Please convince me that CBT can help stressed diabetic.

[Oblomov]

I saw the Pyschaitrist yesterday. Daibetic specialist pyschiatrist. They are concerned at how bad my diabetes is. And it is so bad when I am stressed.
They are going to do loads of things medically and otherwise. have monitor inserted. have another one to look at chemicals released when stressed and what happens to my blood sugars. going be a gineau pig on their research project.
We agreed there is no anxiety of panic attacks. She said I wasn't depressed. One GP had insisted I had AD's but they hadn't worked, so we talked about that.
She also suggested CBT. But what I know about it, I fail to see how this is really going to help me.
But I my mum , dh, and best friend think I have coped well under considerable stress.
So I gave her an example. Following all happened at the same time:
My dh made redundant and we couldn't pay the mortgage. dh had what we thought was a stroke , but turned out to be Bells Palsy, where his face dropped for 6 weeks. Ds1 was being naughty at school, for first time. Losing minues and I wasn't told. Then 3 boys bullied him trying flush head down toilet, saying that they would make him lose more minutes. School dismissive. He was in the middle of being assessed for Aspergers, and I have found his behaviour very stresful and couldn't understand what was wrong, for the last 4-5 years. Ds2 was going through terrible 2's. manageable. normal. My job that i adore, after 5 years of good appraisals suddenly said I wasn't up to he job and asked me to leave offering me a crummy compromise agreemment.
In and amongst all of this my diabetes went mad. I was having on average 2 hypos a day. Instead of my blood sugars being the desired 4-7, I was often 2.4 and physically couldn't speak. Sometimes my bloods were 33.2, so high that I felt ill and was physically sick at work. I would shout at the boys, and then some of the time, I would actually realise that I was low.
So she says that it takes 24 hours to recover froma hypo. And i said I never got that chance, because I was hypo again the next day.
So she says that this is what she specilaises in, assessing how it affects someone.
BUT then she goes on to say, that I am highly strung, that it sounds like ds1 is not that bad, quite normal, rather than Aspergers. I thought this was very dismissive. She had only asked one question about him.
And that i need to look at how to cope.

But I haven't always struggled. Only in the last couple of years. I have great inner confidence. I think cope jolly well considering. But i do need help, becasue I am struggling.
I felt like saying that I'd like to see others cope better.
But I so want to be open minded about it.
But I just can't see what CBT is going to do for me. Am I being too negative ?

I guess one way to look at it may be that CBT provides a framing mechanism.

I've known a few people with complex health conditions who have found CBT helps (anecdote).

snowmash, could you explain, please. I am afraid I don't understand.

I think it's not about coping/not coping or struggling/not struggling.

I think these leaflets say it better than I can - but they are skewed towards using it to manage MH issues:

here

here

I have seen people with MS use it to manage sleep or other issues - so it's really not just MH.

I'd go with a can't hurt attitude, but I guess that's all very well with all the time in the world to do it in ;)

Thank you snowmash. I read both links. I just don't think it has anyhting to do with my situation. I do hope I'm wrong. But i just can't see it.

My boy has t1. He has had hypnotherapy for stress. The best thing for hm has been an insulin pump, which has made managing his condition so much easier. Recently started using continuous glucose management (cgms, the dexcom 7). This has been incredible as we really understand what is happening now.

All the best.

As you know, highs will make you feel really stressed, so if you can cut these down it will really help.

Bramble, I am on a pump and have been for 7 years, since I became pg with ds1. been diabetic for 35 years, since aged 1.
Please tell me more. What do you think would help me ?
Hypnotherapy ? Please tell me more. How is your son doing ?
And what about the highs, you say that it is these that actually casue strss. Really ? I did not know that.

Have a look at this for more info on how CBT can help people with diabetes.

www.diabetesvoice.org/files/attachments/article_118_en.pdf

Hi Oblomov

Pumps are ace! Can your team give you a trial of continuous glucose sensor monitoring? Preferably the dexcom 7 system? This will show the patterns of your levels over a few days and nights (my son gets a couple of weeks out of each dexcom sensor). You can then make changes to the basal pattern on the pump.

My son has a different basal pattern for weekends and we make temporary increases/decreases for activity.

When he gets over a certain level - around 14mmols, he gets really stressed. There's something chemical that goes on when people get high. Other parents report similar things. His vision and concentration go.

The hypnotherapy has worked a bit, but he still needs me very much. It's giving him skills to use to help deal with stressful situations.

Are you carb counting? This really helps to get the insulin dose right with the food.

Sorry if you know all/any of this already, but hope it helps a bit.

Or you could try mindfulness meditation - as per "Full Catastrophe Living" by Jon Kabat Zinn? I've known a couple of people who found this helped them more than CBT (or alongside it) for dealing with chronic stress, chronic long term illness or pain. I even bought the book myself, but it looked rather long - long enough to make me feel suddenly less stressed and able to cope without reading it!

The stress/high blood sugars is a vicious circle - highs can make you stressed and stress sends you higher. It's a bugger!

Have you done basal testing? You know, where you wake yourself up every two hours and test. It gives you a good idea of patterns of blood sugars (a CGMS is better as bramble suggests but getting one depends on how good your team is. We also vary the basal rate massively depending on what we're doing and the same activities and foods affect each of us in different ways.

Agree about carb counting too. If you've had T1 for 35 years you were probably taught how to do this when you were a child, then the idea fell into disuse for a bit, but is now very much in favour again. We find it helps enormously compared to guessing estimating.

Thank you everyone for the latest posts.
My team have suggested athe possibility of veo Bramble. But only for a 3 month trial. We would have to apply for funding for one of my own and apparently it is unlikely but we can try.
In October I had a sensor fitted for a week, one of those that takes a reading every 13 minutes. And we have worked on the findings. But overall things don't seem to be getting much better.

I printed off the CBT link that LCY gave and took it to my pyschologist. ( I am seeing him to help with the relationship between my son and me, which was bad, prior to it being suggested to us that he had Aspergers, when we'd been begging for help for the last 3-4 years. He said he didn't think CBT was for me either. But to go willingly and see what happens.
Mindfullness was also suggested to me, by the hospital rabbit. But i know nothing about it. I will look into that. Can you tell me more please ?

I have done another download for them tonight. I try and do one weekly for them. They are very good and get back to me adjusting my basal last time by 0.1 to still try and conquer my huge 'dawn phenonemen'. WE can but perservere.

Mattell, do you think my carb counting may have gone astray. do you think I should ask them for a daphne refresher ? I thought i was o.k. on that front, but maybe not.

Mattell, I have done lots of 3am tests for them. The3y have never asked me to do more thna : pre break, pre lunch, pre dinner, and bed. Plus the occassional 3 am, which is a killer lets be honest. I did a week of 3 am tests just before christmas.

Hi, Oblomov. Alas, not having read the book, I'm not the best person to explain how mindfulness meditation works - apart from the fact that it is some form of meditation! I know it is recommended by the Mental Health Foundation and has been found to be helpful by people with, eg, cancer, in terms of helping relieve symptoms or otherwise cope with more unpleasant side effects, or deal with a very negative prognosis, as well as helping people suffering from severe stress, anxiety or depression.

Oblomov, I really feel for you. My son has continuous sensor therapy, so we've been able to make changes quickly, and gradually as well. It amazes me how things change for him so often - but he's a little boy going through early puberty. Yours may well be linked to your cycle.

You must be tired out with night testing. I know I am.

Are you on MDI (injections with meals).?

It might help to do a couple of extra tests and target a meal at a time to ensure that your insulin to carb ratios are in hand. For example, test prior to breakfast, then test two hours later. If the numbers are the same, then you have got the insulin to carb ratio right. If your bg is higher or lower you need to change the ratio.
Do this when you haven't had to correct a high before eating (you may need to recheck your correction factor - argh!). I tend to get a few days worth of numbers before we make changes.

Have a look at the NICE guidelines for insulin pumps to see if you could argue for any of the qualifying factors. It's appalling that they're not confident in you getting one - they must be so frustrated as medics that the financial system let them down. Take the trial if you can, it will make such a difference.

I can't tell you anything about mindfulness, I'm afraid, as I don't know about it.

Keep going, sounds like you have a supportive team and that's a good deal of the battle.

Hi Oblomov, I think it?s possibly worth considering a Daphne refresher, can?t hurt, though it does sound like you know exactly what you?re doing and are just going through one of those periodic bad times.

I do think you should do some proper basal rate testing. You basically fast for 8 hours and do tests every 2. The theory is, your readings should not alter at all (or only very little) if you?re not eating and and not bolusing. For the purposes of this, it doesn?t matter if your readings are high, but they should remain more or less the same throughout the 8 hours.

We run 3 different testing patterns: 8am-4pm, 4pm-midnight and 10pm-6am and try to do one every couple of months for each of the DCs (though I have to confess I rarely if ever do one myself!). The nighttime one is a bit of a killer, so we only do that in the holidays or at half-terms.

Thank you for your ideas bramble and matt. I shall definitely give them some thought. And I am due to go to pump clinic next week, for my 3 monthly check, so will discuss it then.

All the very best. Please shout out for support and to celebrate successes.

I think CBT would help just about everyone!