Healthcare professionals can feel a pressure to fill the gaps, to provide more information, to squeeze much into a short period. Avoid this. The diabetes consultation may be the one time the patient actually thinks about their diabetes and silence can be an important part of cognitive processing. If you struggle with silence, count backwards in your head or think of the words of a song to help you. If the silence goes on for so long, you think it is because your patient doesn’t know where to start, simply reflecting this can be beneficial: “It’s difficult to know where to start,” or “It’s hard to know what to say.”

Finish with Next Steps

Many patients report struggling to recall the advice provided to them in consultations. Counter this by recapping what you have spoken about and the strategies you have suggested. Invite the patient to write these down to aid his or her memory.

  • What is my personal goal from today?
  • What will I do to achieve this goal?
  • Weekly review: How am I doing towards goal achievement?

Go Easy on Yourself: You are Not Responsible

As a healthcare professional, you will want to do the best for your patients. However, you are not their parent, and it is not your job to “solve” their health problems. They are adults and they are ultimately responsible for their health decisions. You are in a partnership, and for a partnership to work, collaboration is crucial.

I’d love to help you think more about how to foster empowering and collaborative relationships with your patients. Do get in touch to find out more at .

You may use this article on your website, or for your own e-zine; however, there’s one thing you MUST include: Dr. Jen Nash is a Clinical Psychologist chartered with the British Psychological Society. Dr. Jen helps her clients find solutions with simple and highly-effective psychological strategies to gain freedom from the frustration and stress of living with diabetes. To sign up for her free Diabetes Diary, visit www.PositiveDiabetes.com.

Diabetes doesn’t just affect you, it has the potential to affect your whole family. Ironically, it can be harder for those around you to manage this impact than you! Why? As humans we need to feel in control of the various aspects of our lives and while you are busy getting on with all the many and varied tasks to diabetes self-care, those alongside you are left with nothing they can actually ‘do’ — and nothing to act on —therefore, they don’t feel in control of this anxiety.

This anxiety can express itself in a variety of quite contrasting ways. The two most common are, feeling blamed or hassled by your family; or the opposite feeling, isolated and/or unsupported by those close to you.

You may feel they are observing you at every turn — checking what you are eating and how much attention you’re paying to your medication and exercise regimes. Perhaps they criticize you for being overweight, or disapprove of you for not keeping better blood glucose control, which can feel very blaming. Or maybe they seem to feel the need to ‘advise’ you at all times, which can feel more like lecturing than helpful suggestions. Or perhaps they seem to tell everyone you meet that “He/She’s diabetic, they can’t eat that,” drawing everyone’s attention to the ways in which you are ‘different’, when all you want to do is blend in like everyone else! Or maybe the opposite is true and your loved ones completely ignore your diabetes, leaving you feeling alone and isolated without their help and support.

Whatever way diabetes is affecting your close relationships, here are my top four tips from a previous blog posting, Diabetes and Relationships, to help you better manage.

Diabetes and Relationships

  1. Start TalkingFor most people for whom diabetes is causing a strain on a relationship the problem doesn’t get talked about in an open and straightforward way, rather it becomes a source of arguments or resentments. The first step in making a positive change is therefore to have a frank and honest conversation and get things out in the open. If you and your loved one regularly argue about your diabetes, this may mean you need to think about what to say beforehand so it comes across as calmly as possible. Try stating what you are unhappy with in a matter of fact way (e.g., “When you…..describe what they say or do, “it makes me feel…..insert emotion — upset, guilty, embarrassed etc”) Make clear that you don’t want to blame them, rather that you realise they love you and are trying to help, but there might be more useful ways they can do so if you think about it together.
  2. Tell Them How to Help YouBe clear about what you really want and need from your partner. For example, perhaps they are nagging at you to test your blood glucose more, when what would really be helpful would be if they praised and encouraged you with a smile and a hug when they did notice you test. Or perhaps they are berating you for your need to lose weight, when what would be really helpful would be if you could learn together how to prepare healthy meals, perhaps by researching some cookery books or going to a class together.
  3. Examine the Part You Are PlayingAre you taking responsibility for your diabetes self-care? Often those around you may see that you are ‘sticking your head in the sand’ about your diabetes care and may feel at a loss to know what to do to help. Nagging or hassling you may be the only way they know how to wake you up to the problem. Perhaps you always say, “I’m fine” when asked about your diabetes, even if it’s evident that all isn’t fine. Out of love and worry the person close to you wants to help you to change. By being honest with yourself and those around you about what you are struggling with, you can begin to take steps together to improve your diabetes health, avoiding the need for your loved one to resort to unhelpful nagging behaviour.
  4. Seek Professional HelpIf you have implemented the steps above and are still struggling, perhaps because it is difficult for one or both or you to keep calm or to see one another’s point of view when talking about diabetes, seeing a family therapist or counsellor can really help you have useful conversations. Often having a third, emotionally uninvolved person to listen and help you problem solve can really help you move forward together productively.

By following these steps above, both your relationships with those close to you and your relationship with diabetes will improve for the better.

You may use this article on your website, or for your own e-zine; however, there’s one thing you MUST include: Dr. Jen Nash is a Clinical Psychologist chartered with the British Psychological Society. Dr. Jen helps her clients find solutions with simple and highly-effective psychological strategies to gain freedom from the frustration and stress of living with diabetes. To sign up for her free Diabetes Diary, visit www.PositiveDiabetes.com.