Type 1 Therapist’s Tips for Coping and Grieving During Hard Times

The COVID-19 pandemic has left us all in fear, especially for those who are elderly or have pre-existing conditions. Knowing that we fit this demographic adds an extra layer to this challenging time. It is more important than ever to take care of our mental, emotional, and physical well-being. We spoke to a licensed associate marriage and family therapist, Allison Nimlos, about managing during this difficult period.

Hi Allison, thank you so much for taking the time to talk to me.  I know you are a licensed associate marriage and family therapist and very active within the diabetes online community and do your part to advocate, educate, and support others dealing with this disease.

I follow you on Instagram and have appreciated some of your COVID-19 related posts helping people to deal with our new normal. I thought it would be nice for our readers to hear the perspective of a mental health professional and get some ideas on how we can cope with the situation and keep ourselves sane!

How long have you been living with type 1 diabetes?

97 years. Oh, wait. It just feels that way. I’ve had type 1 diabetes for 26 years.

Photo credit: Allison Nimlos

Did your diagnosis play into your choice of becoming a marriage and family therapist?

Absolutely! Originally, I thought about becoming a nurse or dietitian because I want to become a diabetes educator, but I decided to pursue counseling because I wanted to have the education to help with the mental health toll that I and many others have experienced. I also love the systemic view MFTs [marriage family therapists] take because diabetes affects more than the person with the broken pancreas.

Now I work as both a therapist serving residents of Minnesota with mental health and relational issues, and as a diabetes coach, where I merge my counseling skills with my passion and experience in diabetes education to focus on the three S’s: self-talk, self-care, and sustainable strategies for diabetes management.

When you heard the virus was picking up speed, what were your first thoughts? Fears? How did you prepare for staying at home?

When I received confirmation that supply lines were not going to be disrupted, it definitely quelled a lot of nerves (although I was very happy I could order a 3-month supply of insulin and pump supplies right at the start — it was just lucky timing!). I think my concern was actually with the misinformation around PWDs [people with diabetes] being immunocompromised — we’re not.

A lot of the adjustments have come with evaluating and navigating what changes need to be made, and making decisions around the process of how things get done. I think it’s important to strive for as much normalcy as we can (regular sleep, healthy eating, work/life balance, etc.) because our basic needs need to be met, while remembering that this is not normal, and it’s not going to feel that way.

Photo credit: Allison Nimlos

I know a lot of us are stressed…very stressed. How do you suggest people cope with these emotions? 

I think stress often comes from wanting to control things that are out of our control, so recognizing our power can help. Making a list of things that you are in charge of deciding (how do I want to protect myself when I go out), vs. things that you aren’t in your control (how other people dress) can keep you focused where your attention is most useful.

Many of us try to anticipate what’s going to happen next, and that’s also something that is out of our control. I could spend a lot of time thinking and planning, and then be worried about whether or not I was right, and then spending more time worried that I’m wrong… Or I could just focus on today and this week and making only the decisions that need to be made right now.

Many people have found their blood sugars all over the place amidst the crisis. What do you do to stay on top of your management during this challenging time? 

This is where the mindset and management overlap comes into play! We have to recognize that things are different, and pretending they aren’t is a recipe for disaster. Observe your blood sugar patterns and your lifestyle patterns. What sorts of things are your blood sugars, your energy levels, your mood asking for? What changes can you make to your management to see improvement? When we don’t adapt to our changing needs, it raises our anxiety and stress because we end up battling diabetes using strategies that are no longer sufficient.

For me, I have noticed that my blood sugars are trending much higher lately. It could be less activity, it could be our meals, it could be the low-level but constant stress that I have. Some things I’m working on are changing my insulin settings on my pump, and also making a plan to get some more regular exercise. I’m also making a point to review my Dexcom Clarity regularly to see how those adjustments go.

Many people are staying home. Some are lucky enough to be with family and/or friends; others are doing this all alone. What is your advice to those people who may be feeling very lonely and in despair?

Connection is key. Loneliness, scientifically, really is unhealthy for people. But social distancing does not mean socializing at a distance. People do need to stay home and away from people! Make plans to do things virtually, like attending online meet-ups, calling parents and friends regularly. You’re right, it isn’t the same, and that sucks, but it’s what we have and better than complete cut-off. I encouraged my clients to do an activity with friends and family virtually, such as watching a TV show together or eating a meal together. Making shared memories is a big part of how we feel connected.

Photo credit: Allison Nimlos

On the other hand, many are stuck home with spouses and children for weeks on end and are starting to get a little cranky. What is the best way for families to enjoy this time while respecting each other’s space?

Designated time for solo activities and hobbies, such as reading quietly, putting a movie on for the kids, taking a long shower or bath, or even going outside to a deck or balcony.

I live in New York and haven’t left my house in over three weeks besides to a park to exercise. What are you doing to keep busy, stay active, and keep your spirits lifted?

My 2.5-year old loves to go on walks but hasn’t seemed to notice that we don’t go farther than 2 blocks. We keep a fairly regular schedule with online games, arts and crafts, baking, his toys, reading, watching TV, and thankfully, naptime. I also stay connected with regular virtual meet-ups, including one that I host on Wednesday nights at 8 pm EST.

These are difficult times. Even after the COVID-10 virus dies down, come the warm weather, we will feel the effect of it for years. Many people are losing their jobs and wondering how they will stay afloat. What is your advice on how to stay positive?

Before we can move into positivity and meaning-making, we first have to grieve. It IS okay to be sad and angry and any other emotions you’re feeling. It’s a really big deal that has happened to people, and I don’t think we should feel pressured to feel anything we don’t. They are powerful messengers and need to be listened to, but we also need to make sure they aren’t driving the car the whole time. I try to remember that I have gone through hard times before, and I can get through another. And again, to not try to overpredict how bad or good something is going to be. It’s easy to think “worst-case scenario” — but what if everything works out for the best? We spend very little time sitting in hope.

I might be biased, but I highly recommend finding a therapist to work through the grief, loss, and trauma that comes with an experience like this. We are still available! You can find a therapist in your state (because we can’t practice outside of where we are licensed) by visiting a therapist directory like PsychologyToday.com.

Unfortunately many are dealing with the loss of a loved one due to COVID-19. Dealing with death is hard enough, but during a time like this when you can’t be with your loved one for support how do you recommend people going about mourning? It is a unique time for sure.

How to properly mourn is a question a lot of people in grief ask and it’s one thing most therapists shy away from. There isn’t a process or a procedure, but there are themes and commonalities (hence the 5 stages of grief — which is more of a description for common elements than anything). Anger is going to be a really common emotion right, and that makes sense. Bargaining too. And a bunch of other ones the stages don’t include (because it’s not all-encompassing!). There are no shoulds for grief, no timelines.
But I will say that it is absolutely okay – necessary maybe – to name and feel all the emotions, even the ones we don’t understand and don’t feel we have a right to. People who have lost someone, it’s going to be clear and understood they are grieving. But we have all lost something, our old way of life, and that can also bring up the same feelings of grief, even if not tangibly connected to an individual. However it makes sense to care for your grief is going to be okay right now.

Thank you, Allison, for taking the time to talk to me and for all you do for our community! I hope you and your family stay safe and healthy!

Source: diabetesdaily.com

Food Shaming: Changing How We Talk About Food

This content originally appeared here. Republished with permission.

By Brenda Manzanarez, MS, RD, and Cynthia Muñoz, Ph.D., MPH

You know you shouldn’t be eating that kind of stuff, right?

If you’d just eat better, you wouldn’t have to take so many medications.

I know someone who cut out all carbs and cured their diabetes; have you tried that?

Do any of these comments sound familiar? Maybe someone else has said them to you, maybe you’ve said them to someone, or maybe you’ve thought them about yourself. Either way, comments like this, even if they have good intentions, often come off as judgmental and shaming. This type of “advice” can cause confusion, anxiety, frustration, and an unhealthy relationship with food.

Our Relationship with Food

Food is important when it comes to keeping blood sugar in range, but managing diabetes is not just about glycemic control—we also need to juggle lifestyles, health goals, and mental health.

There are so many factors that influence our food choices, and you cannot see those factors by just glancing at a plate. Food is an important part of our lives, and it can have so many meanings to different people. It can mean health, love, sense of community, or pleasure, but for others, especially people with diabetes, it might cause feelings of anxiety and fear.

Changing the way you eat is a major lifestyle change, and major lifestyle changes always take time.

While you are on this journey, unsolicited advice from strangers and even loved ones can feel more like judgment and might cause you to question yourself or feel guilty about your own choices.

Changing the way you eat is a major lifestyle change, and major lifestyle changes always take time. There are a lot of things to juggle when managing diabetes, so be patient with yourself and with others.

Unintended Consequences

Food shaming often happens when someone’s own preferences and opinions don’t line up with others’. Judgmental comments like “you shouldn’t eat that” may be a projection of their own frustrations or a reflection of their misconceptions about diabetes.

As clinicians who work with children, teens, and young adults with diabetes and obesity, we know that talking about food can be very difficult. We also know that negative comments, pictures, and memes on social media can have a harmful impact on someone’s emotional well-being, especially people with diabetes.

No one should be shamed about their food choices.

No one should be shamed about their food choices. Shame leads to negative feelings about food, which can lead to anxiety, depression, and even disordered eating. And these conditions can cause more damage to physical health than poor diet.

Rethink the Role of Food and Your Health

Instead of thinking of food as “good” or “bad,” or judging people (or yourself) by the way you eat, picture food and eating as being neutral and adopt a non-judgmental way of thinking. The food you put on your plate, is just food that will provide energy and nutrients to fuel your body.

Unlearning what we have been exposed to takes time but being aware of those negative thoughts is a start.

Instead of thinking of food as “good” or “bad,” picture food and eating as being neutral.

Remind yourself that there is no one right way to eat with diabetes— it has to be tailored to your own unique needs— like your budget, taste preferences/favorite foods, cultural norms, cooking skill, time, etc. And you don’t have to feel guilty about enjoying a treat every now and then.

Break the cycle and be nice to yourself and to others. Instead of criticizing people, ask them how they feel about the changes they’ve made and have them decide how they feel about it. If appropriate, provide encouragement.

If you are concerned about a loved one, privately ask how they are doing, and don’t offer advice unless they ask for it. Ask if there is anything you can do to support them, and/or seek information about healthy food choices and incorporate this in your own life as a form of support for your loved one.

If you feel this is a big issue in your own life, don’t be afraid to seek out help—talk to your primary doctor or with a therapist. If you don’t have a therapist ask for a referral from your doctor. To find a mental health provider with knowledge about diabetes, check this directory.

Bottom Line

Food is meant to be nourishment for our bodies and to be enjoyed; find a balance that works for your health, be confident in your choices, and be accepting of other people’s choices.

If you find yourself wanting to criticize someone else’s food choices or appearance, don’t! This is generally not helpful and can have a negative emotional impact.

A neutral and non-judgmental way of thinking is best when talking about food and diabetes; there are no “good” and “bad” foods. The key is to balance what you eat to get the nutrients you need.

If you receive a negative comment from a stranger on social media or in person, remember that person doesn’t know you and how you take care of yourself. Don’t beat yourself up and continue to focus on ways to be the healthiest version of yourself.

Source: diabetesdaily.com

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