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Dr. Jen's Diabetes Diary

The Diary of a Diabetes Psychologist

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Archive for May, 2012

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.

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
6-7am              
7-8              
8-9              
9-10              
10-11              
11-12              
12-1pm              
1-2              
2-3              
3-4              
4-5              
5-6              
6-7              
7-8              
8-9              
9-10              
10-11              
11-12              
12-1am              

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 info@positivediabetes.com 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 www.PositiveDiabetes.com.