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The Diary of a Diabetes Psychologist

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Category: Thinking Styles in Diabetes

Many people with diabetes are anxious or worry a lot about hypoglycemia. In one study, 25% of people with diabetes reported anxiety about hypoglycaemia is a serious problem for them.

Hypoglycemia, or a ‘hypo’ as it is commonly known, is a frequent occurrence among many people with diabetes, both for those with type 1 and type 2.

So why do people worry about hypoglycemia, particularly when, in most cases, they can be treated with relative speed and ease by eating a sugary snack? Well, it’s often because the effects of a hypo can be frightening, embarrassing, uncomfortable, unpleasant and, in their worst cases, fatal.

Getting sweaty, having slurred speech, shaking uncontrollably, or being confused may not seem too bad in the whole scheme of things, but having them occur in a job interview or important work meeting, whilst driving home at night, or on a romantic date may not be so pleasant!

Having just one episode of hypoglycemia that was unpleasant can lead to increased anxiety of it happening again.

This can lead to other behaviours, which may lead to further difficulties with managing diabetes.

  • Running blood sugars high to avoid hypoglycemia.
  • Eating more than needed to keep blood glucose levels elevated.
  • Restricting activities such as driving, exercising, travelling on public transport etc.

In addition to a particularly bad experience of hypoglycemia, three further factors may contribute to excessive worry.

  • You may be experiencing a weakened ability to feel the warning signs of hypoglycemia.
  • The warning signs of hypoglycemia, such as sweating and shaking, occur because of the associated release of the body’s stress related hormones, epinephrine. However, for some people with diabetes, their warning signs are less obvious, and so by the time they do notice the problem, their blood glucose level has dropped so low that taking reparative action becomes even harder. This is known as reduced hypo awareness.
  • You may not be able to distinguish the feelings of hypoglycemia from the feelings of fear.

Many symptoms of hypoglycemia, such as sweatiness or an increased heart rate are the same as signs you would experience if you were fearful. This may lead to a spiral of confusion.

  • You may notice your heart beating a little faster.
  • You may think, “This could be hypoglycemia”.
  • This makes you nervous, so your heart therefore beats even faster.
  • Thinking, “Oh no, this is a symptom of hypoglycemia”.
  • You feel even more nervous and reach for a snack to raise your blood sugar levels.

When actually what you really were experiencing was nervousness! Next issue, I’ll teach you my top five strategies for helping you overcome your difficulties with hypoglycemia. In the meantime, if you are in any doubt, always test your blood glucose levels. To share your experiences and gain support, do visit us on Facebook, we’d love to hear from you!

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 registered 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.

Many people embark on weight loss efforts full of enthusiasm and hope for their new regime, and then lose heart when life gets in the way. My advice is different. Embrace the odd slip or two. Actively expect it. Any change in life is usually a process of two steps forward and one step back. In addictions recovery, these backward steps are known as ‘lapses’ — the times when the old, familiar ways of being are the default action we opt for. Sometimes this can be very unconscious (for example your colleague offers you a biscuit with your tea and you take one simply because that is what you have always done).

It is important to be able to distinguish between a lapse, a relapse, and a collapse.

A lapse is one singular event in which you deviate from your desired goal. An example of a lapse is having a bad day at work or an argument with your partner. You reach for your usual comfort food — crisps or chocolate perhaps, and afterwards, or even while you are still eating, you think, “Why am I doing this?” That is an example of a lapse. Yes, you have made an unhealthy choice; however, you can limit it to just one bad decision, get back on track, and continue.

A relapse is a whole sequence of lapses strung together. Many people have a very polarised view of success and failure. They are either totally on the plan or totally off it. One lapse becomes, “I have messed up once so I might as well give up for today.”

Then one written off day can easily become two, until before you know it you are back to where you started. This is a ‘collapse’.

The important part is to keep perspective and pay attention to your behaviours over the course of the week, not just focussing on a single day in isolation. Remember that the weight has taken a long time to become part of you, so it is likely to take time to be free of it.

If you are interested in learning more about how to gain greater control over your eating, mindset, and the way it affects your life and health, then get your copy of my Positive Diabetes Home Study System. This easy to use guide gives you everything you need to immediately get more control over your diabetes, with a focus on helping you to implement new habits, build momentum and create lasting change to produce the results you want. Life is too short to keep struggling on your own. I know, I’ve been there — I’d love to help you too.

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 registered 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.

Sharing food with others has been a way of celebrating, bonding, and commiserating for centuries. However, one thing that doesn’t get talked about much is how difficult it can be to say no to people when it comes to food choices. One of the reasons you may be uncomfortable saying no is because you do not want to be seen as rude or ‘different’ because you have diabetes. Also, food can be a way of conveying love, care, and affection, and all these layers of meaning can make it even harder to say no. Here are my top three tips for asserting yourself.

  1. Acknowledge you are not being rude: Do this by simply saying, “thank you”. For example if your friend offers you a slice of cake, you might like to say, “Thank you for your offer but I don’t fancy any cake right now.” By communicating both parts of the message (you are grateful she is thinking of you, and saying you don’t want it) you can feel more comfortable and confident in what you really mean.
  2. Use ‘I’ statements: Can you sense the subtle difference between these two responses? “Thanks I don’t really want any cake right now.” and “Thanks but cake really isn’t good for me.” Using “I” in your statements subtly conveys you are taking responsibility for your thoughts and feelings. This allows less space for unhelpful responses such as, “Go on, one bite of cake won’t hurt you!”
  3. Recommend a more suitable action: Shape the behaviour of the person to whom you are responding. If your host is offering you some food you don’t want, you could respond with, “Oh thank you it looks lovely. I can’t manage any just now but I would like another piece of fruit/top up of my drink.” This has two benefits. You are enabling the host to be the host (hosts want to give you something!) and you are taking control of the interaction, not allowing their agenda to get you off track of yours. Alternatively, you can distract the person with, “Oh, not for me thank you; but do tell me about your beautiful/interesting [insert something you have noticed — flowers, painting, dress etc.].

If you are interested in learning more about how to gain greater control over your diabetes and the way it affects your life, then get your copy of my Positive Diabetes Home Study System. This easy to use guide gives you everything you need to immediately get more control over your diabetes, with a focus on helping you to implement new habits, build momentum, and create lasting change to produce the results you want. Life is too short to keep struggling on your own. I know, I’ve been there — I’d love to help you too.

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 registered 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.

Woman Eating DonutDid you know your environment plays a hugely important role when you are trying to change your eating habits? In our evolutionary past we had to seek out food, so there was a natural delay between thinking about food and being able to consume it, now it is everywhere we turn! So much of our everyday lives are done habitually, on autopilot. Think of some of your daily routines — how you shower, get to work, what you eat for breakfast — nine times out of ten you do these in pretty much the same way every day. That is because our brains, as wonderful as they are, have a limited processing capacity and they are designed to create shortcuts to make the demands less arduous. Imagine if you had to concentrate fully on exactly what to do and in which order each time you had a shower!

Spend some time thinking about the ways your environment sabotages your eating goals. Perhaps you keep sweets, nuts, or chocolates on the coffee table and you find yourself snacking on them while you are watching television in the evenings. Maybe your route home from work is past a fast food restaurant that you can ‘drive-in’ to get something to tide you over until dinnertime. It could be you have many unhelpful foods in your kitchen at home. Therefore, when you are hungry, it is too easy, convenient, and tempting to reach for these rather than take a moment to think about an option that might be better for you. Think now about the different environments you find yourself in regularly that sabotage you, and make a note of them here:

Environments that have a tendency to sabotage me:

Environmental Triggers Rate 0 – 10 
   
   
   
   
   

Now you have a clearer sense of the environments that sabotage you, you can start to address them. Rate each on a scale of 0-10, where 0 is it rarely affects you and 10 is it affects you most frequently and most badly. Pick the one that affects you the most to start with, as this will have the greatest impact the quickest. Think about how you can change your environment to support you. Here are some ideas to help you:

  • Store foods you find tempting out of reach and out of eye sight (e.g., in the top cupboard of your kitchen rather than on the counter top).
  • Avoid buying the foods you find tempting in the first place, if they are not at home, it takes a lot of effort to get them.
  • You may want to find a different route home if the food places you pass are too appealing.
  • If you know a vulnerable time is the evening, you may want to rearrange your plans so you’re occupied. You could go for a walk or phone a friend.
  • In restaurants, you could ask the waitress not to bring you the bread bowl; or you could ask for an alternative option to snack on that is lower in calories.
  • Perhaps you snack while preparing your meals, in which case pre-prepared vegetables, etc., may be an effective way of breaking this habit (you can always return to preparing your own when you have shifted this habit).
  • Engage in doing something active with your hands, which means you cannot reach for the food. This could be doing your nails, mending or fixing something, knitting, playing a game on your phone, doing a crossword puzzle etc.

Remember, there are no rights or wrongs with this process. You are simply making small shifts to the habits you have formed that are no longer truly serving you. Treat it like an experiment. All ideas are good ideas at this stage and you can stop the ones you do not find helpful and keep the ones you do. Even if you do not make any practical changes right now, just the simple act of gaining insight into how your environment is hindering you is hugely valuable. It enables you to view your situation from a more realistic point of view — showing you the times when you are not at fault, rather your environment is. This helps you to separate some of your tendency for self-criticism and self-blame. At least if you do continue to eat the snacks on the coffee table, you are doing so with your eyes wide open. Knowledge is empowering and just the increased awareness can translate into different actions over time. List below your own ideas of how your environment triggers you and what changes you can make to help you.

Changes I can make to my environment:

Environmental Triggers Changes I Can Make 
   
   
   
   
   
   

If you are interested in learning more about how to use Cognitive Behavioural Therapy to overcome your struggle with diabetes, then get your copy of my Positive Diabetes Home Study System. Life is too short to keep struggling on your own. I know, I’ve been there. I’d love to help you too.

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 registered 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.

Can you recall the moment you were diagnosed with diabetes? Perhaps it has been a very recent experience and is still fresh in your mind; or maybe it was a number of years or even many decades ago. Dealing with diagnosis is a process not an event, so you may be surprised to learn that it can be as relevant as those who have had diabetes for many years as it is for the newly diagnosed.

Regardless of the time that has elapsed since diagnosis, try to put yourself back to that moment now. Where were you? What was said to you? How was the news conveyed? What was the first thought that entered your head? Who was the first person you told? What were your feelings and reactions in the days and weeks that followed learning the news?

Following diagnosis, it takes time to emotionally accept this new way of life. Accepting a chronic illness has similarities to accepting the death of a close friend or family member — it takes a lot of time and you may find yourself forgetting momentarily, and then experiencing a sinking feeling when the reality hits you. The ‘non-diabetic’ part of you feels like it is gone. You will need time to mourn your loss.

Below is an outline of the stages of grief, first described by the therapist, Elizabeth Kubler-Ross. Do you recognise any of the descriptions in your feelings towards diabetes?

Stage 1: Denial: “This can’t be happening.”

Stage 2: Anger: “Why me?” “It’s not fair.” “How can this happen to me?” “Who is to blame?”

Stage 3: Bargaining: “I’d do anything to turn back time…” “If only I could have done things differently.” “Just let me be okay to see…”

Stage 4: Depression: “I’m so sad.” “What’s the point?” “I miss my old life.”

Stage 5: Acceptance: “It’s going to be okay.” “I can take control and manage this.”

How to Come to Terms with Diabetes — Learning to LIKE Yourself

LIKE is an acronym for the four steps to better managing diagnosis.

Learn
Educate yourself all you can about diabetes. Becoming familiar with the condition, its new vocabulary and learning about all of the various aspects of managing the condition allows you to integrate it as part of your identity and help you become an ‘expert by experience’. Just as you no doubt needed some element of training or teaching to be able to perform your occupation or learn a skill such as using a computer or being able to drive a car, diabetes is just the same. You now call yourself a ‘driver’, ‘computer literate’, or ‘[insert your job title]’, diabetes is no different. You are likely to have been given some information about diabetes from your healthcare team and this is an ideal place to start in learning the basics of the condition.

However, don’t let your learning stop there. Borrow some books from your local library (join one if you need to!), contact diabetes charities to find out about local diabetes support groups and other useful resources these organisations offer. Obtain all the information you can from your healthcare team and ask them for recommendations of support or resources that other patients have found helpful. If you have Internet access, you could join a diabetes Internet forum run by one of the charities and learn from other ‘experts by experience’ who have been on a similar journey to yours and will be able to offer advice, hope and support, so crucial in these early stages of adapting to the condition. Start wherever feels manageable for you; you could set aside five minutes each day or thirty minutes at the weekend to do this.

Learning all you can about diabetes is not just for the newly diagnosed. When you have had diabetes for many years you may feel like you ‘know it all’ — and in some ways you do — you are an expert of your own body and how diabetes affects you specifically. However diabetes knowledge is advancing at an ever-increasing rate, so do not neglect to keep updated with all the new developments.

Inquire
Ask yourself what you can do to improve life with diabetes. At the top of a blank sheet of paper, write, ‘My life with diabetes could be improved by…” Your immediate response may be, ‘Nothing!’ or ‘If I didn’t have it!’ That is okay, that is the resentment towards diabetes speaking, so there is no judgement in it being your initial response. Nevertheless, I want to encourage you to stick with this question for five minutes (set a timer on your watch or phone if that’s helpful) and see what answers surface. Some things other people with diabetes have found helpful are:

  • Is there an educational course you can attend at your local NHS diabetes service? If you have type 1, then there are courses available to support you with your diabetes care. One of these is DAFNE (Dose Adjustment for Normal Eating) may be useful in teaching you how to alter your insulin requirements in line with your food intake. If you have type 2, a DESMOND course (Diabetes Education and Self-Management for On-going and Newly Diagnosed) can help you to gain greater insight into the management of your health. Chat to a member of your diabetes healthcare team about how to be referred to one of these free courses.
  • Would a dedicated kit bag for your diabetes equipment help you to feel more in control?
  • Or an attractive case with a design that reflects your personality?
  • A particular blood glucose meter that stores and memorises your results?
  • An attractive notebook to record your blood glucose results?
  • A session with a dietician to explore different ways of managing your eating regime?
  • A system for remembering to take your medication or test your blood glucose (e.g., putting a note on your bathroom mirror to remind you, or leaving your medication somewhere you will easily notice them, such as by the phone or next to your keys).
  • Anything and everything that makes life with diabetes a bit easier is worth considering.
  • Get in touch with other people with diabetes, as they are the ones who will really know what you are going through. Although healthcare professionals know their stuff and are well-intentioned, they sometimes can’t quite ‘get it’ (just as it is impossible to truly know what it is like to have lost a child, or be widowed, until you experience this yourself). Connect with others through a local support group, or if you use the Internet, on an online support group.

Kindness
Go easy on yourself and show yourself some kindness. It is common to experience a range of painful and powerful emotions towards your diabetes — as well as the anger and sadness that are inherent in the grief cycle; guilt, rage, regret, and numbness are all unnerving with which to contend. These emotions can feel overwhelming. Try to keep reminding yourself that you have encountered an experience of loss and in the same way as any loss; you cannot expect to feel your usual self straight away. Give yourself permission to feel the whole range of emotions, however know that these painful feelings can and will pass. Formulate a ‘Kindness Statement’, keep it somewhere handy (in your diary, bag, or by your bed) and read it at least three times a day. Ideas might be:

  • “I have a right to feel sad/angry/low/frustrated about diabetes but these feelings will pass.”
  • “I am going through a difficult life event, which will get easier to deal with over time.”
  • “I can choose to do something nice for myself.”
  • “Diabetes is demanding right now, but I have overcome other difficult challenges in life and diabetes will be the same.”

Express Emotion
How can you express and let go of some of the emotion you are experiencing? Can you have a good cry? Talk to a trusted friend? Punch a pillow, do some exercise, write in a journal, or see a therapist? If you are interested in learning more about how to use Cognitive Behavioural Therapy to overcome your struggle with diabetes, then get your copy of my Positive Diabetes Home Study System. Life is too short to keep struggling on your own. I know, I’ve been there – I’d love to help you too.

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 registered 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.