Diabetes and depression

Research shows that people with diabetes are twice as likely to suffer from depression.
People with diabetes, suffering from depression usually have higher average blood sugar levels (HbA1c) than people with diabetes without depression. Therefore it is important to recognize and treat depressive symptoms in people with diabetes.
In diabetes care, awareness about diabetes and depression is increasing. However, we know that depressive symptoms in people with diabetes are often not recognized.
If you think that you might suffer from a depression, it is always helpful to discuss this with your diabetes health care professional. Click here  if you want to learn more about symptoms of a depression.

Struggling with the fear of gaining weight

Many people with diabetes struggle with their (ideas about their) weight. Weight and blood sugar have a complex and sometimes difficult relationship. Problems with weight and blood sugar often are different for people with type 1 or with type 2 diabetes. Although the two types of diabetes can be related to any type of weight  issue, we generally see two main problems regarding weight and diabetes: 1) people with overweight (mostly type 2 diabetes), needing more medication to keep blood sugar in healthy ranges, 2) people who are deliberately undermedicating (e.g.) hoping to lose weight.
Both types of problems are serious problems. The first problem (needing more and more medication, while being overweight) can bring people in a so called vicious cycle: because of their overweight and higher blood sugar they need more medication, but because of the extra medication, they put on even more weight.
It hardly needs further explanation that the second problem (deliberately undermedicating)  is an unhealthy and even dangerous strategy for weight maintenance/loss, with increased chances of serious diabetes complications in both the short- and long term.
Because of the complexity of the two problems, it is difficult to give proper and tailored online advise. It is of great relevance to discuss any of these problems with your diabetes health care professional (or any other professional you trust). Having this problem doesn’t necessarily mean that you have an eating disorder or some other mental issue, so you don’t necessarily need to be referred to a therapist for it. Of course, you can be, if you want to, but is not (always) a necessity. However, it will probably be helpful if a diabetes professional can help you in breaking the vicious cycle. Both types of problems need understanding and help from your diabetes professional. And remember: you are not alone! Many people with diabetes struggle with these types of issues. Your diabetes professional has probably helped other people dealing with these issues before.

Coping with fear of needles

  • Start practicing when you are at home, or in another place where you feel safe and comfortable
  • Just hold the insulin syringe or pen in your hand until you don’t feel any anxiety. If you feel anxious when holding the syringe or pen, you can also start by putting it on the table, in front of you and just look at it. Look at it, until you don’t feel anxious anymore. And then proceed with the ‘holding’ step.
  • Practice drawing up the correct dosage of insulin until you no longer experience fear
  • Act ‘’as if’’ you are going to inject, without actually doing so
  • Inject (perhaps into the stomach area first as many people find it less painful as there are few nerve endings there )
  • If you want to try to inject in other parts of the body (not necessary), you can now start to try to inject in your thigh or buttock
  • Continue practicing at other places, a friend’s house, work, a restaurant, in the train

Fear of needles

Feeling uncomfortable about or disliking needles is a normal and healthy response. Having to inject yourself/or being injected simply is no fun. And for some it may even be (a little) painful. Sticking a needle in your own body is not a natural thing to do. In a way, every time we inject ourselves, our brain is telling us ‘’that we are in a dangerous situation’’. Even when we rationally know that these injections are saving our lives, or increasing our health. Rationally we know that it is healthy and good to inject ourselves, emotionally our brain is not that convinced…
Some people have such an intense fear of needles, that they develop negative symptoms every time they have to inject themselves. These symptoms can be:

  • sweating
  • trembling
  • feeling dizzy
  • breathing heavily (hyperventilation)
  • feelings of panic (attacks)
  • fainting

In some, this might even lead to avoiding injections, and not being compliant to their medical regimen.
If you want to continue with an exercise about fear of needles, click here

About diabetes complications

In diabetes care most emphasis is put on optimizing blood sugar. Since persistent high blood sugar may lead to unwanted negative health effects (complications), diabetes health care puts strong emphasis on (helping) preventing high blood sugar and complications, and detecting early warning signs.
Most people with diabetes know about the potential negative health effects of persistent high blood sugar. They know about the potential risks of visual impairment, kidney failure or even amputations. And many have heard of or know someone, who has been confronted with diabetes complications.
It is good to know about the potential dangers of persistent high blood sugars, and about how to increase the chances of preventing complications.
It is also good to be realistic about the chances of developing these complications. Fortunately, most people with diabetes will NOT develop these serious complications.
Most people are aware of the dangers of persistent high glucose levels, and will use it to a good end. They are aware, but not negatively influenced by this awareness. They are trying their best to prevent persistent high blood sugar, and do not ruminate (too much) about future complications.
However, some people worry about diabetes complications more than is good/healthy for them.
If you worry about high blood glucose levels and/or complications too much it is good to educate yourself about the actual risks of developing diabetes complications. Your health care professional monitors the (lack of) progress of these complications and is able to tell you more about your personal risk.
Apart from education about (un)realistic chances of complications, it is best to focus on the things you can influence or change NOW. Even when you are faced with an increased chance of developing complications in the future, there are many things you can do NOW that help you in trying to make your health situation as good as possible: monitor your glucose, being compliant to your insulin regimen, eating healthy, doing exercise. You can even ask your health professional which health behaviours are most influential in the (prevention of the) development of complications.
Being fearful will cost you energy. Energy that is lost, without any effect. See whether you can change this negative energy into effective energy, by changing your self-management for the best!

Negative self-talk

Too bad you did not succeed in fulfilling your goal. That is what (sometimes) happens when trying to reach your goals and changing behaviours. It is all in the game 🙂

When not fulfilling/reaching our goals, many people start ‘blaming’ themselves and (unconsciously) start negative self-talk. 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.

In general, people don’t like hearing negative stuff, so why try to tell yourself that ‘you are stupid/dumb/unworthy etc. for not having reached your goal? Or making yourself feel guilty for not reaching your goal?

Stopping this negative self-talk is not easy, but really necessary when trying to change behaviour!

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.
If you want to learn how to do this, click here to do an exercise on this.

Coping with negative self-talk

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.

Increasing the personal relevance of monitoring

Our brain has less attention for things that are not important to us, so it is hard to perform a behaviour with less attention.
One good question to ask yourself is: is there ANY moment/situation in which you do find it personally relevant/important to measure your glucose? This could be the moments that you are not feeling well, or before dinner, before going to bed, or before doing sports or driving.
In general, we see that many people with diabetes benefit from measuring their glucose. But some situations/time points are more informative than others. If you are used to measure your glucose every morning when you wake up, that in itself is a good thing. But if your blood sugar are similar every day, it might not be the most informative moment to measure your glucose. You might even benefit from changing the moments you measure completely.
Think about which specific moments would be more/most informative to you. Write them down and discuss them with at least one other person, someone who is close to you. Then try to think of a first step/goal in increasing your monitoring. It is not about ‘’doing everything right’’, but about taking a different approach and a first step in change. Try this first step for at least a couple of days.

When you don’t know how or when to assess your blood sugar

Not knowing how or when to assess your blood sugar 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 your glucose. Ask whether a diabetes nurse 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!

Importance of glucose monitoring

Good to know that you question the usefulness of monitoring your glucose levels. We rather know, and try to help you.
Sometimes it may feel as if the monitoring of your glucose is not helping you at all. If you feel that monitoring is not helping you, it is good to discuss with your health care professional. Your health care professional can help in explaining why monitoring of your glucose is helpful in YOUR specific situation.
In more general terms, monitoring of glucose is important to understand what medication is doing for you. Your HbA1c value gives a very general idea of it, but specific glucose measurements give your health care professional much more information about how the medication works for you.
Without these glucose measurements, a health care professional would just have to ‘’guess’’ that your average HbA1c gives a good enough indication of how medication works. Most people with diabetes will feel whenever they have low blood sugar, but they often don’t usually feel their (slightly) higher blood sugar. That means that your body usually only ‘’tells’’ you half of the things that are important to know, and that you (or the health care professional) cannot only trust your feelings with regard to your blood sugar. Knowing these ‘’higher’’ blood sugar is not only important in preventing long term diabetes complications, but also in making you feel more optimal in the short term! If monitoring your glucose would reveal higher blood sugar, it would be possible to try to prevent them/adjust them, to make you feel even more energetic and positive.
Often people will only know ‘’how bad they have felt’’, once they experience that they can feel much better. That is what mon