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Dr. Jen's Diabetes Diary

The Diary of a Diabetes Psychologist

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Eating a Hot DogDo you ever find yourself feeling down, unhappy, or restless, and before you know it, you are eating something you hadn’t planned to? If so, you’re not alone. “Emotional eating” or “comfort eating” is really common, both for people with and without diabetes. As an attempt to feel better (temporarily at least) it’s okay to use food like this some of the time. However, when food starts to feel like it controls you, rather than you being in control of food, and particularly if you have weight to lose, it can be helpful to consider your eating behaviour from a different angle. What is your ‘relationship’ with food? This article will help you understand the way you relate to food and diabetes weight loss is not just a simple formula of “eat less and move more”. There are numerous reasons why the relationship you have with food may be complex and these can be divided into biological, psychological, and social factors.

Biologically, we are fighting against our evolutionary history. Our bodies have evolved to store food in times of plenty to sustain us in times of scarcity and this is at odds with our modern day lives in which food is more than abundant. Our bodies simply haven’t caught up with our contemporary western world.

Psychologically, the connection between emotion and food is one that is established from birth, from the very first time you cried and your mother comforted you with milk. As you grew up, you may have been given sweets to cheer you up after the upset of hurting yourself, or been cooked your favourite dinner when you’d fallen out with a friend. Food is not just a fuel; it has been conditioned as a soother of emotions for as long as you can remember. So now when you’ve had an argument with your partner, or a bad day at work, there can be an impulse to reach for food as a way of calming, distracting, or comforting yourself.

Further, being able to limit food intake to maintain a socially desirable slim body shape is valued in today’s western societies; therefore, eating choices aren’t just made on nutritional content or taste but are complicated by their connection to personal sense of self-worth.

Socially, shared eating experiences are a way of bonding, celebrating, and showing love within our families and communities. Births, deaths, marriages, and all occasions in between are marked by food. Family members may offer food (and keep offering, long after we’ve said no thank you!) as a substitute when it is difficult for them to express love through a hug or saying “I love you”.

So fast forward to the diagnosis of diabetes and you are suddenly required to sharply focus on food and be thoughtful about changing or limiting previously enjoyed food choices. Your doctor, nurse, and dietician will tell you healthy eating is one of the crucial elements of optimal diabetes control; but given the link between food and emotions, it’s hardly surprising that encouragement by healthcare professionals to cut down on fatty sugary food is sometimes difficult to implement.

You know in your head what you should be doing, but it’s hard to break away from the conditioning and pattern of food as an instant route to pleasure, distraction and satisfaction.

However this pattern can be changed. The goal is to reach a place in which you can make a decision about whether or not to eat when you are feeling emotional, rather than it just being an automatic response. An important point to remember is that everyone — of every shape and size — can use food to deal with his or her emotions, and occasionally it can be fine to use food in this way. The danger is when food becomes the only way to deal with emotions. The next article in this series will examine strategies to help you gain control over your eating, the central role of your thoughts in eating behaviour, and how authentic emotional expression can help.

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.

Control XT Test In HandHow is your control?

The psychology of blood glucose testing is the psychology of being in control. In diabetes settings. “How is your control?” is a question we get asked, and ask of ourselves, a lot. Not surprising when we consider one of our most basic human needs is to feel in control. It’s one of the reasons babies cry so much, because they are not able to control their environments at all. They are fully reliant on others, so the discomfort of hunger or a wet nappy urges them to cry for attention to get their needs met. Of course, fast forward from the cradle a few decades and most of us are able to control virtually every aspect of our daily lives. However, diabetes can be one part of life that can feel completely beyond our control at times, even when we feel we are doing everything ‘right’.

Instant Feedback

Blood glucose testing is the key to feeling more in control of your diabetes. It puts you in the driving seat because it provides you with instant feedback on what actions you need to take — whether that’s having more or less to eat, taking additional units of insulin or something else. The important distinction is that the feedback, which blood testing provides, is fact-based rather than feelings orientated. The sense of a lack of control is often grounded on feelings. Blood glucose testing helps you plan for the future. It enables you to see what you might do differently. A high blood glucose result after a new food may mean you might like to give yourself an extra unit or two of insulin next time you make that food choice for example.

Top Tips for Changing Your Blood Testing Routine

 

  1. Set an achievable goal. If you want to make changes to the frequency of your blood testing, set an achievable goal to start — one that is a bit beyond your current comfort level but not so ambitious that it feels overwhelming. So perhaps you currently test a few times a week, in which case maybe increasing this to once per day would be a good starting point to aim for.
  2. Put in place reminders. Think about what time of day you will test (a range of times of day is good to get an overall picture, while a series of consecutive days at the same time can help with troubleshooting particular challenges). Write a reminder in your diary, leave a note where you will see it, or set an alarm on your phone — whatever helps you turn that plan into a reality.
  3. Share your new plan. Tell someone you trust about your goal and plan. If you think it would be helpful, you could invite them to be your Accountability Partner. They have your permission to ask how you’re getting on and gently challenge you if you get off track.
  4. Reward yourself! We don’t do anything in life without a reward. We work for pay and satisfaction, eat for the reward of flavour and the feeling of a full stomach, watch TV, or engage in hobbies to relax, and blood glucose testing is no different. Once you are in the habit of it and start to track the payoffs, you will no doubt feel that the renewed sense of control is in itself an incentive; however, in the early stages of any change, planning rewards are an important part of the process. Develop a list of treats you could engage in and give yourself one each day or perhaps a bigger one at the end of the week. Rewards don’t have to cost anything. They could be listening to music, enjoying a hobby, a relaxing bubble bath, reading a great book, a hug from your partner, whatever works for you.

Alongside the practical actions of blood testing, you might find it helpful to create more positive associations with your blood testing kit. The carry cases that meters come in can be a bit medical looking, so you might like to use a small make-up bag or pencil case that better reflects your personality, style, and identity. This can also act as a symbol that you are making a fresh start with your relationship with blood testing, and enjoying the renewed sense of control it brings. Remember though, there may be some blood glucose patterns that you can’t seem to explain, in which case, ask a member of your health care team . Two heads are always better than one and with all this data to hand, they can combine their expertise of diabetes with your own personal experience — together helping create results to be proud of.

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.

How can someone who only sees you once or twice a year for roughly 15 minutes at a time really ‘get’ what your experience of diabetes is like? Perhaps I am being a little controversial but I believe that, although you might expect them to, the diabetes doctor, nurse, or dietician can’t. However, here’s something you may not have thought of — they are not really there to.

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

However, 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 there can be a disconnect between your experience of being heard in your diabetes appointments. 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 (Diabetes UK, 2008). There are just not enough Clinical Psychologists to go around unfortunately!

Potential Challenges in the Patient — Healthcare Professional Relationship

Common experiences of relating to healthcare professionals from the patient perspective are:

  • Feeling rushed.
  • Being patronised, unintentionally or otherwise.
  • Not being ‘heard’.
  • Feeling misunderstood.
  • Not feeling free to talk about what is really of concern, e.g., that diabetes is getting you down.
  • Feeling scolded or made to feel like a ‘bad’ patient.
  • A pressure to lie about your blood glucose results or other health behaviour.
  • Feeling 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 scarce or stretched resources.
  • Team conflict amongst colleagues.
  • Working to meet government targets, which prioritise ‘hard’ data such as blood glucose levels of their patients over ‘soft’ data such as psychological wellbeing or quality of life.
  • Realising they are not 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 lives 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 perspective of the ‘other’ can be helpful.

There are practical steps you can take today to feel more in control of this relationship. Here are the three P’s of 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 would like to know or say to your health professional?
  2. Participate: The second step is to be an active participant in your appointment. Polonsky (1999), suggests using the ‘ABC’ of effective communication to aid you:
  • 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.

Often writing down some bullet points before the appointment can be helpful, covering the main topics of what you would like to talk about. You can then choose to bring them to the appointment with you, or simply have them in mind to recall them.

  1. 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 you are two adults with an immense wealth of expertise. The healthcare professional has expertise of diabetes and the physical aspects of the condition; and you have extensive 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.

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.