How to Deal with Uncomfortable Situations

We’ve all been there. Whether it’s a coworker telling you that you shouldn’t join in on the company cake or a friend who makes an ignorant joke, there are many times where we are put into social situations where diabetes is a brunt of a joke or just blatantly misunderstood.

How does this make a person living with diabetes feel? Well, that depends on the person, their relationship with their condition, their sense of humor, and their ability to let things go. I bet many of us fall somewhere in the middle, which means at times we say nothing but other times, we feel compelled to put some myths to bed and/or educate our friends and family on a disorder that most know so little about.

About a year into my diagnosis, I went to a party and a friend came over, proudly carrying a dessert tray shouting, “Who wants diabetes?” Now in this instance, I was shocked. At that point, I was newly diagnosed and hadn’t been the brunt of a joke yet. I decided to let this one go. It wasn’t directed at one person, and it wasn’t said maliciously. It was just a distasteful joke, considering I hadn’t slept for days, was just coming out of my honeymoon and each day was a new diabetes adventure.

Fast forward to six years later. My son was only six when I was diagnosed but now he is 13 and always has friends over at the house. This summer, the boys were making different mug cakes concoctions and one joked, “We are totally getting diabetes after this.” I wanted to say nothing. I knew my son would be embarrassed if I chimed in. But then, I thought about their friend who lives around the block from us who was diagnosed two years after I was. I thought about him hearing that joke and I decided to educate. I explained that neither I nor the boy around the block did anything to deserve this disease. I told him that it is an autoimmune condition and we just got unlucky. Next, I went on to explain that people living with type 2 diabetes have it for different reasons, including their genetics. Luckily, this kid is an intellectual one who took interest in what I was saying. Maybe I made a difference.

Here are some main ways that I usually like to handle these types of uncomfortable situations:

Cut People Some Slack

I bring this one up first because I feel it’s very important to take a step back and remember — most if us knew nothing about diabetes until we had to. I have a very good friend who lives with Mulitple Sclerosis; she fights her own battle and I can honestly say it’s one I am not familiar with. While I wouldn’t go around making jokes, I also wouldn’t be aware of the impact that they may make.

Lighten Up

It’s okay to get bothered by insensitive jokes, but it can sometimes be better to just laugh and let it go! It’s better for your mental and emotional state and if you have children, you set a good example about not sweating the small stuff!

Keep Your Cool

This doesn’t only apply to uncomfortable situations involving diabetes, but any circumstance that may trigger you to react suddenly. I often have to remind myself to take a step back, wait a few minutes, and then think about how I should approach the situation. The last thing you want to do is unleash on Betty from down the hall because she asked if you should be eating that cookie. There is always a better way to handle these types of scenarios!

Take the Opportunity to Educate

There is a time and a place to educate; it just may not be worth it when it comes to your 96-year-old aunt who still thinks if you would just start exercising, your blood sugars will normalize. But, there are opportunities, and when appropriate, we should all do our part to shed some light on a disease that is in fact, quite time-consuming and quite demanding. You may be pleasantly surprised by the interest and responses you receive.

Choose Kindness

Let’s remember that everyone is fighting a battle we know nothing about. Chances are, if someone is saying insensitive things or making you feel uncomfortable, it is likely more about them than it is you. So remember that, have grace and choose kindness.

Getting upset with uncomfortable situations is understandable and we can all relate. But focusing on the more important things in life is sure to leave you feeling happier and healthier!

Have you dealt with uncomfortable situations surrounding diabetes? How did you handle it? Share and comment below!


How to Not Let Stress Come in the Way of Your Diabetes Care

With the current state of the world, we are all struggling in some way. Whether you are homeschooling your children, trying to manage a full-time job from the confinements of your makeshift home office, or grieving a recent loss; it is a difficult time for all. We are all adapting to the changes and roll with the punches, but with all the chaos ensuing, our diabetes oftentimes falls to the back burner.

I am trying hard to not let my emotions consume me. I am trying to get through the day and stick to my routine, but being busy and stressed makes me distracted, lack motivation, and not prioritize my diabetes or myself.

Here are five ways to not let stress come in way of your diabetes management:

Start the Day Off Right

I know for me, my emotions change by the day, but a wise diabuddy once told me, “If you put negative thoughts in your head, you’ll have negative emotions.”  Try waking up and being grateful for another day. Start the day right by testing your blood sugar, taking any necessary insulin or oral medications, and any vitamins and/or supplements you may take. Eat a protein-rich breakfast that will give you the energy you need to face the day ahead.

Set Alarms

This is one I need to start doing myself. When we are busy, or anxious, or both, we are likely to delay our eating or even skip a meal. By setting an alarm for a meal or sneak break, you are also allowing yourself a mental break from whatever it is you are dealing with at the moment. It’s a good time to check in with yourself, plan your meal, and dose insulin accordingly, if necessary.

Stay Active

Stress and worry can consume us, so it is in our best interest to keep ourselves busy and distracted. There is perhaps no better way to distract yourself than doing something good for your mind, body and soul. Exercise will not only make you feel physically better but you will release endorphins that will automatically put you in a better mood. “There’s good epidemiological data to suggest that active people are less depressed than inactive people. And people who were active and stopped tend to be more depressed than those who maintain or initiate an exercise program,” says James Blumenthal, Ph.D., a clinical psychologist at Duke University.

Find a Support System

Whether it be a local mom’s group, a diabetes Facebook group or your family members, it is good to have someone to lean on. Finding people that are also struggling but trying to keep positive will help motivate you and also keep you accountable. The diabetes online community is an amazing resource and can change your outlook for the better. You can also find countless blogs of people dealing with difficult times who discuss coping mechanisms that you may find useful. You may walk away with a few new recipes, a new mindset and a new best friend!

Have Grace with Yourself

We are going through unprecedented times and that compounded with the already existing daily life stressors, it’s a lot for anyone to bear. Add in the around the clock job of playing pancreas and it is a lot to juggle. Remember to breathe and be kind to yourself, you are doing the best you can.

Having some systems in place can help you not only manage your diabetes better but live a more relaxing life during these very stressful times. Have you put any measures in place to help you focus more on your diabetes management during times of stress? Comment and share below!


The Mental Impact of COVID-19 on Children with Diabetes

The negative mental impact of a pandemic like COVID-19 is well-known and documented. According to the U.S. Census Bureau, now 1 in 3 Americans is showing signs of clinical depression and anxiety. Coping with this (hopefully) once-in-a-lifetime event is something that a human brain has a hard time assimilating to: extreme and extended social distancing can make one feel anxious and isolated, constant vigilance to adhere to hand washing and mask wearing protocols and the 24/7 news media can increase one’s stress and anxiety levels, financial insecurity from the widespread economic fallout from the pandemic, fear of getting sick, and the unprecedented levels of community spread of the disease are just some of the reasons why people may feel anxious and depressed. Americans have been hard hit: with just 4% of the world’s population, we have 25% of the world’s COVID-19 cases, and researchers, doctors, and scientists alike are fearful of a “twindemic” where flu season and a second wave of COVID-19 cases will coincide over winter, once most outdoor activities become infeasible when the temperature drops across the country.

Children, and especially children with chronic conditions like diabetes that put them at higher risk for more severe reactions to the virus, are especially susceptible to the mental health impacts of the pandemic. A recent study from the American Journal of Pediatrics of over 1,000 U.S. parents in early June showed that 27% said their mental health had worsened since March, and 14% said their children’s behavior problems had gotten worse. Families with younger children reported worse mental outcomes than those with older children. About 10% of all families said their children’s mental and behavioral health worsened.

Vanderbilt University researchers said that disrupted routines are hard on young children, and in the study, 48% of families reported losing their normal childcare. Abnormal school routines can also be hard on children.

“In some communities, school will be remote, and schools should consider working with pediatricians and mental health professionals on how they may address the mental health of children, parents and staff even when school is remote,” the researchers wrote. “To implement these strategies effectively, Congress could consider enhanced funding to schools to address schools’ budgetary challenges related to implementing these recommendations.”

In another study out of China, published in JAMA Pediatrics, researchers in Hubei province,  examined a sample group of 2,330 school-aged children for signs of emotional disturbances. The children had been on lockdown for an average of 33.7 days. Even after one month, 22.6% of children reported depressive symptoms and 18.9% were experiencing anxiety.

These problems are exacerbated in children with diabetes for a few reasons. First, since most children are spared the brunt of the disease, many children without chronic conditions are starting to socialize again, with many schools across the country going back to in-person classes, sometimes with the option for remote learning for students who don’t feel safe. This leaves those affected by chronic disease feeling more isolated than ever before. It’s not just young children that are feeling the negative mental health repercussions of the pandemic. Teenagers and young adults are affected, too.

Ian Fleming, a freshman at CU Boulder, says, “Starting college as a freshman this year has been very difficult. I was looking forward to football games and parties. However, because of the COVID-19 pandemic, I will have to wait for the traditional college experience. I have been overwhelmed and scared because I have type 1 diabetes; I could still have serious complications if I contracted the virus. Being a college student has not helped with this stress as I am in a place where kids are still partying and being irresponsible when we need to unite and protect each other.”

Another college student in Colorado, Faith Riddell-Harding, says, “There are still students (on campus) who are going out and partying, which as someone who is high risk, is somewhat infuriating. I could not justify having a dorm roommate this year, with my compromised immune system, so I worked with the University Disability Center to request a single, until a vaccine is available.”

Second, children and young adults with diabetes are already at heightened risk for depression and anxiety, with rates estimated between 13-17%. Those with diabetes are twice as likely to receive a psychiatric diagnosis by age 18 as kids without the condition. Adding the fear, stress, and anxiety of an uncontrolled pandemic on top of that can mean a recipe for disaster.

Izzy Myszak from Indiana says, “Having type 1 diabetes already brought my mental health down. Coronavirus and T1D has skyrocketed my anxiety.”

Lynda Jimenez, of Arizona, adds, “It’s hard to watch your friends and family not taking this seriously when you have to be extra cautious as someone with a chronic illness. On top of the worry that comes from a pandemic, we have to deal with this dichotomy too.”

Finally, it can be really devastating on one’s mental health with on-going lockdowns and no end in sight to the pandemic. But there is hope. The Centers for Disease Control and Prevention has developed several tools to help you care for your child’s mental health during this time. The COVID-19 Parental Resource Kit offers help for understanding your child’s mental health needs according to their age group. The Essentials for Parenting Toddlers and Preschoolers page helps with common parenting challenges and provides information on building a positive, healthy relationship with your child.

Exercise helps improve mental health

Exercise helps improve mental health. Photo credit: Adobe Stock

Additionally, it’s important to keep children on a regular routine, make sure they’re exercising and getting plenty of fresh air every day, limiting screen time, and that families aim for regular dinners together to ensure that your child is getting both socialization and healthy nutrition. Many families have also created a “social pod” with another family or two to both mitigate COVID-19 risk and maintain mental sanity, while also achieving healthy socialization for their children.

If your child or teenager is exhibiting suicidal ideations or extreme depressive symptoms, call their pediatrician or primary care physician immediately or contact the National Suicide Prevention Hotline: 800-273-8255 to get help immediately.

Maintaining an optimistic outlook and having hope is paramount. Ian adds, “I have been safe and diligent about where I go, who I hang out with, and making sure that I always wash my hands and don’t touch my face, but my hope is that a vaccine comes out soon and we can all have the college experience we were hoping for.”

And sometimes, hope is all we can do.

How has your child with diabetes coped during the pandemic? What strategies have helped you? Share this post and comment below; we love hearing from our readers!


How to Increase Your Life Expectancy

If 2020 has taught us anything, it’s that health is everything. There are simple steps everyone can take to increase their life expectancy, and to give individuals the best chance at living a long, healthy life. Incorporate these simple habits into your daily and weekly routines to increase your life expectancy and improve your health now and into the future.

1. Keep Your HbA1c Low, TiR High

If you live with diabetes, one of the healthiest life-extending habits you can adopt is keeping your HbA1c low and time in range (TiR) high. Tightly managing blood sugar levels can help prevent devastating complications such as blindness, amputation, heart disease, kidney failure and premature death.

In addition, since the HbA1c test is simply an average of one’s high blood sugars and low blood sugars, it’s important to keep your blood sugar consistent and stable, with your time in your target range as high as you can get it. Studies have linked more stable blood sugars (and not gigantic swings between highs and lows) to longer life for those with diabetes. Most people aim for an HbA1c lower than 7%, but check with your doctor for your ideal target.

2. Wear Sunscreen

Wearing sunscreen daily is crucial for preventing the deadliest form of skin cancer, melanoma. Even on cloudy days, your skin will absorb 80% of the sun’s rays, and with it, harmful UV radiation. The American Academy of Dermatology recommends using a broad-spectrum sunscreen of at least 30 SPF every time you go outside. Ample use is crucial: On average, people only use about 20-25% of the amount of sunscreen needed for sufficient protection, so make sure to lather up!

3. Move Your Body

It’s no surprise that exercise is healthy for people, especially people living with chronic conditions like diabetes. Exercise is crucial for heart health, to manage blood sugars, increase lung capacity, and build and tone muscles to prevent future injury. All of the short term benefits of exercise add up to a longer, healthier life. Aim for 30 minutes of moderate exercise most days of the week, more if able! A study showed that people who exercise vigorously for only 3 hours a week had cells that were 9 years younger than nonexercisers.

Photo credit: Adobe Stock

4. Spend Time Outside

Nearly 50% of adults have low vitamin D levels, due to our sedentary lifestyle and the fact that most Americans live and work inside most hours of the day. Vitamin D (which can be absorbed right into the skin when people go outside) is important for proper immune system functioning, healthy teeth and bones, managing depression, and may even help prevent both type 1 and type 2 diabetes! Getting outside for just 15 minutes a day is usually enough to maintain adequate vitamin D levels for most people.

5. Spend More Time with Family & Friends

Blue Zone countries, places around the world that have notoriously long, healthy life expectancies, place a lot of emphasis on socializing with family and friends. Having a social circle can help people get through hard times, reduce daily stress, boost resilience and immune response, and act as a literal shoulder to cry on. This is especially important for people with diabetes who can oftentimes feel isolated and alone with their condition. Connecting with others in our struggle can help extend life expectancy: studies show that maintaining a social circle can help people live up to 50% longer, and having just 3 close social ties can decrease your risk of an early death by 200%. 

6. Eat Whole Foods, Mostly Plants

Consuming a diet rich in fruits and vegetables will be full of vitamins, minerals, and antioxidants that can extend life. Even if you don’t go completely vegetarian or vegan, eating more whole, unprocessed foods is beneficial for a healthy life, and to prevent diabetes complications. Many studies over the years have correlated a plant-forward diet to a lower risk of premature death, as well as protective factors against cancer, heart disease, depression, and dementia. People who eat mostly plants tend to have lower body weight, healthier blood pressure levels, and have significantly lower mortality risk. Bon Appetit!

7. Meditate to Manage Stress

Stress has been correlated with shorter life expectancies, and learning to manage it through meditation and yoga can improve and lengthen your life. Successfully managing stress through meditation can improve the quantity and quality of your sleep, boost your immune response, and improve your relationships, all of which add up to a healthier, longer life. Check out some free meditation apps to get you going!

Photo credit: Adobe Stock

8. See Your Doctor Regularly

Regularly seeing your doctor for screens and tests can catch diseases early (such as cancer), and can ensure an appropriate and timely treatment plan if something is detected. Mammograms, colonoscopies, and pap smears are some of the routine tests and screens scientifically proven to decrease mortality from the diseases they screen for. It may not be fun, but it’s proven, effective, and worth it!

9. Reduce Your Sugar Intake

Sugar is the new tobacco. Dr. Aseem Malhotra, a cardiologist from England, shares, “…added sugar is completely unnecessary. Contrary to what the food industry wants you to believe, the body doesn’t require any carbohydrate energy from added sugar.”

There is evidence linking sugar not only to obesity and higher incidence rates of type 2 diabetes, but also to liver disease, heart disease and tooth decay (which can lead to dementia). If you cut out added sugar from your diet, you are also more likely to gravitate to unpackaged, whole foods, which are chock full of vitamins, minerals, antioxidants, and life-extending properties.

10. Get More Sleep

One in three Americans don’t get enough sleep. Lack of sleep has been linked with a plethora of negative outcomes on many body systems, including cardiovascular, endocrine, immune, and nervous systems. Side effects of not getting enough Zs include obesity, heart disease, hypertension, anxiety, depression, alcohol abuse, stroke and increased risk of developing cancer that can all shorten one’s life. Sleep is when the body replenishes cells, is crucial to proper brain functioning, regulates one’s metabolism, and repairs damage done to the body during the day. Adequate sleep promotes healing of all body systems, and getting enough of it can extend your life. Aim for 7-9 hours per night.

These small, easy changes can add up to many more healthy years. Try to incorporate a few of these strategies into your routine today to increase your life expectancy!


Incorporating a Latinx Lens for Mental Health

This content originally appeared on Beyond Type 1. Republished with permission.

By Mariana Gomez

As I prepared to write this piece, I had to do my own personal research. My family and I moved from México to the United States in July 2019. We have spent a lot of time trying to learn as much as we can to better understand systemic racism in this new home of ours and learn how to work towards a difference. It is our duty not only to learn as parents, but to teach a thirteen-year-old who is watching, learning and is ready to join in any possible way to help his peers.

What I’ve learned? There is major work to be done in health policies, programs and campaigns that address social determinants of health, health disparities, risk factors, and to build health services for the Hispanic/ Latinx population alongside other ethnicities and races.

Because of a lack of easily accessible or fair health services, the Hispanic and Latinx population in the US will pay a high mental health and emotional well-being price during the COVID-19 pandemic. According to Minority Health, poverty levels among these groups will also have an important impact on emotional health.

“Poor access to care due to low rates of insurance, immigration status, language and cultural barriers in healthcare which can include differences between provider-patient in explanatory models of illness and families as the gatekeepers can limit entry into treatment.” (Cortes et al, 2008) as read in the Handbook of Multicultural Mental Health Assessment and Treatment of Diverse Populations.

Talking about Latinx population includes different sub-groups. Us Latinx are a diverse community. Most of us come from different countries and speak different languages. Yes, Spanish is the official language but some will speak native tongues as well.

I am a Mexican Diabetes Educator who believes that talking about Latinx culture in the diabetes space requires us to work on more topics besides food and language barriers in our practice. Diabetes Education must include programs that recognize our many cultural differences as well.

We need more Latinx researchers, professors and conference speakers guiding these efforts in order to build better, stronger but also culturally appropriate strategies and programs. The work we’ve been able to see so far is indeed amazing, but how about incorporating a “Latinx lens” when talking about us Latinx populations and our health needs? Addressing our emotional health is even more complex as these cultural differences should be included in the different programs designed to help.

I found Salud Latina some years ago in a twitter conversation and felt immediately drawn to their mission “to lead the creation of culturally relevant multimedia research, tools, and stories to fuel people to start and support policy, system, and environmental changes in schools and communities to improve Latino child health, reduce disparities, and promote health equity and a culture of health.”

To explore and learn more about these disparities and the way our mental health is being addressed nowadays, I spoke with Rosalie Aguilar, project coordinator for the Salud America! program at University of Texas Health San Antonio.

During the COVID-19 pandemic, is there a need for culturally and linguistically-oriented mental health care for the Hispanic/Latinx population?

Rosalie: Yes! For Latinos and other people of color, COVID-19 has caused disproportionately higher rates of cases and death, job loss, and other inequitable impacts.

Many are also experiencing more mental health issues than in previous eras, according to Dr. Madeline Aviles-Hernandez, the Outpatient Services Director at the Gándara Center.

“This crisis is making life much more difficult for those [Latinos, African-Americans and other culturally diverse populations] we serve, including those in recovery and people who have yet to be treated for such problems as anxiety and depression,” Áviles-Hernández said in a statement. “Minorities have been—and continue to be—less likely to receive mental health treatment.”

The COVID-19 outbreak has resulted in forced isolation, school and business closure, massive job loss, food insecurity, and a litany of other impacts outside of the illness itself.

These ramifications impact more than just physical health, but mental wellness, too, according to Cathi Tillman, the executive director and founder of La Puerta Abierta — a Philadelphia nonprofit providing mental health support to immigrant and refugee communities.

“People who were supporting themselves on some level now can’t,” Tillman told the Philadelphia Inquirer. “They’ve lost their jobs. They can’t congregate socially, or go to church, which is a big part of the community for many people. They can’t come into the office for therapy. For recent immigrants and refugees, the things that were already difficult are 100% more difficult now.”

How are these needs being addressed so far? What kind of help are these groups receiving and how is your organization and team working to provide support? 

Rosalie: Various nonprofits are stepping in to help fill the gap, but there’s still a huge need for mental health care services and additional social support services. There’s also a need to help address the stigma involved with accessing these services.

Our organization is not involved with providing direct mental health care services. But at the Institute for Health Promotion (IHPR) at UT Health San Antonio, the headquarters of Salud America!, we do have a team of community health workers, promotoras, who provide patient navigation and reach out to patients in the Bexar County area to check up on them, provide social support and to help them connect with their health care providers. These services have been associated with less anxiety and depression among patients and fewer hospital readmissions.

There are other groups out there at the national level like NAMI that can also help connect people to services. We really also appreciate that Informed Immigrant, Immigrants Rising, and produced a 10-step guide to help mental health care providers respond to the distress of immigrants whose status is in flux due to ongoing changes to the Deferred Action for Childhood Arrivals (DACA) program, amid coronavirus. We wrote about it here.

Folks can also use or call 211 find support services in their areas. We actually got a chance to speak with the creator of, and tell the story of how he and his team were able to take on the herculean task of digitizing all the social services available in the United States, thus making it easy for people to find and apply for those resources.

How can us Latinx people in the non-profit and health space work and help you? 

I think the important thing right now is to continue to do all we can to prevent the spread of COVID-19 with culturally appropriate messaging and also to continue to push for health equity in Latino communities. If you offer a support service that can be helpful to Latinos let us know, because the word needs to get out.

Also, share our materials on the Impacts of COVID-19 on Latinos and solutions. We have a bilingual infographic, a landing page on “Coronavirus and Latino Health Equity” and a list of actions that could help Latino communities.

What is the biggest campaign you are working on and how can people and our readers join and help?

We are working on several things right now, including culturally aligned messaging to help stop the spread of COVID and also a campaign to help communities get their cities to declare racism a public health issue and commit to action. We know that racism coupled with the impacts of COVID-19 are detrimental to our population. Therefore, we need to do all we can to promote a culture of equity and to reduce bias.


Using Smartphone Tracking to Identify Patients with Depression (ADA 2020)

At the American Diabetes Association (ADA) 80th scientific sessions last week, Dr. Ashutosh Subharwal, Department Chair and Director of Department of Electrical and Computer Engineering at Rice University, put together a compelling presentation that showed the benefits of using smartphone sensors to measure behavior-biology pathways and use those findings to assess, treat and improve healthcare outcomes for depressed patients living with diabetes.

Scaleable Health Labs believes that there should be a bio-behavioral sensing layer to healthcare using simultaneous, non-invasive and accurate measures to provide clinicians with data to better help their patients. They feel using quantitative data from a sensor-based automatic measurement will be more useful than asking patients questions and having their answers be based on their own perception. For example, when asking patients how often they exercise, their answer may vary drastically from the data from their sensor.

The presentation focused on 3 areas: Mobile bio-imaging, behavioral sensing, and data science for health.

Dr. Subharwal proposed two questions:

  1. Can we track depressive/anxiety states?
  2. Can we measure loneliness?

Can We Track Depressive/Anxiety States?

Depression is a common comorbidity of diabetes and is often undetected and untreated. A study explored this in adults and adolescents, using a tool called SOLVD: Smartphone and Online Usage as based eValuation for Depression, by way of a smartphone as a wearable for tracking depression.

The two clinical pilots for SOLVD consisted of the following:

  • Bi-weekly clinical visits.
  • Logging feelings in a MoodReminder Module.
  • The MobileLogger Module, which has the sensor logging social use (phone calls/texts), mobility (GPS/steps/accelerometer) and phone usage (screen time, screen light, etc.), all while being respectful to keep any conversations private.
  • A new parent app for the teenage pilot that used the parent’s feedback as a sensor to measure their children’s mental well-being.

Using this combinational sensor data allowed clinicians to track who, when and for how long the patient was speaking with or texting an individual. They were able to track where the patient was going and the duration of time spent at each location. There were also many other extracted features from the smartphones related to communications, mobility and sleep collected daily, as listed in the chart below.

Key Findings

This method proved to be a useful way to continuously track a patient’s mental state. The patients did not find it intrusive and were willing to be tracked. They saw a strong correlation between the daily self-reported moods and different diagnostic questionnaires in both teens and adults. Also, when patients had fewer phone calls/text messages and shorter frequency of these exchanges, it was predictive of higher depression symptoms. Additionally, as the number of steps walked decreased, there was an increase in the participant’s depressive state.

In both studies, there was a correlation between the data collected from the smartphone and the patient’s psychometric scores, and a noticeably stronger correlation in the moderate to severely depressed participants. The data indicate that the more depressed a patient was, the less mobile and social the person became. This information can help providers to better assess and treat their patients.

Can We Measure Loneliness?

Sociability is crucial to our overall well-being and lack of social encounters are indicators of loneliness. The traditional measures of sociability are often questionnaires, patient self-tracking, the UCLA loneliness scale but all of these require participant effort and many times the report lacks enough detail to draw any conclusions.

SocialSense, an in-person social network (IPSN) is able to track real-life, in-person interactions through audio data. This tracking device is able to detect conversations, detect social scenes and context as well as turn-taking behaviors, with no content analysis to respect participant’s privacy.

The Sociability Clinical Pilot at Baylor College of Medicine (emailed waiting for confirmation) spent 1 week audio-tracking their participants, using the daily smartphone app sensor features discussed above, along with patient baseline psychometric measures.

Key Findings

A decrease in sociability was seen among patients with depression, including fewer longer conversations and fewer social contacts. The SocialSense reports were consistent with the self-reports. SocialSense was also able to detect audio self-talk conversations amongst patients with psychosis.


  • Most patients are willing to be monitored via technology (>80% adherence).
  • These tracking studies are among the first of their kind to study adolescents and adults who suffer from depression. They are also the first to use the new tool for psychiatry, the parent app.
  • Data from the participant’s phone sensor and usage features correlated with symptoms of depression, which was even more pronounced in the moderate to severely depressed patients.
  • The data we can get from wearables can help better evaluate a patient’s mental well-being and develop the most appropriate solutions.

What are your thoughts on the subject? How would you feel about your activities being tracked for health purposes?


Study Shows Large Proportion of Those with Diabetes Lack Psychosocial Support (ADA 2020)

People with diabetes (PWD) are more likely to experience anxiety as compared to the general population. According to the American Diabetes Association (ADA), generalized anxiety disorder occurs in up to ~20% of people with type 1 or type 2 diabetes. It can be difficult to determine the exact reasons for the high prevalence, but many experts believe that in many cases, the anxiety is directly related to diabetes. There is a need for psychological care and self-care support in order for people living with diabetes to be proactive with their care and for overall wellbeing.

This week at the American Diabetes Association’s 80th Scientific Sessions, Dr.Soren. E. Skovlund and his team from Aalborg University in Denmark set out to evaluate the need for and access to psychological care and self-support for people with diabetes.

A national diabetes survey (Life with Diabetes 2019) was emailed to 38,820 members of the Danish Diabetes Association to help gauge the impact of diabetes on daily life, access to care, technology and services and to better understand the priorities and wishes of people living with diabetes. Notably, this is the “largest nationwide Danish survey to date to quantify as well as qualitatively characterize a major need for better access to psychological and other non-medical diabetes care in Denmark”.

Key Findings

  • 19% of PWD felt distress (specifically defined as diabetes taking up “too much of daily life”).
  • 18% of PWD (24% women vs. 12% men) reported the need for a psychologist but had not been referred to one.
  • 36% of PWD and 21% of caregivers did not receive the support they needed to deal with the emotional aspects of diabetes management.
  • 19% agreed that major need for system-wide change to improve psychosocial support; specifically, an analysis of over 1,000 responses found the following key areas of concern: 1) access to new technologies, 2) quality of care in primary clinical practice, 3) A “whole-person” care approach that extends beyond medicine (e.g., focus on exercise, diet, mental health, etc.).


Patients feel overwhelmed by managing chronic health conditions and many do not feel that their needs are being met by their healthcare providers. People living with diabetes need and deserve system-wide improvements including better access to new technology, quality of in-person care and whole-person care, including education about exercise, health and emotional health support.

Psychological care for patients who have diabetes is crucial to improving patient overall wellbeing and health outcomes by and their ability to care for themselves while navigating a chronic autoimmune disease.


What to Expect in a Telehealth Appointment for Mental Health

This content originally appeared on Beyond Type 1. Republished with permission.

By Mark Heyman, PhD, CDE

Due to the confusion and isolation the world is undergoing as a result of COVID-19, countless people are now in need of virtual appointments with mental health providers. And as mental health providers transition to working with clients virtually, many people remain unsure about how conducive remote therapy sessions will be for them. Dr. Mark Heyman addressed some of the concerns regarding telehealth and the potential for impact on mental health.

A lot of people are seeking mental health treatment for the first time – what tips do you have for someone seeking mental health support for the first time now that we’re primarily doing so online? 

Seeking online mental health treatment for the first time may seem a little scary. After all, you are meeting a therapist – who is a complete stranger – over video. Here are a couple of tips to make your first video appointment more comfortable:

  • Fill out and return any paperwork to your therapist before your appointment.
  • Make sure you have a private, quiet place where you will not be interrupted or distracted.
  • Turn off notifications on your computer, or if you are using your phone, put it on ‘Do Not Disturb’
  • Be prepared for the video technology to not work perfectly – even the best systems don’t always work as planned.
  • Write down the reasons why you are seeking therapy at this time; common reasons are that you are having symptoms (e.g., anxiety, depressed mood), something has happened that you want to talk about (e.g., you lost your job or ended a relationship), or you are having a hard time doing things in life that are important to you (e.g., managing diabetes, working, going to school).
  • Write down any questions that you have for your therapist. For example, you may want to ask them what treatment will involve, how long it might last, what kind of experience do they have working with people with issues similar to yours, and what do they know about diabetes. Ask whatever is on your mind – no question should be off the table.
  • Expect the first part of the session to be a little bit awkward, but know that after a few minutes, it will become more comfortable.

How do you (or any mental health provider) approach telehealth visits with new clients? What does the first conversation look like? 

The first session with a new telehealth client is really no different than the first session with someone I am seeing in my office. It is about getting to know them and why they are seeking treatment. I have a series of questions that I use to guide the discussion. For example, I start out by asking about what brings them to therapy at this time. Because I only see people with diabetes, I also ask about their history with diabetes and how things are going with diabetes right now. I want to know about their relationships with family and friends, how they spend their time and what they do for fun. I also always ask about their goals for therapy. What do they hope will be different when they are done? After I learn about the person, I will tell them about how I work and the things I think I can do to help them. Also, if I do not have the expertise to help them, I will let the person know and help them find someone who does. Throughout the session, I am always open to answer any questions the person has.

What about clients who are moving to telehealth from in-person? How does that change the dynamic? 

Though I’ve been doing telehealth for five years, over the past month, I have moved my entire practice online. Honestly, it has not changed the dynamic much at all. I think for most people, seeing me over video instead of in-person does take a little bit of getting used to, but once that happens, treatment continues without missing a beat. The only difference is that I get to see people in their homes and get a window into their natural environment.

One group where the dynamic is a bit different in-person vs. online is teenagers. I find that it is harder for teens to stay engaged online than it is when they are sitting in my office.

In your view, what are some pros and cons of remote therapy?


  • No need to commute to a therapist’s office
  • More flexible scheduling
  • The ability to find a therapist that has experience with what you are struggling with (e.g., diabetes) if there are none in your area


  • For some people, the act of leaving their house and going to a therapist’s office is an important part of treatment (e.g., someone who is depressed)
  • It is easier to avoid engaging in therapy online
  • It is more difficult to see non-verbal cues
  • Insurance does not always cover telehealth (though since COVID-19, that is changing fast)
  • State laws require that the therapist be licensed in the state where the client is physically located

What services or online services do you recommend, if any? 

Right now, almost all therapists have moved their practices online, so looking for telehealth services is no different than looking for a therapist in-person. You want to make sure the therapist you are seeing has experience with the issue you are seeking therapy for. Some great resources for seeing therapists are Psychology Today or if you are looking for a provider who specializes in diabetes, the ADA/APA Mental Health Provider Directory is a great resource. I also wrote an article awhile back on telemental health that is diabetes-specific.


Minding Your Mental Health During COVID-19

I recently saw someone on social media refer to this as a “great pause’ and while I think it is wonderful that many people are viewing this time as an opportunity to spend more time with their family and to appreciate the simpler things that life has to offer, there are many people going through a very different, and traumatic, journey.

In just the United States alone, 1 out of every 5 people suffer from a mental illness and 1 out of every 25 people suffer from a severe mental illness. For those who are afflicted, it is oftentimes difficult to get through the average day without feelings of anxiousness, irritability, depression, etc. Add in a global pandemic and many of what they were told were “irrational” fears have now come to life. The feelings of isolation, fear, grief, loneliness, financial worry are all very real right now and we need to find a way to cope.

So how do we take care of our mental health while also acknowledging that it is a very scary time and that there is a lot that we don’t know? That is an uneasy feeling for anyone, let alone someone who struggles with mental health issues. Like all other things in life, I do believe it comes down to balance.


“The secret of your success is found in your daily routine” by John C. Maxwell is a great quote that is quite applicable at this time. I find that if I get up and get dressed, I have a more productive day than if I lie around in my pajamas. Also, keeping to a schedule (while of course allowing flexibility) for meals will not only keep you focused on what you are doing but can also make for more predictable blood sugars. Just these small steps can lead to less mental anguish.

Prescribe Yourself a Daily Dose of News

Try to limit your news consumption to a level that works for you. Many of us wind up leaving the television on and that can be very unhealthy to listen to and watch all day long. Either allow yourself a certain amount of time watching or pick a few times throughout the day to do a quick check-in. Also, make sure you pick one or two reliable sources that you trust and stick to those news mediums.

Stick with Your Mental Health Care Plan

If you are on medication, make sure you continue to take your medication as prescribed by your healthcare provider. If you are experiencing difficulty or feel the medication isn’t working properly, make sure to call your doctor as they are still available to take their patient’s phone calls and available for teletherapy. And if you haven’t sought professional help in the past but feel the need to do so, check with your health insurance to see what affordable options are available to you. There are also free hotlines that you can use:

  • Mental Health America Hotline: Text MHA to 741741. Mental Health America is a nationwide organization that provides assistance through this text line. You will be linked to someone who can guide you through a crisis or just provide information.
  • National Suicide Prevention Lifeline1-800-273-8255. Crisis intervention and free emotional support are available, which is helpful when you need confidential assistance during a time of emotional distress for you or a loved one. The helpline is open 24/7, and a live online chat is available as well.
  • Crisis Text Line: Text CONNECT to 741741. Specialized crisis counselors are just a text message away on this free, confidential 24-hour support line. To further protect your privacy, these messages do not appear on a phone bill. The text line also provides services and support if you are upset, scared, hurt, frustrated, or distressed.

Control What You Can

Many of us are sitting at the edge of our seat on a daily basis waiting for the next big piece of news to be released. Will there be antibody testing available soon near me? Are they opening my state sooner than I’d like? Are my children’s schools going to open back up this year? While these are all valid questions and concerns, we cannot allow them to take up too much space in our minds. Whatever the case will be, you will navigate the situation and do what is best for you and your family. A great quote to remember is “If it’s out of your hands, it deserves freedom from your mind too.” – Ivan Nuru ”

mental health

Photo credit: Sandis Helvigs (Unsplash)

Keep Your Mind and Body Active

This hasn’t been easy for any of us despite what your experience has been. Whether you’re dealing with the loss of a loved one or simply needing a ten-minute break from your toddler, your emotions are valid. Give yourself a few minutes a day to have a small pity party but then try to move on. Get active by taking a bike ride, going for a walk or take a road trip and get lost on a new adventure.  Exercise your mind by staying connected to friends and family. And when you’re alone, try out a challenging crossword puzzle or start a journal. Keeping busy will not only keep you from feeling lonely, but it will also be beneficial to your overall wellbeing.

This pandemic is affecting us all differently but there is no doubt it has been mentally and emotionally challenging for all. Make sure to acknowledge that while mental illnesses may be invisible, they are very much real and should be treated with care. You owe it to yourself and your loved ones to make yourself a priority during this challenging time.


Diabetes and Divorce: Getting Through the Process

Diabetes can wreak havoc not only on one’s physical health, but on one’s mental and emotional health as well, and oftentimes the toll that diabetes takes will affect the entire family. If you’ve faced or are currently facing a divorce and live with diabetes, you know all too well that it adds a complicated layer that can cause additional stress, heartache, and pain. Here are some ways to protect yourself (and your diabetes!) should divorce come your way:

Court Can Be Ugly

While sometimes divorce can be civil and amicable, going to family court, especially when child custody arrangements are being negotiated or when child support is in the picture, can get ugly. Be prepared for your spouse’s attorney to bring up your diabetes management, and to propose that as a liability against your ability to care for your children. Work with your attorney around this expectation. By providing your attorney your medical records (including HbA1c results), you can defend any argument against you regarding poor diabetes management.

Leaving a Marriage Can Mean Losing Insurance

Leaving any marriage is hard, but this is especially true for people living with diabetes who rely on their spouse’s health insurance, which equals access to insulin, pump supplies, and the ability to see an endocrinologist. Divorce can be a long, brutal process, but knowing that you will lose health insurance gives you time to stock up on supplies, make much-needed appointments, and line up ways to secure health insurance before you have a significant lapse in coverage.

If you were previously unemployed, you may be eligible for Medicaid coverage in your state, or since divorce is a qualifying life event, you can buy a health plan on a state or federal exchange. Check out our resources for securing insurance if you learn that you’ll lose coverage as a result of divorce.

Vulnerabilities Are Laid Bare

As a person with diabetes, we rely heavily on our spouses for everything from helping us take a shot in an unreachable place, to grabbing us a juice for a 3 a.m. low. Losing a spouse means losing part of our support system for managing our diabetes.

If you’re experiencing this sudden loss of support (especially if you struggle with hypo unawareness), try and prepare yourself by getting a continuous glucose monitor (CGM) that can alert you if you go low during the night. Many CGMs now have a “share” option that lets people “follow” your trend lines, and also receive alerts when your blood sugar goes too high or too low. This is an excellent feature for people who live alone and want additional assurance that they’ll be safe when they go to sleep at night.

Additionally, getting a diabetes alert dog can help not only with managing highs and lows, but also with the loneliness that can come with suddenly finding yourself on your own.

Know You’re Not Alone

You may be losing a spouse, but you have a lot to gain in terms of support, if you know where to look. For community encouragement, joining a diabetes support group, volunteering with a diabetes organization, or reaching out to family and friends and letting them know you need some more support around your diabetes can be greatly beneficial. Even becoming more involved in the diabetes online community (on Facebook, Instagram, or Twitter) is an excellent way to stay connected to people from the comfort of your own home.

Go Inward

Divorce is one of the most stressful times in one’s life. Seeking professional counseling can help you return inward, and to start to heal so you can eventually move forward. Counseling can also prepare you to deal with the stressors of moving out, perhaps finding new employment and new health insurance, and dealing with diabetes on your own for the first time in a long time.

Although it can be hard, divorce can also be a truly freeing and necessary step in one’s life, and can lead to beautiful new beginnings. It’s important to take care of yourself and protect your mental health throughout this time. It’s never too early or too late to start (or continue) work with a licensed counselor.

Have you recently gone through the heartbreak of a divorce, while living with diabetes? What aspects of the divorce were the scariest for you, as a person living with diabetes? What tactics and coping strategies helped you the most? Share this post and comment below; we love hearing your stories!


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