Despite all the tools available to help people manage diabetes – the glucometers, the test strips, the insulin delivery devices – there is one huge aspect of diabetes care for which there’s no mail-order supply: emotional support. The constant burden of managing blood glucose often leads to what’s known as “diabetes burnout,” and yet, aside from the occasional support group, people are not always aware of all the resources available to help them cope.
One resource to be aware of is a new online mindfulness-based diabetes management course offered through emindful.com. The class was developed using the mindfulness-based stress reduction programs (MBSR) pioneered by Jon Kabat-Zinn at the University of Massachusetts Medical School, which may benefit people’s health in ways more far-reaching and tangible than mere relaxation.
The new Mindfulness-Based Diabetes Management (MBDM) class aims to use meditation and self-compassion to reduce the stress of life with diabetes and lessen the feelings of burnout. We recently spoke with its teachers – MBSR teacher Steve Alper, L.C.S.W., primary care physician Jeff Horacek, M.D., and diabetes coach and counselor Heather Nielsen, M.A. (who herself has type 1 diabetes) to learn why they think mindfulness can be such a powerful diabetes management tool.
Catherine: Okay, first things first: What is mindfulness?
Steve: The standard definition is “paying attention on purpose, without judging or striving, in each moment of your experience.” In the class, we’ll be learning formal, secular meditation practices – with a particular focus on self-compassion – to help us cultivate present-moment, non-judging, non-striving awareness. The class meets once a week for eight weeks, an hour at a time, and includes one four-hour “retreat.” In each class, we’ll use a combination of multimedia presentations, guided meditation practices, and group discussions to help people learn mindfulness-based skills they can apply to their daily lives.
Catherine: Why do you think we need this? What’s different about a “mindful” approach to diabetes?
Steve: In Western medicine, we tend to think of illnesses as something to subjugate and control. We talk about “winning the war” against diabetes, or “defeating” it, and see it solely through the lens of an adversarial relationship.
But there’s another possibility, which is what we’re hoping to help people develop in this course: to approach diabetes with a sense of humility, to really get to know it. To think of it as a partner, even if it’s a partner you didn’t choose.
Catherine: Why diabetes? Is there something about the disease that makes it a particularly good candidate for mindfulness training?
Jeff: Actually, I can’t think of another chronic condition for which mindfulness could be more useful. Diabetes is such an ongoing emotional burden. Not only can developing mindfulness provide you with tools to cope with its emotional challenges, but since stress may cause insulin resistance, reducing stress may actually help blood glucose control – it can have positive physiological effects.
Heather: Mindfulness can also help us redefine our feelings about food. Our relationship with food immediately becomes “disordered” when we get diabetes – we’re taught to base our food choices on numbers, labels, grams, carbs, portions, and exchanges, and often need to make adjustments and choices that aren’t based at all on our true appetite. Mindfulness training can help us reconnect – or for me, connect for the first time – to our genuine appetites and hungers.
Catherine: I know that an important aspect of mindfulness is learning to stay more in the present. That sounds nice, but it seems tough with diabetes – after all, what we do in the present moment is going to have a direct influence on our health in the future.
Steve: That’s true, but one of the primary ways we affect the future is through our response to the present moment. If we react with frustration and fear, then we may exacerbate our insulin resistance and drive our glucose levels higher. If we can instead have a sense of compassion and kindness and curiosity and perspective toward our diabetes then yes, we may still be frustrated and disappointed, but at least we’re not reacting in a way that exacerbates the situation. I think that can be profoundly powerful.
Jeff: Learning how to manage your reactions is also particularly valuable because diabetes comes with more decisions and data points than other chronic illnesses – from meal planning to blood glucose testing to giving yourself insulin. Each of these situations can be an opportunity to practice reacting mindfully and with self-compassion, instead of blaming yourself for something that may be out of your control. And if you develop these skills toward your diabetes, you might be able to expand them to other areas of your life as well.
Catherine: If someone’s on the fence about the course, what would you tell them?
Steve: I would ask them a question: if I told you that you could experience a sense of peace and ease of being that was totally not contingent on circumstance, would that be of interest to you? If so, then that’s why you should do this class. It’s not that you’ll always feel that way, but you’ll begin to feel that way in moments. You string those moments together, and then your life begins to feel a little different.
Heather: The thing that really hooked me about using MBSR to cope with diabetes is the concept of the past, present and future – the idea that all we really have is this moment. That was so revolutionary to me. I realized how much time I spent wrapped up in regret over what I could have or should have done or worrying about all those potential future complications. I realized I could choose to keep wasting my life worrying and feeling guilty – or I could choose a different way.
To find out more about Mindfulness-Based Diabetes Management Courses, visit emindful.com.
Catherine Price is a freelance journalist and type 1 diabetic who has written for The New York Times, Slate, Popular Science, and O Magazine, among others. She blogs about diabetes at asweetlife.org and you can follow her on Twitter @Catherine_Price. Price is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor and interviewee, and not of Sanofi US, its employees, agencies, or affiliates.
© 2013 The DX: The Diabetes Experience