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Dr. Jen's Diabetes Diary

The Diary of a Diabetes Psychologist


Tag: triggers

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

Woman Eating DonutDid you know your environment plays a hugely important role when you are trying to change your eating habits? In our evolutionary past we had to seek out food, so there was a natural delay between thinking about food and being able to consume it, now it is everywhere we turn! So much of our everyday lives are done habitually, on autopilot. Think of some of your daily routines — how you shower, get to work, what you eat for breakfast — nine times out of ten you do these in pretty much the same way every day. That is because our brains, as wonderful as they are, have a limited processing capacity and they are designed to create shortcuts to make the demands less arduous. Imagine if you had to concentrate fully on exactly what to do and in which order each time you had a shower!

Spend some time thinking about the ways your environment sabotages your eating goals. Perhaps you keep sweets, nuts, or chocolates on the coffee table and you find yourself snacking on them while you are watching television in the evenings. Maybe your route home from work is past a fast food restaurant that you can ‘drive-in’ to get something to tide you over until dinnertime. It could be you have many unhelpful foods in your kitchen at home. Therefore, when you are hungry, it is too easy, convenient, and tempting to reach for these rather than take a moment to think about an option that might be better for you. Think now about the different environments you find yourself in regularly that sabotage you, and make a note of them here:

Environments that have a tendency to sabotage me:

Environmental Triggers Rate 0 – 10 

Now you have a clearer sense of the environments that sabotage you, you can start to address them. Rate each on a scale of 0-10, where 0 is it rarely affects you and 10 is it affects you most frequently and most badly. Pick the one that affects you the most to start with, as this will have the greatest impact the quickest. Think about how you can change your environment to support you. Here are some ideas to help you:

  • Store foods you find tempting out of reach and out of eye sight (e.g., in the top cupboard of your kitchen rather than on the counter top).
  • Avoid buying the foods you find tempting in the first place, if they are not at home, it takes a lot of effort to get them.
  • You may want to find a different route home if the food places you pass are too appealing.
  • If you know a vulnerable time is the evening, you may want to rearrange your plans so you’re occupied. You could go for a walk or phone a friend.
  • In restaurants, you could ask the waitress not to bring you the bread bowl; or you could ask for an alternative option to snack on that is lower in calories.
  • Perhaps you snack while preparing your meals, in which case pre-prepared vegetables, etc., may be an effective way of breaking this habit (you can always return to preparing your own when you have shifted this habit).
  • Engage in doing something active with your hands, which means you cannot reach for the food. This could be doing your nails, mending or fixing something, knitting, playing a game on your phone, doing a crossword puzzle etc.

Remember, there are no rights or wrongs with this process. You are simply making small shifts to the habits you have formed that are no longer truly serving you. Treat it like an experiment. All ideas are good ideas at this stage and you can stop the ones you do not find helpful and keep the ones you do. Even if you do not make any practical changes right now, just the simple act of gaining insight into how your environment is hindering you is hugely valuable. It enables you to view your situation from a more realistic point of view — showing you the times when you are not at fault, rather your environment is. This helps you to separate some of your tendency for self-criticism and self-blame. At least if you do continue to eat the snacks on the coffee table, you are doing so with your eyes wide open. Knowledge is empowering and just the increased awareness can translate into different actions over time. List below your own ideas of how your environment triggers you and what changes you can make to help you.

Changes I can make to my environment:

Environmental Triggers Changes I Can Make 

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