Many people living with diabetes are frustrated by the amount of time they spend dealing with diabetes-related problems. And, of course, they have other problems in their lives unrelated to diabetes as well. Whether they pertain to relationship struggles, anxiety, depression or work stress, people with diabetes have the everyday struggles other people have, compounded by the difficulty of managing a chronic disease. This situation is equally true for many parents of children and teenagers with diabetes. They are managing busy work lives and taking care of their families, all while trying to achieve the impossible task of being someone else’s pancreas.
As a clinical psychologist with Type 1 diabetes, I see many people with diabetes in my practice. Sometimes we focus on diabetes-specific issues like anxiety about hypoglycemia or the grief related to diagnosis and/or the development of complications. Other times we are discussing seemingly unrelated issues, such as a recent divorce or difficulties at work. However, what I often point out to my patients is that diabetes impacts most aspects of our lives, and the different milestones or events in our lives also impact diabetes management.
This creates a great deal of psychological distress. It is no surprise to me that here in Canada where I practice, a study about the psychosocial impact of diabetes indicated about 1 in 4 people with Type 2 diabetes experiences diabetes distress or depression. This was even higher for those with Type 1 diabetes, with almost 1 in 2 people experiencing distress or depression (1).
Stress has a huge impact on diabetes management. It can directly impact blood sugars by raising cortisol levels and spiking adrenaline, and it also impacts our ability to correctly navigate all the decision-making that is required of us day after day, minute to minute. I often say to people, speaking not so much as a psychologist but as a human being who has learned the hard way, “You have to make space in your life for diabetes.” Those who are constantly in a hurry will struggle to safely handle the dangers of walking a blood sugar tightrope.
So how do we create space without sacrificing the pastimes, jobs, relationships and responsibilities that we value in our lives? It is all about developing resiliency. I often describe resiliency as being like the strength of a rubber band versus a brick wall. We can bend without breaking. Sometimes, as people living with diabetes, or as health care professionals helping them, we need to step away from our problems and look for the strengths that are already present. Health care professionals or parents who feel stuck while trying to help someone with diabetes need to look for the self-righting capacities that are already present. Search for qualities and strengths that help manage diabetes. Teach people to be resilient in the face of the problem, even when we cannot solve the problem.
For example, a teenage boy who claims he is way too unorganized and lazy to manage his diabetes properly may show contrary evidence in the way he practices his guitar every day, or keeps his car perfectly clean. A young girl who feels guilty about her inattention to blood glucose testing and defensively claims she just “doesn’t have time” may soften when her parents praise her for her diligence in studying, but point out that she can apply some of that dedication to her diabetes.
The way to use this strength-based approach is not to guilt anyone with the contradiction between diabetes management and attention to other problems in their lives. Whether you are providing this shift in thinking to yourself or helping someone else living with diabetes, always focus on compassion and positive affirmations. Parents who seek to affirm many strengths for their children with diabetes have been shown to help these young people to both feel better and improve glycemic control (2).
Here are some tips to incorporate a strength-based approach in your life as an individual or a family:
1. Seek to retrain your brain to notice more of the positive things you do. You can even keep an affirmation journal that notes the positive contributions you have made at work or at home. Give yourself credit for something small you did in your day. For example, it could be eating a healthy meal or spending quality time with your family. It doesn’t have to be diabetes-related. Feeling good about what you’re doing will help you do something else positive, and that will likely end up being good for your diabetes in some way. As we said before, every area of our life tends to impact diabetes. Generally, positive changes will lead to positive effects on our diabetes.
2. Apply more self-compassion in your life. In other words, treat yourself with the kindness you would show a close friend or a small child. There are plenty of opportunities every day for people with diabetes to criticize themselves. Instead, try to acknowledge that diabetes is hard and be kind to yourself about having to deal with it instead of blaming yourself for the imperfections. Being mindful and accepting of blood sugar fluctuations can help a great deal to improve blood sugar control. It does not mean giving up on your diabetes, it actually frees up your energy to focus on what is within your control.
During an episode of “The Edelman Report,” Steve Edelman interviewed Dr. Bill Polonsky about research that shows that being kind to yourself reduces diabetes distress and depression and reduces A1C (3). You can read more about self-compassion as described by Kristen Neff, one of the founders of the approach at www.self-compassion.org. She not only provides exercises and guided meditations, but corrects many of the faulty concerns people have about self-compassion leading to self-indulgence or losing their edge.
3. If you are a parent of someone with diabetes, make a point of sharing affirmations with your child. This can be done verbally, via text, or any method that works for you. This can help boost your child, and will also lead to you feeling good as you amplify the positive moments in your family life by taking an extra moment to appreciate how nice it is to see your son help his younger brother with his homework or the way your daughter hugged you as she left for school.
These are just a few ideas to help in building resiliency. For more support, try reading Option B by Sheryl Sandberg or for true inspiration read “Man’s Search for Meaning” by Vicktor Frankl. Frankl was a survivor of the Holocaust and a psychiatrist. One of my favorite Viktor Frankl quotes is: “When we can no longer change a situation, we are challenged to change ourselves”.
References
- Vallis, M., et al. Diabetes Attitudes, Wishes and Needs Second Study (Dawn2): Understanding Diabetes-Related Psychosocial Outcomes for Canadians with Diabetes. Can J of Diabetes 2016; 40 (3): 234-241.
- Jasser, SS, Patel, N, et al. Development of a positive psychology intervention to improve adherence in adolescents with type 1 diabetes. J Pediatr Health 2014; 28 (6): 487-485
- Friis AM, Johnson MH, et al. Kindness matters: A Randomized Controlled Trial of a Mindful Self-Compassion Intervention Improves Depression, Distress and HbAIC Among Patients With Diabetes. Diabetes Care 2016.
I think resiliency is the key to living period. But when living is combined with a chronic illness it is essential.
Absolutely!