The Emotional Side of Diabetes

0:03 [Music]0:13 hello thank you for joining us today my name is Muhammad najib ashra uh najib and I'm pleased to be here today talking0:20 to you all as someone who has been living with type 1 diabetes for over 33 years and a patient advocate for people0:26 living with diabetes the topic of mental health is very essential I was unaware of the condition when I0:32 was first diagnosed as a child it took a toll on me when I could not perform regular activities which I could before0:39 diagnosis the questions were too many but at that age science was not so Advanced for me to be guided effectively0:46 or helped in any way except with my family's support I've lived struggles daily since then to reach a stage where0:52 I can now make a difference in mine as well as others people's life how I stay0:58 tuned to my mental health while living with diabetes is simply by acknowledging and accepting that there is some1:03 challenge or obstacle that they need to work on and ignoring is no sign of strength being aware of what your body1:10 is communicating with you is an essential first step towards tackling this giant of mental health the thing1:16 that I find most helpful in managing my mental health is selft talk and a cluster of activities I term ambitious1:24 it stands for accept acknowledge being inquisitive talking or Comm1:29 communicating optimistic and seeking support when needed thank you for listening to my1:35 short journey and with that it's my pleasure to introduce our keynote speaker Dr Jessica kishler who will1:41 speak to us about the emotional side of diabetes including distress burnout and self- advocacy Dr kitler is a clinical1:49 and health psychologist and associate professor in the department of psychology at the University of Viner1:55 she specializes in clinical intervention research and psychosocial adjustment M and coping with type 1 diabetes in Youth2:02 and families she worked as a diabetes psychologist and certified Diabetes Care2:08 an education specialist at two academic medical centers Children's Hospital of Wisconsin and Cincinnati Children's2:15 Hospital Medical Center in the United States for almost 15 years before moving to Viner Ontario in2:22 2020 currently her interest lies in supporting college aged students with type 1 diabetes most effectively2:29 transitioning into young young adulthood she's also involved in diabetes education practices and appreciates2:35 working collaboratively in inter disciplinary settings and with that over2:41 to you Dr gisha hi everyone welcome to the emotional side of diabetes distress2:46 burnout and self- advocacy my name is Dr Jessica kitler and I am a a clinical and2:52 health psychologist at the University of Windsor and an associate professor in the department of psychology I'm also a2:59 certified diabetes IES care and education Specialists um registered in the US and I'm looking forward to um3:06 presenting a little bit today um about mental health and diabetes and how they3:12 intersect this is my disclosure slide um so these are the following for-profit3:18 and non-for-profit organizations that I've had affiliations with over the last two3:24 years and I want to jump right into the three objectives I'd like to cover today in our time together so the first3:31 objective is to really understand the diabetes and mental health clinical practice guideline updates from 2018 to3:41 2023 and then the second is to um learn a little bit more about how the emotional side of your Diabetes Care um3:49 Can impact um your medical care and your interactions in the healthcare3:54 system and then number three I want to um spend some time on advocacy and3:59 learning how to advocate for your own emotional needs within the framework of these new clinical practice4:06 guidelines so like I mentioned before um our first objective is to understand the updates to the diabetes mental health uh4:13 clinical practice guidelines um abbreviated cpg so if you hear me say cpg it it refers to clinical practice4:21 guidelines the last um version was in 2018 and we just published the most4:27 recent version in 2023 and basically what the clinical practice guidelines um it's put out by diabetes4:34 Canada and published in the Canadian Journal diabetes and this is a framework of recommendations and best practices4:42 for the Health Care system in um treating and working with individuals who have all types of diabetes and so4:50 each of the um clinical practice guidelines has chapters and there's one chapter dedicated to diabetes and mental4:56 health this last chapter was last updated in 2018 and so being that it's been 5 years5:03 it was time to do some updates um to those clinical practice guidelines so we5:09 had a expert working group um that was filled with psychiatrists community5:14 members endocrinologists psychologists um Family Physicians um and a wide U variety of5:21 people who have specializations in type 1 type two children adults um and5:26 bringing all of their expertise at the table to really update uh the guidelines5:32 from 2018 so this is a brief timeline of when we started to establish ourselves5:37 in March of 2022 and all of the different steps we went through to have5:43 um an Evidence review and synthesis team over at McMasters um our writing time we5:49 presented at diabetes Canada's professional conference last November and then it was published in June 20235:57 so given that that was a couple of uh months ago I wanted to spend some time talking to you about um these clinical6:05 practice guidelines and how they impact you and how you can expect your diabetes um care to change or to be enhanced um6:14 especially on the emotional or the psychological side of your diabetes so just as a quick big picture6:22 summary um we reorganized this chapter it was a major overhaul into 14 key6:27 messages for people with Di I abetes so we're not we don't have time today to go through all 14 of them what I have done6:35 here is i' I've put in bold um the sections that were new and newly added6:41 from 2018 to to now so that was stigma associated with diabetes financial6:46 burden and Co 19 and then I underlined the um the sections that were heavily um6:52 increased and improved and enhanced and that was diabetes and pregnancy substance use and diabetes and the use6:58 of psychotropic medications or medications for psychological issues like depression and anxiety and and um7:05 the intersection between those medications and diabetes management so7:10 um this clinical practice guidelines is available um on the Canadian Journal of7:16 diabetes website um it is open source you can go and do a deeper dive into7:21 this but what we're going to do today is I highlight I'm going to highlight um a little bit on the section on living with7:28 diabetes and the emotional side of diabetes so we can talk a little bit more about strategies that you can use7:34 to help um you live your best life with diabetes and then we'll shift over a little bit into stigma associated with7:42 diabetes and the financial burden of diabetes just to really understand how these two um situations can really7:49 impact your distress um with diabetes so that's where my focus is going to be but7:54 please um now that you know the cpg updates are out there please go download them go look at them go read them8:01 they're long um but there's lots of other information um for you um to know8:06 and for your Healthcare Providers too so like I said I wanted to start with living with diabetes the emotional8:13 side of living with diabetes and as I'm as you well know I'm not telling any of8:19 you anything new um but just to summarize diabetes can be stressful and8:24 it's associated with challenges and disease acceptance so accepting the fact that you have um diabetes whether it's8:31 type one type two um gestational all of the above as well as treatment8:38 acceptance um if you have type two and you're sort of progressing along from oral medications to to insulin um8:46 accepting that that is the next steps in your in your care and treatment participation your self-management all8:53 of the daily task that you have to do can be very stressful so we also know8:58 that diabetes is is associated with increased likelihood of of of mental health disorders so stress is one thing9:05 but um having a mental health disorder like depression anxiety or uh disordered eating those are the top three um9:14 clinical disorders that we see at a higher rate within individuals with diabetes so we know that we paying9:20 attention to your mental health is very important um and uh and we'll talk a9:26 little bit more about strategies to um enhance this what I'm really going to focus in on today is separate from the9:35 mental health conditions like depression anxiety or disordered eating is really9:40 some of the psychological problems that may not have um a clinical diagnosis but9:45 we know are very significant so the first one being diabetes distress um there's also hesitance to9:53 initiate insulin like I mentioned before and the fear of hypoglycemia sort of the anxiety or the fears of going low or9:59 having a low and an uh unfortunate unfortunate space um so but I will talk10:05 a lot today about um diabetes distress and what you can do to challenge that b10:11 because we know more than half of the people with diabetes will experience diabetes distress at some point um in10:18 their lives so I want to highlight that one even though we know that there's way more pieces to the puzzle in terms of10:25 all of the different emotional pieces to having diabetes so let's jump into how can you improve10:33 let's let's get some take-home tools of how you can improve your emotional side of your diabet Diabetes Care going10:40 forward so I'm throwing around a lot of terms and so I want to slow down a little bit and really spend some time10:47 defining um some words you may have heard or some terms you may have heard and and people use them interchangeably10:54 and so really picking apart what's the difference so there's diabetes distress and then you'll hear diabetes burnout um11:02 and so we're going to talk a little bit about what the difference is and and what this chart is over here on the11:07 right is um a a normal curve and we think if your stress level is very high11:16 then your performance level or your ability to do your diabetes care and your self-management every day all day11:23 um it drops obviously when your distress gets really high you can get so distressed that it impacts your11:30 performance on your diabetes care but we also know too little stress and being11:36 toback or too um or not worried enough11:41 not worried enough but not uh concerned enough or taking it seriously enough um we also know that that can decrease your11:48 performance level because maybe you don't see it as um that important or um11:53 as as um High Enough of a concern for you so we really do like to have this optimal12:01 level of your stress so I'm not here to say oh I'm going to take all your stress away I want you to feel completely12:08 relaxed in at all times there's always going to be a a moderate level of stress12:13 and that's the the place where we feel like that's the optimal level to have a moderate amount and that's where we have12:20 the highest performance and you're not so high that you're moving into distress but you're also not so low that you're12:26 too laidback about all of that need needs to be done so um so that's the12:31 backdrop a little bit of when we're using the word distress and and what we mean about that stress level being too12:38 high or too low or just right in the middle so to get into the definitions a12:44 little bit um of diabetes distress versus diabetes burnout so diabetes12:49 distress is really the negative emotions I.E the stress that we just talked about on the previous slide that's experienced12:57 by individuals with with diabetes and they can feel burdened and challenged by their care or they may have ongoing13:04 worries and um that are associated with diabetes so it's really that emotional side that stressful side and then13:12 diabetes burnout is where you feel mentally emotionally and physically13:17 exhausted by the um by diabetes and you then they start to develop some13:23 difficulties with your Diabetes Care such as avoiding it feels so overwhelming that then you sort of push13:29 it away a little bit and say oh my gosh it's so overwhelming it's normal human reaction if something is super13:35 overwhelming if we have um a big report at work or an assignment at school and13:41 it's just so overwhelming we sort of procrastinate it or put it off or try to avoid it a little bit so that's normal13:48 human behavior but we know when it comes to diabetes if you start to avoid too13:53 much or detach from your support systems too much because diabetes is so f13:58 physically mentally and emotionally overwhelming then you have problems keeping up with your self-management and14:04 your daily cares and you feel powerless and hopeless about diabetes so some ways14:10 you avoid or give up on it a little bit so distress has much more of the emotional side but you may or may but14:17 may or may not still have the ability to keep up with your self-management tasks14:22 but diabetes burnout is you're so overwhelmed that you start to detach and avoid and procrastinate doing your14:28 diabetes on uh over time there was a study that was done that was um a14:34 scoping review um because even individuals in the research world uh14:40 don't always have these uh terms very well articulated but this was a nice14:45 article that sort of talked about the difference between distress burnout and depression because they all can overlap14:52 but also be distinct and so they had just a whole host of different descriptive words over here that that14:59 really lend lent themselves to distress and then to burn out and this is more of15:04 the exhaustion the apathy the disengagement uh and then the depression is when it crosses over into Beyond just15:13 diabetes and you start to become depressed in multiple areas lose interest sleep concentration all of15:20 those things so um it's just a a good thing to do to think a little bit about distress and then when does it tip into15:27 to burnout and then when does it tip into depression so when we're thinking about15:34 um you experiencing distress and and having high levels of distress and you15:39 sort of say oh I'm kind of over that top of that that hump of that curve or you15:45 really experience a really um High stressor I want to teach you very15:50 specific coping strategies because I'm sure a lot of people on this on watching this has seen coping strategies has read15:58 books about it I've done all these different things and as you know one size does not fit all so I can't sit16:04 here and say do this coping strategy and this will work for you no matter what16:09 the stressor is what I want to tell you is we actually have to go back and16:14 actually think about the characteristics of the stressor because not every16:20 stressor is the same therefore not every stressor has the same coping response so16:26 rather than saying oh if I just go for walk that's always going to work or if I just take deep breaths that's always16:32 going to work it's not always going to work and so I have this um graph here to16:39 really show almost like a Choose Your Own Adventure if you will um and you want to think a little bit more about16:46 what is the stressor that I'm experiencing what is it about diabetes right now that is stressing me out is it16:52 that I'm having technology failures is it that I'm having it lows in the middle of the night is it what is it that is16:59 causing the stress or am I having fear of lows am I having worries about future17:05 um complications what what is it that's really making me feel stressed so you have to do a little bit of17:12 self-reflection and then you have to ask yourself do you feel like you can17:17 control and I put control in quotes because like really can we ever really control anything but can you control the17:25 source of that stressor so if the stressor is I work out and I have a low17:31 every time I'm on the treadmill that might be something that oh I might be able to control that in17:39 the sense that yes I could use some problem solving skills to do some different diabetes self-management17:45 skills to cope so before I get on the treadmill I'm going to make sure I have 15 grams of carbs or I'm going to make17:52 sure I'm running at least at a you know at least at a five or a six or something17:57 to make sure that I if I go low I have some wiggle room so there are some18:03 problem solving strategies you can do that you all are masters of of oh let's18:09 tweak this let's try this let's experiment with this so if it is a stressor but it is something you feel18:15 like you have a behavioral change that you can do um to cope then yes use your18:22 problem solving skills but there's sometimes you can you can't really18:27 manage or control the source of the stressor maybe the stressor is even when18:34 I run my blood glucose in target range I occasionally have an a low out of the18:40 blue or I do all these things and and I have this fear of low even though I actually have never had a low driving18:47 but I have this fear of it well you can't always control that fear because18:53 you've done all you can problem solving wise to to prevent the low maybe while you're driving but you can con you can19:00 manage or control the emotion or the thought um in response to that um that19:07 stressor so you say I've done what I can to um be safe behind the wheel of a car19:13 I can do U my deep breathing I can regulate my emotions I can tolerate this19:19 I I know I'm doing the right thing I know I'm safe I know I'm as well as safe as I can be um and I've done the right19:26 the right thing so you can do what we call cognitive reframing of you know my fear of lows are going to be there but19:34 i' I've done what I can to to manage that fear um and I can do things to um19:41 cope with the maybe the heart racing or the fast breath um that is coming19:47 because of that emotional reaction so um you may not be able to control the and19:52 say okay I'm never gonna have a fear of a low in the future there's going to be fears of lows at times but you can Ma19:59 you can manage your reaction to that fear and sometimes diabetes really can20:06 feel like you can't control either the um the behavior or the thoughts around20:13 it right so sometimes okay I can take a behavioral approach I can take a thinking and emotional approach and20:19 sometimes it's just really overwhelming and it might be a a fear of the future20:25 or a fear of having um to have a more intense Ive uh regimen or something like20:30 that and so if you feel like I'm stressed and I don't feel like I can control the behaviors or the emotions20:37 and thoughts then what we want you to do is really engage in what we call mindfulness and that's where for a20:43 little a short period of time um you get a little distance from diabetes and this20:49 is where you can go for a walk you can do your mindfulness breathing um there's all kinds of different tools and20:55 techniques around even just being in the present moment there's a grounding technique where you quickly do five21:02 things you can see four things you can um touch three things you can hear two21:07 things you can smell one thing you can taste so you do something that gets your21:12 body back into the here and now and really grounds you you go out in nature21:18 and you look at the different colors you do a rainbow walk where you try to look around and find one thing that's red21:25 green Roy G blue indigo violet um so you do the uh rainbow walk so21:31 there are all kinds of things where if you can't do the behaviors and you can't get out of your head you do things21:38 physiologically that get your body and your brain back into the present moment grounding you in a mindfulness activity21:47 and that gives your brain a chance to reset decrease the amount of stress21:52 hormones that are being released and help you then go back and focus now you can't stay permanent ently in distance21:59 and mindfulness because then that crosses over to avoidance but you can go there for a brief period of time just to22:06 manage um maybe some of the overwhelming thoughts feelings and behaviors that are happening so I wanted to go through the22:13 slide with a little more depth so that you could really start to think about um where what stressor deserves what type22:20 of a response um so that you can really design it and individualize it for22:26 yourself so now want to switch over to stigma associated with diabetes um like22:32 I said before this was a new section added to the cpg guidelines for22:37 2023 and as uh many of you have probably already heard but I will Define it for us here stigma is the experience of or22:46 or perceived experience of so it can actually be an experience where you have it or you're perceiving that it happened22:55 it it doesn't have to actually have happened you can just perceive it or could be indirect or direct but23:01 basically it's um experiencing that judgment or the shame um that can come23:07 along with having um diabetes and so it could be discrimination it could be23:13 shame it could be judgment but for for some way shape or form others are23:18 judging or discriminating or making decisions and assumptions about you um23:24 based on some characteristic and here we're talking about stigma associated with diabetes so you could have social23:30 stigma where others um May judge on the fact that you have diabetes they may23:35 judge that you quote unquote caused it um or they may may think of myths about23:42 it so that's social St stigma um there's also structural stigma which comes from23:48 um systems like the Health Care System might have stigma um against23:54 individuals um with diabetes again they make make assumptions about um your23:59 physical activity level or they may make assumptions about how well or not well24:04 you're managing your diabetes um so there can be some structural uh stigma24:10 that that happens and especially relevant here is all the diabetes related so they may make24:15 judgments about um you because of your diabetes status and a lot of this can24:21 happen um around weight and weight based stigma that's where a lot of the structural um stigma happens too and and24:28 Healthcare Providers are are not above um perpetuating negative stereotypes about24:36 weight and what uh personality characteristics are associated with weight which then can IM negatively24:43 impact the um patient provider um interactions and Communications and then24:49 individuals can start to internalize or have that self stigma around their weight and shape and and their body24:56 composition and so so there's been some research out there that shows that not only does this just feel uncomfortable25:03 or that this is emotionally um damaging and hard but it also really impacts25:10 Health outcomes so um there's been some research that shows that individuals who25:16 perceive or Andor experience weight-based stigma um in the healthcare25:22 setting um they have higher levels of um elevated cortisol levels and cortisol25:27 levels are is the stress hormone that gets released and when the cortisol levels are released we know that insulin25:34 um isn't absorbed as well and so there's more insulin resistance so the insulin isn't working as well higher blood25:41 pressure and decreased glycemic stability so your blood glucose levels go up and down more um because of these25:49 or related to I shouldn't say because of but related to these patient provider interactions so when people are25:56 perceiving um this stigma it really does have a health impact as well as a a26:01 mental health impact so it's very important that when you notice social26:07 stigma whether this is with um people in your immediate vicinity at your home in26:14 your at your work at your school in your neighborhood or the more structural in your health care System Network um we26:21 know that diabetes stigma um leads to all of these Health outcomes26:28 but it also leads to decreased self-management so if you feel that social stigma of someone's going to26:34 judge you um at work you may be a little bit less likely to pull out um your CGM26:40 on your phone and and and scan your CGM or do something like that so um you want to be very aware of how diabetes stigma26:49 is being internalized by you um in making sure that you don't let it negatively impact uh your26:56 self-management um or your other health uh conditions and one of the ways that you can do this27:03 is really by identifying your support team and really thinking about who is in27:09 your network who do you surround yourself with because the research really shows that if you have a strong27:15 social support network it really does buffer social stigma now I wish I could27:21 wave my magic wand and make some waiter at um a restaurant not discriminate27:28 against you or or demonstrate social social stigma towards you I can't we27:33 can't control Society but what you can control is who's in your immediate27:38 vicinity who's going to help you buffer that help you improve your outlook and your perspective increase your27:44 self-management skills and promote these Health out these positive Health outcomes and that really can help offset27:51 this so some of the places that I want you to right now while you're watching this video is to think about is to um27:59 think about your your social support resources is it all you want it to be are there people that you need to add to28:06 it you could have people in the Inner Circle um parents siblings friends romantic relationships Partners you28:14 could have Outer Circle relationships Healthcare team members who are supportive and and not engaging in in28:20 stigma stigmatizing you extended family community religious groups diabetes28:25 organizations such as diabetes Canada blogs all of social media that are28:30 positive and so typically we think of our social support as coming from our Inner Circle but it doesn't always have28:38 to be we don't have to do this I want you to really be thoughtful about who28:43 you get to place in your social support network we don't have to have the people28:49 that are in the Inner Circle if we feel like they're not actually that helpful28:55 of support so you get to decide which relationships are in your um support29:01 network and which are in the outer and oftentimes it's based on who you trust to support you in an effective way so29:08 really spend some time thinking about who do you want to move in who do you want to move out who's maybe in a little29:15 bit who's in all the way and think of it as something that can move and change over time and that you don't just have29:22 to accept the people who are in your immediate vicinity if you don't feel like they are supporting you very29:29 effectively so I want you to um do a little tree ring exercise I'm just going29:35 to talk you through it so you can either just keep listening to the video or you can pause the video for a few minutes29:41 and do this tree ring exercise and then come back um but what the tree ring exercise is I keep talking about these29:47 inner circles and these outer circles I want you on a piece of paper to draw um29:53 a number of circles so with you in the middle and then an Outer Circle Circle and then maybe another Outer Circle and29:59 you can go as far out as you want I usually suggest that people do two or three rings and I want you to physically30:05 write down who is in your inner circle of support that you trust that you find30:12 effective that would help buffer some of this stigma and I want you to think about maybe some people are in that very30:19 tight Inner Circle maybe some are out a little bit maybe it's co-workers people at work but maybe your inner circle or30:25 people that you see um at home or in your neighborhood and then work is a30:30 little bit outside and then maybe outside of that is your health care you can do it any old way you want but just30:37 spend a moment to actually in a concrete way think about your support network30:42 think about where there might be holes think about wow I actually have a lot30:47 think about where you might want some more holes think about um ways that you can reach out um doing activities like30:55 this with diabetes Canada and and joining and and um interacting and31:00 watching uh workshops and and connecting to other people with diabetes um you31:05 could build that up so take a few minutes and do a treeing exercise for31:10 yourself to really reflect back where your social support network really31:22 stands okay and for those of you who paused your video um to do the tree ring31:28 exercise welcome back for those of you who are continuing to watch and we'll do it later that's fine as well I do want31:34 to shift gears into another source of distress since we're really focusing in on Diabetes distress is the financial31:40 distress of diabetes and so we know diabetes is a chronic condition associated with significant health care31:46 costs there's both the direct cost things like the cost of medications your supplies um if technolog is covered by31:54 your insurance if it's not covered by um your insurance Insurance healthcare provider appointments food plans all of32:00 the things um those are direct but there's also indirect Co costs um if you have decreased um productivity during32:07 work during a day because you're managing a severe low um managing the complications where you might have to32:13 have extra doctor's appointments and and Miss more work or have hospitalizations related to diabetes so we know there's32:20 both direct and indirect costs and so again I'm not telling you anything you don't already know but the um clinical32:27 practice guidelines really talk about um and highlight for the healthc care providers to really put at the Forefront32:34 how much people with living with people living with diabetes are affected by these costs and how these might impact32:41 Optimum levels of self-management so if someone's um not able to afford all of32:47 the insulin that they need in a month or if they're not able to afford all of the strips or they run out and they aren't32:54 able to get more or whatever that is is that these really do impact um one's32:59 ability even with the best of intentions to to take care of diabetes and and do all the self-management tasks sometimes33:07 access to resources and financial um burdens really um negatively impact33:13 one's ability to to take care of diabetes so your Diabetes Care team should should be regularly inquiring33:20 about financial burdens um for you they should be um offering some other33:26 programs government Community programs um that they have worked out to help33:31 offset some of these costs because we know that that distress um if you don't33:37 feel financially stable with your diabetes how do you have um the bandwidth and the and the mental33:43 capacity to manage all of the other pieces of it in terms of feeling overwhelmed with the day-to-day33:49 management so to summarize um how can the cpg guidelines impact your care um33:57 with the awareness and impact of diabetes emotional functioning relationships healthc care providers should regularly ask you about your um34:05 emotional functioning and your coping and your adjustment they should be using34:11 screening questionnaires so the cpg guidelines really um recommended that um34:17 they cons that healthc care providers um should consider it they don't require it34:23 but a healthc care provider should be really asking Andor using screeners and those are34:29 little questionnaires that have been validated that ask about your emotional U functioning with diabetes um and we34:36 have specific ones around diabetes distress and depression and anxiety and so there's all kinds of different34:41 screeners out there so the diabetes team can also help you manage this distress34:47 use them as a resource they have lots and lots of um strategies and coping and34:53 and tools that they can help you with or they can refer ref you to a mental health34:58 services um healthc care providers um are advised and and the cpg guidelines35:04 are very clear about having them start to manage and pay attention to their own35:11 weight-based biases and their own internalization of of weight based stigma to minimize how much that is then35:18 translated to you as as their patients um in these in communication and how35:25 much um their sort of aware of perpetuating stigma and so Healthcare35:31 Providers are um also encouraged to inquire and and really keep up todate on35:36 various um supports for the financial um burdens um and really help reduce the35:41 direct and indirect cost of Diabetes by um assessing counseling and providing35:47 resources for you so um in our last little bit I want35:52 to um end on objective three of of talking about self- advocacy see um so35:58 we talked a lot about different emotional um aspects to diabetes what you can do as an individual to cope but36:05 how do we also look at self- advocacy and what can you um sort of expect and36:10 do within these new um cpg Health Care guidelines for mental health and36:16 diabetes so um you know we don't spend enough time I think talking about how36:23 diabetes also has a silver lining it also has a lot of opportunity for for individuals36:29 to build resilience to have an opportunity to build empathy for others36:35 with chronic conditions compassion you're building your problem solving skills you're becoming adap adaptable36:40 and flexible you're creative in how you um problem solve you have responsibility for your health you learn about yourself36:47 you understand how your body is working and and and what different foods do and exercise you understand your own36:53 strengths your own limitations and um tolerance for distress or being uncomfortable so these are all ways that37:01 you're building your resilience and there's also an opportunity for advocacy37:06 and being part of something that's bigger than just yourself so I want to spend a little bit of time on um the37:12 advocacy part of of bouncing back and and building your resilience so um I37:19 always like to define the terms when I mean resilience this is the process of37:24 adapting well in the face of adversity trauma or other stressors so this is37:30 something where you bounce back it's not a personality trait I know a lot of times we'll say oh this that's a37:35 resilient they're a resilient person it really is a learned behavior and it's through your thoughts your behaviors and37:41 your actions and these are all different ways that you can enhance you how you37:47 have positive values and positive interactions with the world developing other talents and interests outside of37:52 diabetes building your friendships and your support Networks um education even37:58 if it's not formal education how are you learning about diabetes how are you coming to conferences like this how are38:03 you um uh enhancing your knowledge creating that secure base of who is your38:09 support network who are your your people in your place that really make you feel38:15 safe and and that you're not going to be judged and then social competencies around dealing with those social stigmas38:21 and and coping with um things that might happen out there um with related to diabetes stigma so how you might self-38:29 advocate for yourself is we know that mood and anxiety symptoms are common in people with diabetes and can lead to38:36 more formal mental health diagnosis such as um disorder to eating sleeping diabetes distress problems are also38:43 common and so make sure that if your healthc care provider is not asking you38:49 about them or is not giving you the screeners that you are raising these in your um diabetes clinic visits and that38:57 when you are being screened or when a provider does ask you or does give you a formal screener for things like diabetes39:03 distress fear of hypoglycemia depression that you fill out these questionnaires and you fill them out honestly and that39:10 you um don't hold back or feel like you have to look like you have it all together really show what's happening so39:18 that um the healthc care team um knows what's going on and can help you um and39:24 then the last piece um we want you to do is or there's a couple last pieces is if39:29 you feel like you are really getting a lot of social stigma diabetes stigma or you feel like you're getting weight39:35 based stigma either in the Health Care system or um in society or from others39:41 really talk to your Diabetes Care team about your social stigma concerns and39:47 how you might want to build up your social support network and speak up if you're really experiencing it in the39:54 Health Care System um directly from the the healthcare team because this is a a time and a place for all of them to be40:00 um learning and growing um as a society um and as a Health Care system and then40:07 um we know that caring for diabetes effectively is expensive so let your health care team know if you're having40:14 Financial burdens if you're rationing insulin if you're not um doing diabetes40:19 cares as much as you want to because of the financial burden um because it's40:24 really important for individuals and your Healthcare team to know that that's the source of the issue and so they can40:31 help you but also recognize that um you are wanting to do it but you're having40:37 limits to your access so we've developed a self- advocacy checklist um we have a40:43 PDF um form of this as well that you'll be able to download and so as you're going through the checklist I'm um40:49 getting ready for your next Clinic visit um or as just periodically checking in with yourself really be aware of how you40:57 are emotionally reacting to your diabetes we talked about the first three which is why I bolded them the diabetes41:03 distress and burnout diabetes distress related to stigma and diabetes distress about the financial burden of diabetes I41:10 didn't talk about all the other host of things but those are still on there check in about your fear of hypoglycemia41:17 check in on um whether you're having some hesitancy or reluctance to take41:22 more insulin or to initiate insulin if you've been on oral medicine and you're looking to start insulin really looking41:29 at reframing that thought of I need my a41:34 medical regimen to match what I physically need and not seeing it as a41:39 failure or some sort of way that you know you're not doing diabetes Well if you have to take more insulin over time41:47 or you have to move from oral to um insulin that really thinking of this is41:52 what my body needs and this is what I need to match and I'm actually making my body healthier to take the right41:58 medicine for what my bi my diabetes needs so really just using some of those42:04 um thinking and and thought strategies around reframing that um there's issues42:09 with how how well are you accepting it how much are you engaging in some of that avoidance and not participating42:16 because it feels overwhelming are you crossed over into feeling um feelings of depression and anxiety that are about42:23 diabetes but then are also about life in general um and and making sure you're doing a42:28 check-in on that looking at your eating behaviors um looking at um when are they42:34 crossing over into maybe being disordered eating or out of control eating or not enough eating so really42:40 taking stock and inventory and talking to your Healthcare team about that and then filling out any self-report42:46 screeners um open and honestly and if you aren't giving them ask start asking42:52 for them um providers have access to them many of them are free um and and you can go on or you can go42:59 online and there are some that you have access to that you can fill out and bring in or you can ask your team to do43:05 it um and then the last thing is if your you and your team def decide that a a mental health referral is needed um to43:12 go um beyond what the Diabetes Care team can do to support your diabetes distress and other things really follow up and43:20 and find a way to get that extra support so that you are um taking care of both43:25 the phys physical and the mental health side of your diabetes so um I want to end a little43:32 bit here on just speaking up about diabetes stigma um there's an additional diabetes Canada webinar on confronting43:40 diabetes stigma so click over here watch it um if you are someone who really43:46 wants to get more involved in standing up against stigma because there's no such thing as health without mental43:53 health so whether it's stigma about the fact that that you're having emotional uh reactions to diabetes or stigma44:00 around weight or stigma around um feeling shamed and blam because of um44:06 difficulties with managing your diabetes um this uh diabetes Canada webinar has a44:11 great series on um learning how to stand up and and do more things to stop stigma44:18 within our community um and also to stop stigma within our community um and I'll44:23 I'll just end a little bit here with making sure that we're not um pitting type one against type two we all have44:29 different types of diabetes and we don't uh we want to make sure that we are not44:34 accidentally stigmatizing type one versus type two as well so um I'll put that in there to that little plug in44:40 there too because this webinar talks about that as well all right so um in44:46 terms of questions and discussion I hope you all enjoyed um watching this video44:51 and I look forward to um seeing as many of you as I can to my live diabetes44:57 dialogue session which will be Saturday November 18th from 2:15 to 3:15 I'll be45:03 there live to answer questions and have discussion um about this topic and I45:08 really appreciate um all of your attention today and I look forward to seeing you on Saturday thank45:19 [Music] you