Lifestyle Issues

Friends, Relationships, Sex & Babies

Telling others about your diabetes can be difficult, especially when you first meet them. At diagnosis, especially if you've been ill, friends will know something was wrong and are likely to ask how you got on. But how do you bring it up later, especially with someone you fancy? Will it be a big turnoff? What will they think.

Drugs & Diabetes

There is little information on the affects of the different drugs directly on your diabetes. But the effects the drug has on you, especially on mood and concentration may lead you to not care for your diabetes. This could lead to problems, such as getting the munchies with dope or forgetting to take your insulin. Being caught with the illegal drugs can lead to a court conviction. This could affect your job prospects and travel abroad. Some countries will not allow entry if you have a drugs conviction. Act Responsible, and pace yourself when drinking.

Travelling with Diabetes

Travelling with diabetes can generally be easily managed.
Think ahead - ensure you have sufficient supplies for the time away plus spares. Give yourself time to get any letters you may need.
Contact your diabetes nurse or GP for a letter re carrying needles for customs. You may also need a letter stating you are fit to travel for the travel companies insurers.
Make sure you are covered for pre-existing medical conditions when you buy your travel insurance. It's cheaper to pay any additional costs when you buy rather than finding you are not covered and having to pay any medical costs overseas.

Leaving home

You may find yourself thinking a lot about what life would be like away from home, especially when you're asked to tidy your room for the umpteenth time. You probably think about not having to put up with this once you have your independence. There are things you will miss out on though, for instance, having your washing and ironing done for you, meals cooked at regular times. Being reminded to take your glucose tablets with you may drive you wild, however, it'll be down to you once your out on your own.

Emotions

Everyone experiences a range of feelings and emotions. Sometimes we feel happy and excited, other time we can feel low and sad. There are plenty of things that might make you feel emotional such as exams, starting work, managing your diabetes or relationships. People are very different and they feel and react to these things in different ways. It's normal to feel stressed, anxious, angry, low, lonely or that no-one understands us from time to time. For most people these feelings come and go. But sometime we struggle to understand and cope with how we feel.

Friends, Relationships, Sex & Babies

Telling others about your diabetes can be difficult, especially when you first meet them. At diagnosis, especially if you've been ill, friends will know something was wrong and are likely to ask how you got on. But how do you bring it up later, especially with someone you fancy? Will it be a big turnoff? What will they think.

Its better if your friends know about your diabetes so that if you are having a hypo they know what to expect and what they need to do. A serious hypo can be very scary for someone who doesn't know.

• Think about how to approach it beforehand, have a plan in your head. There will never be the perfect time. When you're sitting down for a meal and you need some insulin it's probably too late!
• Have an idea of what you want them to know and how they could help you
• Present diabetes as positively as you can - hopefully not the biggest problem in the world. Have suggestions as to how they can recognise if you are low and how they can then help you.
• Knowing about your diabetes shouldn't stop your friendship. If your 'friend' cannot accept you as you are do you really want them as a friend.

For further advice have a look at this site: www.lifebytes.gov.uk

Sex

Sex can be quite energetic! This can lead to hypos. Make sure you've eating something before hand. Checking your blood glucose because you feel low is not the most romantic thing to be doing. In the excitement, don't forget your bedtime insulin!

Diabetes does not make you infertile. If having sex - take precautions. Barrier methods - such as condoms - also protect you from sexually transmitted diseases. Crossing your fingers and hoping generally does not work that well. For the girls: If you want to go on the pill then a combined pill is probably best if you don't smoke. If you smoke try and give up - until then use a mini-pill. Arrange an appointment with your practice nurse, GP or family planning clinic. Depot injections lasting 3 months are available.

Unprotected sex leads to a high risk of getting pregnant. If you don't want to be pregnant - protect your self - or don't do it!

If you want a baby get some advice about your diabetes before you start. Poor control of your diabetes, especially in the first few months of pregnancy, can give the baby problems.

For the lads - poor control in the long term can cause impotence (where you can't get it up). If this becomes a problem have a word with someone in the diabetes team. Help is available.

Before Pregnancy

Ideally aim to improve your control and reduce your HbA1c - ideally to less than 7% before you become pregnant. It is a good idea to be in good blood sugar control three to six months before you plan to get pregnant. Ask for advice from the diabetes team. You'll need to continue this level of care throughout the pregnancy. Despite advances, babies born to women with diabetes, especially women with poor diabetes control, are still at greater risk of birth defects. High blood sugar levels and ketones pass through the placenta to the baby. These increase the chance of birth defects.

You may need to change other medicines you are taking. If you are smoking then you need to look at stopping both for yours and the babies health. Help is available. Ideally try to stop before you try to get pregnant.

You will also need to cut down or cut out alcohol.

Ideally aim to be a healthy weight for your height. If you start pregnancy weighing too much, you should not try to lose weight. Instead work with your dietitian or doctor to curb how much weight you gain during pregnancy. If you have type 2 diabetes, you too need to plan ahead. If you are taking diabetes pills to control your blood sugar, you may not be able to take them when you are pregnant. Because the safety of using diabetes pills during pregnancy has not been established, your doctor will probably have you switch to insulin right away.

Pregnancy

If you think you are pregnant, contact your diabetes nurse as soon as possible. If you want to carry the babe, they will give you the help to manage your diabetes during and after the pregnancy. If you do not want the baby, they will be able to help in accessing an abortion. If your control was poor over the period your baby was conceived, it increases the risk of problems for the child.

How do high blood sugar levels cause problems? When extra sugar is in your blood, the baby is "fed" extra sugar, too. All this excess sugar can make the baby too big and fat. Delivery of big babies is harder on mum and baby. Because your baby is getting extra sugar, your baby's pancreas makes extra insulin. After birth, it's hard for the baby to stop putting out extra insulin. The baby must be watched over and treated if the blood sugar level drops too low. For some reason, jaundice happens more often in babies of women with diabetes. Jaundice is a build-up of old red blood cells that the body can't process fast enough. This problem goes away rapidly with treatment.

You will be seen regularly during your pregnancy in a joint diabetes antenatal clinic. This will include regular blood tests and checking of your meter? You are likely to need to adjust your insulin regularly as the baby grows inside you. Pregnancy is often a time of great highs and lows. It can be awesome and thrilling - when you hear the baby's heartbeat or feel the first tiny kick. It can be frustrating, even scary. It is always a time of change. Your body is changing as the baby grows. Because you have diabetes, these changes will affect your blood sugar level. The need for more insulin is caused by hormones the placenta makes.

The placenta makes hormones that help the baby grow. At the same time, these hormones block the action of the mother's insulin. During pregnancy, your diabetes control will require more work. The blood glucose checks you do at home are a key part of taking good care of yourself and your baby before, during and after pregnancy. This tighter control may increase your risk of going low (hypo). Pregnancy can also make symptoms of low blood sugar hard to detect. This is especially true during the last three months of pregnancy.

You can increase your chances of delivering a healthy baby by keeping your blood glucose in good control before conception and throughout your pregnancy. To do this, you need a diabetes treatment plan that keeps meals, exercise and insulin in balance. This plan will change as you change with pregnancy. You will also need to check your blood glucose often and keep a record of your results. With your blood glucose in the target range and good medical care, your chances of a trouble-free pregnancy and a healthy baby are almost as good as they are for a woman without diabetes.

The first eight weeks are particularly important for the physical development of your baby. Poor control of blood glucose during conception and through the first eight weeks greatly increases the chances that your baby will develop problems.

You should also have regular eye reviews. Pregnancy can place extra pressure on the small vessels in your eyes which can make retinopathy worse.You should also have regular eye reviews. Pregnancy can place extra pressure on the small vessels in your eyes which can make retinopathy worse.

You will be able to see a dietician to review your eating and should start on 5mg of folic acid a day, available on prescription from your GP.

Delivery and after

At the start of active labour, your insulin needs will drop. You will most likely not need any insulin during labour and for 24 to 72 hours after delivery. Because of the care needed for both mom and baby during and after delivery, home births are not advised for women with diabetes. After your baby arrives, your body begins to recover from the hard work of pregnancy and delivery. Some new mothers have better blood sugar control in the first few weeks after delivery. For many, it's a period of odd blood sugar swings. Not being able to predict how your body will act may leave you puzzled and upset.

Breastfeeding is good for women with diabetes, but it may make your blood sugar a little harder to predict. During the first weeks at home with your baby, you are likely to be tired, stressed from lack of sleep, and off schedule. Odd sleep patterns increase the danger of napping through a snack or mealtime. Low blood sugar is a real danger. It's important for your baby's safety to avoid hypoglyceamia that could confuse you. For all of the above reasons, it is important to check your blood glucose often during this time. Your records of your blood glucose levels will help you and the diabetes team adjust your insulin dose. With baby's arrival, your focus turns to caring for your little one. But keep in mind that to take good care of your baby you need to take good care of yourself. Stick to your habits that helped you keep your blood sugar levels on target during pregnancy.

Breastfeeding

To help prevent low blood sugar levels due to breastfeeding:

• Plan to have a snack before or during nursing.
• Drink enough fluids. Plan to sip a glass of water or a caffeine-free drink while nursing.
• Keep something to treat low blood sugar nearby when you nurse, so you don't have to stop a feeding to treat low blood sugar.

Women who breastfeed use more calories. What you drink and eat can affect your milk supply, as well as your blood glucose. You will need to work with your doctor and dietitian to adjust your meal plan while you are nursing.

There are many legal and illegal drugs around, which can be confusing but they can be divided into three main groups:

 

• Downers (alcohol, tranquillisers, heroin)
• Uppers (tobacco, speed/Ecstasy, cocaine)
• Hallucinogenics (cannabis, LSD, magic mushrooms)

There is little information on the affects of the different drugs directly on your diabetes. But the effects the drug has on you, especially on mood and concentration may lead you to not care for your diabetes. This could lead to problems, such as getting the munchies with dope or forgetting to take your insulin. Being caught with the illegal drugs can lead to a court conviction. This could affect your job prospects and travel abroad. Some countries will not allow entry if you have a drugs conviction. Act Responsible, and pace yourself when drinking.

Downers

Also known as depressants, they slow the body down including thought processes, heart rate and breathing. Includes drugs like alcohol, sleeping pills, tranquillisers, heroin, methadone and painkillers. There is a greater risk of overdose with these drugs ant the risk is increased if the drugs are mixed together. There is also a risk of physical addiction.

Some people use downers to 'come down' after taking uppers, like speed or ecstasy, and find they develop a dependency on downers as a result. Downers can increase the risk of you forgetting to carry out parts of your diabetes care. Alcohol (booze, bevvy) is the most popular drug used by society. In moderation its use is relatively safe, but there are some important considerations for drinking generally and additionally if you have diabetes.

1. Alcohol generally affects young women more quickly than young men because they have smaller bodies.
2. Being drunk can mean that you do things that you regret later, like snog or have sex with someone you don't like or take other risks.
3. Initially alcohol makes blood sugar rise quickly and then fall quickly so there is a risk of having a hypo. There is a higher risk of having a serious hypo over night as the alcohol stops your liver releasing glucose during the night. This can result in death.
4. Other people may confuse your being hypo with being drunk and not take appropriate action.
5. Embarrassing yourself when drunk can lose you friends, relationships and respect.

Be aware:

1. Low sugar alcoholic drinks such as light beers and lagers, (pills) actually contain more alcohol than normal beers. You'll get drunk quicker at greater cost than using normal beers and increase your risk of severe hypo.
2. Alcohol is high in calories - drinking large quantities can cause weight gain.

Keeping a check on the number of units you've drunk is a way of keeping track of what you are drinking.

1 unit of alcohol = standard pub measure of vodka = glass of wine = ½ pint standard beer. Remember, at home most people tend to pour larger quantities than pub measures.

Recommended intake of alcohol for adults is 1-2 units per day for females and 2-3 for males. (There are no recommendations for young people, but likely to be the same or less!). Having alcohol free days is advised.

It is illegal for shops and bars to sell alcohol to under 18's.

Think PACE

Pace yourself - have soft drinks and water regularly, as well as snacks - especially if dancing.

Avoid light beers and lagers as they have more alcohol.

Carbohydrate - eat a meal with potatoes, pasta or rice before you go out and on getting home if drunk large amount. Consider reducing bed time insulin.

Ensure your friends know you have diabetes and what to do if you are hypo.

Further advice from Alcohol concern - 0207 928 7377, www.alcoholconcern.org.uk
Drinkline 0800 917 8282, Frank, Fast Forward 0131 554 4300, www.fastforward.org.uk

Uppers

Also known as stimulants because they speed the body up. May make you hypo as you burn up more energy.

Tobacco. Included as Upper as nicotine speeds up the heart. It's well known that tobacco causes heart, circulation and lung disease and linked to many cancers. Having diabetes and smoking increases the risk of heart and circulation problems greatly. Less known is that smoking increase the risk of needing false teeth! Smoking will also:

1. Increase chance of catching colds and chest infections.
2. Age your skin causing more wrinkles.
3. Stain your teeth and cause bad breath, which is enough to discourage kissing!
4. Burn a hole in your pocket - if you smoke 10 fags a day, it costs around £15 per week, £66 per month and £784 per year
5. Smoking does not help you relax - it actually speeds your body up.

Tobacco smokeline 0800 16 90 169.
Action on Smoking and Health 02077 395 902, www.ash.org.uk

Speed/ Ecstasy: Often used to give extra energy and confidence, especially when out clubbing.

1. Frequently when the high wears off, it's replaced by a low, leaving users feeling depressed, irritable and tired.
2. There is a risk of dehydration where the body loses fluid through continuous dancing or other strenuous activity. If blood sugars are high can occur even faster.
3. Uppers can suppress appetite and combined with dancing can increase the risk of hypo. Symptoms may be hidden as already having adrenaline rush from drug and activity.
4. Heavy users can become physically run down, experience bad skin, unhealthy weight loss and mood swings.

Don't mix uppers with other drugs or alcohol

Do keep fluids up. Drink sugary non alcoholic drinks and water - roughly a pint an hour if dancing.

Have a snack before going to bed and let your friends know how to recognise a hypo and what to do.

Drugscope 0207928 1211, www.drugscope.org.uk
Health Development Agency, www.d-2k.co.uk

Cocaine. Much more powerful stimulant, but wears off quickly. Crack is a stronger form and it's effects are even shorter. Both produce an intense comedown, leaving you feeling extremely low and tired. This could lead you to forget insulin or eating.

Hallucinogenics. These drugs alter the way you see, hear and feel things. They may make you forgetful and not pay attention. This could lead to forgetting to give insulin or giving the wrong dose.

Cannabis. (hash, blow, weed, ganja etc) Comes as blocks of resin, leaves/flowers or rarely as an oil. Usually smoked in joints with tobacco (see tobacco), heated in a bong or mixed with food. Often taken to make you feel relaxed, happy and sociable. It can affect people in different ways depending on the occasion and your personality. Its often seen as a harmless drug but there are a number of short and long term risks attached. Following its reclassification it is still illegal.

Problems

• Many people feel anxious or uneasy after using cannabis
• A common effect is the 'whitey'. Feeling light headed, faint and sometimes sick. It's usually associated with mixing cannabis with alcohol.
• Cannabis gives people the munchies. Making you want to eat everything in sight, especially junk food. This may lead to your blood glucose level going high.
• You can feel out of it, possibly leading to forgetting insulin.
• You can become addicted to the tobacco and its associated health risks. Smoking cannabis on it's own also causes lung damage
• Eating cannabis makes its effects hit harder but can leave you feeling panicky and paranoid

LSD. (acid, trips) When taken the things you hear, see and feel change. The experience may be pleasant but can also be terrifying (a bad trip). Its effects can last up to 12 hours and put you in dangerous situations. It may lead you to forget to eat or take your insulin.

Magic mushrooms (mushies) produce milder hallucinations than LSD but carry the same effects. An added risk is picking poisonous fungi by mistake.

Think RESPONSIBLE

Read the label - make sure you know what your taking or drinking

Eat something before you drink and later on. Check your blood sugar

Save some money to get home

Pace yourself and have regular soft drinks

Others, make sure that someone knows you have diabetes and what to do for hypos

No drug is a safe drug - not even insulin

Safety- make sure you carry ID, watch your drinks

It is OK to say no to drink and drugs.

Be responsible. Know your limits. Never mix booze with drugs

Look out for yourself and others

Enjoy yourself, take care and stay safe

Information taken from Glucose to Ganja, a Lifescan leaflet, developed by a group of young people in Scotland who have Type 1 Diabetes

Can I travel with Diabetes?

Travelling with diabetes can generally be easily managed.

Think ahead - ensure you have sufficient supplies for the time away plus spares. Give yourself time to get any letters you may need.

Contact your diabetes nurse or GP for a letter re carrying needles for customs. You may also need a letter stating you are fit to travel for the travel companies insurers.

Make sure you are covered for pre-existing medical conditions when you buy your travel insurance. It's cheaper to pay any additional costs when you buy rather than finding you are not covered and having to pay any medical costs overseas.

It's worth also completing an EHIC form obtainable from Department of Health Website

What should I do before leaving?

1. Check insurance covers pre existing medical conditions, EHIC from Department of Health Website.
2. Obtain customs letter re carrying needles from GP or clinic.
3. Obtain fit to fly letter if requested by carrier from GP or Clinic.
4. Storage of insulin - flight. Some carriers will take insulin off of you on the plane, returning it at meal times. Remember to get it back when you get off the plane! You should carry spare insulin in your hand luggage - do not pack in suitcase if flying. It might freeze in the hold.
5. Plan the timing of your insulin with your journey and flight. Discuss this with your specialist nurse, especially if there is a time difference greater than 3 hours. If you have an early morning flight it might be easier to have your morning insulin with breakfast at the airport or on the plane, rather than before you set off from home.

What should I make sure I take with me?

1. Ensure have sufficient stock for your holiday- insulin, hypostop, meter, blood testing sticks, ketone sticks, glucose tablets, spare pen.
2. Make a note of the names of your insulin, other medication, meter strips in case you need to obtain a prescription whilst away.
3. Your travel insurance documentation and EHIC from Department of Health Website

What should I do during the journey?

1. 1) Depending on your journey you may need to make an adjustment of your dose or take an extra dose of short acting insulin.
2. 2) Keep a check on your blood sugars during the journey. If you are running high you may need to take extra insulin.
3. 3) Carry spare snacks in case journey's delayed, meals not suitable etc.
4. 4) You may find yourself running high on a long journey due to reduced activity levels.

What should I do whist on holiday?

1. Send us a postcard!
2. Your activity and lifestyle is likely to be very different to being at home. You will need to check your blood sugars more frequently and adjust your insulin dose and times.
3. If trying new activities think ahead as to how it may affect your diabetes, i.e. re activity, timing of snacks/meals. If strenuous you may need to reduce your insulin before hand or have extra food.
4. Store your insulin out of direct sunlight, preferably in a cool cupboard. If very hot - 0ver 30oC, you may need to keep it in a fridge. Keep spare insulin in a fridge if available.
5. Try new foods, but see how affect your blood sugars. Look at adjusting your insulin when try again.
6. Carry something for hypos when out and about.

What should I do for coming home?

1. Same advice as above regards your journey.
2. On getting home, it may take a few days for your insulin levels and blood sugars to stabilise - especially after long journey's.

Travel checklist

1. Check insurance covers pre existing medical conditions, EHIC from Department of Health Website
2. Obtain customs letter
3. Obtain fit to fly letter if needed
4. Storage of insulin - flight and accommodation
5. Timing of insulin with journey and flight. Adjustment of dose, extra dose
6. Meal times
7. Activities
8. Readjustment on return

Taken from Diabetes UK

Air travel and insulin

People with diabetes can still bring insulin with them onto aircraft despite new security restrictions introduced as a result of tragic events in the USA. Those travelling should bring a letter from their doctor explaining their need to carry syringes/injection devices and insulin.

A number of airlines have brought in new restrictions on what items can be brought onto their aircraft in hand luggage. This has led to concern about travelling with insulin and a number of people have been advised that they can either not travel or must put their insulin in baggage in the aircraft's hold. This is not the case. Insulin should not be stored in the hold as low temperatures can damage it.

The doctor's letter explaining your need for insulin and injection devices should be presented to the airline staff, and if you do encounter any problems you should request to speak to a manager or senior member of staff.

On some airlines, once on board the plane, cabin crew may request that medication be handed over for storage during the flight. For this reason it may be advisable to put insulin and syringes/needles in a separate carrier bag.

Some GPs will make a charge for writing a letter. If you travel frequently therefore, it would be a good idea to ask your doctor to phrase the letter in such a way that it can be used more than once.

In addition to a doctor's letter, a Diabetes UK Insulin user's identity card may also help the cardholder to verify his/her need to carry syringes and medication. Please note however, that this card does not hold any statutory status at present, and police or customs are not required by law to recognise the card and the information printed on it. Nonetheless, they are aware of its existence and producing the card may ease any problems you might otherwise encounter. Those travelling may wish to contact their airline in advance for the most up-to-date information on this issue.

Leaving home

You may find yourself thinking a lot about what life would be like away from home, especially when you're asked to tidy your room for the umpteenth time. You probably think about not having to put up with this once you have your independence. There are things you will miss out on though, for instance, having your washing and ironing done for you, meals cooked at regular times. Being reminded to take your glucose tablets with you may drive you wild, however, it'll be down to you once your out on your own.

Leaving home can be a very positive step, but it's also worth considering a few things as part of your preparation for moving out, for instance:

• How much do you rely on your family when it comes to your diabetes?
• What things will you have to take responsibility for once you move away?
• How will you organise managing your diabetes as well as many other things like paying bills, studying, work, cleaning, appointments and so on?

Life away from home...

If you're off to college, university or starting a new job in a new area you may be facing the prospect of sharing accommodation with other people. So what may worry you and your parents most about this? Maybe it's concerns about 'what ifs', for instance, what if you have a hypo away from your family and the people who know you?

These worries are normal don't need to be a problem for you or your parents, if you demonstrate that you know how important it is to tell people around you (especially the people you share with) about your diabetes and how to help you if you ever need it.

Go easy on them....

For you moving out could be very exciting, however children flying the nest can be very upsetting for your parents. After years of caring for you, your leaving can create a big gap in their lives. So resist getting into an argument if they appear overprotective at times and try to understand what's going on for them.

Your relationship with you parents will change over time once you leave home. They may start to relate to you on a more equal footing, especially if they see you are coping ok with independence.

Sharing with others...

Living with friends can be great, but it's not like living at home. So how can you survive this?

• Be realistic about expectations - i.e it's never going to be as clean and tidy as your own home.
• Be fair and considerate - you can't expect others to be quiet, tidy pay their share of the bills if you don't do your bit.
• Be flexible - there may be times when others don't stick rigidly to agreements.
• Be up front - if there is a problem, discuss it with the others, don't try to avoid it.

Living on a budget...

Its often difficult to make your money stretch when you first leave home. Be careful not to sacrifice your health though for the sake of having cash to spend on your social life. It's not something you want to do if you have diabetes.

Don't forget people with Type 1 diabetes are exempt from prescription's charges. Make sure you pick up an exemption form from your GP. Chemist or social services office if you haven't got one already.

Your diabetes should not stop you from moving out of your home when the time is right. It's just one more thing you'll have to manage independently.

Managing Emotions

Everyone experiences a range of feelings and emotions. Sometimes we feel happy and excited, other time we can feel low and sad. There are plenty of things that might make you feel emotional such as exams, starting work, managing your diabetes or relationships. People are very different and they feel and react to these things in different ways. It's normal to feel stressed, anxious, angry, low, lonely or that no-one understands us from time to time. For most people these feelings come and go. But sometime we struggle to understand and cope with how we feel.

Feeling Low...

When you are low in mood you may experience feelings of sadness, think that the things you do are not good enough and find it difficult to know how to cope with this .

There are many things that may contribute to you feeling low or down, for example...

1. Arguing with friends or family
2. Feeling left out or not being part of a group
3. Having trouble with your boyfriend/girlfriend or even just a friend
4. Struggling to manage your diabetes
5. Being bullied at school or elsewhere
6. Worrying about how you look

It's ok not to feel positive and happy all the time. For a small number of people feeling down or low in mood can go on for a long time and it can prevent them from getting on with their every day lives. This is when it is useful to talk to someone about how you feel. Talking about how you feel might help you feel more able to cope.

Things you could do to help yourself...

Try to talk to someone you like and can trust. Even if you feel you can't control what is making you feel unhappy. They may be able to listen and help you think things through.

1. Do something active - physical activity can be particularly helpful.
2. Keep a diary of your daily thoughts and feelings.
3. Find something that interests you and spend time on it.
4. Plan to focus on things you usually enjoy and make some time every day for these things.
5. Make a small start on the things you have been avoiding.
6. Look after yourself, resist the temptation to cope by drinking alcohol, or using drugs. These may give some immediate relief but this soon wares off and then it creates a number of other problems.
7. Challenge negative thinking, try to argue or challenge gloomy thoughts.
8. Try to concentrate on the good things you achieve each day, rather than the negative.

If you continue to feel down and don't feel able to talk to friends or family it may be worth talking to a member of the Diabetes team and they can arrange for you to see the team psychotherapist.

Feeling Stressed...

Stress can be positive and it can also be negative. A little stress can help us through the day, for example it can give us the drive to complete daily tasks. It is positive where we feel stimulated but not pressurised, busy but not overwhelmed. When the pressure becomes distressing this in negative stress.

Signs of stress...

Signs of stress include:

1. Emotional signs - nervous, worrying all the time, frightened, difficulty concentrating, unable to remember things, feeling irritable or feeling moody without knowing why.
2. Physical signs - muscle tension, tingling or numbness in fingers or toes, headaches, general aches and pains, stomach churning or indigestion, sweating, palpitations, dizzy or light headed, low energy and difficulty sleeping.
3. Behavioural signs - Can't sit and relax, speak faster than usual, start things and don't finish them, eat more (or less), and avoid doing things.

It is important not to automatically assume that these symptoms are always due to stress so ask you diabetes team or doctor to check these out if they continue.

Stress & Blood Glucose Control...

Many people notice that when they are stressed their diabetes can become more difficult to control. For some when they are stressed their blood glucose can rise and for others they alternate between hypoglycaemia and hyperglycaemia.

This happens because stress affects diabetes in two ways. Firstly, it has a direct affect upon the body's chemistry. When stress levels build the body releases adrenaline and other hormones into the blood stream to help it cope. Our heart rate, breathing rate and blood pressure all increase, and stores of glucose and fat in the body are released, providing energy to our muscles. These hormones interfere with the action of both the insulin you inject and any insulin you produce yourself. As a result most peoples blood glucose level will rise.

Secondly, when we find stress difficult to manage we often try to compensate by doing something that make us feel better, for example eating more than usual, (often foods which are not good for us), drinking alcohol or smoking more.

These things can make us feel better for a short while but they don't sort out the problems causing the stress. Not only do stress levels affect diabetes - diabetes itself can also be a cause of stress.

Things you could do to help yourself...

1. Discuss your worries.
2. Try to identify the things you find stressful.
3. Take steps to tackle what it is about these situations.
4. Make sure you have time for the things you enjoy.
5. Make time time to relax - listen to music or read.
6. Try to get enough sleep.
7. Take regular exercise.
8. Stop taking on extra things and say no.
9. Reduce caffeine, alcohol and nicotine intake.

If you continue to feel stressed and don't feel able to talk to friends or family, it may be worth talking to a member of the Diabetes team and they can arrange for you to see the team psychotherapist.

EXAM STRESS and how to beat it...

See childline for lots of useful tips on how to get through your exams and manage the stress this can create.

Feeling Angry ...

Anger is an emotion that we all experience. It's normal and healthy to get angry and to express it when there is good reason, but you must be sure that it is to the right person , at the right time and to the right extent. Unfortunately anger can be very uncomfortable for some people and sometimes it may be very destructive. There are two common problems with anger they are, when we let it build up inside, or 'bottle it up', or when we 'let rip' too easily..

Things that can make you angry...

1. Being let down or letting ourselves down.
2. Things being unfair.
3. Having to do something we don't want to do.
4. Not being listened to.
5. Feeling lonely or rejected.
6. Too much pressure.
7. Being unwell ourselves.
8. Being shown up infront of other people.

Things people do when they are angry...

1. Hit out at others.
2. Shout at or pick on people.
3. Get into trouble.
4. Break things.
5. Wind others up.
6. Say nasty things to hurt others.

Or we can turn in on ourselves by..

1. Feeling low.
2. Refusing to do things.
3. Not talk to anyone.

Some of these things can make you feel better for a very short time but they can also create more problems. Often other people will not understand why we behave like this.

Things you could do to help yourself...

1. Recognise angry feelings and deal with what has made you angry, don't bottle it up.
2. Talk it over with someone before you decide how to deal with your anger.
3. Take a step back when you feel yourself getting angry, take a deep breath this will provide you with time to think about how you are going to deal with this situation.
4. Sometimes it might not be what you think so it can be helpful to look at things from another point of view to get a more balanced idea of what is really going on.
5. Learn to relax.

If you feel your anger is creating problems for you and you don't feel able to talk to friends or family about it, you could talk to a member of the Diabetes team and they can arrange for you to see the team psychotherapist.