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.

Conclusions

  • 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?

Source: diabetesdaily.com

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.).

Conclusion

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.

Source: diabetesdaily.com

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?

Pros:

  • 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

Cons: 

  • 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.

Source: diabetesdaily.com

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.

Routine

“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.

Source: diabetesdaily.com

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!

Source: diabetesdaily.com

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

Mental Health and Coping with Coronavirus

By Mark Heyman

I would be willing to bet that you have been feeling more anxious than usual over the past couple of weeks. It is easy to feel overwhelmed by all the news and with all changes we’ve had to make to our daily lives because of the current coronavirus pandemic (COVID-19). When you throw diabetes into this mix, things can feel even more stressful.

As a person with diabetes, taking care of your mental health is especially important when you’re feeling stressed. Here are some strategies you can use to stay emotionally healthy during these uncertain times.

Focus on What You Can Control

This situation is anything but normal, and it’s likely that you are feeling like things are out of your control. Let’s be honest – right now there are lots of things that you do not have control over and that is scary. Focusing on things you do have control over can give you a sense of stability, which can calm your mind. Not sure where to start? Here are some suggestions:

  • Stick to a routine. Get up at the same time every morning, take a shower and get dressed. Creating a structure to your day can help life to feel a bit more normal.
  • Follow public health recommendations. You have control over doing your part to stop the spread of COVID-19. Wash your hands regularly, keep up with social distancing and stay away from crowds.
  • Keep managing diabetes. No matter what is going on around you, you still have the ability to manage your diabetes. Make healthy food choices, stay active, monitor your blood sugar and take insulin. Even if you don’t have perfect control of your numbers, you will know that you’ve done everything you can to keep your blood sugars in range.

Give Yourself Space for Your Emotions

All of the uncertainty in the world right now is unsettling and scary. These are not emotions that are comfortable or fun, and your first instinct may be to try to avoid feeling them. Remember, it is okay to feel whatever it is that you are experiencing. Give yourself permission to feel whatever emotions come up for you –  you can handle it!

Be Kind to Yourself About Your Management

Stress can make blood sugars a lot more difficult to manage. Keep this in mind during these stressful times and be kind to yourself, especially if your blood sugars are not where you would like to see them. Instead of getting down on yourself for not doing “a good enough job” with diabetes, try telling yourself that you are doing the best you can in this difficult situation. Showing kindness to yourself is no different than showing kindness to others. If you get down on yourself (as a result of frustration over your diabetes, or any other reason), ask yourself what you would tell a friend who was in the same situation.

Stay Connected

We need to stay connected with the people in our lives, especially when things are rocky. Our friends and family can give us support, reassurance, and maybe even a good laugh to lighten the mood – all of which are essential to our mental health. Just because we are experiencing “social distancing” does not mean we can’t stay connected. Send an email or text, call someone on Facetime, or even pick up the phone. We are all in this together!

Caring for Others

Caregivers of people with diabetes also need to stay emotionally healthy during this time. People often think that taking care of themselves means not taking care of others, and nothing can be further from the truth. In fact if you don’t care for yourself, you’ll likely have a much more difficult time caring for others.

Dr. Heyman went live on the Beyond Type 1 Daily Instagram, answering community questions about tackling mental health in the midst of COVID-19. Watch the full video:

Source: diabetesdaily.com

Managing the Emotional Toll of Diabetes and COVID-19

The world as we know it has changed due to COVID-19, the illness caused by the novel coronavirus. The number of businesses closing, people being quarantined (mandatorily or voluntarily), laws changing to contain the spread of the disease in the United States, cities invoking curfews and travel bans, and people dying is changing by the hour. If it suddenly feels as though you traveled through time and landed in the zombie apocalypse, you’re not alone.

Add to that the layered anxiety and worry that comes with having diabetes in the time of an unmitigated infectious disease (of global pandemic proportions) disaster, and it can become too much to manage. It can be a complicated mix of concern for the world, the risk to yourself, and how you feel about the risk to loved ones in an environment of uncertainties and unknown unknowns. Here are our top ways to manage the stress:

Know the Facts

Having diabetes doesn’t necessarily put you at any higher risk for getting COVID-19, but you can be susceptible to more severe complications if you acquire the disease. Do not panic. Do not get sucked down into the rabbit hole of myths and conspiracy theories. Learn the facts from reputable sources only. Following advice from The World Health Organization and the CDC are two good places to start. You may have increased anxiety around diabetes and coronavirus (that’s expected and warranted), but unnecessary stress doesn’t help, either.

Disconnect

Most of us are working from home these days, and while that’s an excellent way to help contain the spread of disease and protect people with preexisting conditions like diabetes, it’s also keeping many people glued to their screens for most of the day, and that means, glued to the news. Get away from your computer screen, the news, Twitter, and the chaos of Facebook for some time each day (walks outside are excellent, now that the spring weather is upon us!). Set limits on how much you watch the news (it’s crucial to stay informed, it’s not so crucial to watch CNN for 7 hours straight). Or better yet, limit screen time to evenings only.

Infographic by The World Health Organization

Be Prepared, Not Panicked

There’s only so much you can do, but make sure you do it! Practice proper social distancing, hand washing techniques, stay home if you’re sick, and avoid crowded places, sick people, and high traffic areas (airports, etc.).

If you can, stock up on two weeks’ worth of food, toiletries, and medication, and make arrangements to work from home, if able. It’s understandable that most people cannot afford to stock up on fresh food and medication. More affordable, shelf-stable food items that can go a long way include canned goods and frozen vegetables, and dried beans and rice. That being said, there’s no need to necessarily hoard grocery items, as grocery stores do not have any supply-chain issues and hoarding for yourself may cause deprivation for others (although, of course, make sure you have more than enough supplies to treat low blood sugar at home). Additionally, check out our advice for obtaining additional diabetes supplies without breaking your budget during this crisis.

If your job requires in-person time (if you work in the service industry, are a healthcare worker, provide city services such as garbage collection or sanitation, or your boss simply won’t budge on a work from home arrangement), try and maintain 6 feet distance between you and others, ask for latex gloves if you work in a grocery store or are a mail carrier and touch lots of objects (be sure you know the proper way to use them!), and avoid standing near sick people. Also, wash your hands thoroughly and often. If you can find it, hand sanitizer also is extremely helpful when on the job if running water and soap aren’t readily available. COVID-19 is caused by a novel Coronavirus, meaning it’s never been seen before, and the epidemiological characteristics of the spread of the disease are still being uncovered. It’s best to use extreme caution. It’s recently been revealed that it *may* be airborne, although studies are conflicting.

After you’ve adequately prepared, don’t continue to panic. Falling to hysteria won’t help anyone, but being prepared can give you peace of mind if you’re forced to be at home for a while.

How to Protect Others from Getting Sick - Coronavirus 2

Infographic by The World Health Organization

Move Your Body

Exercise is one of the main ways to decrease stress, and just because many cities are closing down their gyms, doesn’t mean you can’t move your body. Aim for a moderate activity for at least 30 minutes every single day. Warming weather can mean outdoor runs or walks, bike rides or hikes, and YouTube is an excellent resource for yoga and meditation classes and various cardio routines. Check out this article for even more ideas! You may not be able to control a lot right now, but moving your body is one concrete thing you can do to feel better.

Create Structure

With school closings and changing work routines, nothing feels normal right now and that can cause a lot of anxiety. Try to create some sort of structured routine (small changes can make a big difference!). Wake up at your normal time, even if you don’t have a commute right now. Make your bed every morning. Shower. Put on pants (yes, some people need a reminder to change out of their PJs when working from home!). If you usually have Tuesday night pasta night, have your Tuesday night pasta night. Sticking to a routine is especially important if you have children at home and they’re not in school currently, but a routine is healthy for everyone.

Check in on Your People

Gathering in crowds is not recommended right now, per CDC guidelines, but that doesn’t mean you shouldn’t check in on your friends and family. Skype, FaceTime, or even good old-fashioned texts and phone calls are excellent ways to stay in touch with everyone. We’re all in this together, and reminding people that they aren’t alone is crucial right now for mental health and sanity.

Supporting loved ones amid covid-19 pandemic

Infographic by The World Health Organization

Do Something Tangible

When you take away social gathering, date nights out, going to the movies, playing mini-golf, going bowling, and your kids’ weekly ballet class, everything suddenly feels…digital. Do something tangible: clean out the garage you’ve been meaning to clean out for the past 2 years, go through your clothes for Goodwill donations, repaint and rearrange a room, learn how to knit, dig around in your garden, pull out the dusty Scrabble and Scattergories games from the basement and have a game night, master your grandma’s cornbread recipe–anything that is physical will benefit you tremendously, and help peel you away from the constant stream of anxiety-provoking news.

Eat Healthy

The whole world being on pause right now might have given you license to stress-eat ice cream every night last week, or pour one too many glasses of wine over the weekend, but keeping a healthy eating routine will fuel your body and make you feel better over the long run. What feels good in the moment isn’t always the best thing for us over the long haul, and making sure we’re drinking enough water, eating plenty of vegetables, and getting good sources of protein will sustain us much better than ice cream ever could (sorry to say!).

Allow Yourself Some Grace

The world isn’t operating at 100% right now, and so it’s okay that you aren’t, either. You haven’t been able to concentrate on your work emails at all? Haven’t had the motivation to cook an elaborate meal? Not feeling optimistic about the future? Give yourself some grace, and allow yourself to slow down and feel this moment. This is a global pandemic, and (hopefully only) a once-in-a-lifetime event. Things are not normal, and it’s unreasonable to expect yourself to pretend like everything’s okay. It’s okay to not be okay right now.

Know This Is Only Temporary

Everything is in extremes right now, and it’s foreign to many of us. Maybe you’ve had to cancel travel plans, maybe you’ve had to return home from a study abroad program early, or you’re missing out on a Broadway play. Maybe you’ve even postponed your wedding. These are not normal times, and things won’t always be like this. Eventually, you will be able to go to the movies again, go to concerts with large crowds and not worry, get dinners, go bowling and grab happy hour without a care, and when you do, you can toast to happiness and good health, and getting through this horrific time, together.

How are you coping emotionally during this difficult and complicated time in the world? Share this article to help a friend, and comment your thoughts below; we would love to hear them!

Source: diabetesdaily.com

Life With Type 1 Diabetes: A Gamer’s Take

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

By DJ Lipscomb

I never thought I would be the type of person who watched someone play video games on the internet. But here I am, a 32-year-old dad who loves video games and not only watches other people stream, but recently started a streaming page + podcast dedicated to video games. Oh yeah, and did I mention I also have type 1 diabetes?

The Name of the Game

I was diagnosed with type 1 at the age of ten and it completely changed my life. It required me to grow up a lot faster than I would have liked and has shaped so many decisions I have made over the last 22 years. I remember being so terrified to do basic things on my own as a kid, even thinking that I might die. As a parent to three minions of my own now, I would never wish that feeling on any of them. That type of mentality is not easily shaken, but I eventually was able to push through the fear and not allow this illness to keep me from being everything I wanted to be.

Lipscomb

Image source: Beyond Type 1

The funny thing about growing up fast is that you leave a lot of “kid” stuff behind. I played video games a lot as a young kid. My brother and I would spend hours playing Gameboy or Super Nintendo. Looking back, I can see now how my diagnosis shifted my mentality on what I thought was age-appropriate. I just didn’t feel like a kid anymore. I had new responsibilities that had life-threatening consequences if ignored. Sure, I still played games, but I lost that pure innocence and fun that comes along with jumping into a brand new world for the first time because I was obsessed with keeping my blood sugar in check.

After going through some major life changes in 2016, I suddenly found myself faced with an opportunity to take stock of who I was and who I wanted to be. My diabetes had suffered immensely as a result of the stress from a divorce, I was out of shape, and I was a little lost. I remember one of the first things that I did for myself during that transition was buy a Nintendo Switch. I will never forget the moment I hooked the Switch up and played The Legend of Zelda: Breath of the Wild for the first time. That joy I had forgotten suddenly rushed back through my veins. I knew at that moment, gaming would forever be a part of my story.

Fast forward to today. I am the healthiest I have ever been thanks to a major shift in my diet and to a recently introduced workout regimen. I own a successful consulting and media company called Exhale Creative that helps brands determine what type of content they need to create in order to help them grow and better reach their audience. We also produce 99% of the content for those clients. I have been a hired guitar player, touring all over the world and playing in front of tens of thousands of people (that’s a whole other glucose management article on its own). And now, I am chasing down a new dream called Patch Notes.

How to Stream

Patch Notes was created to celebrate the intersection of life and video games. We want to show how video gaming can bring out the best in people while simultaneously breaking down stereotypes about who or what a gamer is. We stream on Facebook Gaming, and you can find our podcast on iTunes and Spotify.

When Facebook announced that on Giving Tuesday they would match dollar for dollar the money raised through charity streams, I was thrilled to raise some funds for Beyond Type 1. I have had the privilege of interacting with several members of the Beyond Type 1 team and truly love the light they shine on all things diabetes. And even though I did not raise an abundant amount of money during our stream, my growing community did step up and donate while we hung out and played Pokemon Shield.

My platform is growing and I can’t think of a better way to use it than to help people, who like me, face this illness every day. It is also worth noting that there are several type 1 diabetes people (T1Ds) who watch the stream, which has made it feel even more meaningful to me. I am excited to host more streams that bring awareness to a disease that is often misunderstood or misrepresented, and look forward to bringing in more donations to help others with diabetes pursue their passions.

You can go back and watch the stream (and still donate) here. And come hang with us anytime at Patch Notes.

Source: diabetesdaily.com

Shadow’s Edge: Video Game Designed to Help Kids Cope With Chronic Disease

Being a kid is hard enough as it is. Add in having a chronic disease and it can make those very special years potentially very isolating ones. Shadow’s Edge is a virtual reality game that allows children to process and express their feelings about their disease — or whatever else they may be going through. This mobile game can help change the experience of a serious diagnosis, or challenging times, by combining art therapy and cognitive behavior therapy and giving children a safe place to not feel so alone.

Action video games can help reduce depression in teens and Shadow’s Edge hopes to help bring positivity and community to those who need it most. Founder and philanthropist, Sherri Sabrato Brisson, is a brain cancer survivor who initially co-wrote a book, “Digging Deep: A Journal for Young People Facing Health Challenges ” with Rose Ofner, to help kids process their chronic disease or serious illness and it had great success. She then met Rosemary Lokhorst, who is now the game producer because of how much she loved the concept and that is how Shadow’s Edge was born.

Shadow’s Edge is a free and completely donation funded, virtual city that has just been overtaken by a storm, much like our lives after being hit with a diagnosis of some kind. The storm removes all the color from the city, much like our disease has the potential to take away some of our happiness…if we let it. The object of the game is to bring back the color to the city through writing and art, which helps empower the player to take on whatever it is they are going through.

Shadow's Edge

Photo credit: Shadow’s Edge

So far, Shadow’s Edge has worked with many organizations and university clinics in the US, Brazil and in Europe, focusing on kids and teens with cancer, and has received very good feedback, especially from doctors. Currently, they are running a complex research study nearby the Lurie Children’s Hospital in Chicago, with more than 100 kids testing Shadow’s Edge. So far, the results have been fantastic, and the game is helping these children build up the resilience to tackle the challenges they are facing.

I was able to chat with Sherri to find out more about Shadow’s Edge and their plans for the future.

Sheri, the journey you went through with brain cancer must have been so traumatic. Did writing your first book, Digging Deep: A Journal for Young People Facing Health Challenges, prove to be therapeutic? What about creating this game?

As a survivor, I can tell you, I know how difficult it was for me to even know how I was feeling at the time, let alone be able to express these feelings.

On my 25th anniversary of survivorship from brain cancer, I envisioned a world where every young patient has real-time access to the tools he or she needs to build emotional resilience through their experience.

I started by co-authoring Digging Deep: A Journal for Young People Facing Health Challenges, with Rose Offner, MA. I donated 35,000 journals to hospitals across the country, but it still wasn’t enough. So, we decided to meet young people right where they are—on their phones, playing games.

Seeing the success of your book shows that there is a need for resources and tools for people who have serious illnesses or a chronic condition. How do you think Shadow’s Edge can help fill that gap for our children?

Just like the physical journal, Shadow’s Edge helps teens build their emotional endurance to tackle the challenges they face through the power of their personal narrative. There are very few resources directed at teens today. Our aim is to meet them where they are – on their phones, playing games. So this time, teens are engaged through their medium—their phones or tablets—to express themselves through writing and now, covering a city in graffiti! Through gameplay, teen players realize they needn’t stay in their confined world—they have the power to reshape their world into whatever they choose. Through their expression, they can create beauty where there was once dilapidation: There can be light; There can be color; There can be hope. And, there can be a community.

“When starting to play Shadow’s Edge, a teen may not even know how they feel or what is troubling them. As they continue through their journey, they often discover they are at a different place emotionally in the end—there may be a sense of resolution, a greater understanding, a place of peace”.

I know for me personally, when I was diagnosed with type one diabetes, finding community changed everything for me. I was so much better off mentally and emotionally and had a much better outlook on my future. How does playing this video game help children connect with others? 

Yes – connection is key to build resilience and to feel better! Teens asked us for a space that is theirs only, where they can express things for themselves, as they are not always clear or ready to connect. Interestingly, this working with oneself helps to reach out. Additionally, the game has an in-game sharing space (once you reach the new level, Disillusionment). There you receive a means to see other players’ art and provide messages of support and where you can publish your graffitis. The community aspect is one that we are focusing on to expand – it is the key ask of players to build on.

I could see how the concept can be applicable to many different obstacles a child could be facing, what other areas are you focusing on and what do you hope to accomplish?

We are expanding the content so that teens facing a variety of difficult situations can benefit from it – these can be changes in the family like a divorce or death of a family member, bullying, anxiety, stress, depression, identity questions.

Shadow’s Edge has the potential to help so many children going through hardships. Where do you see Shadow’s Edge going from here?

We are working on expanding the community aspect of the game. We want to create a community around self-expression where teens facing all kinds of challenging situations can share, collaborate to create art, find psychoeducational content and just connect with each other.

As a brain cancer survivor, what message would you like to share with people facing a health battle of some kind? 

Your challenge does not define who you are, you define this. When you are ready, take an active role in opening up–every time you tell your story you tell it a little differently, this make you integrate it and see new perspectives. Practicing this also supports you to understand you are stronger than you think, getting comfortable with your story and owning it as a part of you, but not all of you.

Shadow’s Edge is available on both IOS and Android, and available in 6 languages.

They also have a special website dedicated to helping parents and healthcare professionals who are helping a young person with illnesses, see more information at www.diggingdeep.org.

Source: diabetesdaily.com

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