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Dr. Jen's Diabetes Diary

The Diary of a Diabetes Psychologist


Tag: positive diabetes

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

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.

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.

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.

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