There are practical steps you can take today to feel more in control of this relationship with your healthcare team.

Here are the

3 P’s of improving your relationship

with the individuals in your healthcare team.

Plan

Planning may feel like the last thing you want to do before a trip to the doctor, but it needn’t take long and can even be done in the waiting room or on the bus on the way to the appointment.

Think back over the last week or month –

what has been confusing about your diabetes
? Or surprising? Or encouraging? What are the top three things you like to know or say? Jot these down on paper or as a note on your phone to remind you once the appointment begins.

Participate

Step number two starts when you walk into the consultation room. Early on in the appointment, let your doctor know that you’ve planned for the visit.

This enables her or him to see that you are being an active ‘participant’ in your appointment, the second ‘P’ of working with

healthcare professionals
In order to better participate, William Polonsky, a US writer suggests using the ‘ABC’ of effective communication:

• 
  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

Partner

The third step is to understand and keep in mind that you and the healthcare professional are ‘Partners’ – equals.

Rather than feeling like a passive recipient of their medical expertise, remember that you are two adults with an immense wealth of experience. The healthcare professional has expertise of diabetes and how your biology operates, and you have immense expertise developed through your daily life with diabetes. Together,

you and your doctor
can share that expertise with one another to work towards the benefit of your health.

While some readers will be able to read these 3 Ps, implement the steps and begin to make changes right away, for others, it can feel harder to make a shift. This is when it’s worth thinking about what’s going on with your emotions that’s causing this difficulty. To help you with this, you might like to try this exercise:

• Bring to mind a particular diabetes healthcare professional that you are finding it a bit of a struggle to relate to.
• Take notice of the emotions that you are experiencing. Are they positive or negative?
• Put a label on these feelings you are experiencing. Hopelessness? Contentment? Anger? Joy? Embarrassment? Tension? Support? Sadness? Uncertainty? Fear? Security? Shame?
• Notice this feeling. Think about who else in your life (especially from your early life) you also have those kinds of feelings about.
• What figure comes to mind – Your strict headteacher at school? A kindly babysitter? A family member who makes you feel guilty that
  
  you’re not a ‘good’ diabetic
  ? A supportive uncle?

Psychodynamic models of therapy

Associate the feelings you have about the healthcare professional with the feelings you have about someone else in your life may seem like an odd exercise, and in some ways it really is!

But psychodynamic models of therapy offer the idea that the way we relate to people in our life today, particularly ‘authority’ figures such as healthcare professionals – are modelled on these relationships with early caregivers.

So perhaps you relate to your diabetes doctor as if they are your controlling headteacher from school, who you always wanted to secretly rebel against.

Or your supportive uncle, who if you smiled sweetly for long enough would always ‘let you off the hook’ if you did something wrong. You might think this is complete nonsense and if it’s not a helpful idea for you, then don’t make use of it. But if this way of thinking does resonate with you then do make use of these reflections.

Knowing that some of the feelings that you have towards your doctor or nurse actually belong in the past and are no longer serving you in your adult relationships, can, over time, help you to relate in a more helpful way, with the ultimate goal of improving your health.

This is one of series of Psychology articles by

Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

When you feel depressed or low, you might like to try and get into the habit of becoming aware of the thoughts you are having when you notice your mood changing.

Writing down your thoughts may feel like a lot of effort, but it can really help you to capture and explore your styles of thinking, and see which are helpful and which are less so.

Use our

5 step process

to assist you in challenging your thoughts.

The 5-step process

Step 1: What is the Situation or Event?

For example,

measuring your blood glucose level
and it being higher than you expected, stepping on the scales after a week of healthy eating and not having lost any weight

Step 2: What do you tell yourself? What are the thoughts you notice running through your mind?

“What have I done wrong? I can’t do this. I’m a failure.”

Step 3: What is happening in your body and what do you do?

• Mood – hopeless, frustrated, fed-up
• Body sensations – low energy, feel sick, dry mouth, slumped shoulders
• Behaviours –
  
  ate some comforting food, avoided engaging in blood testing/healthy eating for the rest of the day

Step 4: Challenge Your Thoughts

Ask yourself some helpful questions:

• What is the evidence for and against this thought?
• Is thinking this way helping me?
• Are there other ways of thinking about this situation?
• If a friend told me they were thinking this way, how would I respond?
• Am I thinking in ‘all or nothing’ terms?

Step 5: Come up with an Alternative, Balanced Thought

• I have tried but just because I haven’t got the result I wanted it doesn’t mean that I’m a failure.
• If a friend was feeling this way I’d help her think about what she could do differently next time, or suggest she phone her diabetes nurse to ask for advice.

Examining your thinking styles in this way is likely to feel a bit strange at first, however with practice it will feel easier (like any skill you have learned – such as

driving a car
or tying your shoelaces!). Soon enough you will be naturally using more supportive, constructive thinking styles without even realising.

In addition to talking

therapies such as CBT
there are other, more practical ways you can help yourself through low mood to lift feelings of depression.

Do more exercise!

Doing more physical activity
each day can have a beneficial impact on your diabetes health as well as your mood.

Finding time to relax can be very helpful.

But equally important is that you find ways to increase your pleasurable pursuits – life with diabetes can be hard work so make some time for some fun or enjoyable activity each day.

Finally,

talk to your GP about a NHS referral to a psychologist, therapist or counsellor to help you manage your low moods.

Many people feel a sense of stigma about seeking support of this type, but there is no shame in reaching out for help with someone who is trained to help you.

You

can

overcome your difficulties with

depression, and taking action is the first step.

This is one of series of Psychology articles by Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

The most crucial part of coming to terms with the diagnosis is to learn to LIKE yourself as a person with diabetes. Although it’s rarely talked about by your diabetes doctor or nurse, it is really important to come to terms with the fact diabetes is now a part of your identity.

It is invaluable to learn to ‘like’ your life even if it includes the ups and downs of managing diabetes. Sounds tough? It doesn’t have to be.

Here are four steps to help you:

Learn

Learn all you can about diabetes. Obtain information from your healthcare team, borrow some books from the library, join a diabetes support group or the

Diabetes forum
and learn from others  who have been through what you are experiencing and can offer you their ‘expertise by experience’.

Inquire

Inquire about how you can improve your daily life of coping with diabetes. Is there an educational course you can attend, such as

DAFNE
if you’re type 1 or

DESMOND
if you’re type 2? Ask your diabetes team about how to be referred to one of these free courses.

Ask your diabetes team about how to be referred to one of these free courses. Would a kit bag for your diabetes equipment help you to feel more in control? A particular blood glucose meter? Any tool or opportunity that helps you feel more in control of your diabetes is worth exploring.

Kindness

Show yourself some kindness and go easy on yourself.

It is common to experience a range of painful and powerful emotions towards your diabetes – anger, sadness, guilt, rage, regret; or sometimes a deep sense of numbness which can be equally challenging to grapple with.

These emotions can feel intense and overwhelming – you have encountered a loss and in the same way as any loss, you can’t expect to feel your usual self straight away.

However, know that these painful feelings can and will pass.

Express Emotion

Many of us feel we need to be ‘strong’ and keep our emotions about our diagnosis hidden. However it is actually a healthier and therefore stronger response, to be able to express some of the (very natural) emotions you will be experiencing at this time.

Can you talk to a trusted friend?

Have a good cry?

Punch a pillow, do some exercise, write a journal, see a therapist? People are often tempted to use

alcohol,

cigarettes
or other substances to manage and dull the overwhelming emotions they are experiencing, in an attempt to try to distance themselves from the painful reality they are living.

These substances are indeed shortcuts to feeling better in the short term. It is therefore very likely that you might feel a greater desire to use them in the midst of having to cope with a whole new range of feelings and all of the practical challenges that accompany diabetes.

However, you know that using these coping mechanisms for anything other than the very short term is not ideal. Yes, they mask the root problem – but the root problem is still there.

This is where techniques drawn from psychological therapies of coping can be helpful.

This is one of series of Psychology articles by

Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

National clinical health guidelines have demonstrated that cognitive behavioural therapy (CBT) is useful for people with diabetes who are struggling with managing diagnosis.

Here is a three-step technique for using CBT.

Cognitive behavioural therapy (CBT) can often be useful for people with diabetes as CBT requires you to examine your thoughts – in this case, about your diabetes.

What is cognitive behavioural therapy?

CBT was developed by the psychiatrist Aaron Beck in the 1960s. It proposes that there are four aspects to parts to depression.

1. 
   Thoughts and thinking styles (cognitions) –
   
   about ourselves, others and the future
2. 
   Feelings, emotions and moods
   
3. 
   Behaviours
   
   – the actions we take, or don’t take
4. 
   Physical symptoms
   
   – what happens to our body

There are three steps to using CBT in its simplest form:

Step 1: What are the thoughts you notice running through your mind?

Some examples might be:

• “What have I done to deserve this?
• “I can’t do this.”
• “I’m a failure because I have diabetes”

Step 2: Challenge Your Thoughts

Take each thought in term and ask yourself some questions about it:

• What is the evidence for and against this thought?
• Is thinking this way helping me?

For example, for the thought, “There is nothing I can do to stop

diabetes complications
”  – is there

really

nothing you can do?

Educate yourself though

diabetes related books
and internet resources recommended by your healthcare team.

What does the research demonstrate about the likelihood of diabetes complications?

Step 3: Think of an Alternative, Balanced Thought

• “I may not be able to control whether I develop complications but I can feel in control of trying my best to keep healthy”
  
  
• “The research shows that those who
  
  test their blood
  are more healthy and less likely to develop long term complications”

Being

diagnosed with diabetes
is an immense life change to cope with. By becoming more aware of your experience of how you are coping you can allow diabetes to become a part of your identity, enabling you to work with it rather than fighting against it. This is crucial for your short and long term health.

For anyone with diabetes, experiencing negative emotions such as anger, frustration, hopelessness, fear, guilt and shame is very common.

According to NICE when a person is first diagnosed with diabetes, they will often go through similar psychological stages as that of bereavement:

• Disbelief
• 
  Denial
• 
  Anger
• 
  Depression

Higher HbA1c levels have been found to be associated with physical symptoms including hyperglycemic score, mood including levels of displeasure, depression, tension and fatigue and with worse general well-being.

We look at how

emotions can affect your life

and diabetes management:

Diabetes and Emotions Guides:

Diabetes and Anger

Diabetes and Anxiety

Diabetes and Guilt

Diabetes and Depression

Diabetes Burnout

Tiredness and Diabetes

Diabetes and Mindfulness

The relative association varied between 1.02 and 1.36 for each percentage difference in HbA1c. The relation between HbA1c and some mood states have been found to be modified by neuroticism a patient who is less inclined to complain was associated with worse glyceamic control.


^[45]

Mindfulness
training has been shown to address depression, stress, anxiety, chronic pain all of which have been implemented with better glycaemia control, diabetes management and greater reported quality of life:

• 
  Mindfulness and hypoglycemia
• 
  Mindfulness’ effect on blood gluose levels and blood pressure
• 
  Mindfulness and sleep
• 
  Mindfulness and back pain

More likely to suffer from depression

According to the NHS people with diabetes are twice as likely to suffer with depression.

Evidence presented by the National Diabetes Support Team indicate that ‘recovery from depression is associated with reductions in HbA1c levels of between 0.5% and 1% suggesting that treating depression can not only improve quality of life but could also significantly reduce the risk of complications.’

Some stressors may emerge after many weeks, months or years following diagnosis. Alternatively, there may be difficulties that arise upon initial

diabetes diagnosis
and continue without being resolved.

These may include:

Diabetes and Emotions Guides:

Your Diagnosis

Comfort Eating and Overeating

Healthcare Professionals

Compulsive Behaviour

Low Moods and Depression

Increase Your Motivation

Sex, Diabetes and Relationships

Needle Phobia

Dealing with Denial

Long Term Complications

Worry and Anxiety

Tackling Lifestyle Changes

A NHS Confederation briefing paper has highlighted the importance of integrating the treatment of physical and mental healthcare and acknowledges the increased prevalence of mental health needs amongst people with physical health conditions. The paper also accepts that treatment of the mental health needs has a positive impact on physical wellbeing (NHS Confederation).

This section features Psychology based articles written by

Dr Jen Nash, a Clinical Psychologist and

Charlotte Summers, a Mindfulness-based diabetes researcher.

Many people with diabetes are anxious or worry a lot about

hypoglycemia
– in one study 25% of people with diabetes reported that anxiety about hypoglycemia is a serious problem for them.

Hypoglycemia is a frequent occurrence among many people with diabetes, with mild to moderate episodes (those that you can treat on your own) occurring about twice a week on average for the person with

type 1

• Read more about
  
  what a hypo is

Why do you worry about hypoglycemia?

So why do people worry about hypoglycemia, particularly whe, in most cases, they can be treated with relative speed and ease by eating a sugary snack? Well, its often because the

effects of a hypo can be frightening, embarrassing, uncomfortable, unpleasant and, in their worst cases, fatal.

Getting sweaty, having slurred speech, shaking uncontrollably or being confused may not seem too bad in the whole scheme of things, but having them occur in a job interview or important work meeting, whilst driving home at night or on a romantic date may not be so pleasant!

Having just one episode of hypoglycemia that was unpleasant can lead to increased anxiety of it happening again.

This can lead to other behaviours which may lead to further difficulties with

managing diabetes
:

• Running
  
  blood sugars high
  to avoid hypoglycemia
• Eating more than needed to keep

  blood glucose levels
  elevated

• Restricting activities such as driving, exercising, travelling on public transport etc.

In addition to a particularly bad experience of hypoglycemia, there are three further factors that may contribute to excessive worry:

• You may be experiencing a weakened ability to feel the warning signs of hypoglycemia
• The warning signs of hypoglycemia, such as sweating and shaking occur because of the associated release of the body’s stress related hormones, epinephrine. However for some people with diabetes, their warning signs are less obvious, and so by the time they do notice the problem, their blood glucose level has dropped so low that taking reparative action becomes even harder. This is known as reduced
  
  hypo awareness

• You may not be able to distinguish the feelings  of hypoglycemia from the feelings of fear

Many symptoms of hypoglycemia, such as sweatiness or an increased heart rate are the same as signs you would experience if you were fearful. This may lead to a spiral of confusion:

• You may notice your heart beating a little faster
• You may think: “This could be hypoglycemia”.
• This makes you nervous, so your heart therefore beats even faster.
• Thinking, “Oh no, this is a symptom of hypoglycemia”
• You feel even more nervous and reach for a snack to raise your blood sugar levels

When actually what you really were experiencing was nervousness!

You may find predicting or estimating your blood glucose level challenging

Everyone’s experience of hypoglycemia is unique, therefore although you have likely been taught to be alert for certain signs of hypoglycemia, your own response may be totally different – e.g. a particular taste in your mouth or an unusual feeling in your legs.

Top 5 strategies for helping you to overcome your difficulties with hypoglycemia

Tell your healthcare team

If you frequently experience

low blood glucose levels, the first thing that may be needed is a change to your diabetes regime – medication type, the dosage, or the timing of medication and/or food. Your doctor will be able to help with this.

Also, if you are experiencing less warning signs than previously, there are ways of recovering these, through avoiding all hypos for as little as a few weeks. This needs careful planning to avoid the opposite problem of overly high blood glucose levels, but is very possible with guidance.

Immediately before checking your blood glucose, guess what the number will be

Increase your confidence in your hypoglycemia awareness by estimating what yours is before you actually test. Write down what your guess is, then test and write down the actual result. If you often guess incorrectly, then use the following strategies to help you.

Learn your unique ‘alarm bells’ that are your own warning signs of hypos

Everyone has their own individual ‘alarm bells’ that is their body’s way of telling you that you are low. Keep track of what you notice going on for you when you have a hypo (obviously best thought about

after

you have recovered from one!). Is it a physical symptom (heart racing, tingling in a certain part of your body, sweating, shaking, heart palpitations) or a change in your mood or in your ability to think clearly?

Find out what works best for treating your hypoglycemia

Experiment! Some people like to

try chocolate, but because of the high fat content, it can be slow to raise blood glucose levels.

Fast acting sugars
contained in glucose tablets and glucose drinks can act more quickly. There’s nothing worse than eating a snack and it not working so try a variety of foods and see what works best for you.

Once you’ve found what works best for you, always carry some of this with you. You may also want to try:

• 
  GlucoTabs
• 
  Glucojuice

If you tend to think you are having reactions even when you are not, try a breathing exercise

If you think you may get yourself into the anxiety cycle described earlier, then a quick relaxation exercise can help control your panic so that you can discover whether or not you are experiencing hypoglycemia.

Try the following quick exercise:

• Sit comfortably in a chair
• Close your eyes
• Take a slow, deep breath in so your lungs are full
• Hold this breath for the count of 3 seconds
• Breathe out as fully as possible for a count of 5 seconds
• Repeat this sequence for two more breaths
• Open your eyes and notice any subtle differences in how you feel, both in your body and your mind
• With a bit of practice, over time you will be able to notice a feeling of relaxation
• Once you feel comfortable with the technique, begin to practice this when you are having hypoglycemic symptoms that you are not sure whether or not are real
• If they weaken it is likely it is a false alarm, but in the beginning
  
  always
  
  test your blood glucose level to see if you are correct
• With frequent practice, over time you can expect the false alarms to occur less frequently

This is one of series of Psychology articles by

Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

Some of the changes you need to make when you are

diagnosed with diabetes
may feel immense – but if you think about it, every significant change in life actually involves lots of small changes, which over time equate to real progress in a particular area.

That is why it is crucial to break big lifestyle changes into small, manageable action steps.

For example, if your goal is to get to a healthy weight when you’ve spent all your adult life being overweight, this is likely to feel like a huge shift – perhaps the biggest life change you’ve ever contemplated.

Some people love these huge goals, but for others, just focussing on the big end goal may feel overwhelming and may trigger doubts about whether this big change is really possible.

For that reason, the final goal may need to be broken down into small, achievable tasks that are small enough to be completed on a daily basis. An example of this might be:

• Doing research on the internet (perhaps on the
  
  Diabetes Forum
  ) into people who have successfully lost weight
• Seeking out someone who has already achieved what you’ve desired and talking to them about how they did so
• Making an appointment with a dietician/nutritionist about starting a weight loss regime
• Reading some health magazines with success stories of people who have successfully lost weight

These are much more achievable and actionable and things you can do to move you towards your goal right now.

It’s easy to see that by just completing small actions daily, weekly and monthly you will be moving ever closer to your goal.

The momentum of achieving progress on your goals in this way can be so motivating.

Use the chart below

Now is your opportunity to see for yourself! Use the chart below to list your goal and the small steps you need to take to achieve them.

Now you have a clear sense of the actions you need to make your desired diabetes goal a reality, the next step is to refine the goals you have so that they are SMART goals:

• 
  Specific
  
  – The goal is well defined
• 
  Measurable
  
  – The goal is able to be tangibly measured by an outside observer
• 
  Attainable
  
  – The goal is obtainable
• 
  Realistic
  
  – The goal is within the availability of resources, money and time
• 
  Time Bound
  
  – There is a time limit to the goal – enough time to achieve it but not too much time, as this can be counter-productive.

• Download the table above, so you can fill it out:
  
  Set your goals
  [PDF]

For example:

• To
  
  lose weight
  is a goal
• To weigh 10 stone by 31 December 2023 is a SMART goal, as it includes the five elements listed above

Let’s look at each of these factors in more detail.

Specific

The first point is to be as specific as possible. So rather than just stating a general goal like I want to lose weight or ‘I want to exercise more’ the important part is to be very specific.

If you just say that your goal is to lose weight then you have achieved this goal whether or not you’ve lost one pound or one kilogram. So being specific is very key, because it allows you to measure your success and is a clear indicator of whether or not you’ve met the goal.

Measurable

It is important that you can objectively observe whether you’ve reached the goal or not. So in the case of weight loss – the weighing scales will show whether or not you’ve achieved the goal or not – there is objective evidence that is based on fact, not just a feeling.

Likewise if you want to test your blood glucose more frequently and you state you will test twice per day – someone else can objectively witness the achievement or non-achievement of this goal.

Attainable

So why is it so important to set attainable goals? The goal needs to be achievable to ensure you don’t get disheartened with progress if it is impossible to meet it.

For example, if your barrier is about eating and weight, then perhaps your goal might be, I will lose 2 stone in weight – something that you know is achievable for you. You may need to get some help at this stage from your healthcare team to think about whether it is indeed an achievable goal given your current circumstances.

If you have a very big goal to lose a lot of weight then you may need to break down this large overall goal into smaller goals to help you stay on track – taking it 1 stone or 10 kg at a time.

You also need to consider your personal circumstances. If your goal is to test your blood glucose three times a day but you currently never test and have a family of young children to care for, a more achievable goal to begin with may be to test once a day. This can always be reviewed and increased at a later date.

Realistic

It’s also important not to reach for the stars too soon with goal setting. Taking baby steps is really important. Although small steps can sometimes seem insignificant, the idea is that they’re easy and they don’t move you too far out of your comfort zone.

However, over the course of a week, or a month, or three months, or 6 months, or a year…. all of those baby steps of moving you in the right direction will have had a cumulative effect.

So for example if one of your actions is to cut out the biscuit you eat with your mid-morning cup of tea – it might seem like a small thing but over the course of the year it is likely to show a really dramatic difference on the weighing scales.

Time bound

It is crucial to have a time by which you will achieve the goal so that you are motivated to maintain momentum. You might like to be in time for a particular event such as a holiday or your birthday – e.g. by my birthday I will be 10 stone 5 pounds.

However it is also important to take it slow and be patient. Personal change is challenging and working through this home study system is personal change, albeit in the area of health.

Many people get frustrated and want to see personal change straight away, over night if possible!

But the difficulty is that the problem has most likely become a problem over a long period of time. For example with weight gain, this can often occur just by eating a relatively small amount of additional calories each day.

So the problem has arisen in a small and steady way and in just the same way the problem will be solved in a slow and steady way.

So it is important to emphasise that you do need to be patient – but like everything in life if you take consistent action on your goals you will get the desired result in the end.

This is similar to when you learned how to drive a car or developed some other new skill and the advantage of this is that because it’s a lifestyle change rather than a quick fix; you’ll be able to improve your health in a much more sustainable and long lasting way.

Take a moment now to turn to write out the next goal you plan to action, ensuring it is as SMART as possible.

• Download the table above, so you can fill it out:
  
  SMART goals
  [PDF]

The final point about goal setting is to focus on immediate action. So while you’re sitting here now I want you to write down something that you can do immediately, before the end of the day, some very small task that will get you moving towards progress and a different future for yourself.

So this could be something like spending 5 minutes before the end of the day reviewing your goals, making a

healthy choice at dinner
e.g. some fruit for dessert, making sure your

blood glucose testing
kit is in order, whatever is relevant to your goal.

It doesn’t have to be a complete overhaul of your usual routine but rather some small action that you can do with relative ease to symbolise that you are starting afresh with a new sense of purpose towards your goals.

This is one of series of Psychology articles by

Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

It’s a common yet serious experience for many people living with diabetes, where the continuous demands of self-care begin to feel impossible to sustain.

When someone is experiencing diabetes burnout, they might stop checking their blood sugar levels altogether.

Skipping or forgetting insulin injections or medication becomes more frequent, and previously established healthy routines may slip, making way for old habits that don’t support good diabetes management.

It’s not about negligence but rather an accumulation of stress and fatigue that can leave someone feeling completely defeated.

Typically, diabetes burnout doesn’t happen overnight.

It’s often the culmination of years spent measuring blood sugars, counting carbs, dealing with blood sugar fluctuations, attending countless medical appointments, and living with the perpetual pressure to manage a condition that never truly rests.

What happens in diabetes burnout?

At its core, diabetes burnout is marked by behaviors that might seem like an effort to reclaim a sense of normalcy or freedom.

People might find themselves eating whatever they like, disregarding the consequences, or guesstimating insulin doses without checking blood sugar levels, craving the temporary relief from constant vigilance.

The hope of feeling liberated, however, often backfires, potentially leading to dangerous blood sugar highs or lows, increased fatigue, or hypoglycemic episodes that, in severe cases, may result in a diabetic coma.

Moreover, the emotional burden is equally profound.

People in the throes of burnout often experience:

• Stress
• Anxiety
• Depression

The term diapression has been coined – which refers to having depression and diabetes.

Feelings of anger, resentment, guilt, and shame are common, as well as a pervasive sense of helplessness.

These psychological struggles can amplify the difficulty of diabetes management, creating a cycle that feels hard to break.

Preventing diabetes burnout

Preventing or alleviating diabetes burnout involves a compassionate approach.

Recognise the signs

It’s normal to feel frustrated, unmotivated, or anxious about your diabetes care. If you’re skipping appointments, avoiding glucose checks, or feeling detached from your management plan, it could be a sign of burnout.

You’re not alone

Remember, it’s okay to ask for help. Whether it’s support from friends, family, healthcare professionals, or connecting with the diabetes community, sharing how you feel can make a huge difference.

Simple steps to feel better

1. Take a break from diabetes tasks for a short period with guidance from your healthcare team.
2. Focus on small, manageable goals rather than aiming for perfection.
3. Celebrate the victories – no matter how small they seem.

It’s important to switch things up and keep routines fresh – like experimenting with new diabetes-friendly recipes to make meal planning less monotonous.

Seeking social support, whether from friends, family, or a diabetes community, can be a powerful way to combat feelings of isolation. Connecting with others who understand the unique challenges of living with diabetes can be incredibly uplifting.

Mindfulness-based courses have also gained recognition in the UK for their effectiveness in diabetes management.

Structured programmes help individuals understand and manage the emotional impact of the condition, teaching strategies to cope with stress, anxiety, and feelings of burnout. They provide tools to build resilience and restore a more balanced, manageable approach to daily care.

Ultimately, recognising the signs of burnout early and taking proactive steps to address it can make a world of difference.

Remember, it’s okay to acknowledge that living with diabetes is hard. Seeking support and being kind to yourself are crucial parts of staying healthy, both physically and emotionally.

Living well with diabetes is a marathon, not a sprint, and it’s essential to give yourself grace and be patient to yourself along the way.

Mindfulness is a technique that teaches an individual to become aware of moment-by-moment thoughts, emotions and physical sensations in a non-judgemental way.

Mindfulness has been shown to be effective in supporting diabetes management.

It is a coping technique that can be adopted to come to terms with adversity and enhance mental and physical wellbeing.

What is mindfulness?

Mindfulness is a technique adopted to becoming aware of moment-by-moment thoughts, emotions and physical sensations in a non-judgemental way.

The foundations of mindfulness lie in the ancient practice of meditation; mindfulness can be adopted and practiced by anyone irrespective of cultural or religious orientation.

In the US, mindfulness is being increasingly used for eating habits and diabetes management. Research has shown that mindfulness enhances clinical effect of glycemic control.

Mindfulness guides

Mindfulness has been shown to have an impact on a number of issues in regards to diabetes. Read the latest research in guides to:

• 
  Mindfulness and hypoglycemia
• 
  Mindfulness, blood gluose levels and blood pressure
• 
  Mindfulness and sleep
• 
  Mindfulness and back pain

How does mindfulness work?

Mindfulness can help break down the constant cycle of becoming stressed, anxious and depressed. Pressures and strains of everyday life cause an internal battle of avoidance and attraction.

People strive to avoid ‘negative emotions’ such as guilt, sadness, frustration and anger and instead are attracted to feelings of happiness and contentment.

In essence, people have been taught to believe that feeling these ‘negative’ emotions is unfavourable and that we are in some way mentally ill due to the experience of those feelings.

Mindfulness encourages attention and focus on the present moment and the development of non-judgemental consciousness, this allows the person to accept the way they are feeling rather than constantly battling to try and change it.

How can mindfulness help me?

Mindfulness based approaches has been scientifically proven to ease depression, anxiety, stress and aid the management of destructive emotions.

Additionally there are no side effects like those seen in alternative medications prescribed to improve symptoms of

mental illnesses

Mindfulness based approaches has been found to be particularly effective in supporting diabetes management and the mental turmoil that is accompanied with a diagnosis of such as chronic physical illness. It can address the feelings of

guilt, anger and aid self-acceptance to encourage the fulfilment of an unobstructed life.


^[36]

Mindfulness has also been found to have an enhanced clinical effect of

glycemic control
so not only aids psychological health but could potentially have a positive impact on the management of the physical condition.


^[37]

People with diabetes often report symptoms of neuropathy which can affect up to 50% of people with type 1 and

type 2 diabetes

Symptoms include numbness or pain in:

• Arms
• Hands
• Legs
• Feet

Neuropathy
can also affect the organs, including the heart and sex organs.

Back pain is also suffered at a greater rate in diabetes; it could be an added symptom of neuropathy or could be an indication of kidney problems or urinary tract infections. A consultation with a doctor and a simple blood test can help eliminate possible causes of back pain.

Mindfulness found to reduce back pain

Mindfulness
meditation has been reported in numerous scientific investigations to have a positive influence on pain management, in general and chronic back pain in particular.

One study conducted in 2008 reported that after an 8 week mindfulness based pain management course, people meditated on average 4.3 days a week for approximately 31.6 minutes per session.

They reported on a Chronic Pain Acceptance Questionnaire that their pain management had improved and were better able to accept and function with the level of pain they were experiencing.


^[42]

According to the UK prospective Diabetes study, diabetics with controlled blood pressure, which is within the normal range, are 30% less likely to suffer from diabetes related complications, including heart attack and strokes, when compared to their poorly controlled counterparts.

Additionally, the research states that normalising high blood pressure has a greater impact on the life expectancy and quality of life for a diabetic than

blood glucose levels

Research conducted at the Medical College of Georgia, USA has examined the effect a meditation program has on resting blood pressure and heart rate in young adults.

The findings compared students who had taken part in meditation training for three months against students who had participated in health education classes. It was reported that meditation significantly reduced blood pressure and heart rate at various measure points throughout the day and night.


^[38]

A study conducted by researchers at the Department of Internal Medicine, University of Kentucky, establish that regular practice of Mindfulness Meditation may have the potential to reduce systolic and diastolic blood pressure, which can subsequently reduce the risk of hypertensio, heart attack and stroke.


<sup>[39]

[40]</sup>

Hypoglycemia is a concern for people with diabetes and often causes heightened anxiety due to the unpredictable nature of when a hypo may occur.

Hypoglycemic episodes
are less common for a person with type 2 diabetes but could arise as a result of dietary decisions.

Hypoglycemia is considered to occur when blood sugar levels fall below 4mmol/L.

Hyperglycemia, which is when blood glucose levels are higher than 10 mmol/L, tends to be a greater problem for people with type 2 diabetes, attributed to more long term complications associated with diabetes, particularly cardiovascular problems such as high blood pressure, heart disease and stroke.

Improving blood glucose control with mindfulness

Mindfulness has been shown to

increase glycemic control

and subsequently reduce the chances of having hypoglycemic, hyperglycemic episodes, leading to a reduction of the mental distress associated with diabetes management.

Study 1: Reduction of HbA1c and blood pressure

A team of researchers lead by Dr Rosenweig, conducted a study where participants completed a mindfulness course for 8 weeks along with keeping a diary of the exercise and diet regimes.

At a one month follow up point,

HbA1c levels
and blood pressure were significantly reduced, in the mindfulness participants, over the participants who had not completed the Mindfulness course.

It is blood pressure that in diabetics has been linked to additional complications such as heart attacks, hypertension and stroke. Though body weight did not change over the course of the research, the participants reported that emotionally they felt less anxiety and depression meaning  they subsequently were in a better frame of mind to self manage their diabetes.

[37]

Study 2: Reduction of HbA1c

Another study compared a course of Acceptance and Commitment Therapy (ACT) which included teaching participants about acceptance and mindfulness techniques with a standard

diabetes education
day.

When comparing patients who had only attended the education session, at a 3 month follow up period those diabetics in the ACT reported they used the coping strategies learned on the course and reported better diabetes self-care.

The diabetics in the ACT condition were more likely than those in the education alone group to have their glycated hemoglobin (HbA1c) levels in their target range.

It was concluded that the changes in HbA1c levels were as a result of changes in acceptance coping, mindfulness and improved self care instigated by the ACT course.

[44]

Often someone who is suffering from stress, a mental or emotional disorder or have been newly diagnosed with a chronic physical condition like diabetes will find that sleep patterns are hugely impacted.

A research study conducted at the University of Calgary in Canada, found that a mindfulness based stress reduction course can have a significant impact on reducing sleep disturbance and improving sleep quality.

There was also a significant reduction in stress levels, mood disturbance and fatigue.


^[41]

The benefits of getting adequate unbroken sleep include:

• Increase tolerance and ability to cope with stress
• Decrease irritability and anger
• Clarity thoughts and judgements
• Improve memory
• Improve general health and wellbeing
• Increase energy levels
• Enhance mood
• 
  Lower blood pressure

The memory of the moment of the

diabetes diagnosis
is a profound one. Psychologists call it a ‘flashbulb’ memory, in which you can recall all the exact elements of the moment heard the news, with startling clarity.

Dealing with the diabetes diagnosis has been compared to the experience of grief.

This is the first psychological guide from Dr Jen Nash and is designed to help people to come to terms with their diabetes diagnosis.

What’s in this guide?

There are 3 parts to this guide on coping with diabetes diagnosis:

• 
  Part 1:
  
  Emotional impact of diagnosis and grief
• 
  Part 2:
  
  
  Ways of coping
• 
  Part 3:
  
  
  Using cognitive behavioural therapy

Emotional impact of diagnosis

The diabetes diagnosis can cause a grieving for your lost health, in the same way as you may grieve for a lost loved one. It is a natural human tendency to live life rarely thinking about our health or mortality.

And why should we, until something life-changing happens, such as being diagnosed with a chronic

health problem such as diabetes
Suddenly, you are hyper-aware that no life is without its limits.

Below is an outline of the stages of grief – do you recognise any of these descriptions in your feelings towards diabetes?

The 5 stages of grief

Below is an outline of the stages of grief – do you recognise any of the descriptions in your feelings towards diabetes?

• 
  Stage 1:
  
  Denial
• 
  Stage 2:
  
  Anger
• 
  Stage 3:
  
  Bargaining
• 
  Stage 4:
  
  Depression
• 
  Stage 5:
  
  Acceptance

You may not have experienced all of these emotions towards diabetes, or in this particular order.

Experiencing the emotions

However, I’m sure you can see the similarities between these thoughts about diagnosis, and thoughts you may have when faced when you lose someone close to you.

In fact many people fluctuate between these different stages for many years, getting stuck at denial, or between anger, bargaining and

depression, perhaps with small acceptances along the way.

The experience and after effects of diagnosis can resonate for a long time, so whether you are recently diagnosed or have had diabetes for many years, you may still be experiencing its impact. You can help yourself manage the potential difficulties better if you can recognise at which stage of the ‘grief’ process above you are currently in.

This is one of series of Psychology articles by

Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

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Do you ever reach the bottom of a packet of crisps or biscuits and wonder how you got there? Perhaps you’re someone who needs or would like to

lose weight, and know what you

should

be doing, but can’t seem to follow the seemingly simple advice to “eat healthier” given by your healthcare professionals.

The crucial concept to understand about comfort eating is that food isn’t just a source of fuel and energy for the body. Rather, food is intimately linked to our emotions.

Food and emotions are linked

The connection between emotion and food is one that is set down from birth – your mother soothed you with her milk when you were crying.

As you grew up, she gave you sweets to cheer you up after the upset of hurting yourself, or a biscuit when you got in from a hard day at school, or cooked you a roast 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.

Fast forward to the

diagnosis of diabetes
and you are suddenly required to cut down drastically on what you’re eating. Not only this, but there are potentially major health consequences if you don’t. Given what you’re read above, it’s hardly surprising that encouragement by healthcare professionals to cut down on fatty sugary food are not acted upon.

You know in your head what you

should

be doing, but it’s hard to break away from the pattern of food as an instant root to pleasure, distraction and satisfaction.

Changing the reason you eat

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 their 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.

So let’s take a look at what the psychological models teach us about how to break this pattern between

food
and emotions.

• 
  The most important step is to become more mindful of your eating behaviour
  
  A very practical strategy you can use to do this is to put a post-it note on the fridge, cupboard, in your wallet if you tend to buy it there and then – wherever you tend to reach for the comfort. Seeing the note itself may be enough to trigger a different response, or you might like to have a question written directly on the post-it. e.g. “Is the answer in here?”
• 
  What emotion are you feeling as you reach for the food?
  
  The emotion may be positive or negative – anything that stirs up strong feelings can be relevant. Start by labelling it, is it anger, sadness, fury, excitement, hurt, disappointment, excitement, sadness, triumph, boredom, loneliness, shyness, feeling unattractive, worthless? You might like to say to yourself, “I am…..” and fill in the blank. For example :“I am [insert emotion] at [insert situation/person/trigger for emotion] because [insert reason]”
• 
  What are your thoughts about what’s happened?
  

When it comes to why you are eating, ask yourself at least one of the following questions, or even all of them!

• Can food solve this emotion, or the problem that led to the emotion?
• Am I engaging in “compare and despair” – where I compare myself to others, which makes me feel bad about myself?
• Is there another way of looking at this situation?
• Am I getting things out of proportion?
• Am I mind-reading what others might be thinking?
• Am I engaging in black-and-white thinking?
• What advice would I give a friend in this situation?
• Am I putting more pressure on myself, setting up expectations of myself that are almost impossible? What would be more realistic?
• What do I want or need from this person or situation? What do they want or need from me? Is there a compromise?
• What would be the consequences of responding the way I usually do?
• Is there another way of dealing with this? What would be the most helpful action to take? (for men, for the situation, for the other person)
• Am I exaggerating the good aspects of others, and putting myself down? Or am I exaggerating the negative and minimising the positives? How would a friend see this situation? What’s the bigger picture?

After having done this exercise, you may still go ahead and eat the food – don’t beat yourself up for this!

Change takes time and by simply pausing and thinking about the reasons behind your actions you are making a great start.

At least if you eat this time you will be making the choice and doing it with your eyes wide open.

Soothing your emotions

You might like to think of some other way to dissipate or soothe these emotions – engage in a distracting and enjoyable activity, talk to someone about how you are feeling or write it down – whatever resonates for you.

Finally, next time you go to your diabetes

dietician
or doctor and they tell you to ‘lose weight’, perhaps you could share some of these ideas with them. Breaking out of the secrecy tied up in comfort eating is one of the most important things you can do.

By becoming aware of your emotions you can see that they have evolved to support and guide you. With time, emotions can become your friend rather than an enemy to be dulled with food.

This is one of series of Psychology articles by

Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

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Struggling to manage difficult emotions and lows connected to diabetes is very common for people with both

type 1
and

type 2 diabetes, those who are newly diagnosed and those who have been living with the condition for many years.

Many of the challenges of daily life with diabetes or

diabetes diagnosis
can cause a whole range of emotional reactions including anger, hopelessness, fear, worry, bitterness, frustration irritability, guilt and shame.

It’s natural to feel

low

sometimes!

These are strong emotions and are usually experienced as negative, and it is natural to feel ‘low’ when having to deal with these alongside diabetes.

Feeling ‘low’ or ‘a bit down’ is different from feeling ‘depressed’, however depression is very common among people with diabetes and is unfortunately, often overlooked or not easily spotted by

healthcare teams

Individuals with diabetes are twice as likely to experience depression as the general population. Coupled with this, it has been demonstrated that people with both diabetes and depression are far more likely to have poorer

blood glucose management

So why do people with diabetes become depressed?

The daily tasks of

managing diabetes
can be a huge challenge – juggling medication, injections, blood glucose monitoring, regular clinic visits along with all the usual stresses of life can put people with diabetes at real risk of developing difficulties with low mood.

Not everyone with diabetes develops depression – why is this?

Depression is caused by a combination of biological, psychological and social factors.

This means that some people are more prone to developing difficulties managing low mood due to their family background; for example a family member with depression; and early experiences, for example bullying or

lack of nurturing relationships

However, in addition to these psychological and social factors such as thinking styles, coping styles and the

level of social support
available also play an important role.

So what exactly is depression?

Depression is diagnosed when

5 or more of the following symptoms

are present everyday for more than two weeks; and they interfere with daily routines such as work, diabetes self-care, childcare or social life

• persistent sad, irritable or ‘empty’ mood
• loss of interest in activities once enjoyed, including sex
• significant change in appetite or body weight (gain or loss)
• difficulty sleeping, waking very early (feeling sad) or oversleeping
• feelings of worthlessness, helplessness, guilt
• decreased energy, fatigue, feeling ‘lacklustre’
• restlessness and irritability
• difficulty concentrating and remembering
• recurring thoughts of death or suicide

How many of these depression symptoms do you recognise in your own life? Although depression doesn’t just go away by itself, it can be successfully treated.

Cognitive behavioural therapy

Antidepressant medication can be useful, but research indicates that talking therapy, particularly

Cognitive Behavioural Therapy (CBT), either alone or in combination with antidepressant medication, is very effective in tackling the symptoms of depression.

CBT was developed by the psychiatrist Aaron Beck in the 1960s. It proposes that there are four aspects to parts to depression – thoughts; feelings, emotions and moods; behaviours; and physical symptoms.

Aaron Beck and the psychology researchers that followed him, showed that by changing any of the components above, particularly our thinking patterns, we can begin to make positive changes to our experiences of low mood.

All of us, with and without diabetes have thoughts that are sometimes unhelpful.

It is human nature to be self-critical to some extent; it evolved as a way of keeping us striving to do better (which, in the harsh days of ‘survival of the fittest’, kept us alive!).

Some types of thinking are less helpful than others

However, there are certain types of thinking that are less helpful that people with diabetes can often find themselves engaging in. Some of these are listed in the table below:

This is one of series of Psychology articles by

Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

Diabetes doesn’t just affect you. It can impact each of your close relationships, including your relationship with your partner, family and friends, and can even affect your sexual relationships.

Have you often thought about how those around you help or hinder your diabetes care?

Diabetes can of course cause worry and anxiety for the person with diabetes; but the irony is it can often cause even more in those around the person with diabetes than for the

diabetic
themselves.

This is perhaps because while the person with diabetes is occupied engaging in their diabetes self-care, those alongside them may be feeling there is little they can actually do to help – and therefore have no way to rid themselves of this anxiety.

Be aware of anxiety

This anxiety can express itself in a variety of quite contrasting ways.

The two most common are: feeling isolated and/or unsupported by those close to you or the opposite; feeling blamed or hassled by your family.

But have you considered that it may be anxiety that is causing them to react in these potentially unhelpful ways.

Do you recognise your situation in any of the following scenarios?

1. Perhaps they criticise you for
   
   being overweight, or berate you for not keeping good blood glucose control, which can feel very blaming.
2. Or possibly the opposite is true and your loved ones completely ignore your diabetes, leaving you feeling alone and isolated without the help you would like to support yourself.
3. Perhaps they seem to tell everyone you meet that “He/She’s diabetic,
   
   they can’t eat that
   ” drawing everyone’s attention to the ways in which you are ‘different’, when all you want to do is blend in like everyone else.
4. You may feel that those close to you are observing you at every turn – checking what you are eating and how much attention you’re paying to your
   
   medication
   and exercise regimes.
5. Or maybe they seem to feel the need to ‘advise’ you at all times – which can feel more like lecturing than helpful suggestions.

Whatever way diabetes is affecting your close relationships, here are my top tips to help you manage better.

Communicate

The first step in making a positive change in your relationships is to have an honest and

straightforward conversation with your loved one
In many situations in which diabetes is causing a strain on a relationship the problem doesn’t get talked about openly, and it therefore becomes a source of arguments or resentments.

If you and your loved one regularly argue about your diabetes, this may mean you need to think about what to say beforehand so it comes across as calmly as possible.

Arguments with your spouse can often lead to bad moods which then translate into the bedroom. If this happens,

lack of a sexual relationship
can become another issue between yourself and your partner.

Try stating what you are unhappy with in a matter of fact way. For example: “When you [describe what they say or do], “it makes me feel [insert emotion – upset, guilty, embarrassed etc]”)

Make clear that you realise they love you and are trying to help, but there might be more useful ways they can do so if you think about it together.

Ask for help

Be clear about what would be the best sort of help your loved one could give you. For example, perhaps they are criticising you for your need to lose weight, when what would be really helpful would be if you could learn how to

prepare healthy meals
together.

Or maybe they are nagging at you to

test your blood glucose
more, when what would really be helpful would be if they praised and encouraged you with a smile and a hug when they did notice you test.

Take personal responsibility

Are you being honest with yourself and taking personal responsibility for your diabetes self-care?

Often those around you may see that you are ‘sticking your head in the sand’ about your

diabetes care
and may feel at a loss to know what to do to help.

Nagging or hassling you may be the only way they know how to attempt to wake you up to the problem.

Perhaps you always say, “I’m fine” when

asked about your diabetes, even if it’s evident that all isn’t fine.

By being honest with yourself and those around you about what you are struggling with, you can begin to take steps together to improve your diabetes health, avoiding the need for your loved one to resort to unhelpful nagging behaviour.

Seek professional help

If you have implemented the steps above and are still struggling, think about

professional help
Often having a third, emotionally uninvolved person to listen and help you problem solve can really help you move forward together productively.

It may be challenging for one or both or you to keep calm or to see one another’s point of view when talking about diabetes, so seeing a family therapist or counsellor can really help you have useful conversations.

By implementing these steps, your

most important relationships
– with your diabetes and with your loved ones, will improve.

This is one of series of Psychology articles by

Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

For many people with diabetes, injections are simply a necessary part of life. Yet for many, both

newly diagnosed
and those who have been managing the condition for many years, the injection process can be very distressing.

But what turns a plain dislike of injections into a phobia? Well, a phobia is an irrational fear of a particular situation, which is exaggerated and cannot usually be explained away.

Dislike of needles

A small degree of dislike of needles is perfectly normal – most people would avoid them if they possibly could. But this fear is heightened in people with needle phobia, to the point where they cannot bear the thought of

injections

Needle phobia is common in the general population – some studies suggest the rate of occurrence is as high as 10%. When you consider that only 7% of the population have diabetes, it is evident that there are many people with diabetes out there having to contend with both!

Symptoms of needle phobia

The symptoms of needle phobia can vary greatly from one individual to another. The main feature is

anxiety

at the thought of injections, leading to avoidance of injections.

This may be associated with:

• feeling dizzy and light-headed
• a dry mouth
• palpitations
• sweating
• trembling
• over-breathing
• feeling sick
• even fainting

Why does it occur?

Although it can be difficult to be entirely sure what causes a phobia, the most common causes are thought to be:

• An upsetting experience of needles when young, for example, a painful procedure at the hospital or at the dentist
• A fear that has been ‘modelled’ by an adult close to the child, either through actual observation of their fear, or being told a story that implied injections and needles were very painful.
• There is also evolutionary value to a fear of needles. In the past, an individual with a fear of being stuck with a thorn or a knife was less likely to die in accidents or in encounters with hostile animals or other humans.
• Prior to the 20th century, even an otherwise non-fatal puncture wound had a reasonable chance of causing a fatal infection.
• So a trait that had positive survival value prior to the 20th century now has the opposite effect as it means people struggle to engage in valuable healthcare regimes.
  
  

How to cope

Gaining skills of relaxation and confidence is the key to making injections less painful. You will develop confidence over time and with practice, using a combination of relaxation and developing your own personal ‘Fear Hierarchy’.

• Create your own ‘Fear Hierarchy’ – a series of steps of actions that you could take to over come your fear. Write down a list of these, beginning with the least feared action and progressing to the most feared. The first could be something you find relatively easy, e.g. perhaps watching someone else inject.
• Rate your fear associated with each of these on a scale of 0-10, where 0 is no fear at all and 10 is the most fear you could possibly experience.
• Use the relaxation exercise described below as you engage in the feared activity and continue to practice it on a number of different occasions until you can do it with a fear level of 3 or below. Then move onto the next step on your fear hierarchy.

Try the following relaxation exercise:

• Sit comfortably in a chair
• Close your eyes
• Take a slow, deep breath in so your lungs are full
• Hold this breath for the count of 3 seconds
• Breathe out as fully as possible for a count of 5 seconds
• Repeat this sequence for two more breaths
• Open your eyes and notice any subtle differences in how you feel, both in your body and your mind
• With a bit of practice, over time you will be able to notice a feeling of relaxation
• Once you feel comfortable with the technique, begin to practice this when you are working through your fear hierarchy

Examples of Fear Hierarchy steps could be:

• 
  Hold the insulin syringe
  or pen in your hand until you don’t feel any anxiety.
• Practice drawing up the correct dosage of insulin until you no longer experience fear.
• Act ‘as if’ you are going to inject, without actually doing so
• Inject (perhaps into the stomach first as many people find it less painful as there are few nerve endings there)
• Inject in other parts of body – thigh, buttock – also known as
  
  alternate site testing
• Inject in different geographical locations– at a friend’s house, in a restaurant, on a train.

This is one of series of Psychology articles by

Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

Many people with diabetes are fearful about some aspect of the condition – scared of medication, implementing new health regimes, starting new behaviours and routines, ending old ones and this is just the day to day challenge of living with a chronic health problem.

What about those fears that float and linger about the future – the possibility of developing long term complications?

These can often be the worst, but also often the least voiced. They are so intangible – we seem to know of people who develop none at all, whilst others are hugely affected by them. There can also be a sense of injustice.

So what are long term complications? Diabetic retinopathy, blindness, loss of sensation in hands and feet, kidney damage are amongst many of the possible

diabetic complications
But once you know what you’re dealing with, what can you actually do about the daily worry? Here are my top four strategies for dealing with it:

Educate yourself about the actual risks of developing long term complications

Yes

people with diabetes

do

develop long-term complications; some for seemingly no good reason – and this is, like many aspects of health; unfair.

However, newer, more refined medicines for both

type 1
and

type 2
are being developed all the time, along with more advanced technologies for dealing with it – continuous

blood glucose monitors, insulin pumps, at home blood pressure monitors and still more to come.

The future is brighter for all of us (both with and without diabetes) as the medical field advances.

Did you know that the first

insulin treatment
‘guinea pig’ in 1922 – Elizabeth Evans Hughes – lived well in to her seventies. Just imagine how far insulin has advanced since then!

Allow yourself to think about your ‘hidden’ thoughts about diabetes risks

Yes there are health risks with diabetes, but there are risks you take with your health every day. Don’t believe me? Have you ever been in a car on a busy road? Taken a flight? These are behaviours with odds that you may well not return home that day. Seem unlikely? Perhaps they are – but then people are in road traffic accidents every day.

So yes, there are

risks with diabetes
but living a full life also includes elements of risk taking, so do your best to keep these in perspective.

Remind yourself of the actual facts

For somen, the identification of the first sign of long term complications can lead to a feeling of impending doom – with the person feeling certain that they are now going to be on a downward trajectory of ill health.

However, in many cases the opposite can be true, the

diagnosis of a particular complication of diabetes
can bring a fresh motivation to care well for one’s health – especially given that changes to health behaviour can seriously halt if not

reverse
some complications.

Remind yourself of this, perhaps with a supportive statement written in your diary or on your computer screensaver where it will remind you often – “Every time I choose to make a wise health choice I am moving further away from developing complications”.

Focus on what you can control – good diabetes self-care

One of the most effective health increasing tools you have at your disposal is a feeling of self-control.

This is because it puts you in a position of power – that you

can

make changes that will lead to better health outcomes.

This might be exercising more, making a healthier food swap, testing your blood glucose once more per day than you currently do, making that

healthcare appointment
you’ve been putting off for ages.

Although a low level of fear can be helpful, in that it can keep you motivated – knowing that you can take positive action, and that your actions do matter – is an incredibly good antidote to fear.

Use the information and support available here on the forum to help you focus on what

is

controllable, and your conscious and hidden fears about the long term

effects of diabetes
will diminish.

This is one of series of Psychology articles by

Dr Jen Nash, a Clinical Psychologist who has been living with type 1 diabetes since childhood.

Anxiety can be defined as a fear-based mental state, normally felt as a discomforting emotional state accompanied with physical sensations in the body.

Anxiety based mental disorders (i.e. people diagnosed with SAD or GAD) are people who appear anxious about almost everything.

This has a detrimental effect on their ability to carry out normal day to day activities.

What are the symptoms of anxiety?

Symptoms include excessive worry and unnecessary anxiety for numerous activities with symptoms being present and continuous for a minimum of 6 months.

Anxiety is difficult to control and is accompanied by somatic symptoms including:

• Shaking
• Heart palpitations
• Excessive perspiration
• Crying

Often it will be a state of mind that is reached after years of dealing with the condition.

People diagnosed with diabetes are approximately 20% more likely to suffer from anxiety than those without diabetes.


^[33]

What are the causes of anxiety?

Being diagnosed with diabetes can instigate anxiety in a number of ways.

People with diabetes may potentially be anxious about how their condition will be perceived by others including friends, family and work colleagues.

Anxiety may also arise over what could happen if they were

experience a hypo
while driving or whilst looking after their children.

Excessive worrying can lead to social anxiety.

Symptoms of social anxiety include

• Being fearful of leaving the house or place of comfort
• Anxiety of being around people, known or strangers
• Avoidance of social interaction

Why might I be anxious?

People diagnosed with diabetes may be anxious about the long term implications of their condition.

Greater than 70%, of diabetics could develop macrovascular conditions including heart attack and stroke. Furthermore, between 5% and 10% are reported to experience microvascular complications ranging from problems with eyes, limbs and kidneys.

Additionally people with diabetes may experience excessive worry about death, what would happen to them, their family and loved ones.

In most cases of type 2 diabetes, there is often anxiety

regarding weight
and diet. It is widely publicised that being overweight can be a cause of the condition, therefore as well as anxiety of how to control weight and diet, emotions such as guilt and anger may also occur.

How can I avoid anxiety?

Appropriate stress management may be key to avoiding conditions such as anxiety. Relaxation techniques include:

• Breathing exercises
• Yoga
• Tai chi
• Meditation
• Self-hypnosis

Relaxation methods such as the ones listed above are all be effective in relieving stress. Mindfulness based training in combination with diabetes management are proving an invaluable approach to aid the process of acceptance, while alleviating anxiety and stress.

Research conducted at the psychology department at Stanford University used brain imaging technologies to examine the effect of mindfulness training on social anxiety. They reported that participants who completed the mindfulness course showed reduced symptoms of anxiety and depression and demonstrated an enhanced self-esteem.


^[34]

Mindfulness practices help to adjust the relationship one has with their panic and anxiety with acceptance, compassion and awareness.

This methodology has been shown to be significantly more effective in the long term. It has been scientifically proven to enhance quality of life and allow the practitioner to develop a disassociation with panic and anxiety, meaning they no longer need these states to define who they are or how they live their lives.


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