Not knowing how to monitor or reduce your carbohydrates is an important barrier in your diabetes self-management. This is something that requires attention in the health care setting in which you are treated. Please contact your health care professional to explain that you have difficulties in monitoring and/or reducing your carbs. Ask whether a dietician, diabetes nurse or doctor can explain it to you (again). Don’t be shy or ashamed to ask! It is good and brave to acknowledge that you want to learn more about your self-management!
We know that many people with diabetes experience negative emotions because of their diabetes. These negative emotions can be any negative emotion, such as anxiety, anger, shame, guilt, failure.
Sometimes these negative emotions are directly related to high or low blood sugar. When having high or low blood sugar, many people experience negative emotions. Research even shows a relationship between higher HbA1c’s and negative emotions.
Many negative emotions, in various diabetes related situations can arise.
You may think that taking your diabetes medication (tablets or insulin) gives you negative emotions.
Try to ask yourself: is my negative emotion a direct consequence of my low/high blood sugar? (‘’Do I feel physically uncomfortable, and therefore emotionally negative?’’)
Or is my negative emotion a more indirect consequence of my diabetes (such as feelings of disappointment or failure)?
If your negative emotion is DIRECTLY the consequence of high/low blood sugar, the best thing you can do is focus on optimizing your blood sugar, and not on the emotions. When experiencing high or low blood sugar our brain is negatively influenced and more vulnerable to negative emotions. We just cannot prevent them… The only thing we can do is try to prevent the higher and lower blood sugar (and we will not always succeed…), and tell the people who are close to us, that these negative emotions are part of dealing with diabetes…. This is no fun, but it is good to be realistic about these negative emotions, and to understand that they are just temporary. As soon as our blood sugar stabilize, our emotions will stabilize as well.
Click here if you want to learn more about emotions that are more Indirectly related to diabetes.
The traffic light metaphor is a well-known and widely used metaphor/exercise in psychology.
The red, orange and green colours of the traffic light symbolize phases in our well-being.
- In green, we feel relaxed, happy, physically well. We are ok. In this green phase we feel comfortable both emotionally and physically. With regard to our blood sugar, in the green zone they are ok. No hypo’s, no hypers, no discomfort of increasing or decreasing blood sugar. We feel comfortable in every way.
- In red, we feel totally miserable. We have crossed a line and must pay the price… Emotionally we may feel exhausted, panicked, sad, depressed, stressed or experience another very negative emotion. Physically, many unpleasant and varying symptoms can be present: headaches, nausea, dizziness, pain, shortness of breath, but also high or low blood sugar.
Often, people will say that ‘’all of a sudden’’ they went from feeling ‘’green’’ to ‘’red’’. One minute they were fine, and the next they felt horrible. Be it emotionally, be it physically, or with regard to blood sugars: this sudden change is not as sudden as we think.
- In most cases, we have been warned by our body and brain about the approaching red phase. As if our body and brain are telling us: ‘’Alarm! Be aware! Something unpleasant is coming up!’’ This alarm phase is the ‘’orange’’ phase. In this orange phase we start feeling uncomfortable. In many ways our body and brain are trying to tell us that ‘’we have crossed a line’’. Our body and brain are trying to tell us that we need a short break, something to eat or drink, a relaxing moment, medication, some positive distraction, the attention of a loving person… And although we ‘’know’’ that this is what we need, we don’t really act upon these needs. Many times we are just too busy or inattentive to pick up upon those signals… It is not that we really cannot feel them, but in our busy daily lives, we have unlearned ourselves to pay attention to them. When ‘’ignoring’’ these signals, the uncomfortable feeling will get stronger and more negative, and eventually will lead to the ‘’red’’ phase.
For many reasons, it is good to improve your skills to recognize the signals in the ‘’orange’’ phase, and to act upon them. This is how you can try to prevent or decrease the ‘’red phase’’, be it about high/low blood sugar or panic attacks.
But before you can do something with these signals, you will have to become increasingly aware of the signals first.
When you want to train yourself in recognizing ‘’your orange signals’’, there are some things you can do:
- Whenever you experienced a ‘’red phase’’ (panic, intense sadness, hypo’s, hyper’s etc.), take some time to think about the moments BEFORE the red phase. How were you feeling a couple of hours before? Do you think you have ignored any signals (hunger, irritation, tired, feeling warm/cold, feeling emotional etc.), maybe because you were busy or thinking that ‘’it could wait’’? If you have felt (a little bit) uncomfortable in the hours before you entered the ‘’red phase’’: hooray! Then you have probably started to recognize the first ‘’orange signals’’
- Start increasing your awareness on the ‘’orange signals’’ by asking yourself how you feel, at various timepoints during the day. It takes only 30 seconds, and you can easily do it at all moment when you are ‘’waiting’’ (for the coffeemachine, printer, for the traffic light, in the elevator, during public transport etc.). Use these seconds/minutes to train your awareness, by asking yourself whether you think you have ignored/are ignoring any signals (hunger, sleep, irritation, feeling warm/cold, feeling emotional etc.)
- If your awareness on the ‘’orange signals’’ has increased, you can start to act upon them. Of course, this does not mean that you will need to go to bed, when you feel sleepy during the day at work… Or that you can just take a lunch break whenever you need.. But sometimes a ‘’microbreak’’ is already a first good step, towards less ignoring of and acting upon important signals. Examples of microbreaks are: just getting something to drink, opening a window, doing a one-minute breathing exercise, doing some stretching etc.
Hopefully, these tips will help you in your first attempts to recognize and influence your traffic light!
Self-managing your diabetes can be quite a challenge. Many people with diabetes find it difficult to combine their ‘diabetes goals’ with all the other things they do in daily life. ‘Just’ taking care of your diabetes is difficult enough as it is, but taking care of your diabetes while being at work, performing sports, taking care of your children, being with your friends etc. is a challenge!
In diabetes care, focus has shifted from ‘getting the right numbers’ to implementing diabetes in your daily life in the most positive way. The numbers (glucose and HbA1c) are still important, but health care professionals now realize that implementing diabetes in your life in a positive way probably is the best way to optimize glucose levels and HbA1c. Or put differently: if you are struggling with how diabetes fits into your life, then you are probably also struggling with the glucose levels.
Luckily, most people eventually find a way to fulfil both their diabetes goals and their personal goals in daily life.
If you feel that there is a (hindering) conflict between your diabetes goals and your personal goals, it is good to further explore the conflict.
The following questions might help you in examining the conflict:
Which personal goals are difficult to achieve because of diabetes?
- work related goals
- goals related to family, friends or other significant others
- goals related to sports/exercise/hobbies
- goals related to other social activities (e.g. going out, eating out etc.)
Which part of having diabetes is hindering you in pursuing your personal goals?
- the actual self-management actions (e.g. monitoring blood glucose, taking pills, injecting insulin)
- low or high or fluctuating blood sugar (e.g. hypo’s, hypers)
- opinions or ideas of other people about having diabetes (e.g. not wanting to be seen as ‘’different’’/not wanting to be a ‘’burden’’ to others)
The next thing to examine is: HOW CAN CHANGING/IMPROVING YOUR DIABETES SELF-MANAGEMENT contribute to achievement of your personal goals?
Or put differently: if your diabetes self-management would run smoothly and easily, which personal goals would be easier to achieve?
E.g. ‘’If I would have less hypo’s/fluctuating blood sugar, I would probably be able to start running again.’’ or
‘’If I would be able to inject insulin in the presence of other people, I would probably go out more often…’’
If you are able to make such a connection between your personal goals and diabetes self-management goals, you have already won half the race. This is the most important thing to know. The second step is to discuss exactly this goal with your diabetes health care provider (nurse, GP, internist). This is what is most important now for you in the treatment of your diabetes. Diabetes health care professionals have many ideas and tips of how to help you with these things. And they will understand: if this is what is important for you, and it is changed positively, then it will also change your diabetes positively!
Stress will always be a part of our lives. No matter how smooth and efficient we organize our jobs and private lives, stress will sometimes be part of it. In general, a little stress every now and then, will not do us too much harm. We may not be able to prevent that type of stress, but it doesn’t influence too negatively.
However, the chronic, or frequently returning stress does damage our mental and physical health. It is therefore worthwhile to try to minimize these chronic or frequently returning stressors. These are the stressors that ‘’wear us out..’’
In general there are a few tips to help prevent chronic stress. They may sound simple, but they are not. Often it takes a lot of practice before one can regularly use them.
If you want to work on stress prevention, and make a meaningful change in your life, choose 1-3 tips to start with. Write down these tips and discuss them with your partner, good friend or anyone else that is close to you. It is important to mention them out loud, to make sure that your brain becomes extra aware of this ‘’exercise’’. From then on, you can start trying to implement these first tips. Make them more specific to be extra successful. E.g. adapt ‘’say no’’ into ‘’say no to extra meetings at work’’ or ‘’say no to Henry, who wants me to start the ambitious project’’ or ‘’say no to social events that I don’t really like’’. If you have such a specific exercise, you will notice that become better at (e.g.) saying no or delegating. And that will help you in preventing more stress in the future! It is difficult, but it works. Just give it a try, and try every tip that you choose for at least a few weeks.
- say no more often
- practice with delegating more tasks
- identify your own ‘’musts’’ that are not really ‘’musts’’: think of things/tasks you do of which other people have told you are that they not really necessary/you could postpone them
- start with (gradually) postponing tasks, if cancelling/not doing them is too difficult
- if you are sick/not feeling well, don’t try to ignore it, listen to
Stress and diabetes have a complex relationship. It is well known that stress influences your diabetes, in both direct and indirect ways.
Stress is seen as a state in which both physiological and mental changes take place. The mental changes refer to the more alert, but also more nervous or more emotional state that stress can bring us in. Mentally, we are not at our best, when being stressed.
Physiological changes refer to hormones that are released to prepare our body for ‘’danger’’: to make us more alert, and to bring our body in a so-called fight/flight/freeze mode. In this mode we have ‘’extra energy’’ to deal with a dangerous situation, just as our ancient ancestors needed when confronted with wild animals (then you want to fight/flight/freeze J). Nowadays, this physiological stress response is only effective and needed in very specific situations, but our body ‘’turns it on’’ every time we experience/perceive a stressor. Unfortunately, this physiological response also influences our blood sugar. People with diabetes, who monitor their glucose, often report the influence of stress on their blood sugar.
Scientifically, we still have not fully unravelled the relationship between glucose and stress. Part of the Power2DM research therefore is focused on this specific relationship. We want to understand more how stress influences glucose, how long it lasts, and what we can do about it. That is why we have asked you to fill out your stress levels (multiple times per day). We can relate them to your glucose, and learn much more about this relationship.
What we already know, is that there are general tips that are helpful for everyone experiencing stress. And because of the influence of stress on glucose, these tips might be even more important for people with diabetes:
- when feeling stressed, try to engage in a physical activity. It can be walking, running, jumping, cycling, or any other exercise or sports. Your stressed brain in the fight/flight/freeze mode needs physical input/stimuli to get off the ‘’danger’’ track. Your brain can not ‘’feel stressed’’ and engage in a physical activity at the same time
- when feeling stressed, try a breathing exercise. In a way, this is also a ‘’physical activity’, giving your brain input to be more relaxed. Our breathing is an important connection between our brain and body, and it works both ways. If you are stressed/anxious/emotions, you will notice your breathing getting more superficial and quicker. And when you are doing a breathing exercise to make your breathing slower, your brain will start being less stressed/anxious/emotional. Breathing exercises can be very ‘mindful’ or even sort of spiritual, but they can also be very short and goal oriented, without the spirituality. Just search online for breathing exercises in your own language, and you will find various versions. Try several, to find out which ones suit you best. Once you have a breathing exercise you like, PRACTICE! If you really want to feel less stressed, doing breathing exercises is one of the best things you can do. The good thing is that you can practice them anytime, everywhere: while doing the dishes, being in the elevator, driving the car, at work etc. Try to make it you second nature to focus on your breathing every now and then.
- try to make sure that you get enough sleep. Without sufficient sleep our body becomes stressed more easily. Try to look at relaxing and sleeping as an ‘’investment’’ in your health and efficiency. If you are less stressed, you will work more effectively and will be able to get more things done, then when you are staying up late every night, trying to work on all the things on your to-do-list. When stressed, we spend more time on all the things we do. So, try to relax and get to bed early, when you feel your body needs it!
Being active, doing things we like helps to maintain or improve our well-being. Our brain is able to reduce the impact of negative emotions, negative experiences or stress, by releasing a sort of ‘’natural anti-depressants’’ that make our body and mind feel more relaxed. These ‘’natural anti-depressants’’ are released when we are active (exercise/sports), or doing something pleasant.
In our busy lives, many people find it difficult to find the time to do something pleasant/relaxing. And sometimes people even forget which things they liked to do, or which things made them feel relaxed.
If you want to engage more in pleasurable activities, but you are unsure what to do: here is a list of things you can think about. Hopefully it inspires you to think of even more pleasurable things to do!
If you are in a low mood, it is important to do pleasurable activities regularly, to release your natural ‘’anti-depressants’’. However, don’t expect that any of these activities makes you feel better right away. It is just as with taking ‘’anti-depressive pills’’, it takes a few weeks before you will notice differences in your mood. If you are really depressed, you might not even really enjoy the activities right now. That is why it is so hard to improve your mood: you have to perform activities you are not really enjoying at the moment…. But keep up the good work! Within a few weeks you should start to feel a little better!
Go for a walk or a run (preferably in a natural setting, such as the woods or a park)
Listen to (your favourite) music
(Re-)read your favourite/a book
Visit or invite a friend
Get a massage
Drink coffee/tea in a nice café
Take a relaxing shower/bath
Call someone you like on the phone
Watch your favorite/a movie
Surf the internet on topics you like
Dance (just in your living room or any other place)
Go to a museum
Draw, colour or paint
Write a postcard or letter to someone you like
Visit the library or a nice bookstore
Read your favorite magazine/newspaper
Play a musical instrument
Ride your bicycle
Go to a concert
Go out for a picknick
Practice yoga or meditate
Play cards or a board game
Do a crossword puzzle.
Prepare a healthy and nice meal
When not having reached your goal, or not having succeeded in following upon your plans, there might be many reasons and explanations. Similarly, there might be many solutions and helpful tips to increase your chances of goal progress next time.
Below, we summarize general tips that might be helpful in increasing your chances of goal progress/following upon your plans
- Create a (n extra) cue to make sure you won’t forget the plan: make a reminder in your phone/computer, put a note/post-it on a place that you see most of the day
- Make sure that your plan is explained/mentioned to at least one person who is close to you. He/she could simply ask how you are doing, and whether your plan worked out.
- Make sure that you won’t start talking/thinking negatively about yourself. Try to motivate yourself with a positive slogan/mantra. And be sure that you won’t use a negative slogan/mantra. If you want to know more about this, you can click here for more information on negative self-talk
Give yourself a small reward for every time you succeed. This can be something simple: taking a few minutes/some time for yourself, watch your favorite tv-series, take a bath, drink your favourite coffee/tea (for an inspirational list of pleasurable activities, click here.
Knowing that lifestyle is an important factor in the development of type 2 diabetes, many people incorrectly assume that having diabetes ‘’is their own fault’’, or that ‘’they are to blame’’.
Unfortunately, this assumption about diabetes is often confirmed in the media. This assumption ignores the fact that other factors, such as genes, also play an important role in the development of type 2 diabetes. Diabetes is never just a matter of overeating…
For people with type 2 diabetes, having feelings of guilt or self-blame is not helpful. This negative self-talk is believed to be helpful, but in reality only ‘helps’ to feel bad about yourself and making it even more unlikely to reach a goal next time. Research shows that having negative emotions (about yourself) increase the chances of depression and worsens/deteriorates your self-care, with higher HbA1c’s as a possible consequence.
Therefore, it is important to try to be (more) positive about all the effort you are putting in your diabetes self-management.
However, because this self-talk is so powerful and automatic, it is quite difficult to change it yourself. You will need someone else to help you change this negative self-talk. Or at least: you will need someone else’s voice to teach you how to talk differently and more positively to yourself.
Think of someone who you really like (and who really likes you J), and try to ‘’borrow’’ his/her voice. What would he/she say to you about not having reached your goal?
What would be positive in his voice? And what would be helpful to you?
Try to write down at least 3 positive/helpful things that this person would say to you. Write them down on a nice looking piece of paper/postcard and keep them with you. Look at the card/paper at least once a day.
Depression can be diagnosed by a health care professional, based on specific symptoms. A diagnosis of depression is made, if five or more of the following symptoms persist for a minimum of two weeks:
- loss of interest in activities/pleasures
- low energy and increased fatigue
- sleeping problems (either sleeping too little/too much)
- increased or decreased appetite or weight
- feelings of hopelessness/negativity
- having thoughts about death or suicide
- feelings of restlessness
- feelings of sadness, anxiety
- problems to concentrate/memory problems
If you experience several of these symptoms, it is always good to contact your general practitioner of diabetes health care professional. They can help you.