Dr. Jen's Diabetes Diary

Dr Jen Nash, Clinical Psychologist, www.PositiveDiabetes.com

With Valentines Day fast approaching, your thoughts may be turning to your
nearest and dearest. Have you considered how your diabetes is affecting your
close relationships – with your spouse, partner and those in your wider family
network?

Diabetes can cause a great deal of anxiety – often a lot more in those
around the person with diabetes rather than the diabetic themselves. This is
perhaps because while the person with diabetes is busy taking the lead with
their diabetes self-care, those alongside them are left with nothing they can
actually ‘do’ – and no way to discharge this anxiety.

This anxiety can express itself in a variety of quite contrasting ways. The two
most common are:

feeling blamed or hassled by your family; or the opposite
feeling isolated and/or unsupported by those close to you

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.

Perhaps they criticise you for being overweight, or berate you for not keeping
good blood glucose control, which can feel very blaming. Or maybe they
seem to feel the need to ‘advise’ you at all times – which can feel more like
lecturing than helpful suggestions. Or 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. 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.

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

1. Start talking

For most people for whom diabetes is causing a strain on a relationship the
problem doesn’t get talked about in an open and straightforward way, rather
it becomes a source of arguments or resentments. The first step in making a
positive change is therefore to have a frank and honest conversation and get
things out in the open. 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. Try stating what you are unhappy with
in a matter of fact way (e.g. “When you…..describe what they say or do, “it
makes me feel…..insert emotion – upset, guilty, embarrassed etc”) Make
clear that you don’t want to blame them, rather 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.

2. Tell them how to help you

Be clear about what you really want and need from your partner. For example,
perhaps 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. Or perhaps they are berating
you for your need to lose weight, when what would be really helpful would
be if you could learn together how to prepare healthy meals, perhaps by
researching some cookery books or going to a class together.

3. Examine the part you are playing

Are you taking 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 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. Out of love and worry the person close to you
wants to help you to change. 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.

4. Seek professional help

If you have implemented the steps above and are still struggling, perhaps
because it is difficult for one or both or you to keep calm or to see one
another’s point of view when talking about diabetes, seeing a family therapist
or counsellor can really help you have useful conversations. Often having a
third, emotionally uninvolved person to listen and help you problem solve can
really help you move forward together productively.

By following these steps above, both your relationships with those close to
you and your relationship with diabetes will improve for the better. Now the
only thing left to do is figure out how to spoil your loved one this Valentines
Day!

How did you get to be a diabetes psychologist?

Hello and welcome, I’m Dr. Jen Nash, I’m a Clinical Psychologist and was diagnosed with type 1 diabetes at 6 years of age. To answer this question I’d like to share a little of my story. Over the years of life with diabetes I have experienced a range of difficult emotional – stress, frustration, depression, denial, eating difficulties, worry about long term complications, guilt of not doing things ‘right’, fear of hypoglycaemia, shame and fear about being different, denial, embarrassment and more. I’m guessing you may have experienced some of these too.

Each of these experiences, in their own way, negatively impacted on my capability to care for my diabetes to the best of my ability. None of these were things that I felt able to discuss with my health care team, as committed and dedicated as I know they were. I felt incredibly alone, and simply buried my head in the sand and thought “I’m fine now…I’ll think about this on another day”. But of course, like most things that we put off until tomorrow, that day never did seem to come.
But thankfully a shift finally started, soon after I qualified as a Clinical Psychologist. I realised that there are actually some very simple, practical and pragmatic tools that could have helped my psychological well-being if I’d have known about them. These weren’t particularly new or groundbreaking ideas, but the potential impact they could have on my life and my health, both physical and psychological – would be.
So I started putting them to use in my own way. Some of them worked brilliantly, others not so well, some took time to learn and implement, others I could make use of and see the result straight away. I was excited about this. I wanted to share these ideas with others. But I didn’t know one other person with diabetes! Incredible, isn’t it?! I’d shut myself away for so long, trying to do it all by myself and pretending it wasn’t really such a big deal anyway, that I was completely isolated with it all. I decided this information was too good to keep to myself. I realised that although there are a handful of Clinical Psychologists and Nurses out there helping those with diabetes with more extreme distress, there was no one out there addressing the psychological needs of those everyday people with diabetes in a systematic way. So I decided to do something about this.
I set up Positive Diabetes with the commitment to help other people with diabetes have access to the knowledge and information they need to bring about positive improvements to their health and wellbeing.

Since then I’ve been fortunate enough to work with many people with diabetes, spoken in front of a wide range of audiences and have created the “Positive Diabetes System”, a series of steps every person with diabetes needs to apply to achieve increased diabetes health and wellbeing.
Who are your clients?
I work with people just like you who want to gain control over their diabetes. Specifically, I work with individuals with type 1 and  type 2 who want support with issues such as:

• Dealing with diagnosis
• Weight loss – how you may be sabotaging your weight loss efforts
• Increasing Motivation – you have more that you think! I’ll teach you to tap into yours
• Depression and low mood – you are twice as likely to suffer from low mood than someone without diabetes – I’ll help you to improve your mood and wellbeing
• Implementing health regimes
• Eating difficulties – is food your drug of choice? I’ll help you beat eating addictions and other problems with food
• Anxiety – about long term complications, using needles or seeing healthcare professionals, or simply dealing with life with a chronic health problem
• Dealing with guilt and shame – of not being a ‘good’ diabetic, or simply of having diabetes in the first place
• Implementing healthy routines – step by step instructions of how and why to do this
• Sexual difficulties – for many people, diabetes enters the bedroom – I’ll help you how to manage the impact of diabetes on your sex life.
• Communicating with health care professionals – I’ll teach you my ABC of effective communication and how to get the most out of your health team
• Managing the impact of diabetes on the family – whether they provide too much help or too little, I’ll help you problem solve so your family can be the support system you really need

What happens if you haven’t yet worked with someone with my difficulty?
I have worked with many clients with a wide range of difficulties, so most likely I have worked with people with at least a similar experience to yours.

However, every person’s experience is unique, so if I haven’t worked with someone like you are not at a disadvantage. An important aspect of being a Clinical Psychologist is being able to be flexible in my approach – my Doctoral level training enables me to work with a range of presenting conditions within individuals across the life span. I use a number well-researched and evidence based varying psychological models, such as cognitive behavioural therapy, narrative therapy, solution focussed approaches and psychodynamic models.
How are you different from other healthcare professionals I work with?

Although I may work with you on similar issues to other health professionals, e.g. nutrition, implementing exercise routines etc, I will take a psychological approach to your difficulties. So, what does this mean in practice? Many times, people with diabetes go to see their Dietician or other health professional and know what they should be doing, it is their mindset and emotions (their psychology) that are holding them back from implementing these. A practical and common example is that your goal is to lose weight, and your Dietician advises you to cut down on evening snacking, but you find yourself feeling unable to resist the crisps or chocolate, it is likely that a Psychologist is well placed to help you. I can help you to uncover the reasons why you feel you ‘can’t resist’, gain insight and we can work through a programme to change your behaviour.
This is just one example of the ways I can help you. Through my personal experience of diabetes and of working with many other people living with the condition, I’ve become very experienced at this and that’s why my clients get results (and I throw in a healthy dose of compassion, humour and encouragement, which ALWAYS helps!)
What type of personality do you work best with and what is expected of me?

The Positive Diabetes programmes were created for people with diabetes who would like to end the feeling of struggle and being out of control with their diabetes. They were created for you to implement proven and evidence based psychological strategies which will lead to you gaining a powerful sense of control over your diabetes.
However, it is important for me to say from the outset that these programmes are not a ‘magic want’ to ‘cure’ your struggles. Like all personal change, they require you to invest time and effort. Think of yourself as a ‘co-therapist’ who is working with me in partnership to implement the insights you will gain for improvement in your health. You are an expert in your own lived experience of diabetes, and I have experience of psychology applied to diabetes. Together we can combine these two valuable sets of expertise for your benefit.
Does this really work?

Clients who have used the Positive Diabetes programmes gain a fresh approach to their diabetes that, over time and with their dedication, allows them to gain control of their diabetes and their health, simply and consistently. The insight you will gain into the emotional basis for your behaviour will enable you to finally work with your diabetes, rather than against it.

The Positive Diabetes programmes involve taking a psychological and emotional approach to your diabetes difficulties. This involves looking at your struggles with diabetes using one or more of the following evidence based psychological approaches:

Cogntitive Behavioural Therapy – This involves examining the role of your thoughts (cognitions) on your unwanted emotions and behaviour towards diabetes. In becoming more aware of your thinking patterns, we can begin to evaluate which are more and less helpful to you. We can begin to replace the less helpful ones with thoughts that are more empowering and move you forwards towards positive change in your health and wellbeing.
Narrative Therapy -We each have our own unique ‘narrative’, or life story, of who we are and how we exist in the world. When there is something in our life we want to change, it can be helpful to externalise this and begin to think about the different strands of an alternative narrative. What would the person embodying this new narrative say, how would they behave, who would they choose to spend their time with, how would they use their time? By imagining this future desired you, you can begin to move yourself closer to this reality.

Systemic Therapy  -Systemic therapy focuses on you in relation to those in your ‘system’ e.g. their networks of family, friends, work colleagues etc. Difficulties in life are deemed to be an expression of a difficulty located in the system, rather than the individual. By making changes to how you relate to those in your system, you can begin to related differently to others and instigate positive change in your life.

Solution Focussed Therapy – Rather than focussing on your difficulty, we look at the exceptions to the problem: the times in which life is a little better, or the problem isn’t affecting you quite so much. For example, what is different on days when you make healthy lifestyle choices? Who are you spending time with, not spending time with, what activities are you engaging or not engaging in etc. By focussing on what is different about these experiences, you can begin to become aware of what factors in life are contributing to the problem and it’s resolution, and therefore increase your implementation of appropriate and empowering solutions.

Psychodynamic therapy  – A psychodynamic approach deems the relationship between the psychologist and the client to be an opportunity to observe the ways in which the clients relates behaviourally and emotionally to people in their daily life. The way we interact with others is formed through our earliest relationships, which may have served us well in the past, but which may now be outdated. For example, using a psychodynamic approach can help us examine the function of eating behaviour/comfort eating as an emotional soother, or a way of stabilising difficult emotions, which is often related to early experiences and relationships with care givers. Gaining awareness of your emotional response to events in your life can help you better deal with distress and the stresses of life.

What results can I expect?
The goal of working with the Positive Diabetes programmes is to gain a new, psychologically informed insight into your diabetes care. You will identify the barriers that are preventing you from achieving better control over your diabetes. This may be achieving improved blood glucose control, implementing a healthier diet, exercising more, losing weight, giving up smoking etc. You will learn the practical actions you can take right away to put an end to feeling out of control with your diabetes. Further, you will discover how your thinking and emotional patterns have a profound impact on your experience of diabetes-related stress and by paying attention to these, you will gain a powerful sense of personal control over your physical health and psychological wellbeing.
How quickly can I expect results?
The answer to this question depends very much on the nature of your difficulty with diabetes, how long you have been struggling with it and how much you can commit to the therapy option you choose. That said, virtually all clients can expect to gain insight and support in the very first session of a Positive Diabetes programme.
Jen, based everything I’ve read and heard about you, I know you’re the one I want to learn from. What are my options for getting started with you?
Congratulations on making a decision for success! I am so happy to work with you to achieve greater diabetes health and wellbeing.
To get started with gaining increased control over your diabetes, here are the different programmes I have created to help you:

1. We highly recommend that you start with the self-help ebook, ‘Diabetes De-Stress’. It is a great introduction to the basics you need to teach you step-by-step exactly what to start doing – and stop doing – in your diabetes care, in order to consistently feel more in control of your health.
2. With your purchase of ‘Diabetes De-Stress’, you automatically receive 1 free months membership of the popular Positive Diabetes Support System. This includes two audio or video training session each month with an accompanying PDF ebook of the transcript. After the first trial month, members continue to automatically receive support from me at a low monthly fee, unless you tell us otherwise. This is a really affordable way to achieve support with getting your diabetes in control. .
3. If you would like personalised, bespoke support you can take advantage of  Positive Diabetes Private Consultation by working with me personally over the telephone. I offer three levels of individual programmes:

• Bronze Consultation: one 50 minute telephone session per month with accompanying workbook
• Silver Consultation: two 50 minute telephone sessions per month with accompanying workbook
• Gold consultation: Four 50 minute telephone sessions per month with accompanying workbook

These are three-month programmes, where we identify your top challenges with diabetes and work together to overcome them. Depending on the precise nature of your difficulties and goals, I will work with you to create an individualised programme for you to overcome your diabetes struggles with my one to one personalised support.

Ok, I know which option I want. How do we get started?

Great! Did you know that one of the most prominent characteristics of successful people is that they take action? They are decisive, take action and they move forward towards success faster as a direct result of this. These people often make decisions bases on their gut instinct. So, that being said, since this feels right for you, then go for it.
Here’s what to do: to find out more about private consultations, just give my support team a call at (+44)7737 169 429 or email us at info@positivediabetes.com and we’ll send over the consultation fees and be happy to answer any question you have.

I can’t wait to meet you in person or on the phone to get you started on your path to more control and peace of mind over your diabetes health.
If I’m not sure I’m ready to get started, how can I sample your work at low cost to see if it’s the right solution for me?
A way to sample the Positive Diabetes approach is by subscribing to the weekly email newsletter. This provides you with proven tips, the latest tools and powerful techniques from my Positive Diabetes programmes. It is a must for anyone who wants to begin to gain control over their diabetes health. Sign up on the homepage, www.PositiveDiabetes.com
Ok I’m ready to do this for myself, but I have a couple of additional questions. Can I call you?

Yes, I’d be happy to. If you have any questions just email my team at info@positivediabetes.com or call us directly on 07737 169 429. We’ll be happy to walk you through the different options to see which one will be the very best for you.

I can’t wait to help you overcome your difficulties and see you succeed and I’m honoured to be the one to help you!

Something that I hear time and time again in my work with people with diabetes is, “I have no motivation”.

They know what they should be doing to care for their health, but they can’t seem to summon up the how.

So when I tell them, “You are one of the most motivated people I have ever seen” – they tend to stare at me in complete disbelief!

But then I explain.

They are motivated to do all sorts of things in life.

Watch their favourite TV show. Eat a delicious meal in the company of loved ones. Sleep late on the weekend. Spend a day pursuing an enjoyable pastime or hobby.

I bet there’s not a single person reading this who finds that the concept of ‘motivation’ enters their mind when they are thinking of doing these fun activities! In fact, if you are anything like me you are raring to go and experience the enjoyable feelings that these activities bring you.

So the crucial difference with these things is that they are a short-term route to good feelings – which health-promoting activities such as exercising, eating healthily or testing your blood often aren’t, especially when you are just beginning to engage in them.

No one feels motivated to do something if the costs seem to outweigh the benefits. Go to the gym in the evening or curl up on the sofa watching TV? I’m sure you can see what I mean!

So the secret with motivation is to link the activity that feels like a challenge with one that feels easy. You could:

• Plan your exercise so it’s immediately followed by watching your favourite TV show.

• Make the doctors appointment you’ve been putting off for months and visit your favourite museum or gallery afterwards.

• Test your blood glucose and then phone a friend you love to chat with straight after.

By pairing the “not so fun” with the “fun”, you’ll reward yourself today, while building up health and vitality for the future.

To find out more about the concept of motivation and how to increase yours, you might be interested in the self-help guide, ‘Diabetes De-Stress’ – find out more here: http://positivediabetes.com/diabetes_book.html

It includes a set of simple, well-researched techniques based on cognitive behavioural therapy -  that can help you meet the challenges of your diabetes self-care regime with fresh enthusiasm and motivation, increasing your health and wellbeing.