Building resiliency: the path to living well with diabetes
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 living with Type 1 diabetes myself, I counsel 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. Since all the different challenges, milestones and events in our lives also impact diabetes management, these other issues are really important to address in therapy.
Living with chronic illness creates a great deal of psychological distress. However, diabetes is unparalleled in terms of the burden on the patient (or caregiver/ parent). In order to manage it well, it requires near constant attention. Improved technologies are helping those who have access to them. We see better results. However, the required focus on diabetes and constant behaviour management is still very onerous and can even drive anxiety by raising our expectations of better and better results.. 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.
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. Keep an affirmation journal that notes positive behaviours throughout your day, whether related to diabetes or other areas of your life. Give yourself credit for all efforts, even if the outcome doesn’t meet your expectations. For example, it could be eating a healthy meal, even if blood sugar did not cooperate. 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. So try to record 3 affirmations a day and see what happens to your thoughts and mood!
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.
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’s mood, 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 daughter laugh with her sister, or your son tidy up the kitchen. The big accomplishments like an improvement in A1C are wonderful to celebrate, but notice the small moments too! Many young people with diabetes resent the pattern of people asking about their diabetes when they walk through the door, reflecting that they feel like medical teams or parents forget about them as human beings before their disease.
4. Consider reaching out for professional help! Whether you just need a few sessions or you choose to develop a long-term therapeutic relationship, our team is here for you. We specialize in helping people with diabetes. You can meet us in person in the Ottawa area, or by telephone or video-conferencing if you are at a distance. Call 613-614-4236 or email firstname.lastname@example.org for more information.
By Michelle Sorensen, M.Ed., C.Psych.
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