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Dr. Jen's Diabetes Diary

The Diary of a Diabetes Psychologist

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Archive for May, 2013

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.