Diabetes and Wellbeing by Dr. Jen Nash

Diabetes and Wellbeing by Dr. Jen NashI recently finished reading “Diabetes and Wellbeing” by Dr. Jen Nash, and I really enjoyed it.

Subtitled “Managing the psychological and emotional challenges of diabetes types 1 and 2” Dr. Nash set out to help us find some good ways to deal with the challenges we face dealing with the daily demands of diabetes.

Dr. Nash is a Clinical Psychologist near London, is the founder and director of PositiveDiabetes.com and has lived with type 1 diabetes since she was six years old. She says she went into psychology to figure herself out, but I think it’s something she’s just naturally good and we all got lucky that she found her calling right away. 🙂

Diabetes and Wellbeing covers a really wide range of focus areas. Take a look at some of the areas Dr. Nash covers:

  • Dealing with diagnosis
  • Depression, low mood and burnout
  • Fear, anxiety and worry
  • Food, weight and emotions
  • Relationships
  • Implementing change
  • Managing setbacks

There were many areas that really hit home for me, and many sections of the book where it seemed Dr. Nash could see exactly what was inside my head and already knew many of the things I struggle with. I found myself dog earing page after page, often even scribbling notes in the page margins.

So many pages dog eared!

So many pages dog eared!

One of the biggest takeaways from Diabetes and Wellbeing was a sense of normalcy to struggle with so many of these things. And to have a permission, of sorts, to explore these areas of diabetes that are not talked about enough.

It gave me some tools and resources to explore these areas in my own head, which is something I’m often simply afraid to do, and it also helped equip me to have difficult conversations with my healthcare providers if necessary.

Cognitive Behavioral Therapy for Diabetes

This book takes an explicit Cognitive Behavioral Therapy (CBT) approach to making changes, and that was an approach that was agreed upon between Dr. Nash & her publishers before starting the book. Dr. Nash said that it’s just one of many different approaches that she uses to help people, but you should know before starting that you’ll find only the CBT approach here.

The NHS website does a good job of explaining what CBT is if you are curious to learn more. I know that both Dr. Nash and the resource I offer here for CBT information are both from London, but that’s just a neat coincidence. This type of therapy is used widely around the world.

That’s actually a great transition into something else I’d like to mention. Dr. Nash is from London, so there will be a few “UK’isms” that may catch you off guard. That typically means an extra “u” somewhere (colour vs. color, or behaviour vs behavior, for example), but you might notice other things that don’t quite fit. Wasn’t a big deal for me, but I’d be interested to know if you find other things that just don’t seem right to you as a reader from a different local. I’m sure Dr. Nash would love to know as well.

Resources

Dr. Nash closes Diabetes and Wellbeing with a list of resources, where I was pleasantly surprised to be listed, along with many other greats, as a motivational and support resource. Thank you, Dr. Nash! Very cool! 🙂

Discount Code! Dr. Nash has graciously offered a 20% discount code that you can use to order Diabetes and Wellbeing if you’re interested. Visit www.wiley.com/go/nashdiabeteswellbeing and use code NASH1 when checking out.

Diabetes Hope Conference

I’m also thrilled to share that Dr. Nash is joining us as a panelist for the 2014 Diabetes Hope Conference! Shortly after reading her book and connecting with her via Skype to chat, I asked her to get involved. She will bring an awesome perspective to our panel about the patient/doctor relationship, and I’m very excited to watch it! I hope you can tune in, too.

To learn more and register for your free (virtual) seat, please go to DiabetesHopeConference.com.


Disclosure: Dr. Nash sent me a free copy of Diabetes and Wellbeing, but did not ask me to write about it. I really enjoyed it, found it helpful, and wanted to share it with all of you.

Found My Way?

I’ve been feeling better lately (thank you retail therapy).

Feeling lost is something that comes and goes when dealing with a lifelong thing like diabetes.  Maybe it is a little more noticeable for us because we’re the ones “in charge” of those delicate daily decisions.

I also believe that when our blood sugars are out of whack, our chemical balance is taken for a ride along with it.  This pulls and tugs on our emotions just as literally as a puppet-master pulling strings on his/her marionette.

I’ve also noticed that when things are going better, we are much less mentally occupied by diabetes.  That, for me, is a testament to just how mentally draining it can be to fight to get things back to better.  The mental load is like carrying a football player on my back everywhere I go.

Sometimes you have to take a break and figure out a better approach.  Sometimes that means not fighting so hard to force everything back in the lines in one fell swoop, but rather gradually try to convince the crayons to behave themselves.

Lost So Long?

I’ve been feeling very emotional about my diabetes recently.

It feels very vague and hard to identify.

lostThere is nothing really specific I can pin it to, no real point of frustration or trouble.  More like a low level, under the surface disturbance that has gotten my emotional undies all in a bunch.

I was reading one of Birdie’s posts and it hit me.  How can I possibly feel so utterly lost sometimes when I’ve been dealing with diabetes for my whole life?  That feeling of “lostness”, not in terms of loss (a different issue altogether), but rather not knowing where to go and what to do, really hit me.

I think it is important for me to recognize those feelings when they come up, especially when I am able to put a word to what I’m feeling.  I’ll try to dig into it more and see what comes of it.

For the Record – Absolute Shyte

Just for the record, my diabetes management has been absolute crap for the last couple of months (plus).

I think it is some kind of mourning period from my last A1C surprise.

Really high blood sugars and a “poor me” attitude have left me feeling tired and cranky, irritable and angry.  I feel like I’m coming through it now, but damn, what a ride.  I’ve been trying to eat it all away which makes me feel even worse after the first 10 minutes of food induced pleasure.

This period of acute depression is downright paralyzing, and when I fight up the strength and energy I apply it in a rebellious way rather than productive.

It dawned on me that I go through this period of mental struggle after every “bad” A1C result.  It takes me almost a full three months to pull out of it, lining me up for another shitty A1C result.  The difference seems to be that I expect this one to be crap, and can then get on with life.  It’s the ones that surprise me that throw me off balance.

With that recognition, and about a month before my next blood draw, I’m working through the last bits (I think) of bad attitude and moving on.

Never Quite “There”

Medical caduceus symbol with a big letter D on itI’m not a huge “road trip” guy.  I’ve never mastered the art of enjoying the trip. Instead I’m usually focused on reaching my destination so I can be done driving.  I’m always glancing down at the clock or the odometer to see how much driving is left.

I just want to get there.

I recently moved, and moving is another one of those things.  It is a HUGE job, but you are motivated to finish by the finish itself!  You know that the big heavy boxes and furniture will, at some point, be all moved and you won’t have to lift them anymore.

With diabetes, I’m just never quite there.  I never feel like I’m doing well enough, trying hard enough, living smart enough.  I expressed my frustrations a long time ago, and really nothing has changed since then (over two years ago).   I’m still frustrated.

I believe that most other things have a start and finish.  You engage in a big job, you bust your ass, you finish, and can proudly look back on what you have accomplished.

Why does living with diabetes feel so different?

My first thought is because it never ends.  It is forever.  Is that why?

Maybe that has something to do with it.  But I don’t feel the same way about something like physical fitness.   Maybe it is because I don’t get kicked in the teeth when I stop to take a breath.

Attitude has more than a lot to do with it.  But there are times I just can’t conquer the negative side of things.

I think that I have to find a way to enjoy the trip while I’m driving.  I have to find a way to know that every little thing I do is helping, and that there is no “end”.  I have to know that there will be setbacks and unexpected detours, and not let that stop me from driving and enjoying the scenery along the way.

Maybe I pull off at a rest stop for a minute to stretch and get a fresh Diet Coke, then get back in the saddle.

Anyone have a AAA guide for this trip?

Feeling Little

Oh how I wish that the title was some witty way of bragging about all the weight loss that is (not) happening for me.

Instead, it’s how I feel tonight. In terms of will power and the ability to stick with my plan.

I’ve talked a little about my meal plan. I’ve also talked about the Power of Food.

Tonight I fell down because I was tempted with potato chips, pizza, and brownies.

And I ate all of them. Not all of all of them, but some of all of them. Too much of all of them.

Why is it so hard sometimes to resist those temptations that we are faced with? Maybe I try to be too strict with myself. Or maybe I fall down in times of low blood sugars.

Why is food so powerful sometimes? How does it have the ability to make the best of our intentions collapse into chocolate laced brownie crumbs?

I think that while I am beginning to really appreciate the effect of food choices on my blood sugar, that it often makes me mad and angry. It makes me rebel against it.

But afterwards I feel little. Small and weak willed. Unable to make the “right choice” in the heat of the moment. What kind of person am I if my resolve fails when a brownie is put in front of me?

The “power of food” cuts both ways, and it deserves a little more respect from me. The respect we give Mother Nature for her awesome, life giving gifts on one hand, and her devastating destructive powers on the other.

maewestquote-temptation

Invisible and Invincible

Diabetes is, for the most part, an invisible condition. Unless you spend a bit of time with me, you may never know that I walk the never-ending tightrope of blood glucose management.

Even if you do spend a bit of time with me, you have to pay close attention to notice the seemingly little tasks that make up parts of my day. Checking my blood sugar, manipulating my pump – those are pretty much the only things that you can see from the outside. And like any seasoned veteran, I am good at being discreet when I want to be.

Even when not making a conscious effort at going unnoticed, these tasks are done quickly. A BG result in less than 10 seconds, a bolus in a matter of a few presses of well-known buttons.

Except for extreme situations, where things spiral out of control, I am able to keep it all under wraps. I have not needed help with a high or low blood sugar for many years. And unlike other conditions, where the person struggles physically with symptoms, diabetes does not manifest in external signs for a very long time – possibly not at all, ever.

But this does not mean that I do not struggle a great deal with the management. It’s just all inside. On the outside people see me as a strong, independent, successful person with few worries. But on the inside I am fighting for every second of decent blood sugars, constantly wary of diabetes invading and interrupting whatever activity I am doing, or planning on doing.

It’s like taking shifts on guard duty – except your shift never ends. There is no one to take over for you.

It all weighs on my heavily at times, and eats up more than it’s fair share of my energy. I am tired. Not in a physical sense, and almost not even in a mental sense. As ada said “Tired to my soul”.

As I look out the window. The sun is bright and happy. It looks inviting. Makes me want to be outside. But I step out of the door and am hammered by the sharp cold sting of the wind.
Looks are deceiving. Just as if you were to step into the world of diabetes. Something that many of us make look easy – but living life on a tightrope gets old quickly.

einstein_www-txt2pic-com

 

A Flash of Anger

Not long ago I did a post called “What exactly is it“. This post talked a little bit about trying to figure out what exactly it is about living with diabetes that bothers me. There was some really great comments on that post. One of the most valuable group of comments I might have ever gotten.

I had an experience shortly after that post that really helped me to identify one of the things that bothers me.

Many of us find a routine. A set of actions that produce predictable results. We follow that routine, and for the most part are able to expect a certain outcome. Or at least feel pretty confident that the outcome will not be something outrageous.

My typical morning routine is to have an english muffin with butter and peanut butter for breakfast. Along with some Diet Coke. I bolus for 30 grams of carbs, and it usually works out pretty nicely.

I’d like to share my logbook sheet from Friday, January 26th:

SetChangeSpike

I woke up at 163 mg/dl. A little high, but I’m not complaining. Took a correction bolus, changed my site (I was supposed to have changed it the day before) and got ready and went to work.

At work, before breakfast I tested at 107 mg/dl. Perfect!

I enjoyed my breakfast, and started to get busy working. An hour and a half later, I felt like shit. Sleepy, trouble concentrating, restless, just overall crappy. I tested my blood sugar, and it was 275 mg/dl.

There was a very identifiable flash of anger. I just wanted to smash my meter for that split second. I could feel the adrenaline spike, the rapid increase in heartbeat and all that. I was pissed. But just for a few seconds. What the hell happened?

Oh yeah – my site change. I’ve talked about that many times before. Where I spike up real high after the first meal on a new infusion site. I’m still trying to work through it – but sometimes the variables are overwhelming and I just pull back. It’s not consistent, and that makes it a real bear to figure out. But – that’s not the point of this post.

The point is – I felt like shit, and didn’t do anything wrong.

I did the same thing that I do most mornings, and most mornings it work just fine.

This was a very tangible feeling, that feeling like crap. It made me very angry for a few seconds. That too was a very tangible feeling.

Of course, it didn’t last long – the anger. It was a quick flash, then I was able to start figuring out what I needed to do. As you can see, my judgement was affected by my frustration – I piled the insulin on through the morning and for lunch and after lunch, and ended up low late in the day because of it.

I was so frickin’ frustrated!! I just wanted my blood sugar back down. Mostly I just wanted to stop feeling so crappy I guess. At the time I figured that I would happily deal with a low just to stop having to deal with the high.

A very clear, real life experience of what exactly it is…

What exactly is it…

What is it that I hate so much about Diabetes?

I spend a fair amount of time and energy being angry about diabetes. There is a lot of raw emotion there. There are a lot of feelings of it being unfair, of it being hard to do well. There is a lot of vague fear or worry about what is in store for me later in life.

But I have recently started to wonder, what exactly is it that I hate so much about diabetes? Why does it bother me so much on some days, and what exactly am I so mad about?

foggyIs it a tangible thing? Is it some physical thing that I can touch and feel? Something real? Or is it all of the intangible emotions that go along with a chronic condition? Might I be better able to cope with it all if I can identify what exactly is going on?

There is a lot of work that has to be done when trying to manage diabetes well. We all know that. Some days it feels like it is just too much. But what feels like too much? What is it that pushes those frustration buttons?

There are days where you feel like crap. You have some highs or lows that literally wipe you out. They take you down and hold you there until they’ve had their way with you.
Sometimes they are unavoidable. They just happen.

What is so frustrating about those is the fact that life does not slow down and wait for you. Most of the time you have to find a way to push through whatever difficulties you are having.

How many of you have been at work, with a high blood sugar for whatever reason, the blood in your veins feeling as thick as molasses. Feeling so very tired. Every blink feels like there are magnets trying to keep your top & bottom eyelids together. You would give anything to just sleep until your insulin brings that high blood sugar back down.

Frustrated because it will take HOURS for that to happen, and you have so much to do.

Or how about being bitten with a ripping low blood sugar during a meeting or an important phone call? I consider that one to be a very tangible frustration.

There are financial frustrations too. I am very fortunate to have health insurance, and I am thankful for it. But there is still a very real financial burden to deal with for supplies and medicine. I know that there are many of you out there who simply can’t afford to get what you need for optimal care.

How about other aspects of that financial piece such as the denial of private life insurance or disability coverage?

Is it the fact that we have to plan and prepare for everything? We have to do our best to anticipate everything that might happen and be ready for it? Most of the time that is not too hard – or maybe we’re just getting good at it. So much practice you know…

Is it the ever present fear of future complications? It’s like a big storm cloud always on the horizon. We all do our best to stay clear from that storm, but what if it’s not good enough? What if we are not trying hard enough? And just how fierce will that storm be? Will we be able to deal with it?

There are almost always a bunch of extra hoops for us to jump through. Little things like time for medical appointments, or needing to take a little extra time to prepare for an outing. The work involved in making those preparations mentioned above.

We have to be so damn conscious of the food we eat. Even if the dietary choices are not the best, we still need to know how many carbs we are eating. I think that is the hardest part for me. Not hard as in difficult, but rather just the fact that I need to count (or try to count) every damn thing! I hate it.

Another aspect of things that gets to me often is the fact that I did everything “right” and didn’t get the result I was expecting. Two plus two does not always equal four.

After almost 27 years, I know that it doesn’t always work like that, but it still makes me mad every time. It feels like a slap in the face.

I look at my average day to day stuff, and in the big picture it’s really not that bad. But maybe it’s the fact that it’s day-to-day, everyday, forever and always, that makes it hard to bear.

What is your story? What is it that you really hate about diabetes? Have you come to a point where you are able to healthily deal with it all mentally? How?

I Don’t Deserve This High

I did everything that I am supposed to do, according to what I’ve been told.

I followed all of the “rules”.

I counted all of the carbs.

I checked my blood sugar.

I did all of the math.

(68g carbs / 7.5g per unit = meal bolus) + (current BG (163)- target BG / 35 mg/dl per unit) = total insulin to cover my meal and bring my slightly elevated current BG down to my target BG.

My “meal” was two vend bags of wheat thin crackers from the machine. Maybe not the best choice nutritionally, but it’s not like I had a snickers bar and pop tarts for dinner. And it wasn’t really a meal, per se, but rather an afternoon snack.

One hour and forty five minutes after eating I check my BG.

Insert the strip, poke the finger, squeeze the finger, apply the blood, BEEP, watch the little animated symbol, BEEP, a mumbled “mother fuck” escapes my lips, 303 mg/dl.

I probably tested a little bit too early, a fair amount of insulin on board yet, I did have a heck of a time battling lows during basketball (that’s fun – I’ll tell you about it someday), I may have had some exercise ketones floating around, but when I checked there were none showing. Lots of possible reasons to be running a bit high, but 303 mg/dl is uncalled for in my opinion.

Is my infusion set working? Did I reconnect it properly after showering when I was done with basketball? I surely would have noticed an eleven and a half unit bolus if I wasn’t hooked up correctly, right (puddle of insulin, wet clothes, the smell of it)? So what gives? Was my food choice really that bad? Maybe, but it seems like a lot of “punishment” for wheat thins.

Is it necessary to be trying to “figure it out” for an entire lifetime? Is there a point where one can stop troubleshooting things? A point where things run smooth? Enough already!

There are still so many unknowns to diabetes, and living the life with it is a never-ending source of blogging material.