Mini-Lesson: Mindfulness Strategies for Managing Diabetes Distress
New Beginnings: A Discussion Guide for Living Well With Diabetes
What You Need to Know
People with diabetes have many things to manage—from keeping track of medicines and doctors’ visits to trying to meet recommended healthy eating and activity goals. Added to the daily pressures of balancing work and home, it’s no wonder that stress is a common complaint for people with diabetes.
Research tells us that as many as 1 in 3 adults with diabetes report feeling a range of negative emotions, such as stress, guilt, fear, anxiety, sadness, and anger, because of their diagnosis. This feeling is sometimes called “diabetes distress. ”
People with diabetes distress may also lack confidence in their ability to manage their diabetes and overall health. Recognizing these feelings and taking steps to control them can have a positive effect on a person’s quality of life. Two tools that can help people manage diabetes distress are mindfulness and meditation.
Mindfulness has many benefits, such as relieving stress, reducing chronic pain, lowering blood pressure, and improving sleep. Mindfulness takes practice, but the benefits can be life-changing. It can help some people with diabetes regain control of how they feel.
This lesson has resources and questions to lead a small group discussion with people who have diabetes. It can be used as part of an existing class or as a stand-alone activity. This discussion can be led by a diabetes care and education specialist, health educator, community health worker, peer counselor, or anyone with training and experience leading support groups and group education.
Important note to group leaders: You do not have to practice mediation or mindfulness yourself to use this mini-lesson with your participants. This lesson (like all of the mini-lessons, modules, and Connecting Threads resources) is about leading a discussion, not being an expert.
Outline:
- Identifying feelings about diabetes
- Strategies for managing diabetes distress
- Increasing self-awareness through mindfulness
- Reducing stress through meditation
By the end of this session, participants will be able to
- Use mindfulness to increase self-awareness of feelings and actions
- Understand the benefits of meditation and how it relates to diabetes distress
- Commit to one mindfulness or meditation activity to try for one week
Key Message
- Diabetes distress is a way to describe the range of feelings that you may have about your diabetes. For example, you may feel overwhelmed, sad, anxious, scared, stressed, guilty, or angry.
- Before you can try to manage or reduce these feelings, you need to be aware of them. Mindfulness and meditation practices can help you become more aware of your feelings and how you can focus on more positive feelings.
- There are many ways to be mindful or meditate. Emotional benefits of either of these practices can include:
- Gaining a new perspective on stressful situations.
- Building skills to manage stress.
- Increasing self-awareness.
- Focusing on the present.
- Reducing negative emotions.
- Increasing patience and tolerance.
Going Virtual Tips
- Take a few minutes at the beginning of the session to explain the features of the video teleconferencing platform and the ground rules for virtual sessions. For example:
- Mute video or phone when not speaking.
- Say your name before speaking (especially on the phone).
- Participants are not required to have or use a video camera. They can submit photos of themselves instead. This may make group members more comfortable.
- For the story, you can read it live during the online session or pre-record yourself, a colleague, or even a participant reading it. You can then insert the audio file into the New Beginnings PowerPoint template [PPT – 599 KB] with graphics that match the topic.
- If you choose the Mindful Eating sample activity, tell participants what they need before the session so they can be ready with their food of choice before the session begins. See the Connecting Thread: Facilitating New Beginnings Online [PDF – 221 KB] for ideas on how to adapt activities.
- Play a short music clip (1 to 2 minutes) to begin or end your session with quiet meditation time. You can also find sample online meditation activities to try together as a group.
Session Outline
Group Leader Instructions
Group Leader Instructions
Talking Points and Discussion Questions
Talking Points and Discussion Questions
Say:
Say:
Managing diabetes requires a daily to-do list. There are so many things to remember. When we combine that with all of the other things we juggle at work and home, it is understandable that you would feel overwhelmed, stressed, anxious, or a range of other uncomfortable feelings. Sometimes we call this diabetes distress.
Managing diabetes requires a daily to-do list. There are so many things to remember. When we combine that with all of the other things we juggle at work and home, it is understandable that you would feel overwhelmed, stressed, anxious, or a range of other uncomfortable feelings. Sometimes we call this diabetes distress.
Ask:
Ask:
Can you recall times when you have felt diabetes distress?
How do you know when you are feeling this way?
Have you tried anything to make you feel better?
Can you recall times when you have felt diabetes distress?
How do you know when you are feeling this way?
Have you tried anything to make you feel better?
Say:
Say:
The most important thing that we can do is be aware of our feelings and know that it is okay to have them. We all have moments or periods of time when we are not feeling our best or most confident. But if we don’t stop to acknowledge these feelings, we can’t find a way to manage or reduce them.
The most important thing that we can do is be aware of our feelings and know that it is okay to have them. We all have moments or periods of time when we are not feeling our best or most confident. But if we don’t stop to acknowledge these feelings, we can’t find a way to manage or reduce them.
Say:
Say:
Read Casey’s story:
Casey has had type 2 diabetes for two years. She works full-time at a law firm and has two small children. Most days she races from work to pick up her children at daycare before it closes. When she gets home, she immediately opens the snack cabinet in her kitchen to find cookies or crackers to nibble on while she makes dinner. Her phone lights up with new email messages from work and new social media content from friends. As she cooks, she takes bites from the food she is cooking and then she finishes what her kids don’t eat. After everyone is in bed, she relaxes on the sofa, but not before grabbing another snack.
Read Casey’s story:
Casey has had type 2 diabetes for two years. She works full-time at a law firm and has two small children. Most days she races from work to pick up her children at daycare before it closes. When she gets home, she immediately opens the snack cabinet in her kitchen to find cookies or crackers to nibble on while she makes dinner. Her phone lights up with new email messages from work and new social media content from friends. As she cooks, she takes bites from the food she is cooking and then she finishes what her kids don’t eat. After everyone is in bed, she relaxes on the sofa, but not before grabbing another snack.
Ask:
Ask:
What do you notice about Casey’s eating habits?
How do you think Casey is feeling when she gets home from work?
Be sure to bring a list of medicines you’re taking your diabetes self-care records.
What do you notice about Casey’s eating habits?
How do you think Casey is feeling when she gets home from work?
Be sure to bring a list of medicines you’re taking your diabetes self-care records.
Say:
Say:
One strategy that could help Casey be more mindful of her eating habits and help her slow down and relax is adding a “mindful minute” into her calendar for when she gets home and before she starts eating and cooking. She can even do this activity together with her children.
She can use this time to:
- Ask herself if she is hungry, thirsty, or neither. She can stop and think about how her body feels and when she last ate or drank.
- Listen to a recorded meditation or song.
- Recite a prayer, favorite quote, or mantra (personal saying).
One strategy that could help Casey be more mindful of her eating habits and help her slow down and relax is adding a “mindful minute” into her calendar for when she gets home and before she starts eating and cooking. She can even do this activity together with her children.
She can use this time to:
- Ask herself if she is hungry, thirsty, or neither. She can stop and think about how her body feels and when she last ate or drank.
- Listen to a recorded meditation or song.
- Recite a prayer, favorite quote, or mantra (personal saying).
Ask:
Examples can include: eating something before she leaves work, especially something with protein that can fill her up; having healthy snacks like fruits, vegetables, or nuts ready to eat when she gets home; and making sure she takes time to sit down and eat with her children.
Ask:
Examples can include: eating something before she leaves work, especially something with protein that can fill her up; having healthy snacks like fruits, vegetables, or nuts ready to eat when she gets home; and making sure she takes time to sit down and eat with her children.
What are some other ways that Casey can manage her eating habits after work?
What are some other ways that Casey can manage her eating habits after work?
Say:
Say:
Mindfulness—taking time to slow down and be in the present—can be helpful for more than just eating behaviors. You can try to be more conscious of your thoughts, feelings, and actions around exercise, how you cope with stress, and how you manage your schedule.
Mindfulness—taking time to slow down and be in the present—can be helpful for more than just eating behaviors. You can try to be more conscious of your thoughts, feelings, and actions around exercise, how you cope with stress, and how you manage your schedule.
Ask:
Ask:
What is one area of your life where you think you could take time to be more mindful?
What is one area of your life where you think you could take time to be more mindful?
Say:
Say:
Changing behavior is not easy, but when we take time to notice our feelings and our actions, we can take steps to improve them.
Changing behavior is not easy, but when we take time to notice our feelings and our actions, we can take steps to improve them.
Meditation
Group Leader Instructions
Group Leader Instructions
Talking Points and Discussion Questions
Talking Points and Discussion Questions
Say:
Say:
Coping with the stress of living with diabetes is a difficult thing to do, but meditation can help. Meditation is a state of contemplation, focused attention, and reflection aimed at improving emotional wellbeing.
Coping with the stress of living with diabetes is a difficult thing to do, but meditation can help. Meditation is a state of contemplation, focused attention, and reflection aimed at improving emotional wellbeing.
Say:
Say:
There are many ways that meditation can be practiced. Many people think of meditation as sitting on the floor with your legs crossed, but there are many other ways to meditate.
A few ways to meditate are:
- Guided meditation that focuses on breathing, stress reduction, and deep relaxation. There are free guided meditations available online and in apps.
- Mindfulness meditations include practices like journaling, spending time in nature, and taking time to pause and think.
- Mantra meditations use repetitive sounds or sayings to clear the mind and refocus on goals.
There are many ways that meditation can be practiced. Many people think of meditation as sitting on the floor with your legs crossed, but there are many other ways to meditate.
A few ways to meditate are:
- Guided meditation that focuses on breathing, stress reduction, and deep relaxation. There are free guided meditations available online and in apps.
- Mindfulness meditations include practices like journaling, spending time in nature, and taking time to pause and think.
- Mantra meditations use repetitive sounds or sayings to clear the mind and refocus on goals.
Ask:
Ask:
Has anyone ever practiced one of these forms of meditation, or maybe one that I didn’t mention?
How does it make you feel?
[If not]
Do you know someone who does?
Has anyone ever practiced one of these forms of meditation, or maybe one that I didn’t mention?
How does it make you feel?
[If not]
Do you know someone who does?
Ask:
Ask:
If you haven’t tried any form of meditation before, what has kept you from trying it?
If you haven’t tried any form of meditation before, what has kept you from trying it?
Say:
Say:
All new practices or behaviors take time for them to feel routine and for you to notice an effect on your daily life.
Something like taking mindful pauses throughout the day, meditating every few days, or journaling at night takes practice, especially if you are the type of person who gets overwhelmed or stressed easily.
For meditation to become a part of your daily life and have a true effect on how you cope with stress, try committing to a specific practice for several weeks before ruling it out.
All new practices or behaviors take time for them to feel routine and for you to notice an effect on your daily life.
Something like taking mindful pauses throughout the day, meditating every few days, or journaling at night takes practice, especially if you are the type of person who gets overwhelmed or stressed easily.
For meditation to become a part of your daily life and have a true effect on how you cope with stress, try committing to a specific practice for several weeks before ruling it out.
Ask:
Ask:
What is a meditation practice you think you could commit to for one week?
[For those who didn’t answer the first question]
What is difficult about being willing to commit to one of these practices?
What is a meditation practice you think you could commit to for one week?
[For those who didn’t answer the first question]
What is difficult about being willing to commit to one of these practices?
Say:
Say:
Even short periods of meditation can lower stress levels and reduce anxiety. By feeling better, you can take better care of yourself and your diabetes.
Even short periods of meditation can lower stress levels and reduce anxiety. By feeling better, you can take better care of yourself and your diabetes.
Close the session
- Take final questions.
- Thank the group for their participation.
- Encourage participants to try a mindfulness or meditation activity at least once during the next week.
- Remind participants about the next session. Ask if they have specific questions or issues they would like addressed.
- Ask participants to do the session evaluation.
Sample activities
Mindful eating activity
[If food can be brought into the session for this activity, you can do it as a group. Or you can have participants try it at home].
This activity allows you to pause and get to know the food you are eating. It starts by selecting one food to pay attention to. It is easier if you pick a food that doesn’t have a lot of different flavors. Once you have selected the food, follow these steps:
- Notice the taste of the food in the first bite. For example, is it sweet, salty, spicy, or bland?
- Completely chew and swallow this bite of food before taking another.
- Take another bite. Does the taste change as you continue eating? Do you enjoy it more, less, or the same as you continue to eat it?
- Do you notice a point when the flavor decreases?
- Continue to eat the food until it is finished.
When we remove or limit distractions and focus on the food we are eating, we can better recognize when we are hungry or full.
Other ideas for mindful eating activities:
- Take a moment to become aware of eating triggers such as thoughts, feelings, or environmental cues other than true hunger that prompt a desire to eat. Are you really hungry or thirsty?
- Keep track of how hungry or full you feel 5 to 10 minutes after you finish a meal. Continue to check these feelings over the next few hours. What do you notice?
- Practice mindful eating at a restaurant. Take a “mindful minute” and pause to think about:
- What to order.
- How hungry you are.
- How much to eat when the food comes.
- When the food no longer tastes good.
- Your hunger and fullness level over time.
- Create a list of other ways to manage stress when you want to eat but aren’t really hungry. Examples include taking a walk, writing in a journal, practicing a hobby, or calling a friend or family member.
Personal mantra
A personal mantra is a positive statement written by you, about you. It may or may not be religious. It may be based on your favorite quote or song. The statement connects to your life and feelings. By repeating this statement daily and as needed, you may be able to calm yourself and refocus your mind and goals. Examples of mantras include:
- I appreciate how hard my body works for me.
- My family is there to support me.
- I am open to receiving help for my diabetes and my health.
Practice saying your mantra aloud, slowly, 10 times.
Other ideas for meditation activities:
• Make an “I’m grateful for…” list. Write down 5 to 10 things that you’re grateful for. Let your mind focus on each of these things for 1 to 2 minutes. Think about which of these items are specific to today and which are constant. It’s easy to focus only on the challenges in life. Reminding ourselves of the positive parts of life helps us be more grounded and self-aware.
• Find a time during the day to practice sitting meditation for 10 minutes. Focus on your breathing. When you start thinking of other things, stop and focus on your breath again. Try to increase the time or the number of days when you can quietly meditate.
Fletcher M. (2017). How to incorporate mindful eating in diabetes care. ADCES in Practice. 5(6), 34-38.
Priya G, & Kalra S. (2018). Mind-body interactions and mindfulness meditation in diabetes. European Endocrinology, 14(1), 35–41.
Kreider KE. (2017). Diabetes distress or major depressive disorder? A practical approach to diagnosing and treating psychological comorbidities of diabetes. Diabetes therapy: research, treatment and education of diabetes and related disorders, 8(1), 1–7.
Mayo Clinic. (2019). Meditation: A simple, fast way to reduce stress. www.mayoclinic.org/tests-procedures/meditation/in-depth/meditation/art-20045858
Miller C. (2017). Mindful eating with diabetes. Diabetes Spectrum. 30(2);89-94.