Diabetes and emotional health

Diabetes and emotional health

A practical guide for healthcare professionals supporting adults with Type 1 and Type 2 diabetes

This practical guide, UK edition (2019) was produced by Diabetes UK under a royalty-free, UK only, non-exclusive sub-license from Diabetes Australia.

The original Australian handbook (2016) was developed by the Australian Centre for Behavioural Research in Diabetes (ACBRD) as an activity of the Mental Health and Diabetes National Development Programme, which was funded as part of the National Diabetes Services Scheme (NDSS). The NDSS is an initiative of the Australian Government administered with the assistance of Diabetes Australia. Leadership for the Mental Health and Diabetes National Development Programme is provided by Diabetes Victoria. The ACBRD is a partnership for better health between Diabetes Victoria and Deakin University.

The UK Expert Reference Group overseeing the adaptation to the UK cultural, linguistic and healthcare context is listed on page 5.

Suggested citation: Hendrieckx C, Halliday JA, Beeney LJ, Speight J. Diabetes and emotional health: a practical guide for healthcare professionals supporting adults with Type 1 and Type 2 diabetes. London: Diabetes UK, 2019, 2nd Edition (UK).

? The Commonwealth of Australia as represented by the Department of Health, 2016 (original Australian edition), and 2019 (UK edition).

The views expressed are those of the authors and do not necessarily reflect those of the Australian Government. The Commonwealth is not responsible for any recommendations, views, ideas or strategies expressed in this document.

Diabetes UK and Diabetes Australia believe that the information contained in this resource was accurate and reliable at the time of publication. The websites quoted in the resource were accessible at the time of publication. Diabetes UK and Diabetes Australia cannot take responsibility for the accuracy or future availability of these sites. Furthermore, on behalf of the authors, Diabetes UK and Diabetes Australia take no responsibility for any adverse consequences that may arise as a result of using the content of the resources for clinical purposes. Health professionals need to take into account the individual circumstances and needs of people with diabetes when they apply the skills outlined in this resource in their clinical practice.

For permission to copy or use any part of this resource, contact Diabetes UK on 0345 123 2399.

Selected photographs from Shutterstock, iStock and Gary Radler Photography.

Table of contents

Foreword.....................................................................................................................................4 Expert Reference Group..............................................................................................................5 Acknowledgements.....................................................................................................................6 Acronyms and abbreviations........................................................................................................7 Introduction..................................................................................................................................8 How to use this guide ...............................................................................................................13 Chapter 1 ? Communication and engagement..........................................................................21 Chapter 2 ? Facing life with diabetes.........................................................................................40 Chapter 3 ? Diabetes distress....................................................................................................53 Chapter 4 ? Fear of hypoglycaemia (and other diabetes-specific fears).....................................71 Chapter 5 ? Psychological barriers to insulin use.......................................................................95 Chapter 6 ? Depression...........................................................................................................114 Chapter 7 ? Anxiety disorders .................................................................................................138 Chapter 8 ? Eating problems ..................................................................................................159 Chapter 9 ? Referring to a mental health professional .............................................................181 Appendix A: Peer support .......................................................................................................188 Appendix B: Examples of strategies to address diabetes distress ..........................................191 Appendix C: Examples of strategies for overcoming psychological barriers to insulin use.......195

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Foreword

It is a great pleasure for me to introduce you to Diabetes and emotional health ? a practical guide for healthcare professionals supporting adults with Type 1 and Type 2 diabetes.

This guide will be of real help to healthcare professionals in supporting people living with diabetes with their emotional needs. Currently in the UK 3.8 million people are living with diabetes, an increase in 100,000 since the previous year. Numbers of people affected by diabetes are expected to rise to 5.5 million by 2030.

Treating diabetes costs the NHS at least 10 billion pounds each year, with almost 80% of that being spent on treating the complications of diabetes. The NHS is in danger of being overwhelmed by diabetes. With so much being spent on complications, there has never been a more important time to make sure people with diabetes get the support they need to manage their condition.

We know that diabetes doesn't just affect people's physical health. It can also have a huge impact on their emotional health too. Diabetes is relentless, and requires constant attention, awareness and decision making. It was not surprising then, that our Future of Diabetes report (2017) found that 64% of people sometimes or often feel down because of their diabetes. And that less than 25% of people with diabetes get the emotional and psychological support they need from the NHS. As well, people with diabetes are twice as likely to suffer from depression, and they are more likely to be depressed for longer and more frequently than those without diabetes. There are also specific psychological conditions relating to diabetes such as diabetes distress, fear of injections or hypos and eating disorders. Poor emotional and psychological wellbeing is associated with poorer quality of life, poorer management of diabetes and an estimated 50% increase in healthcare costs.

Against this background, there has never been a greater need for practical resources to support healthcare professionals in looking after the emotional needs of people with diabetes.

This guide has been developed from the Diabetes and Emotional Health Handbook published by the National Diabetes Services Scheme in Australia and authored by a team of healthcare professionals specialising in psychology and diabetes. It has been adapted for a UK audience by an equivalent expert group of UK clinicians. The guide will help any healthcare professionals working with people with diabetes to discuss emotional needs, use consultation time more effectively and to know when to refer on. There are also dedicated chapters on the common emotional issues faced by people living with diabetes, such as eating problems, depression, diabetes distress and adjusting to life with diabetes.

Diabetes and emotional health ? a practical guide for healthcare professionals supporting adults with Type 1 and Type 2 diabetes provides an evidence-based and practical resource for all healthcare professionals involved in the care of adults with diabetes. It will be invaluable in helping support their emotional health as well as physical, and so provide true holistic care.

Chris Askew CEO, Diabetes UK

4 Diabetes and emotional health

Expert Reference Group

Dr Jen Bateman

Dr. Jen Bateman (n?e Nash) is a Clinical Psychologist, specialising in diabetes and weight management. She is the author of two 5* Amazon rated books, `Diabetes and Wellbeing' (WileyBlackwell, 2013) and `Your Weight Isn't About Food' (2016). Jen is an Editorial Board Member of the `Journal of Diabetes Nursing' and `Diabetes & Primary Care'. Jen was named an `Outstanding Educator' Finalist in the Quality in Care Awards 2014 and was awarded the honour of a `World Diabetes Day Hero' in 2012 by the International Diabetes Federation. She has served as an Advisory Board Member and Consultant on numerous strategic health initiatives, including the NHS England, `Language Matters' (2018) Diabetes Position Statement.

Jen has been living with diabetes since childhood and is open about her personal experiences of recovery from emotional eating difficulties, to encourage others who may be struggling. Get free educational resources at .

Dr Mark Davies

Mark graduated from Queen's University Belfast in 1998 with a doctorate in Clinical Psychology. Prior to this he worked as a Research Psychologist at St George's Hospital Medical School, University of London. Since June 2000 he has worked at Belfast City Hospital where he provides a clinical psychology service to people with diabetes and the healthcare professionals who care for them across Belfast Health & Social Care Trust. Most his working time is spent talking to people with diabetes about a wide range of psychological issues that can impair their ability or willingness to look after their diabetes. In addition, he provides supervision and training to a range of healthcare professionals both locally and nationally. He has published widely. He is particularly interested person-centred practice and is a member of the Knuston Ireland faculty, which runs an empowerment and counselling skills training course each year for diabetes healthcare professionals across Ireland.

Professor Jackie Sturt

Professor Jackie Sturt is a behavioural scientist and both a registered general and mental health nurse in the Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London. Much of her academic career has been spent working in diabetes, developing, evaluating and supporting the implementation of complex interventions to support patient selfmanagement. She has undertaken a number of systematic reviews in diabetes distress and is also interested in how timely access to healthcare, via digital consulting, can support people to self-manage their diabetes. Whilst working at Warwick Medical School she held an NHS clinical secondment from 2010-12 to develop "The Diabetes Listener service" supporting patients struggling to cope with their diabetes.

Rosie Walker

Rosie owns and runs the independent company Successful Diabetes (successfuldiabetes. com), which provides workshops, books resources, education and consultancy for people living and working with diabetes.

She's a former diabetes specialist nurse and has worked both locally and nationally in developing diabetes services and education since 1985. In addition to nursing and diabetes, she's gathered additional academic qualifications and expertise in psychology, higher education, active listening and counselling.

She's inspired by a person-centred philosophy and cares deeply about supporting people with the emotional and psychological aspects of living and working with diabetes. Rosie is proud to have worked with Diabetes UK on adapting this unique and special, practical resource for UK health professionals.

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