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1 Coach on Call It was great to talk with you. Thank you for your interest in. I hope you find this tip sheet helpful. Please give me a call if you have more questions about this or other topics. As your health coach, I m ready to help in any way I can. Living with diabetes can be tough. Taking good care of yourself includes taking medicines, checking your blood sugar, getting regular exercise, and cooking healthy meals. Despite your best efforts, at times you may not be able to keep your blood sugar in a healthy range. For many people with diabetes, these challenges may lead to what is called diabetes distress. It can look like stress, anxiety, or depression. You may feel worried, frustrated, concerned, or defeated about your diabetes. Diabetes distress makes it hard to enjoy life and manage your diabetes well. The good news is that it can be treated. The first step is awareness. Do you struggle with diabetes distress? The statements below describe the feelings of someone with diabetes distress. Check how much of a problem each one has been for you during the past month. Feeling Feeling that diabetes is taking up too much of my mental and physical energy every day. Feeling that my doctor does not know enough about diabetes and diabetes care. Feeling angry, scared, and/or depressed when I think about living with diabetes. Feeling that my doctor does not give me clear enough directions on how to manage my diabetes. Not a A Slight A Moderate A Serious CMN UPMC_17_1649 Copyright 2017 UPMC Health Plan, Inc. All rights reserved C ON C CA DIABETES DISTRESS 17CA0696 (MCG) 9/7/17 PDF

2 Page 2 of 7 Feeling Not a A Slight A Moderate A Serious Feeling that I am not testing my blood sugar often enough. Feeling that I am often failing with my diabetes routine. Feeling that friends or family are not supportive enough of self-care efforts (such as planning activities that conflict with my schedule or encouraging me to eat the wrong foods). Feeling that diabetes controls my life. Feeling that my doctor does not take my concerns seriously enough. Not feeling confident in my day-to-day ability to manage diabetes. Feeling that I will end up with serious long-term complications, no matter what I do. Feeling that I am not sticking closely enough to a good meal plan. Feeling that friends or family do not appreciate how difficult living with diabetes can be. Feeling overwhelmed by the demands of living with diabetes. Feeling that I do not have a doctor who I can see regularly enough about my diabetes. Not feeling motivated to keep up with my diabetes self-management. Feeling that friends or family do not give me the emotional support that I would like. The more moderate and serious problems you have related to your diabetes, the more difficult it can be to deal with any one of them. Having multiple challenges and problems can often lead to depression. The symptoms of depression include: Lack of interest in doing things you used to enjoy. Change in sleep patterns.

3 Page 3 of 7 Loss of energy. Change in appetite and/or weight. Trouble concentrating. Feeling hopeless or like a burden to others. If you are depressed: Do your best to solve some of the problems above that you checked as moderate or serious. This can go a long way toward helping you feel better. Reflect on which problems you are most ready and able to tackle. Work with your health coach to set small, realistic goals toward resolving them, one at a time. (If you feel unable to tackle any problems at this point, that is okay. You may need to treat your depression first, as described below.) Seek treatment. If the symptoms of depression last more than two weeks, tell your medical team how you feel. Follow through with the treatment that you and your doctor agree on. This may include medicine to help with your depression or seeing a therapist or counselor for talk therapy. Treating your depression can make it easier to solve some of the moderate to serious problems you have been struggling with. The two approaches go hand in hand. Keep in mind that poor control of diabetes can cause some symptoms that look like depression. High and/or low blood sugar can cause mood swings, tiredness, or feeling anxious. Low blood sugar at night could disturb your sleep. Ways to ease diabetes distress Below are some recommended ways to ease diabetes distress. Check one or more that you would like to try. q Find a medical team that is right for you. Everyone is different. Do not be afraid to try several medical practices until you find one you feel comfortable with. You may want both a primary care provider and a diabetes specialist. A good fit between you and your doctor makes it easier to manage your diabetes well. Good diabetes management is key to easing diabetes distress.

4 Page 4 of 7 q Set small, realistic goals. Do not try to do everything at once. For example, you may want to work toward making your evening snack a healthy one. This week, you may set a specific goal to eat a small container of no-sugar-added yogurt on Monday, Wednesday, and Friday evenings. Focus on that. When you succeed, move on to eating a healthy snack on more evenings of the week. Trying to do too much, too quickly can make you feel frustrated, discouraged, and defeated. Instead, plan to build on small successes, one step at a time. Not sure where to begin? Talk with your health coach and medical team. q Reach out for support. Join a diabetes support group in your community or online. Subscribe to a magazine, blog, or podcast for people with diabetes. It can make all the difference to learn how others with diabetes handle their challenges and also share your feelings and insights with them. Talk about your diabetes with family and friends who are supportive and understanding. Remember to tell your medical team about your stress and emotional struggles. Research has shown that diabetes distress has a direct impact on your health and ability to care for your diabetes. q Learn healthy ways to manage your thoughts and emotions. Consider talk therapy (cognitive behavioral therapy). A counselor or therapist can help you learn to notice and change ways of thinking that can cause you to feel sad, angry, anxious, or upset. You may want to talk with your health coach about the online program, Beating the Blues US. Over the course of eight self-directed sessions, it can help you: Learn how your thoughts are connected to your feelings and behaviors. Improve your mood. Learn better ways to handle problems and cope with stress. Be more confident. Strengthen your relationships. q Keep things in perspective. Accept that you cannot control everything. At times, an illness or life stress may play havoc with your blood glucose or derail your routine for exercise and healthy eating. Plan to do your best. Aim for good enough instead of perfection. When you get off track, stay positive and begin anew.

5 Page 5 of 7 q Practice ways to relax daily. A few examples: Do something every day that gives you pleasure. For example, work on a hobby, listen to music, or watch a favorite DVD or TV comedy show. Spend time with people you enjoy. When you feel down, you may feel like avoiding people. But you should not be alone all the time. Identify people you can talk to or do things with. Plan ahead for times to get together. If you can, talk to them about how you feel. Practice taking slow, deep breaths. Listen to calming music or take a warm bath. Keep a good sense of humor and stay optimistic. Do yoga, meditate, or pray. q Make time every day to do some physical activity. Practice good sleep habits. Choose healthy meals and snacks. Limit caffeine, alcohol, and added sugars. As you know, these healthy habits are key to managing your diabetes. But keep in mind that they are also great ways to fight stress and feel better overall. This in turn can make it easier to take care of your diabetes. Kick-start this positive cycle with a small action step today! Important: Get help right away if you have thoughts of harming yourself or others. Call your doctor or a mental health center. Or call the UPMC Health Plan emergency phone line. The line is open day and night, every day of the week. The number is You can also go to the nearest emergency room.

6 Page 6 of 7 Take Action My SMART* goal for this week Do your best to reach the SMART goal you set with your health coach. Write it here. Check the box when you have completed it. Check when completed Staying on the path to wellness When you are ready, choose one or two tips you checked above in the section Ways to ease diabetes distress. To help you put them into action, set a weekly SMART goal for each one. Write your goals below. Check the boxes when you have completed them. SMART Goal 1: SMART Goal 2: *SMART goals are specific, measurable, appropriate, realistic, and timely. For example, Next week I will measure my blood glucose before and after each meal on Monday, Wednesday, and Saturday. SMART goals help you succeed! If you have any trouble setting your weekly SMART goals, ask your health coach for help. The information in this tip sheet is for educational purposes only. It is not intended or implied to be a substitute for professional medical advice. Before making changes, always talk to your doctor about what is right for you.

7 Page 7 of 7 Sources:. American Diabetes Association. Available at google.com/. Accessed May 19, The Screening Scale. Available at diabetes-distress.pdf. Accessed May 19, 2016.

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