This webinar provides a framework for understanding how living with diabetes interferes with a person's quality of life. Diabetes distress is very common in those living with diabetes and is often overlooked in diabetes management services. Yet diabetes distress can be easily identified, and a number of coping strategies have been shown to be effective in helping people manage distress. The goal of this session is to empower the person living with diabetes, as well as care givers, to be more aware and confident in managing diabetes distress.
Speaker: Dr. Michael Vallis
Speaker: Dr. Michael Vallis
0:03
[Music]0:09
hi there my name is Michael valis I'm a0:12
health psychologist from delaz0:14
University in alax and I'd like to make0:17
this presentation uh to you concerning0:20
the really important concept of diabetes0:23
distress some of the burdens associated0:25
with diabetes and importantly how we can0:28
move from being over welmed to being0:31
empowered these are my disclosures the0:34
interactions that I have with uh0:36
for-profit uh0:38
companies and the reference point for my0:41
presentation is the following0:44
psychological issues associated with0:46
diabetes are certainly not experienced0:49
by0:50
all very few people experience0:52
psychological issues with diabetes all0:54
of the time but many people experience0:57
occasional Tim limited problems and1:00
managing diabetes is really around1:02
overcoming challenges and so in some1:05
ways we need to accept the condition and1:08
work with it and this is where the1:11
distress and the mental health aspects1:13
of diabetes become so veryThe Mental Health Continuum1:16
important and it's critically important1:18
for us to put the distress associated1:20
with diabetes into the proper context1:23
and so I'd like to explain that to you1:25
by talking about mental health really as1:26
a Continuum and this is quite an1:29
important um uh uh perspective really to1:33
appreciate and let me explain it to you1:36
because it really just describes life1:38
and our experience of the events that1:40
occur in our lives and what I mean by1:42
that is the perception of threat will1:46
naturally lead to the feeling of anxiety1:48
the perception of loss naturally leads1:50
to the feeling of sadness or depression1:53
and the perception of intrusion or1:55
unfairness leads to the perception of1:58
the experience rather of anger so if2:00
you're feeling irritable if you're2:01
feeling resentful if you're feeling sad2:03
if you're feeling anxious it's sometimes2:05
useful to think okay what's the threat2:07
what's the loss what's the point of2:09
unfairness because this then can give2:11
you a framework from which to move2:14
forward and what's important about that2:17
is because psychologists divide up2:19
emotional experiences that people have2:22
into two general categories and as you2:24
see one category which describes many2:27
experiences that we have from a mental2:29
health point of you is what we call2:31
primary emotions and this is where you2:33
would expect that the threat would2:36
create anxiety and a little bit of2:38
threat should create a little bit of2:40
anxiety a lot of threat should create a2:43
lot of anxiety a threat that doesn't go2:45
away should create anxiety that lasts2:47
and I'm hoping that you can see how I'm2:49
normalizing that experience because2:51
what's really important about this is2:53
life is ex is filled with stresses and2:56
strains and those have emotional impact2:59
and what what's important about there is3:00
how we cope with those emotions how we3:02
go to move forward from those emotions3:04
and it's really by expressing them not3:06
keeping them bottled up and actually3:08
seeking support and so that happens3:10
everywhere so that's really important I3:12
think in terms of an empowerment point3:14
of view acting on your distress as3:16
appropriate but it is important to note3:18
that sometimes stress gets overwhelming3:20
we call those secondary emotions and3:23
that's when you start to see some of the3:25
emotional difficulties and so don't3:27
assume if you're struggling that in fact3:29
there's a significant problem it may be3:31
that this is something that can be3:32
managed if it's faced and3:35
supported um it's important to3:37
understand The Human Condition and and3:39
when you think about the fact that you3:40
know we have our plans we have our our3:43
organized approach to life and all is3:45
good but then life is also full of3:47
stress and what's really important to3:49
understand is that as stress goes up in3:51
in a person's life it's really common3:53
for self-care to go down and so this is3:56
why it's important for us to identify3:57
the stress so we can take action onQuality of Life4:01
it and this is a point that I I think is4:04
worth thinking about is that currently4:06
in the in our in our society and4:09
certainly inside the medical system we4:11
we really have only one way to talk4:13
about mental health and we tend to talk4:14
about it in terms of of the diagnosis of4:17
mental health disorders so the language4:19
is often oh you're down well maybe4:21
you're depressed or maybe you have an4:22
anxiety disorder you're struggling with4:24
maybe you have a personality disorder4:27
and so there's the tendency to use4:28
language that really finds um4:31
significant mental health disorders and4:33
those are based on really what's called4:35
the diagnostic manual um and and it4:39
really identifies Psychopathology is the4:42
term which really means pathology of the4:46
psyche but maybe the experiences that4:49
people have are more normal that is4:52
perhaps they're not abnormal and fall4:54
outside of what would be anticipated4:56
just like what I'm describing about4:58
perception of lost threat5:00
and so this raises the question as to5:02
whether the emotions that someone is5:04
experiencing should be seen as just part5:06
of life to be managed or something that5:08
really needs help and if we look at this5:10
kind of Continuum of distress then at5:13
some point the distress becomes so high5:16
that it interferes with functioning and5:18
this is where the diagnosis comes in but5:21
there's a lot of Journey before you get5:23
to that point anxious when threatened5:26
sad when experience a loss angry when5:28
experiencing unfairness5:30
and so this sort of normal understanding5:32
of emotions leads us to try of5:35
understand like how do we really5:38
understand ourselves and so a really5:40
useful way of thinking about this is5:43
what we call quality of life and what's5:45
important about quality of life is that5:46
it identifies distress as an important5:49
component but doesn't stop there quality5:51
of life is a balance between distress5:54
the things that pull you down but also5:56
well-being the things that bring you up5:58
and shifting from overwhelmed to6:00
empowered sometimes means focusing on6:02
the well-being Dimension not just the6:04
distress Dimension what I like about6:06
this model is it allows us to understand6:09
okay if you're feeling distressed what's6:10
driving that distress and that distress6:13
could be driven by the chronic disease6:15
by diabetes itself and we know there's a6:17
lot of aspects of diabetes that do cause6:19
distress which I'll talk about but it's6:22
also important to understand that just6:23
problems of living social what we call6:25
the Social determinance of health so6:27
income location6:30
marginalization uh life event stresses6:33
that are really just m barriers that6:36
would get in the way Social Services can6:38
sometimes be really really useful there6:40
and also we recognize that there could6:42
be Psychopathology here so this is a6:44
model that maybe guide you a little bit6:46
and in terms of how do you manage the6:48
distress that you're experiencing but6:50
equally important with this is this idea6:52
that we can talk about positivism or6:55
resilience coping skills building on6:58
your strengths and so I know this is a7:00
talk about diabetes to stress but IPositivity7:02
think it's important for us to7:03
contextualize this by thinking about7:05
positivism what can you do to enhance7:08
the positive experiences in your life7:10
and this is really what we call a7:12
strength based approach that promotes7:15
really resilience that ability to get7:16
back and there's research in this area7:19
around happiness that tells us that um7:22
that happiness isn't really the result7:24
of huge accomplishments and huge efforts7:26
but actually small daily habits that7:29
really determine well-being and habits7:32
are that are shown to be consistent7:34
amongst people that are you know7:35
naturally happy they devote time to7:37
family and friends they practice7:39
gratitude and optimism they Savor life7:41
Pleasures engage in meical activity7:44
they're able to stay in the moment so7:46
there does seem to be some strategies7:47
that we could adopt that might actually7:49
build on our7:51
positivism and when we look at um7:54
noticing the good in life what we see is7:56
that intentional activity seems to be a7:59
extremely powerful determinant of how8:03
you're how optimistic how much of a8:05
positive attitude that you take genetics8:08
plays a big role but there's a lot that8:10
we can do and optimism therefore really8:12
could be looked at as a habit so as you8:15
think about managing distress please8:16
also think about what you could do8:18
independently to increase the positivism8:20
in your life and so we sometimes talk8:22
about these happiness interventions as8:24
you see here regularly setting aside8:26
time to recall moments of gratitude8:29
positive thinking about8:32
oneself practicing altruism and kindness8:36
affirming your most important values and8:39
savoring your positive experiences now8:42
this is an attitude that one can adopt8:44
that's been associated with improved8:46
coping and so I wanted to put distress8:50
presentation in the context of happiness8:53
at the same time and so now let's talkDiabetes Distress8:55
about distress and this I think is8:58
relevant for most of us us and so if9:00
you're living with diabetes if you're a9:01
family member or affected by diabetes9:04
then it's important to recognize9:05
potential sources of distress and if we9:07
ask this question what's distressing9:09
about diabetes we actually have a lot of9:11
answers the behavioral demands of9:13
self-care can be overwhelming there's a9:15
lot of work to do maintaining glucose9:18
control is actually9:20
complex uh diabetes selfcare demands are9:24
constant there's no real breaks and9:26
diabetes can be unforgiving and diabetes9:29
is certainly plagued by9:32
uncertainty and so what you see there is9:35
the threat and the loss and the9:38
unfairness when you think about what9:40
it's like to navigate the world of9:42
diabetes and so this really justifies9:45
kind of the normalization of the concept9:47
of9:49
distress and so one of the things that9:51
we um find helpful when we think about9:53
the concept of diabetes distress is to9:58
really understand understand what's9:59
driving it and in particular we like to10:03
uh to frame diabetes distress in terms10:06
of what the source of distress is10:08
because then you can direct your coping10:10
resources towards those let me be more10:13
clear the first aspect of diabetes10:16
distress that we like to identify is10:18
what we call the emotional burden the10:21
sense that you're feeling overwhelmed or10:22
feeling bad about yourself because of10:25
your diabetes that emotional weight if10:27
diabetes was a a weight that you carried10:29
in a napsack would it be a you know one10:31
lb loaf of bread would it be a 5 lb B10:34
bag of potatoes would it be a 50 lb iron10:37
andil would it be a two-ton truck what's10:38
the emotional burden second what10:43
distress is associated with all of the10:45
self-management tasks what we call10:47
regimen distress the self- monitoring10:50
the monitoring activity the10:52
recordkeeping the medical therapies the10:55
monitoring your feet and eyes over time10:58
all of the time masks that could be ever11:00
present in a person's life can be11:03
burdensome and then there's the11:05
relational aspects of diabetes we don't11:08
experience or live with diabetes in11:11
isolation and here we talk about11:13
provider based distress something that11:15
as a psychologist think is really11:16
important for individuals living with11:18
diabetes and Healthcare Providers to11:21
acknowledge which is sometimes the11:23
medical system the relationship with the11:25
provider can be distressing and if11:27
you've ever felt like uh sometimes going11:29
to see um a medical provider or ENT11:31
diabetes you feel like you're being11:32
called into the principal's office or11:33
you're feeling guilty that you're not11:35
doing enough that's the kind of Provider11:37
distress that we'd like to identify so11:39
we can help you work through and the11:41
final aspect of distress is what we call11:43
social support distress people in your11:45
life so emotional burden if diabetes11:48
were a weight on your backpack that you11:50
carried around how heavy would it be11:51
important question to reflect on because11:55
you may use words like you're feeling11:57
overwhelmed you're feeling burnt out11:59
you might experience what we call a12:02
sense of powerlessness that there's12:03
nothing that you can do because of the12:05
complexity because of the number of12:08
different factors that actually impact a12:10
person's glucose level at any moment in12:12
time you can feel sometimes like there's12:14
not a lot that you can do to make a12:16
difference and by identifying these it'12:18
be really important for you because12:20
acknowledging them bringing them into12:22
the care plan is in most cases the way12:26
that you manage these burdens regimen12:29
distress is really around the actual12:31
management tasks eating related distress12:35
as you well know diabetes changes your12:37
relationship with food because of12:39
glucose in the food that virtually most12:42
Foods we eat so they do have an impact12:44
on your glucose levels and therefore12:46
kind of food almost becomes like a12:48
medicine in a way and so that is a12:51
source of distress and certainly12:53
hypoglycemia distress which I'd like to12:55
talk about in a little um bit because12:57
it's also an important important aspect13:00
and so with regard to the the regimen is13:02
it just overall tasks or specifically13:04
related to food or to the potential for13:06
low glucose levels and if you can13:09
understand your emotional experience13:10
that's then the strategy that leads to13:12
the solutions that can be helpful to you13:15
provider-based13:16
distress um you know have you ever felt13:18
like I can't really tell my diabetes13:20
doctor what's really on my mind or my13:22
doctor provides my diabetes doctor13:25
providers don't really understand what13:26
it's like to live with diabetes I don't13:28
really get the help I need from my13:30
diabetes providers um my diabetes13:32
providers don't know enough about13:33
diabetes care and so you can see from13:36
what I'm presenting here these are13:37
actually normal these are common13:40
experiences that people have and so13:42
we're trying to really you know open up13:44
the uh opportunity and encourage people13:46
living with diabetes to express these13:48
concerns to us so we can then help13:51
manage those and social support distress13:54
people might treat you differently if13:56
they find out you have diabetes you may13:58
feel that you have to hide your diabetes13:59
from other people you're concerned that14:01
diabetes makes you less attractive to14:03
employers people will think less of you14:05
and we do see there is a signal for14:07
diabetes stigma and again if you're14:10
experiencing this this I think can be14:12
really beneficial for you to become14:13
aware of because when we understand the14:17
sources of our distress so threat loss14:22
unfairness then that allows us to direct14:25
our coping resources and when it comes14:28
to coping14:29
the best way to think about it is for14:31
you to identify what's worked for you in14:34
the past so what are your natural coping14:38
strategies what are the coping14:40
strategies of your friends or people14:42
that you trust or people that you might14:45
be encounter who also live with diabetes14:47
who are able to manage the diabetes14:50
quite well so can we learn from others14:52
in other words trying to to Really14:54
encourage us to problem solve and to14:57
really kind of identify ify the nature15:00
of the stour the more specific you know15:01
what the problem is the more you can15:03
match that to a strategy and Diabetes15:07
Care is Shifting towards providing you15:09
with the opportunity not only to problem15:11
solve around eating behaviors or15:14
exercise behaviors or self-monitoring of15:16
your blood glucose but also your15:18
emotional15:19
experiences now as we talk about15:21
diabetes distress there's also important15:23
to talk about two uh relevant issues for15:26
diabetes that have sort of also been15:29
identified through this work that we've15:30
done in defining diabetes distress as a15:33
separate category and that is um forPsychological Insulin Resistance15:37
particularly with type two diabetes15:39
there's often some concerns that people15:41
have around um shifting from oral15:44
medication just taking pills to taking15:46
insulin and interestingly the term15:48
that's used is called psychological15:50
insulin resistance um I'm just showing15:53
you data from a large survey based study15:56
16 countries were involved in the Sur15:58
survey and you can see that a great16:00
number of people with type 2 diabetes um16:03
actually you know are concerned about16:06
starting insulin means that that you16:08
know you've not really been able to do16:10
your job really well so so these are16:12
saying that this is actually a concern16:13
and and there are certain attitudes that16:15
people have around whether diabetes um16:19
takes control away from you when you16:21
shift to insulin whether that means your16:23
disease is more serious whether it means16:25
that it to you you feel that perhaps16:27
it's a it's a personal failure so again16:31
understanding these attitudes can be16:33
really really important because what we16:35
know is that type two diabetes can16:37
sometimes progress to the point where16:39
your pancreas doesn't produce enough16:40
insulin anymore so insulin resistance16:43
becomes insulin insufficiency and16:45
insulin is then required and so askingAttitudes16:49
yourself a number of questions might be16:50
really helpful in identifying any16:53
attitude that you might have that would16:54
interfere with care and the reason that16:57
I'm describing this is because there's a16:59
very recent phenomenon that we've become17:01
aware of in Diabetes Care called inertia17:03
and that is when it's appropriate from a17:05
medical point of view for people's uh17:08
care to be intensified but there's a17:10
delay in the intensification and there's17:13
number of factors that are responsible17:15
for that delay and one of the important17:16
factors is your own attitudes and so17:19
asking yourself and having an17:20
opportunity to talk about these17:22
attitudes might speed up the care which17:24
results in better control for you do you17:28
feel that insulin will take control or17:29
Freedom away from you do you think that17:31
starting insulin means that you failed17:34
are you nervous about or anxious about17:37
injecting do you think that starting17:39
insulin is more work than it's worth17:41
that you won't get any benefit from it17:43
do you think that insulin means that17:45
your disease is more serious and do you17:47
lack confidence these are relevant17:50
questions if you could take these issues17:53
take these questions if you struggle17:55
with any into your provider then your17:57
care plan can take these into17:59
consideration the final thing that IFear of hypoglycemia18:01
want to really talk about is is the fear18:04
of18:05
hypoglycemia which we know is actually18:07
really really common especially if18:10
you've ever had a serious hypoglycemic18:12
event which is when your blood sugars18:14
Get Low to the point where you can't18:15
really treat them yourself and this is18:18
important because what we we've18:19
uncovered is that that this type of18:22
hypoglycemia experience is very18:24
stressful it's a really powerful stress18:27
and it's such a stress that people will18:29
sometimes allow their blood sugars to18:31
stay high in order to avoid going low um18:35
showing you additional data about18:37
concerns about hypoglycemia this is from18:39
that same study that I'd mentioned U18:42
before 16 countries just showing how18:44
common it is for people living with18:46
diabetes to experience this fear of18:49
hypoglycemia so there's a strategy thatManaging hypoglycemia18:51
we've encouraged people to do that can18:52
help them to manage hypoglycemia18:54
sometimes what will happen is your18:56
provider will recommend you get your18:57
sugars under control18:58
but managing the fear of hypoglycemia is19:00
a fear problem not a glycemia problem so19:03
the first thing we do is we determine a19:05
safe zone so what blood sugar range do19:07
you feel comfortable with right now if19:08
you're going to leave the house what are19:09
you comfortable with and that's the19:11
starting point that's in a way the19:12
psychological safe Zone and then we19:15
don't make recommendations based on19:17
ideal we don't recommend that you you19:18
know get your glucose levels let's say19:20
between seven and nine right away what19:22
if your safe zone is 12 to 15 what we do19:24
do is we sort of start with that and19:26
then we try to lower Gra gradually the19:28
psychologically safe range till it19:31
becomes the medically safe range so once19:34
you've got this on board then there's19:37
this gradual strategy it's important19:40
because it's a strategy that really19:42
engages you so you're in charge it's not19:45
something that's done to you and then19:47
you gradually are able to lower that19:49
psychologically safe range to the19:51
medically safe range so I hope this has19:53
been useful to you we've talked about19:55
diabetes distress we've talked about19:57
fear of H glycemia we've talked about19:59
psychological insent resistance and20:01
importantly we've talked about20:03
positivism thank20:10
you
[Music]0:09
hi there my name is Michael valis I'm a0:12
health psychologist from delaz0:14
University in alax and I'd like to make0:17
this presentation uh to you concerning0:20
the really important concept of diabetes0:23
distress some of the burdens associated0:25
with diabetes and importantly how we can0:28
move from being over welmed to being0:31
empowered these are my disclosures the0:34
interactions that I have with uh0:36
for-profit uh0:38
companies and the reference point for my0:41
presentation is the following0:44
psychological issues associated with0:46
diabetes are certainly not experienced0:49
by0:50
all very few people experience0:52
psychological issues with diabetes all0:54
of the time but many people experience0:57
occasional Tim limited problems and1:00
managing diabetes is really around1:02
overcoming challenges and so in some1:05
ways we need to accept the condition and1:08
work with it and this is where the1:11
distress and the mental health aspects1:13
of diabetes become so veryThe Mental Health Continuum1:16
important and it's critically important1:18
for us to put the distress associated1:20
with diabetes into the proper context1:23
and so I'd like to explain that to you1:25
by talking about mental health really as1:26
a Continuum and this is quite an1:29
important um uh uh perspective really to1:33
appreciate and let me explain it to you1:36
because it really just describes life1:38
and our experience of the events that1:40
occur in our lives and what I mean by1:42
that is the perception of threat will1:46
naturally lead to the feeling of anxiety1:48
the perception of loss naturally leads1:50
to the feeling of sadness or depression1:53
and the perception of intrusion or1:55
unfairness leads to the perception of1:58
the experience rather of anger so if2:00
you're feeling irritable if you're2:01
feeling resentful if you're feeling sad2:03
if you're feeling anxious it's sometimes2:05
useful to think okay what's the threat2:07
what's the loss what's the point of2:09
unfairness because this then can give2:11
you a framework from which to move2:14
forward and what's important about that2:17
is because psychologists divide up2:19
emotional experiences that people have2:22
into two general categories and as you2:24
see one category which describes many2:27
experiences that we have from a mental2:29
health point of you is what we call2:31
primary emotions and this is where you2:33
would expect that the threat would2:36
create anxiety and a little bit of2:38
threat should create a little bit of2:40
anxiety a lot of threat should create a2:43
lot of anxiety a threat that doesn't go2:45
away should create anxiety that lasts2:47
and I'm hoping that you can see how I'm2:49
normalizing that experience because2:51
what's really important about this is2:53
life is ex is filled with stresses and2:56
strains and those have emotional impact2:59
and what what's important about there is3:00
how we cope with those emotions how we3:02
go to move forward from those emotions3:04
and it's really by expressing them not3:06
keeping them bottled up and actually3:08
seeking support and so that happens3:10
everywhere so that's really important I3:12
think in terms of an empowerment point3:14
of view acting on your distress as3:16
appropriate but it is important to note3:18
that sometimes stress gets overwhelming3:20
we call those secondary emotions and3:23
that's when you start to see some of the3:25
emotional difficulties and so don't3:27
assume if you're struggling that in fact3:29
there's a significant problem it may be3:31
that this is something that can be3:32
managed if it's faced and3:35
supported um it's important to3:37
understand The Human Condition and and3:39
when you think about the fact that you3:40
know we have our plans we have our our3:43
organized approach to life and all is3:45
good but then life is also full of3:47
stress and what's really important to3:49
understand is that as stress goes up in3:51
in a person's life it's really common3:53
for self-care to go down and so this is3:56
why it's important for us to identify3:57
the stress so we can take action onQuality of Life4:01
it and this is a point that I I think is4:04
worth thinking about is that currently4:06
in the in our in our society and4:09
certainly inside the medical system we4:11
we really have only one way to talk4:13
about mental health and we tend to talk4:14
about it in terms of of the diagnosis of4:17
mental health disorders so the language4:19
is often oh you're down well maybe4:21
you're depressed or maybe you have an4:22
anxiety disorder you're struggling with4:24
maybe you have a personality disorder4:27
and so there's the tendency to use4:28
language that really finds um4:31
significant mental health disorders and4:33
those are based on really what's called4:35
the diagnostic manual um and and it4:39
really identifies Psychopathology is the4:42
term which really means pathology of the4:46
psyche but maybe the experiences that4:49
people have are more normal that is4:52
perhaps they're not abnormal and fall4:54
outside of what would be anticipated4:56
just like what I'm describing about4:58
perception of lost threat5:00
and so this raises the question as to5:02
whether the emotions that someone is5:04
experiencing should be seen as just part5:06
of life to be managed or something that5:08
really needs help and if we look at this5:10
kind of Continuum of distress then at5:13
some point the distress becomes so high5:16
that it interferes with functioning and5:18
this is where the diagnosis comes in but5:21
there's a lot of Journey before you get5:23
to that point anxious when threatened5:26
sad when experience a loss angry when5:28
experiencing unfairness5:30
and so this sort of normal understanding5:32
of emotions leads us to try of5:35
understand like how do we really5:38
understand ourselves and so a really5:40
useful way of thinking about this is5:43
what we call quality of life and what's5:45
important about quality of life is that5:46
it identifies distress as an important5:49
component but doesn't stop there quality5:51
of life is a balance between distress5:54
the things that pull you down but also5:56
well-being the things that bring you up5:58
and shifting from overwhelmed to6:00
empowered sometimes means focusing on6:02
the well-being Dimension not just the6:04
distress Dimension what I like about6:06
this model is it allows us to understand6:09
okay if you're feeling distressed what's6:10
driving that distress and that distress6:13
could be driven by the chronic disease6:15
by diabetes itself and we know there's a6:17
lot of aspects of diabetes that do cause6:19
distress which I'll talk about but it's6:22
also important to understand that just6:23
problems of living social what we call6:25
the Social determinance of health so6:27
income location6:30
marginalization uh life event stresses6:33
that are really just m barriers that6:36
would get in the way Social Services can6:38
sometimes be really really useful there6:40
and also we recognize that there could6:42
be Psychopathology here so this is a6:44
model that maybe guide you a little bit6:46
and in terms of how do you manage the6:48
distress that you're experiencing but6:50
equally important with this is this idea6:52
that we can talk about positivism or6:55
resilience coping skills building on6:58
your strengths and so I know this is a7:00
talk about diabetes to stress but IPositivity7:02
think it's important for us to7:03
contextualize this by thinking about7:05
positivism what can you do to enhance7:08
the positive experiences in your life7:10
and this is really what we call a7:12
strength based approach that promotes7:15
really resilience that ability to get7:16
back and there's research in this area7:19
around happiness that tells us that um7:22
that happiness isn't really the result7:24
of huge accomplishments and huge efforts7:26
but actually small daily habits that7:29
really determine well-being and habits7:32
are that are shown to be consistent7:34
amongst people that are you know7:35
naturally happy they devote time to7:37
family and friends they practice7:39
gratitude and optimism they Savor life7:41
Pleasures engage in meical activity7:44
they're able to stay in the moment so7:46
there does seem to be some strategies7:47
that we could adopt that might actually7:49
build on our7:51
positivism and when we look at um7:54
noticing the good in life what we see is7:56
that intentional activity seems to be a7:59
extremely powerful determinant of how8:03
you're how optimistic how much of a8:05
positive attitude that you take genetics8:08
plays a big role but there's a lot that8:10
we can do and optimism therefore really8:12
could be looked at as a habit so as you8:15
think about managing distress please8:16
also think about what you could do8:18
independently to increase the positivism8:20
in your life and so we sometimes talk8:22
about these happiness interventions as8:24
you see here regularly setting aside8:26
time to recall moments of gratitude8:29
positive thinking about8:32
oneself practicing altruism and kindness8:36
affirming your most important values and8:39
savoring your positive experiences now8:42
this is an attitude that one can adopt8:44
that's been associated with improved8:46
coping and so I wanted to put distress8:50
presentation in the context of happiness8:53
at the same time and so now let's talkDiabetes Distress8:55
about distress and this I think is8:58
relevant for most of us us and so if9:00
you're living with diabetes if you're a9:01
family member or affected by diabetes9:04
then it's important to recognize9:05
potential sources of distress and if we9:07
ask this question what's distressing9:09
about diabetes we actually have a lot of9:11
answers the behavioral demands of9:13
self-care can be overwhelming there's a9:15
lot of work to do maintaining glucose9:18
control is actually9:20
complex uh diabetes selfcare demands are9:24
constant there's no real breaks and9:26
diabetes can be unforgiving and diabetes9:29
is certainly plagued by9:32
uncertainty and so what you see there is9:35
the threat and the loss and the9:38
unfairness when you think about what9:40
it's like to navigate the world of9:42
diabetes and so this really justifies9:45
kind of the normalization of the concept9:47
of9:49
distress and so one of the things that9:51
we um find helpful when we think about9:53
the concept of diabetes distress is to9:58
really understand understand what's9:59
driving it and in particular we like to10:03
uh to frame diabetes distress in terms10:06
of what the source of distress is10:08
because then you can direct your coping10:10
resources towards those let me be more10:13
clear the first aspect of diabetes10:16
distress that we like to identify is10:18
what we call the emotional burden the10:21
sense that you're feeling overwhelmed or10:22
feeling bad about yourself because of10:25
your diabetes that emotional weight if10:27
diabetes was a a weight that you carried10:29
in a napsack would it be a you know one10:31
lb loaf of bread would it be a 5 lb B10:34
bag of potatoes would it be a 50 lb iron10:37
andil would it be a two-ton truck what's10:38
the emotional burden second what10:43
distress is associated with all of the10:45
self-management tasks what we call10:47
regimen distress the self- monitoring10:50
the monitoring activity the10:52
recordkeeping the medical therapies the10:55
monitoring your feet and eyes over time10:58
all of the time masks that could be ever11:00
present in a person's life can be11:03
burdensome and then there's the11:05
relational aspects of diabetes we don't11:08
experience or live with diabetes in11:11
isolation and here we talk about11:13
provider based distress something that11:15
as a psychologist think is really11:16
important for individuals living with11:18
diabetes and Healthcare Providers to11:21
acknowledge which is sometimes the11:23
medical system the relationship with the11:25
provider can be distressing and if11:27
you've ever felt like uh sometimes going11:29
to see um a medical provider or ENT11:31
diabetes you feel like you're being11:32
called into the principal's office or11:33
you're feeling guilty that you're not11:35
doing enough that's the kind of Provider11:37
distress that we'd like to identify so11:39
we can help you work through and the11:41
final aspect of distress is what we call11:43
social support distress people in your11:45
life so emotional burden if diabetes11:48
were a weight on your backpack that you11:50
carried around how heavy would it be11:51
important question to reflect on because11:55
you may use words like you're feeling11:57
overwhelmed you're feeling burnt out11:59
you might experience what we call a12:02
sense of powerlessness that there's12:03
nothing that you can do because of the12:05
complexity because of the number of12:08
different factors that actually impact a12:10
person's glucose level at any moment in12:12
time you can feel sometimes like there's12:14
not a lot that you can do to make a12:16
difference and by identifying these it'12:18
be really important for you because12:20
acknowledging them bringing them into12:22
the care plan is in most cases the way12:26
that you manage these burdens regimen12:29
distress is really around the actual12:31
management tasks eating related distress12:35
as you well know diabetes changes your12:37
relationship with food because of12:39
glucose in the food that virtually most12:42
Foods we eat so they do have an impact12:44
on your glucose levels and therefore12:46
kind of food almost becomes like a12:48
medicine in a way and so that is a12:51
source of distress and certainly12:53
hypoglycemia distress which I'd like to12:55
talk about in a little um bit because12:57
it's also an important important aspect13:00
and so with regard to the the regimen is13:02
it just overall tasks or specifically13:04
related to food or to the potential for13:06
low glucose levels and if you can13:09
understand your emotional experience13:10
that's then the strategy that leads to13:12
the solutions that can be helpful to you13:15
provider-based13:16
distress um you know have you ever felt13:18
like I can't really tell my diabetes13:20
doctor what's really on my mind or my13:22
doctor provides my diabetes doctor13:25
providers don't really understand what13:26
it's like to live with diabetes I don't13:28
really get the help I need from my13:30
diabetes providers um my diabetes13:32
providers don't know enough about13:33
diabetes care and so you can see from13:36
what I'm presenting here these are13:37
actually normal these are common13:40
experiences that people have and so13:42
we're trying to really you know open up13:44
the uh opportunity and encourage people13:46
living with diabetes to express these13:48
concerns to us so we can then help13:51
manage those and social support distress13:54
people might treat you differently if13:56
they find out you have diabetes you may13:58
feel that you have to hide your diabetes13:59
from other people you're concerned that14:01
diabetes makes you less attractive to14:03
employers people will think less of you14:05
and we do see there is a signal for14:07
diabetes stigma and again if you're14:10
experiencing this this I think can be14:12
really beneficial for you to become14:13
aware of because when we understand the14:17
sources of our distress so threat loss14:22
unfairness then that allows us to direct14:25
our coping resources and when it comes14:28
to coping14:29
the best way to think about it is for14:31
you to identify what's worked for you in14:34
the past so what are your natural coping14:38
strategies what are the coping14:40
strategies of your friends or people14:42
that you trust or people that you might14:45
be encounter who also live with diabetes14:47
who are able to manage the diabetes14:50
quite well so can we learn from others14:52
in other words trying to to Really14:54
encourage us to problem solve and to14:57
really kind of identify ify the nature15:00
of the stour the more specific you know15:01
what the problem is the more you can15:03
match that to a strategy and Diabetes15:07
Care is Shifting towards providing you15:09
with the opportunity not only to problem15:11
solve around eating behaviors or15:14
exercise behaviors or self-monitoring of15:16
your blood glucose but also your15:18
emotional15:19
experiences now as we talk about15:21
diabetes distress there's also important15:23
to talk about two uh relevant issues for15:26
diabetes that have sort of also been15:29
identified through this work that we've15:30
done in defining diabetes distress as a15:33
separate category and that is um forPsychological Insulin Resistance15:37
particularly with type two diabetes15:39
there's often some concerns that people15:41
have around um shifting from oral15:44
medication just taking pills to taking15:46
insulin and interestingly the term15:48
that's used is called psychological15:50
insulin resistance um I'm just showing15:53
you data from a large survey based study15:56
16 countries were involved in the Sur15:58
survey and you can see that a great16:00
number of people with type 2 diabetes um16:03
actually you know are concerned about16:06
starting insulin means that that you16:08
know you've not really been able to do16:10
your job really well so so these are16:12
saying that this is actually a concern16:13
and and there are certain attitudes that16:15
people have around whether diabetes um16:19
takes control away from you when you16:21
shift to insulin whether that means your16:23
disease is more serious whether it means16:25
that it to you you feel that perhaps16:27
it's a it's a personal failure so again16:31
understanding these attitudes can be16:33
really really important because what we16:35
know is that type two diabetes can16:37
sometimes progress to the point where16:39
your pancreas doesn't produce enough16:40
insulin anymore so insulin resistance16:43
becomes insulin insufficiency and16:45
insulin is then required and so askingAttitudes16:49
yourself a number of questions might be16:50
really helpful in identifying any16:53
attitude that you might have that would16:54
interfere with care and the reason that16:57
I'm describing this is because there's a16:59
very recent phenomenon that we've become17:01
aware of in Diabetes Care called inertia17:03
and that is when it's appropriate from a17:05
medical point of view for people's uh17:08
care to be intensified but there's a17:10
delay in the intensification and there's17:13
number of factors that are responsible17:15
for that delay and one of the important17:16
factors is your own attitudes and so17:19
asking yourself and having an17:20
opportunity to talk about these17:22
attitudes might speed up the care which17:24
results in better control for you do you17:28
feel that insulin will take control or17:29
Freedom away from you do you think that17:31
starting insulin means that you failed17:34
are you nervous about or anxious about17:37
injecting do you think that starting17:39
insulin is more work than it's worth17:41
that you won't get any benefit from it17:43
do you think that insulin means that17:45
your disease is more serious and do you17:47
lack confidence these are relevant17:50
questions if you could take these issues17:53
take these questions if you struggle17:55
with any into your provider then your17:57
care plan can take these into17:59
consideration the final thing that IFear of hypoglycemia18:01
want to really talk about is is the fear18:04
of18:05
hypoglycemia which we know is actually18:07
really really common especially if18:10
you've ever had a serious hypoglycemic18:12
event which is when your blood sugars18:14
Get Low to the point where you can't18:15
really treat them yourself and this is18:18
important because what we we've18:19
uncovered is that that this type of18:22
hypoglycemia experience is very18:24
stressful it's a really powerful stress18:27
and it's such a stress that people will18:29
sometimes allow their blood sugars to18:31
stay high in order to avoid going low um18:35
showing you additional data about18:37
concerns about hypoglycemia this is from18:39
that same study that I'd mentioned U18:42
before 16 countries just showing how18:44
common it is for people living with18:46
diabetes to experience this fear of18:49
hypoglycemia so there's a strategy thatManaging hypoglycemia18:51
we've encouraged people to do that can18:52
help them to manage hypoglycemia18:54
sometimes what will happen is your18:56
provider will recommend you get your18:57
sugars under control18:58
but managing the fear of hypoglycemia is19:00
a fear problem not a glycemia problem so19:03
the first thing we do is we determine a19:05
safe zone so what blood sugar range do19:07
you feel comfortable with right now if19:08
you're going to leave the house what are19:09
you comfortable with and that's the19:11
starting point that's in a way the19:12
psychological safe Zone and then we19:15
don't make recommendations based on19:17
ideal we don't recommend that you you19:18
know get your glucose levels let's say19:20
between seven and nine right away what19:22
if your safe zone is 12 to 15 what we do19:24
do is we sort of start with that and19:26
then we try to lower Gra gradually the19:28
psychologically safe range till it19:31
becomes the medically safe range so once19:34
you've got this on board then there's19:37
this gradual strategy it's important19:40
because it's a strategy that really19:42
engages you so you're in charge it's not19:45
something that's done to you and then19:47
you gradually are able to lower that19:49
psychologically safe range to the19:51
medically safe range so I hope this has19:53
been useful to you we've talked about19:55
diabetes distress we've talked about19:57
fear of H glycemia we've talked about19:59
psychological insent resistance and20:01
importantly we've talked about20:03
positivism thank20:10
you
Category Tags: General Tips, Management, Healthy Living;