Traffic light

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!

Stress prevention

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

Coping with your Stress

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!

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.

Coping with negative emotions because of exercise

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 a specific part of diabetes self-management. Of course, no part of diabetes self-management is really ‘’fun’’ or enjoyable. But some activities might induce more negative emotions than others. You mentioned, that doing exercise gives you negative emotions. This is important to know. We hope we can help you modify those feelings.

  • Do you know which negative emotion you have about exercise? Does it feel boring? Do you feel sad about it? Do you feel angry, that you have to spend time on it? Are you anxious about having hypo’s? Or maybe too self-conscious about your looks while doing sports?
    Or maybe there is another negative emotion that you are aware of.
  • It is important to realize that emotions always are ‘’true’’, these are your individual feelings. They might not be useful, or logical, but that is the way you feel. In the section “Managing your Emotions” you will find specific information about specific emotions, such as feeling anxious about hypo’s, feeling stressed, feeling depressed/sad. If you recognize any of these emotions, please take a look at the website to read the texts that refer to what you are feeling
  • Another thing to ask yourself is: do you feel ‘’good’’ ‘’better’’ or positive in any way, AFTER sports/exercising? If so, you are probably still on the right track…, but your brain might just need more time to ‘’get used to’’ this new behaviour. The positive feeling afterwards works as an important reward for your brain, but it takes time for your brain to ‘’connect’’ this positive feeling (reward) to sports/exercise. If you would continue to perform your exercise/sports, and you would have this positive feeling afterwords, your brain will even learn to long for this feeling …, and make you want to perform sports/exercise more and more…

If you have tried to do sports/exercise for a while, and you keep experiencing negative emotions without the ‘’reward feeling’’ afterwards, then it may be time to adjust your goal. Click here if you want to read more on why and how to adjust a goal. Click here if you want to read more on how chose different ‘’exercise’’ goals.

Coping with your fear of hypoglycaemia

You may have used the tips and advices we gave when you recognized your fear of hypoglycaemia and your excessive safety behaviours.
In case you forgot them, you can click on this link, to Worrying about low blood sugar.

If you want to work on limiting the excessive safety behaviours yourself, you could make a so called ‘’safety ladder’’. By means of this ladder you will be able to make a hierarchy of your fears and safety behaviour, and to take a first step in changing your behaviour.

Before trying to make this ladder and changing your behaviour, it is good to think about the purpose of trying. Why would you change your behaviour? And what will it do for you?

One of the reasons of changing your safety behaviours is that we hope you will be able to broaden your comfort zone.
When you take a look at this picture, you can see your comfort zone in green. This is the ‘so called zone’ that you feel comfortable in. With your safety behaviours you will make yourself feel safe and as comfortable as possible. However, this means that you ‘offer’ some freedom and flexibility. The more safety behaviours you perform, the more safe you will feel. But the more anxious you will feel when you are outside of your comfort zone.

In the picture you see an example of someone who feels comfortable in his comfort zone performing his personal safety behaviours: staying at home, frequently checking blood glucose, or always being in the presence of others.
When this person is not able to perform (all) his safety behaviours he will need to step outside of his comfort zone. Which, of course, feels anxious and uncomfortable. And the more he stays in his comfort zone, the less comfortable he feels when having to step outside his comfort zone.
In the example you see ‘’sleeping alone in a hotel’’. That would be described as his worst nightmare: not having others around, and going to bed alone would be the most frightening thing he could imagine.
You’ll probably understand that his anxiety would be extreme, when he would be forced to do this. And he would probably quickly return to his comfort zone, to never step out of it again J

When trying to reduce anxiety it is important that you will try to do it slowly and stepwise.
That is what the ‘’safety behaviours ladder’’ is for!

Below, you find an example of such a ladder. For this person, not eating a midnight snack (and thus having ‘’lower’’ blood sugar in the night) would be the most frightening thing to do. That would not be a very wise first step.
However, this person thought of a first step: ‘’Not unnecessarily checking blood glucose when feeling ok and relaxed, and his partner being around…’’ That step would make him only feel slightly uncomfortable, but would certainly not be his worst case scenario.
This would be something he could start to practice. First telling his partner about it (for emotional support and help!), and then starting to ‘’not measure blood glucose’’ under these specific conditions.

Question: try to think of a first step on your ‘’safety behaviour ladder’’.
Which safety behaviour would you be able to let go of, under specific conditions, and only feeling slightly uncomfortable?
Would it be one less measurement of glucose? Not eating a carb snack? Injecting a little more insulin? Going out/doing physical exercise?
Write down the specific behaviour, and discuss it with at least one person. Try to perform the behaviour a few times.

How to deal with frustration

Sometimes, people with diabetes try their hardest without any apparent result… They injected insulin/took their medication, they monitored glucose, they watched their foods, they exercised, and still their blood sugar values are not in control… Of course, this might lead to feelings of frustration or even thoughts such as ‘’Why am I doing all this?’’ ‘’Does this have any effect, at all?’’
We can totally understand these thoughts and feelings. And they are perfectly normal.
However, we can tell you that your effort in self-management is ALWAYS useful! Always.
Unfortunately, diabetes is no mathematics. It might be tempting to think in mathematical terms, but in the world of diabetes maths means that 2+2 = 4, but sometimes it is 6, or even 7 or 2.5. Without any clear reason.
Most people with diabetes find that extremely frustrating. You are trying so hard, and yet: it seems as if nothing happens..
Keep in mind that if you would do NOTHING or LESS it would be much worse. That means your effort in self-management makes a change!!!  It is just not visible how your effort helps in preventing this worse situation. That is important to remember: your intentions were the best, but it just did not work out the way you hoped…. The next time it probably will.
At these moments it is good to keep in mind that diabetes is no mathematics, and that you can only do your best. Try not to be too negative about your actions/y

Feeling uncomfortable telling about your diabetes

Some people with diabetes feel uncomfortable telling about their diabetes, or about performing their self-management in public. Instead of monitoring their glucose and injecting their insulin in public, they would rather do that in a more private place, without other people seeing them. Sometimes this ‘private’ self-management works out fine, but often it means that people cannot really ‘’be themselves’’ and don’t get the support/space they need to perform optimal self-management. It might even lead to situations with people experiencing a hypo, without telling the people around them, or postponing insulin injections/glucose measurements.
People who are anxious about telling about diabetes or showing their self-management, usually fear that others might feel negative about their diabetes. They might feel that ‘’people will see them as being different’’ or ‘’that they won’t belong anymore..’’ When fear of other’s opinions is the main reason that you perform your self-management in privacy, then it would be better to try to change that. Since diabetes self-management is such a big part of one’s life, it is not good to hide it from others… In a way, you are hiding a part of yourself, which in the long term will not feel good.
Of course there will be annoying people who have a negative or strong opinion on diabetes (usually they really don’t know that much about diabetes), but usually, these people are not our dearest and closest relatives/friends. Your challenge then, is to disclose about your diabetes to people that you are close with, and to ‘’hide’’ it from people you don’t really like/who totally don’t understand. If there are close relatives or friends that have negative opinions on your diabetes, it would be good to discuss it with them. Being it such a big part of your life, it is important that the people who are close to you understand what living with diabetes means to you. Start with the person you trust most, and start with changing just 1 self-management task (either blood glucose monitoring, or injecting insulin etc.). Hopefully, you’ll notice that the people who are important to you have understanding (and even respect) for the fact that you are taking good care of yourself, by self-managing and not hiding your diabetes.

Negative emotions when (not) monitoring your blood glucose

You reported to have negative emotions when (not) monitoring your blood glucose. Know that you are not alone. Many people with diabetes will develop negative emotions about monitoring glucose, mostly because they focus too much on the outcome of the measurement. Basically, people ‘punish’ themselves emotionally, when having high or low blood sugar. And thoughts will automatically pop up, such as ‘’I should have done this..’’ or ‘’I should not have done that…’’, blaming themselves for not having the best glucose levels.
Our advise? STOP IT NOW! Blaming yourself is ALWAYS counterproductive, and will not help in optimizing your glucose levels nor in increasing your glucose monitoring. When blaming ourselves, our brain is ‘’negative’’ and functions less optimal: we simply cannot perform at our best anymore. It might even lead to a stress reaction, that increases blood sugar…. So, the best you can do is stop blaming yourself.
Focus on your behaviour, in stead of the outcomes/numbers. When you have done a fingerprick: make yourself a compliment. Well-done!! Regardless the outcome. You were able to contribute to your health in a positive way: you monitored your glucose. And when the outcome was not what you hoped it to be, it was even more important that you monitored. Good!
If you want to change your negative feelings about monitoring, try to make yourself a compliment every time you do it. It is even more productive when you let others (help to) make you a compliment!