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Dr. Jen's Diabetes Diary

The Diary of a Diabetes Psychologist


Category: Thinking Styles in Diabetes

As a Clinical Psychologist who has lived with diabetes for more than 25 years, I’m here to give you permission to find life with diabetes difficult. The demands of living with diabetes have been likened to a job; in which you work 24 hours a day, 7 days a week, 365 days a year with no break, no holiday, no reward, and no praise. I’m not sure about you, but I wouldn’t stay in a job like that for very long! However, the person with diabetes has no choice but to deal with these demands each and every day, perhaps all the while being told, “It’s only diabetes. What’s the big deal?”

However, you and I know the real story. Dealing with diabetes involves daily challenges, frustrations, and stress. Diabetes doesn’t just affect your body, it affects your emotions and mind too. It’s little surprise then that depression is very common among people with diabetes (two to three times more common in fact). But the good news is there are LOTS of ways to overcome it, too many to mention in this e-zine!

One excellent three-step strategy I ask my private clients to do to improve their mood is to increase the activities that give them a sense of pleasure and those that provide a sense of achievement. To feel good about your life, you must experience these two aspects to your activities, but when you are depressed, both of these are at risk. Depression means you are prone to not feeling like you want to engage in the activities that give you pleasure and tasks that involve a certain level of mastery or achievement tend to feel difficult to do.

So how do you find out which activities bring you pleasure and achievement?

Step 1: Fill in an Activity Diary

You will find an example Activity Diary below. Each hour of your waking day has a slot, for you to fill in everything that you do.

Example Activity Diary

Time Friday Saturday Sunday
6-7am Awake in bed Asleep  
7-8 Shower Asleep
8-9 Commute to work Breakfast  
9-10 Emails Watched TV  
10-11 Meeting with boss Went to the park  
11-12 Report writing Shopping  
12-1pm Phone calls Lunch with sister  
1-2 Lunch at desk Lunch with sister  
2-3 Meeting Internet  
3-4 Typed up minutes Housework  
4-5 Emails Housework  
5-6 Commute home Coffee & phone call  
6-7 Phone call — mum TV  
7-8 Dinner Dinner at home  
8-9 TV Drinks with friend  
9-10 TV Cinema  
10-11 Chores Cinema  
11-12 Read book Home, read book  
12-1am Sleep Sleep  

Your Activity Diary

Time Mon Tue Wed Thu Fri Sat Sun

Step 2: Assess Your Levels of Pleasure and Achievement

Give each activity a rating for both pleasure and achievement. Score the activity on a scale of 0-10, where 0 is no pleasure/achievement at all and 10 is the most pleasurable/challenging task you could imagine doing. So each activity should have 2 numbers P=? and A=? Do not spend time wrestling too much between ratings (e.g., “Am I a 6 or 7?”). Just go for the figure that feels most appropriate.

Step 3: Increase Your Levels of Pleasure and Achievement

To do this, ask yourself the following questions:

  1. Did my activities affect my mood? How?
  2. What activities helped me feel better? Why?
  3. What activities helped me feel worse? Why? Are these activities in my best interest to do?
  4. Were there certain times of the day (e.g., mornings) or week (e.g., weekends) when I felt worse?
  5. Can I think of anything I could do to feel better during these times?
  6. Were there certain times of the day or week when I felt better?
  7. Looking at my answers above, what activities can I plan in the coming week to increase the chances that I will feel better this week?

By being aware of and increasing the levels of pleasure and achievement in your life, you will feel more in control of your mood and the frustrations of diabetes will be less all-consuming.

Are you interested in learning more strategies about how to overcome depression, including the one simple change that will dramatically improve your mood right away? I’ve developed a brand new audio course that teaches you the precise ways you can overcome depression and burnout. To find out more, please register your interest at and a member of my team will be in touch! 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

Life with diabetes can be tough. In the busy setting of the Diabetes Clinic,
discussions about managing diabetes can often focus solely on the medical
and physical aspects, however it is common to have a whole range of
emotions towards diabetes. You may experience anger, frustration, guilt,
hopelessness, fear, shame, rage, bitterness, irritability, despair, fright, fear
and worry, among others. These difficult feelings can easily be overlooked.
Along the with the obvious physical impact, diabetes affects our:
  • Emotions – moods and feelings
  • Thinking – about ourselves, others and the future
  • Behaviours – the things we do or don’t do
  • Our relationships with other important people in our lives
Experiencing difficult emotions connected to diabetes is very usual and
depression can be an often overlooked problem. Depression has been
found to be very prevalent among people with diabetes, in fact individuals
with diabetes are twice as likely to experience it as the general population.
Furthermore, despite findings that people with both diabetes and depression
are far more likely to have poorer blood glucose management; the
report, “Diabetes: State of the Nations” (2005), published by Diabetes UK,
highlighted the lack of recognition and psychological support for people with
What is Depression?
Depression is different from feeling ‘a bit down’ or ‘low’. Depression is
diagnosed when:
• Five or more of the following symptoms are present every day for more
than two weeks; and
• They interfere with daily routines such as work, diabetes self-care,
childcare or social life:
  • persistent sad, irritable or ‘empty’ mood
  • loss of interest in activities once enjoyed, including sex
  • significant change in appetite or body weight (gain or loss)
  • difficulty sleeping, waking very early (feeling sad) or oversleeping
  • feelings of worthlessness, helplessness, guilt
  • decreased energy, fatigue, feeling ‘lacklustre’
  • restlessness and irritability
  • difficulty concentrating and remembering
  • recurring thoughts of death or suicide.
Why do people with diabetes become depressed?
Depression is caused by a combination of biological, psychological and social
factors. This means that some people are more predisposed to developing
depression due to family background and early experiences, but factors such
as thinking styles, coping styles and the level of social support available
are also crucial. The daily requirements of managing diabetes can be a
huge challenge – juggling medication, injections, blood glucose monitoring,
regular clinic visits along with all the usual stresses of life can put people with
diabetes at real risk of developing difficulties with low mood.
How Is Depression Treated?
If you recognise yourself in the list of depression symptoms above then you
are not alone. Although depression doesn’t just go away by itself, it can be
successfully treated. Antidepressant medication can be useful, but research
indicates that therapy, particularly Cognitive Behavioural Therapy (CBT),
either alone or in combination with antidepressants, is very effective in
tackling the symptoms of depression.
What is Cognitive Behavioural Therapy?
CBT was developed by the psychiatrist Aaron Beck in the 1960s. It proposes
that there are four interrelated aspects to depression:
1. Thoughts and thinking styles (‘cognitions’)
2. Emotions and Feelings
3. Behaviours – what we do or don’t do
4. Physical symptom
The theory of CBT recommends that by changing any of the components
above, particularly our thinking patterns, we can begin to make changes to
our mood.
Unhelpful thinking in depression and diabetes
Everyone, with diabetes or not, has thoughts that are sometimes unhelpful.
When you feel depressed or low, you might like to try and get into the habit of
becoming aware of the thoughts you are having when you notice your mood
changing. Writing down your thoughts may feel like a lot of effort, but it can
really help you to capture and explore your styles of thinking, and see which
are helpful and which are less so. Below is a 5-step process that you can use
to assist you.
5 Steps to Challenging Your Thoughts
Step 1: What is the Situation or Event?
For example, measuring your blood glucose level and it being higher than you
Step 2: What do you tell yourself? What are the thoughts you notice
running through your mind?
“What have I done wrong? I can’t do this. I’m a failure.”
Step 3: What is happening in your body and what do you do?
• Mood – hopeless
• Body sensations – low energy, feel sick, dry mouth
• Behaviours – snapped at my partner
Step 4:Challenge Your Thoughts
Ask yourself some helpful questions:
• What is the evidence for and against this thought?
• Is thinking this way helping me?
• Are there other ways of thinking about this situation?
• If a friend told me they were thinking this way, how would I respond?
• Am I thinking in ‘all or nothing’ terms?
Step 5: Come up with an Alternative, Balanced Thought
• I have tried but just because I haven’t got the result I wanted it doesn’t
mean that I’m a failure.
• If a friend was feeling this way I’d help her think about what she could
do differently next time, or suggest she phone her diabetes nurse to
ask for advice.
You’re Not Alone
When you first begin to examine your thinking styles it is likely to feel
unfamiliar, however like any skill you have learned, with practice it will feel
easier until you are naturally having more supportive, constructive thinking
styles. However, many people gain from the support of a Psychologist or
Counsellor, so you might like to talk to your GP about a NHS referral or
investigate seeking a private therapist for yourself.
Other ways to manage your thinking
As well as CBT there are other ways you can help yourself through
depression. Becoming more physically active can have a positive impact
on your diabetes control as well as your mood. Finding time to relax can
be very helpful. But equally important is that you find ways to increase your
pleasurable activities – life with diabetes can be hard work so make sure you
have time to inject a bit of fun into your life!

I’ve been really struggling with my blood glucose control this past week. A few things are stressing me out at the moment and this always has a negative impact on the results I see – a pattern which is very common and probably familiar to many of you reading this. It’s SO frustrating isn’t it?! Not only are you feeling frazzled by the stressor itself, but coupled with that you’ve got high blood sugars to worry about – and you’re not even doing anything ‘bad’ – like non-stop comfort eating which is what I personally feel like doing at times like these :)

It’s so disheartening. And easy to slip into the habit of berating and criticising yourself for not being able to control your diabetes. Whenever I start realising I’m doing this I begin to take notice of the thoughts I am having. Psychological theories teach that thoughts are the seeds to our emotions and behaviours, so if we can ensure our thoughts are empowering and helpful to us, then we are well on the way to managing our inner experiences.

So how do I do this? Well I keep a diary or notebook on me and get into the habit of writing my thoughts down when ever I am feeling very stressed or frutrated about some aspect of my diabetes. I then find a quiet moment in the day to sit down with my notebook for 10 minutes with a cup of tea and start to evaluate what I’ve written down. I take each thought in turn and ask myself the following questions:

1. Is thinking this way helping me?

2. Are there other ways of thinking about this situation?

3. If a friend told me they were thinking this way, how would I respond?

I noticed that when I tested my blood glucose level and it was higher than I expected, I was having thoughts such as,

“What have I done wrong? I can’t do this. I’m a failure”

By sitting down and asking myself the three questions above, I realised I could answer this internal chatter with:

“I have tried but just because I haven’t got the result I wanted it doesn’t mean that I’m a failure”


“If a friend was feeling this way I’d help her see what she could do differently next time, or suggest she phones her diabetes nurse to ask for advice.”

Can you see how much kinder this way of thinking is? Over time you will begin to notice those thoughts that fail to support you and start replacing them with more constructive thinking styles.

Thankfully, my major stressor has passed this week but with some work deadlines approaching, I’m sure I’ll be using these strategies again in the coming couple of weeks – why don’t you do something different and try it too?! Good luck, I’d love to hear how you get on!

There is SO much to be frustrated about in the diabetes life.

Constant rounds of blood glucose checks, insulin injections, oral medications, healthy eating, exercise, medical appointments, eye examinations, foot health checks..….and even when you think you’re doing everything right, you still get disheartened by an unexpected high blood glucose result or a similar reminder that you aren’t doing things ‘right’.

The first thing to know is that you’re not alone! Every person with diabetes has frustrated feelings – including me – and I’m a Psychologist!

 But there ARE ways you can help yourself. 

The first step in your ‘Top 10 Tips for Living a More Positive Diabetes Life’ guide  (receive your copy FREE at by completing the box at the top left of the page)  is to become aware of your thinking styles.

 Noticing and managing the thoughts that you regularly have are an important part of managing the frustrations caused by living with diabetes. Psychological research consistently demonstrates the benefit of ‘CBT’ – Cognitive Behavioural Therapy, in helping people manage their diabetes-related depression, frustration and stress:

 So how can you begin to use CBT today? Start to become more mindful of the thoughts you are having before, during and after you notice yourself feeling dissatisfaction or stress with your diabetes. Thoughts can be very fleeting and learning to notice them rather than respond to them automatically is a valuable skill. Get into the habit of writing your thoughts down so you can begin to discover which of them are helping you and those that are not.

Look out for the next issue when we’ll be learning how to tackle specific diabetes-related thoughts that are very common and are likely to be standing in the way of you living a more positive life!