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Dr. Jen's Diabetes Diary

The Diary of a Diabetes Psychologist

Archive

Archive for July, 2010

How can someone who only sees you once or twice a year for about 15 minutes at a time really ‘get’ what your experience of diabetes is like?  The diabetes doctor, nurse or dietitian can’t. But here’s something you may not have thought of – they’re not really there to.

 Let me explain. Of course your healthcare team want you to be in control of your diabetes and in good health. They are passionate about helping you to manage the delicate balance between food, insulin and activity so that your blood glucose control is just right. This is fantastic – it’s where their skills and expertise lie and they can advise you based on their expert knowledge of the inner workings of the human body.

 But as committed and as dedicated as they are, they are not your psychologist, your counsellor or your friend. They aren’t there to help you work on the other ‘inner workings’ of your body – your emotions.

 That’s why Clinical Psychologists are the newest members of the Diabetes Team. It’s thankfully becoming more and more recognised that managing diabetes takes an emotional toil as well as a physical one. Government health guidance is calling for greater access to psychological therapies – yet a recent survey in the UK showed that less than one third of Diabetes Centres have access to specialist psychological services. There are just not enough of us! That’s why I’m passionate about offering you education and advice through this blog and the other work that I do.

 So, today I’d like to share some ideas about how you can feel more connected with your healthcare team. Common experiences of relating to healthcare professionals that I hear from people with diabetes I work with are:

  • Feeling rushed
  • Feeling scolded or made to feel like a ‘bad’ patient
  • Not being ‘heard’
  • Feeling misunderstood
  • Not feeling free to talk about what is really of concern e.g. that diabetes is getting you down
  • Being patronised, unintentionally or otherwise
  • A pressure to lie about your blood glucose results or other health behaviour
  • Feeling that the healthcare professional is an “expert” and can’t be disagreed with
  • Not attending health appointments at all and avoiding healthcare professionals entirely.  

Some common challenges from the healthcare professional’s point of view are:

  • Not having as much time to spend with patients as they’d like
  • Feeling pressure to be the ‘expert’
  • Feeling at a loss to know how to help
  • Working within an environment with stretched resources
  • Team conflict amongst their colleagues
  • Working to meet government targets which prioritise ‘hard’ data such as blood glucose control achieved over ‘soft’ data such as psychological wellbeing or quality of life
  • Not being able to fully appreciate the lived experience of diabetes (being an ‘expert’ rather than an ‘expert by experience’)
  • Having to maintain the caring role at work when experiencing personal challenges in their life outside of work

How does it feel to read these two lists? Do any of them resonate with your experience or surprise you? Just viewing the relationship from the other person’s perspective can be helpful.

But there are practical steps you can take today to feel more in control of this relationship. Here are the 3 P’sof improving your relationship with the individuals in your healthcare team:

1. Plan

The first step is to plan for your appointment. Think back over the last month – what has confused you, or surprised you, or encouraged you, or frightened you about your diabetes? What are the three things you like to know or say?

 2. Participate

 The second step is to be an active participant in your appointment. William Polonsky, a US writer suggests using the ‘ABC’ of effective communication:

  • Assertiveness– express yourself with confidence
  • Brevity – speak as briefly as you can, staying to the point at all times
  • Clarity – express yourself clearly, using short sentences and simple words

 3. Partner

The third step is to understand and keep in mind that you and the healthcare professional are equals. Rather than feeling like a passive recipient of expertise, remember that you are two adults with an immense wealth of expertise. The healthcare professional has expertise of diabetes and how the body works and you have immense expertise gathered through your lived experience of daily life with diabetes. Together, you can share that expertise with one another to work towards the benefit of your health. 

However, while some people reading this will implement these steps and begin to make changes right away, for others, it can feel harder to make changes. This is when it’s worth thinking about what’s going on inside you that’s causing this resistance. To help you with this, you might like to try this exercise:

  •  Think about your diabetes healthcare professional now.
  • Take notice of the feelings you are experiencing. Are they positive or negative?
  • Put a label on the feelings you are experiencing – hopeless, contented, angry, joyful, embarrassed, tense, supported, sad, uncertain, frightened, secure, shameful…?
  • Now try to associate the feelings you have about the healthcare professional with the feelings you have about someone else in your life. Who from your past do you also have those kinds of feelings about?
  • What figure from your early life comes to mind? Your strict headteacher at school? A kindly babysitter? Your controlling parent? A supportive uncle?

This may seem like an odd exercise, and in some ways it really is! But psychodynamic models of therapy offer the idea that the way we relate to people in our life today, particularly ‘authority’ figures such as healthcare professionals – are modelled on these early relationships.

So perhaps you relate to your diabetes doctor as if they are your controlling headteacher from school, who you always wanted to secretly rebel against. Or your supportive uncle, who if you smiled sweetly for long enough would always ‘let you off the hook’ if you did something wrong. You might think this is complete nonsense and if it’s not a helpful idea for you, then don’t make use of it.

But if this way of thinking does resonate with you, then you may be interested to know that in psychology-speak, this inner model of relating is called your ”Relationship-to-Help’.  Becoming more mindful if your personal relationship-to-help can really assist you to relate to your healthcare team in a more balanced, adult way, improving your ability to take their advice on board and increase your health and wellbeing

 If you’d like help to think about your own ‘relationship-to-help, or any other aspect of your diabetes wellbeing, I’d love to hear from you. I offer free 20-minute ‘Get Aquainted’ calls to help you think about your diabetes in a different way – email info@positivediabetes.com for further details!

 

Life with diabetes is tough. Not only do you have to deal with a chronic, long term condition that has no cure – but you have to do this largely on your own, every day for the rest of your life, all the while under the cloud of the possibility of developing long term complications.

Some people can reach out to the support of family members and health care professionals, however at times this support can feel more like well meaning but ‘scolding’ health care professionals and loving but ‘nagging’ family members.

Dealing with diabetes can therefore feel like a very lonely place. The diabetes life has 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. You wouldn’t stay in a job like that for very long! However the person with diabetes has to do this every day, perhaps all the while being told, “It’s only diabetes. What’s the big deal?”

A further complexity with diabetes is that it is a medical problem so it is therefore dealt with in a medical setting – with a focus on the medical regime of insulin dosage, weight management, blood glucose control and so on. However in the busy setting of a medical clinic, there is often limited opportunity to discuss the daily challenges, frustrations and stresses of living with diabetes. Sometimes it feels like our well-meaning medical team are repeating the same good advice every time we visit – test your blood glucose more, eat less, exercise more, smoke less, check your feet more, drink less.

The problem is, you are usually aware of what you should be doing – the struggle is in implementing it consistently. You may leave the diabetes clinic full of motivation, adamant that his time will be different. But weeks, days or even hours later, you lose track and struggle to get back on target.

The reason for this is a simple one – knowledge about what you should be doing just isn’t enough. A research trial conducted in the 1980s, ‘The Diabetes Control and Complications Trial’, conclusively demonstrated that achieving tight blood glucose control improves health and wellbeing. Yet this knowledge alone was shown to have little impact on the day to day behaviour of people with diabetes. This is similar to the warnings provided on cigarette packets, which have been demonstrated to actually only make a small impact on the desire for smokers to give up.

There are a whole range of reasons why people struggle to implement the health advice they know they should be following. This is because health does not exist in isolation from the person. It is affected by a complex interaction of meanings, emotions, thoughts, memories, behaviours, relationships with others and much more. Diabetes doesn’t just affect your body, it affects your emotions and mind too. These can have an extremely profound affect and interact with your ability to care for your diabetes. There is an important but often neglected psychological aspect to living with the condition.

To find out more about the psychological aspect of living with diabetes I’d love to arrange a 20 minute ‘Get Acquainted Call’ with you to help you think about what you are finding stressful with your diabetes care and how to find solutions to help you. 

Send me an email at info@positivediabetes.com to arrange your complimentary call now. I’d love to help you to ahcieve the greater health and wellbing you are strivng for.

www.PositiveDiabetes.com

I was always convinced I couldn’t do a single press up. That is until a friend challenged me that I could – the only ‘catch’ being that I had to solemnly agree to follow his every instruction.

“Well”, I thought – “I don’t know what makes him so confident that he can teach me something I’ve tried and failed at a million times before….but I’ll humour him and show him exactly how weak and puny my arms really are!”

So there he was…telling me exactly how to position my body, how to breathe, what thoughts to think………and guess what? Although I’d tried and failed a million times before, here I was, following his directions to the letter …and finding myself doing one press up…then 2….then 3!

Ok, so then I collapsed on the floor in pain – but so what!

I’d done something I’d never thought possible, just by following the instructions of someone who knew how.

And the more I thought about this, the more it made sense. How did I learn how to do anything in life without following instructions? Learning how to write, swim, cross the road, drive a car…….in all these activities I had someone with me, telling me what to do, what not to do and cheering me on along the way.

So what on earth has this got to do with diabetes?! Well – everything actually. Do you need to lose weight, eat healthier, quit smoking, exercise more, test your blood glucose more regularly? Have you tried on your own a million times before but didn’t achieve the results you wanted?

It’s likely that you need a step by step plan of how to achieve the outcome you want. There may be someone you know who can help you with this – perhaps your diabetes nurse or a friend with diabetes could become your ‘Mentor’. If you know someone like this, why don’t you ask them? I’m sure they’d be glad to help you and share what’s worked with you.

If you are willing to become a Mentor, or would like one, I may be able to help. Drop me a line and I’ll do my best to match potential Mentors with Mentees!

You may also be interested in my Positive Diabetes Self-Help Programme – teaching you all about the barriers that stand in your way of good health and the exact steps you need to overcome these. I will help you to create a step-by-simple-step plan to enable you to finally reach your goals successfully and increase your diabetes health and wellbeing. You can find out more about it here: www.Positivediabetes.com/diabetes_selfhelp.html

Remember….if in doubt follow the instructions :)

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”

and

“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! drjen@positivediabetes.com.

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 www.PositiveDiabetes.com 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: http://www.iop.kcl.ac.uk/news/default.aspx?id=259

 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!