Diabetes and psychology: a partnership whose time has come

Finding a psychologist who understands the unique challenges posed by living life with type 1 diabetes can assist people to recover quickly from setbacks and prevent deterioration in their mental and physical health.

My job as a psychologist does not involve the nuts and bolts of blood glucose management. That role is filled by other health professionals. Rather, my work involves collaboratively working with a person to understand past and present issues that prevent them from achieving their diabetes goals, treating any psychological problems such as anxiety and depression, eating problems and sleep difficulties to name a few.

The most common reason for someone with diabetes coming to see me is diabetes burnout. This mood state involves feeling overwhelmed with the demands of diabetes self-care, feeling scared about getting off-track with diabetes management and worrying about living with complications in the future.

Practices that build resilience such as learning to have a relationship with difficult thoughts and feelings rather than being identified or fused with these internal phenomena can improve a person’s mood fairly quickly. Acceptance strategies can assist clients to understand they are much more than their diabetes. Whilst the demands of diabetes are relentless, psychological therapy can help a person put them into perspective. Rather than becoming overwhelmed, a diabetes self-care regimen is seen as being a small part of a rich, full and meaningful life, enabling a person to cultivate a non-judgemental attentiveness to their lived experience of diabetes.

Over time, continued efforts to build resilience by gaining mastery over the mind can have a profound impact, resulting in actual changes in the structures of the cerebral cortex. Research using MRI scans have shown increased activity in the brain correlated with reduced anxiety and depression and increased pain tolerance.

A case from my practice that illustrates the above was John. He was a 32 year old man working part-time in sales and studying a degree in health science. Over the past 5 years, his HbA1c had crept upwards and was sitting at 9%. He was using a pump to administer his insulin and when he thought about his diabetes he was overcome with a general lethargy. He often resisted giving a bolus of insulin at meal times because interrupting the flow of his life just seemed too hard. Recently he had also been experiencing symptoms of anxiety such as an elevated and pounding heart-beat, a feeling of butterflies in his stomach and sweaty palms. He often confused these symptoms with hypoglycaemia and began to feel that diabetes was taking over more and more of his life.

In John’s case, remediation of his symptoms and improvement in his mood was achieved with short-term therapy of 4 sessions. Strategies from mindfulness-based cognitive therapy, soothing rhythm breathing, imagery and practising self-compassion helped John to interrupt the habitual reactive state which surfaced whenever he needed to take care of his diabetes. This allowed him to accept what he needed to do to manage his diabetes and get on with his life.

Hopefully, as health professionals and the general public continue to appreciate that the mind and body are intimately connected, seeing a psychologist will become common place, and people like John and others will derive lifelong benefits from paying attention to both their physical and mental health.


Dr Lisa Engel is a Health Psychologist and Diabetes Educator. She has worked with people with diabetes for over 20 years and has a practice in Sandringham and South Yarra (in Melbourne, Victoria).

Contact Details: 0439 036 847   lisaengel@netspace.net.au   www.lisaengel.com.au